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The Most Common CPAP Problems and Their Most Effective Solutions

  CPAP therapy is the premier treatment for obstructive and central sleep apnea, and its benefits continue to surprise researchers health specialists around the world, but it's not without its impediments, especially for new patients. Awkward phases, side effects, and difficult machine adjustments can plague the initiate right off the bat. But for the benefit of those struggling with compliance, here are a few of the most common CPAP complaints, along with a short list of possible solutions to help people on their treatment journey. Whether it’s a leaky mask or dry sinuses, those who have been doing this for years know how to address those concerns, and keep you breathing through the night.
1. Leaks and Improper Seals
Proper seal is crucial for CPAP therapy to operate correctly and with the most benefit to the user. If a mask leaks, the first step is to correct the seal. Start by tightening and adjusting the headgear until the mask fits snugly but comfortably in place. You may also want to use a mask liner or additional padding. Liners can tighten the seal in a way that also provides additional comfort while absorbing oil and debris from the face for a cleaner touch. Also note that your position on the pillow can sometimes affect your seal. Try adjusting your sleeping position so that the mask is not strained by pressure or movements. There are CPAP pillows as well that conform to the shape of the mask and help to secure your position. If these solutions fail to correct your leak, you may need another mask size, or consider another mask design. Sizing guides can also be found for most brand names and models. Simply enter your mask type into the search page and check the specifications. The manufacturer’s website is a good place to start if you can’t find it right away. On the manufacturer’s website, you should be able to access or print out the guide as a PDF. Mask leak is a common challenge, and most accompanying software will detect and measure any leak for you, providing data on how much air is lost throughout the night. Use this information to make adjustments as needed, being careful not to over tighten when securing the straps. Mask fit varies with position, movements, and time, so with the right choice and regular adjustments, you should be able to avoid any persistent or problematic leaks that will affect your therapy.  
2. Noise
CPAP machines have come a long way since their introduction, and one of the biggest improvements is in noise reduction. But there are some patients, as well as some bed partners, who have difficulties adjusting to the low hum of the engine or air exhaust. If this is an issue, first check your filters to make sure there is no clogging or improper fitting. Filters should be swapped out regularly for the best results. If filters are not causing the noise, check with your supplier or a specialist to make sure your device is working properly. Also keep in mind that you will occasionally hear changes in pressure or machine responses if you use auto-CPAP devices. This shouldn’t be lasting more than a few seconds at a time, so it should be fairly tolerable. If the sound continues to bother you or your bed partner, perhaps consider using earplugs or earphones to bed. You can also make volume adjustments to familiarize yourself with the device’s sounds and presence. Often this is simply a matter of normalizing the use of the device as a part of your life’s routine. Many users and partners have learned to enjoy the low-decibel sounds of CPAP, as they represent health, better breathing, and a safe night’s rest.
3. Skin Irritation, Sores or Bruising
This issue comes back to mask fitting, and how to ensure a proper seal. If irritation or sores develop, most likely the mask is too tight. Or if this occurs over time, there may be wear on the seal padding. Again, mask liners, pads, skin protectors, or moisturizers can help, and there are many effective products on the market for improving mask seal and fitting comfort, but in most cases this is an indication that your mask fit needs further adjustments. A leaky or unbalanced fit leads to inadequate air pressure, which can irritate the skin. In no case should you ever be bruising the skin with your mask. This is far too tight and unnecessary. If a leak is causing you to tighten to this extent, there is something wrong with the fit. Try adjusting both the pads and the straps together until you feel more comfortable and no longer experience irritation or abrasiveness when moving. It’s always good to try out your fit with a few movements in your prefered position. As with the issue of leaks, you may want to ask your supplier or another specialist to help you find a different size mask, or an alternative model that may suit your needs better. Some, for example, very much prefer the nasal masks, especially the nasal pillow masks that avoid facial pressures altogether.
