Continuous positive airway pressure (CPAP) is the gold standard for treating sleep apnea. The reason CPAP is the go-to treatment for so many people with sleep apnea is simple: It works. If you have issues with your CPAP, don’t let those problems get your treatment off track! Read this article for advice and tips on:

And don’t forget these basic CPAP safety tips:

  • Do not eat or drink while using your CPAP or BIPAP. You are likely to inhale food or drink into your lungs.
  • Avoid eating large meals 1–2 hours before using your CPAP or BIPAP

CPAP Mask Fitting and Adjustment

Getting the Best Mask Fit

Mask leak is one of the most common challenges for CPAP patients. Here’s how to get the best fit and adjustment.

  • When you go to bed, sit on the bed and place the mask on your face with straps loose.
  • With the machine blowing air, lie down with your head on the pillow in your normal sleeping position.
  • Slowly tighten your mask straps until you get a good seal, being careful not to over-tighten.
  • Pull the mask out and away from your face about 2 inches, then gently lay it back on your face. This allows the dual mask cushions to inflate which will assure the best possible seal and comfortable fit.

Side, Stomach or Back Sleeping?

Mask fit varies with sleeping position, so if you fit the mask for side or stomach sleeping, you will need to readjust if you roll onto your back. This is why many patients train themselves to sleep only on side or stomach.

Mask Fit Tips for Different Equipment

  • Full face mask — If you have forehead pads / bracer, tighten the upper strap first, then follow with lower strap positioning and fit.
  • Nasal pillow mask — Place mask on face and position headgear, placing side straps above ears. Gently slip nasal pillows into nostrils, making sure to rotate the angle of the pillow barrel for a comfortable fit. The pillows are meant to lie just inside the nostril opening, not to be aggressively inserted. Proper placement should not cause the tip of the nose to be raised.
  • Mask headgear — Masks come with a “one size fits most” head gear. Larger or smaller strapped headgear may be available by special order.

CPAP Mask Troubleshooting

My mask causes skin irritation, sores, or bruises

A CPAP mask should not cause pain or discomfort if it is sized correctly and fitted properly. You might be over-tightening your mask. Or your mask cushion may be worn out and need replacing. Another option to resolve skin irritation and mask leak is using mask liners called RemZzz.

I like my mask, but I still get occasional sores or leaking

Your CPAP clinic can order products that might be helpful if you like your mask but sometimes have problems.

  • Gecko nasal pad — This is an easy-to-use gel pad that goes across the bridge of the nose and under the mask. It helps prevent leaking from the upper part of the mask frame and good for patients whose nose bridge is narrow or prone to cuts or irritation.
  • SoreSpot CPAP Skin Protector — This is a unique fluid-filled bandage that minimizes friction and helps prevent skin irritation.
  • RemZzz full face and nasal mask liner — These are applied directly to the silicone mask cushion to help absorb facial moisture and oil. They prevent skin irritation and pressure marks as well as reduce noisy mask leak.

I wake up without my mask but can’t remember removing it

This is a common occurrence, especially during the early adjustment period of CPAP use. Chances are, you removed the mask because it was uncomfortable or there was an air leak. This might indicate that your mask is not the best choice for your face, or that it is not fitted properly. If it keeps happening, call your CPAP clinic about an adjustment or a new mask.

I am claustrophobic and I can’t get used to the nasal mask

Patients who experience claustrophobia usually find that the small size and simplicity of the nasal pillow mask are more tolerable. There is an adjustment period for most people as they get used to sleeping with any mask on the face. Your goal is definitely to sleep all night on CPAP, but using it as long as you can each night is better than nothing. Try to increase the time you can keep it on over time until you reach your goal.

My eyes are swollen or irritated

Eye irritation may indicate an air leak in the top area of your mask, but no air should be escaping with a properly sized and fitted mask. Gently tighten the top mask straps, taking care not to over-tighten. A leak might also indicate a worn mask cushion that needs to be replaced. Some people naturally sleep with their eyes partially open, which can cause dryness or irritation; they benefit from wearing a simple fabric eye mask. If the problem is chronic or persistent, consult with your sleep or primary care physician.

I use a nasal pillow mask, and my nostrils are sore

Most masks have exhalation ports, a tiny cluster of holes that allow the escape of the CO2 (carbon dioxide) we breath out. Check these tiny holes during your routine mask cleaning to make sure they are not soiled or clogged by body oil or bedding lint. When clogged, they can cause the mask to make a whistling noise. Use a sewing needle or toothpick to keep the holes free flowing.

My bed partner is bothered by the air flow from the exhalation ports of my mask

All masks have exhalation ports to allow the escape of CO2 (carbon dioxide). The higher your machine’s pressure setting, the harsher this escape flow will be, but some masks have better air diffusion than others. You might be able to resolve the problem by side sleeping with your back turned to your bed partner. If this does not work, check with your CPAP clinic to discuss a resolution.

The tube is pulling on the mask

When you move from side to side, the tube connecting the machine to the mask can pull the mask and break the seal. Some people also find they cannot get comfortable with the tubes on the bed. Here are two possible solutions:

  • Extension arm — Buy an extension arm light that swivels at the base and can be clamped to the head of the bed. Remove the light and attache the extension arm so that it can rotate from the left to the right side of your bed. Attach one end of a flexible stretch cord to the arm and the other to the tubing, to keep the tubing from resting on the bed.
  • Teacup holder — Attach a single teacup hook to the headboard and add a loop of string to hold the tubing up.

