(January 8, 2024) — 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!

Try the troubleshooting tips in this article for CPAP mask problems.

For other problems, check out these other CPAP articles:

• Troubleshooting CPAP Machine Problems
• Troubleshooting General CPAP Problems
• Traveling with Your CPAP Machine

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” headgear. 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.