4. Dryness in Mouth, Throat, Nose, or Eyes
These issues can be caused simply by the air itself. The air entering the mask may be dry, humid, or simply abundant. A CPAP humidifier will add moisture to the airflow and often solves this problem immediately. Using a humidifier is a good idea in general, as it makes for a much more comfortable CPAP therapy experience, opening up the nasal passages and providing a soothing dampness to every breath. Heated humidification also gives some patients a calming effect that helps them to breathe easier. When using a humidifier, start your therapy at the lowest heat setting then turn it up until it reaches the level most comfortable to you. This may change based on the temperature of the room or environment, or simply due to changes in preference. Dryness can also be caused by mouth breathing during sleep. You may not even know that your mouth is dropping open while you sleep, which can direct air into your throat instead of your nose. If this is the case (you may have to ask a bed partner or record yourself), using a chin strap can secure the mouth and jaw while asleep. Another alternative is a full-face mask, which covers both nose and mouth. Often made of soft and elastic material, chin straps are ideal for both comfort and support, giving patients the security for added freedom of movement without worrying about the mouth dropping open and drying throughout the night. If dryness is primarily a nasal issue, using a nasal cream like Rhinase or NeilMed can help moisten the sinuses and last through both day and night. But always check to make sure your mask fits well. A leaky mask can dry out your nose. If you have to tighten straps often to prevent air leakage, the mask does not fit properly. Nasal stuffiness, including itching and congestion can also occur. This can often go away after the first few weeks of CPAP use, so keep in mind that changes do occur while you are adjusting to the therapy. Also, seasonal effects such as allergies can cause problems with the therapy. Use of a saline spray or other allergy suppressant can also help with CPAP. Always talk to your regular physician if such problems persist. The following solutions can also help to troubleshoot dryness and irritation from CPAP:
  • Position affects airflow. It is best to sleep on your side or to elevate your head so that breathing is made easy and natural. The CPAP machine can then operate without obstruction or difficult inclines.
  • Try an AutoSet machine. An APAP machine adjusts automatically to your breathing patterns and will provide the pressure needed from one moment to the next.
  • Always make sure to clean your CPAP mask and accessories regularly and as needed. This will keep the system flowing well and also ensure that everything is safe to use and germ free.
  • If you are experiencing dryness in the eyes due to the direction of the airflow, make sure that the mask isn’t sitting too high on the bridge of your nose, as this can direct air into the eyes and cause dryness and irritation over time.
5. Water in Hose, Mouth, or Nose
Water in the tubing is caused by too much condensation when there are significant temperature differences within and without of the CPAP system. Since colder air holds less moisture, more water will condense as the air cools. This is known as “rainout.” The best way to correct rainout is to heat the air, either by using a hose cover to trap the heat within, or by using a heated hose. A heated hose uses heating coils to warm the air in the tubing directly, which prevents condensation, while hose covers help to contain the higher temperature within the tubing through insulation. Both of these methods of heat containment are effective in reducing condensation and rainout, and in most cases no further solutions are needed.
6. Removing the Mask in the Night
It is not uncommon for patients, especially new patients, to wake in the morning with their mask removed, but without any memory of removing it. In some cases this suggests that the mask choice may not be ideal for the patient’s needs, or that it simply is not fitted properly. Professionals suggest that comfort issues are the first and most likely culprit for this behavior, as some disagreement is causing the patient to reach for the mask and remove it, either unconsciously or semi-consciously. Similar to sleepwalking or sleep eating, this behavior can lead to frustration when trying to control it, especially for those trying to be compliant with their treatment. The first solution suggested by CPAP and sleep disorder professionals is pressure adjustment. If your pressure setting is inadequate, you may be removing the mask as a result of breathing difficulties. As the same time, if your mask is leaking or too loose, the same conditions may occur. A tight mask may also cause pain or discomfort on the skin. To ensure that your pressure is adequate, check with your provider or another sleep specialist who can help. Your data should be easily accessed via SD card or online. It’s also good to use the ramp feature to increase comfort at the onset of therapy. Starting at a low pressure should help you fall asleep without disruptions. Other comfort features such as heated humidification can have similar benefits. The goal is to optimize comfort during the initial moments of sleep onset, hopefully achieving deep sleep by the time the pressure rises and breathing events may occur. Some specialists may even prescribe medication such as a mild sleeping pill to help with the first few weeks of CPAP use, as the adjustment period is very important to ongoing compliance and effective therapy routines.