CPAP Machine Problems

My CPAP machine is so noisy that I (or my bed partner) can’t sleep

Today’s machines are nearly silent, so unless your are extremely sensitive to noise (try ear plugs), this would indicate a problem.

  • Check the machine filters. They should be changed monthly and when they are visibly discolored.
  • If you use an AutoCPAP, there will be a slight noise as the machine changes inhalation pressure. If your machine is otherwise noisy, there may be a machine defect. Make an appointment to have the machine evaluated at your CPAP clinic.

I get tangled in my CPAP tubing during the night

Try placing the tubing behind your head near the top of your pillow or positioned behind the headboard bed post.

I keep pulling my CPAP machine off the nightstand

The length of standard CPAP tubing is about 6 feet. Active sleepers who toss and turn are more apt to tug on the tubing and pull the machine off the bedside table. Your CPAP clinic can order tubing in 10-foot lengths, which can give your more freedom of movement, especially when combined with a tubing lift.

CPAP Humidifier Problems

Dry mouth, dry throat, runny nose, stuffy nose, or sneezing

Adjusting the CPAP humidifier or temperature setting can usually resolve those issues. Start with the lowest heat setting, and turn up as needed for more moisture. For dry mouth, try Biotene spray or oral rinse. For nasal lining dryness, try Ocean or other simple saline sprays. Both are available over the counter. Consult with your physician if the problem persists.

Water in CPAP tubing

Excess condensation can form in the tubing when your bedroom temperature is cooler than the air coming from the machine. Most CPAP suppliers offer inexpensive, insulating hose covers that can resolve this common problem.

White or pink film in humidifier water chamber

Bacteria can develop quickly, and you should always clean it immediately. Using distilled water (as all manufacturers recommend) can help avoid bacteria, though it’s okay to use tap water occasionally.

  • Daily cleaning — Every morning, empty any leftover water, rise the chamber with water, and let it air dry.
  • To remove film — Fill chamber with 1/3 white distilled vinegar and 2/3 tap water. Let sock for one hour. Rinse with clear tap water and air dry.

Water spill

Always remove the water chamber from the machine before filling with distilled water. Spilling water into the machine may compromise the interior circuits, damage the machine, and void the warranty.

General CPAP Problems

I have trouble falling asleep on CPAP

If your CPAP pressure feels overwhelming at the beginning of the night, your machine may have a feature called “ramp” that can be set to start your pressure at a lower setting and gradually increase it over a period of time.

I don’t like wearing the mask to bed

Practice makes perfect. To help get used to wearing the mask during sleep, practice by wearing it during the day while you are sitting in a chair watching television or reading. With your focus shifted from from the mask to a familiar activity, CPAP use will become more of a habit and part of your routine.

I am still snoring

Snoring, choking, and gasping noises should be eliminated during CPAP use. If you are still making noises, it could mean that your machine pressure is not strong enough. Call your CPAP clinic to find a solution.

I get air in my stomach, boating, and gas

This is a common CPAP issue called “aerophagia.” The air delivered by your CPAP machine is entering your esophagus and stomach instead of the lungs. Your CPAP pressure may be set too low or too high. Or you may be a mouth breather but not wearing a full-face mask. Consult your physician if the problem is chronic and persistent.

My pillow is a problem

Often, side or stomach sleepers find that their head sinking into the bed pillow causes blockage of the mask’s exhalation ports, which creates the risk of dangerous CO2 (carbon dioxide) poisoning. Other people find that their pillow pushes the mask frame off center, causing mask leak, pressure point soreness, or bruised cheek bones. Contact your CPAP clinic for a PAPillow, a specially made bed pillow designed for CPAP users who are side or stomach sleepers.

7 Quick Tips for Traveling with Your CPAP Machine

If you need CPAP to get a good night’s sleep, that does not change when you travel! Going on the road with your CPAP machine is probably easier than you think. Here are some quick tips for traveling with your CPAP machine.

  1. If you are flying always carry your CPAP machine as a carry-on bag. It should not count toward the airline’s carry-on limit. Airport security x-ray machines will not hurt your CPAP.
  2. Make sure to carry an extension cord and an adapter plug that works for your destination, including a country-specific plug adapter if you are traveling internationally.
  3. Also be sure you have an adapter that will receive your 3-pin CPAP plug and let you plug it into a 2- pin electrical outlet.
  4. For a CPAP humidification unit, be sure you have access to purified or distilled water. If you are flying TSA regulations will allow you to carry distilled water in your checked bags, but it is not practical to carry large amounts of water like that.
  5. If you are traveling by car, keep your CPAP machine in the passenger compartment with you, rather than in the trunk, to avoid exposure to temperature extremes.
  6. If traveling by car, camper, motor home, or boat consider a 12-volt adapter for operating your CPAP from a cigarette lighter plug. But NEVER use CPAP when the vehicle’s engine is running.
  7. If your destination is at a significantly higher or lower altitude than your home, check with your sleep specialist. Altitude can affect the performance of your CPAP machine, and the machine may need to be adjusted.