7. Gas or Bloating Resulting from Therapy
Painful gas and bloating is a CPAP machine side effect known as aerophagia. Aerophagia is gas and/or excessive internal air caused by the swallowing of air during therapy. If this is done long enough, painful bloating and gas can occur by morning, or throughout the following day. Again, a pressure adjustment or change of mask style may be all you need. But a lower setting, use of the ramp features, or switching to an APAP or BiPAP setting can reduce the amount of air ingested. A BiPAP machine or setting will continually reduce the pressure during exhalation periods, reducing the amount of air you’ll ingest upon inhale. Most effective, but also more difficult for some, is the avoidance of inhalation during therapy. If you can normalize your CPAP therapy breathing and reduce the inclination to swallow the air into your stomach, you will in turn reduce the amount of air or gas in your system. This may take practice, but is worth the effort, as effective breathing is healthier all around, and will contribute to your overall goal of effectively treating sleep apnea.  
8. Headaches
Headaches can be caused by high or low pressure settings, but it is always best to consult with a specialist before testing different levels. An APAP machine can do this automatically, as long as the device is set to the correct and most effective pressure range for your needs. Oftentimes headaches or migraines are related more to sleep problems than the therapy itself, requiring only that you learn to sleep better with CPAP to reduce the aches and pains of waking unrested. Lack of proper sleep can also lead to a compromised immune system, which can cause sinus problems that also lead to headaches as your body fights to stay healthy. Heated humidification is one way to treat this, as it tends to open up the sinuses and improve overall breathing. Because headaches can be caused in a number of ways, and sometimes unrelated to CPAP, it is best to take the easiest steps first and proceed with alternative masks and devices if simple adjustments fail to relieve you of the symptoms. Checking your mask fit, your humidification level, your air pressure, and your bedtime routine can all contribute to better therapy results and a reduction of headaches over time. But if none of this works for you, try another mask style that will free your breathing from any potential obstructions (nasal pillows, for example, may mimic congestion).  
9. Feeling Claustrophobic
When patients have feelings of being trapped, suffocated, or claustrophobic during CPAP therapy, their instinct is to stop the treatment immediately. But this problem is easier to overcome than some may assume. The first professional recommendation is to use a smaller mask such as a nasal or nasal pillow mask, rather than any full-face models. Other possible fixes include lower pressure settings, using the ramp feature, and desensitizing yourself to the CPAP experience. Always practice therapy by wearing the mask during the day, or during early evening experiences as the sleep time nears. In addition, relaxation exercises such as slow breathing, meditation, or bathing may help reduce stress or anxiety related to any negative therapy experiences. Claustrophobic feelings are often associated with a fear of losing control, and taking control of your own treatment is a prerogative. All of this will take time, so don’t get into a hurry or demand immediate success. With time and patience, great things are possible.  
10. Difficulty Falling Asleep
This is the final and most common difficulty reported by new CPAP users. If you cannot fall asleep on CPAP, or the therapy is waking you up or causing too much discomfort, start with your comfort features. Make sure your machine has Exhalation Relief. Exhalation Relief, like a BiPAP system, will lower the pressure during exhalation. As with some of the other comfort problems mentioned, a lower pressure and/or ramp will help as well. Some beginners find it helpful to start with a lower pressure setting and raise it gradually to an optimal level as the weeks proceed. As a rule, you should always keep an optimistic view, regardless of any challenges or difficulties. As with most therapies, the more you put into it with patience and effort, the more you will reap the benefits. What most long-term CPAP user say is that the initial challenges are the most difficult part of the process. Once you are past the adjustment period, things will get easier. And keep in mind that a new mask, setting, or accessory can make a big difference. Sometimes a little trial and error is the best path to perfection. And with PAP therapy as a treatment of choice, perfection means a longer, healthier, and more restful life ahead.  
National Sleep Foundation - NCBI - Respiratory Care - - - - Very Well Health - -