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Easy CPAP Answers to Common CPAP Questions

Anna Rodriguez, RPSGT and Clinical Director of, recently sat down to write out her responses to common CPAP questions that are asked by both new and old patients. 

What are the best practices when at home, alone, to achieve a proper seal?
Wash and dry your face thoroughly, apply your CPAP mask in front of a mirror to ensure it fits properly (a nasal mask should fit above the upper lip & just below the middle of the eyes on the bridge of the nose, a full face mask should fit below the lower lip & just below the middle of the eyes on the bridge of the nose). Adjust mask for comfort by tightening the headgear straps and then connect the CPAP hose to the CPAP unit and power CPAP unit on. If you feel air escaping around the mask re-adjust mask and tighten headgear straps.

Should I have to tighten the headgear this much?
Most patients believe “the tighter the mask, the less it will leak”, not true.  Typically, due to the type of material most masks are made from, the tighter the mask the more leak you will have.  If the mask has to be tightened so tight to avoid leaking making it uncomfortable, the mask does not fit properly, and you should be refitted for a mask.

Is my pressure too high for a nasal CPAP mask (or other type)?
Nasal interface nasal systems (nasal pillows) are not recommended for patients requiring pressures of 10 cm H20 or higher, this typically causes severe dryness and may be difficult to tolerate. Typically, high pressures (> 15cm H20 pressures) are tolerated by patients using most nasal and full face masks.

Are certain mask types better than others for certain facial structures?
The ResMed Quattro or Quattro FX Full Face mask works well for patients with a “boney bridge of the nose”.  These masks work well and help relieve the pressure on the bridge of the nose.

The Fisher and Paykel Forma Full Face mask works well for patients with facial hair, this mask fits under the chin to help eliminate leaks around the mouth.

The Respironics TrueBlue Nasal mask typically does not leak, even with higher pressures.  The ResMed Mirage Micro is a very light weight nasal mask, making it very comfortable and easy to use.

What do I do when I have a seal when I start to sleep, but wake up later without a seal?
Typically, during sleep you may change positions which may shift your mask and create a leak.  If this happens you should readjust your mask then return to sleep.  Another option, check out our web site, we have several CPAP Bed Pillows which are specifically made for patients using CPAP which will help the CPAP mask from shifting and creating leaks.

What can I do if it just doesn’t seem to work for me?
Request a “desensitization” session with your Sleep Lab; this may help with tolerating CPAP. If you feel CPAP “does not work” for you, schedule an appointment with your sleep doctor to discuss other options.

How do I resolve general mask discomfort?
This problem usually arises because either the patient adjusts the headgear too tight or because the mask does not fit properly.  A CPAP mask should fit the face snuggly to avoid air leak but not so tight that is feels uncomfortable or causes pain. If a mask has to be pulled tightly to prevent leaks the mask does not fit properly!  You should contact your sleep specialist or home health provider and let them know that your mask may not fit well and you would like to try another size or style mask. There are a number of makers of CPAP masks and not every nose can wear every mask.  Do not let anyone tell you that a sore on your nose is to be expected!

I have nasal congestion, irritation or runny nose that seems to be caused by using CPAP.
Your nose is your airway’s humidifier. It warms and humidifies the air that you breathe.  If the CPAP begins to dry your nose, your body will increase the production of mucus in the nose to add more moisture to the inhaled air. Unfortunately, this may cause nasal congestion and a runny nose. In some cases the dryness will cause irritation, burning and sneezing.  These symptoms can be alleviated by the use of a humidifier with your CPAP.  Some sleep specialists order a Passover (cold water) humidifier with the initial CPAP order. If you do not have one of these speak with your sleep specialist.  If you already have a humidifier and still experience these symptoms you may need a heated humidifier.  This is a water pan that sits on a heating unit and is attached to CPAP just like the passover humidifier.  Heating the air and the water will allow the air to carry more moisture as it travels to your nose (just like the summer air is more humid than winter air).  In almost all cases this resolves nasal congestion and irritation if it is caused by CPAP.

I have difficulty breathing through my nose. 
If you have allergies, chronic sinus problems or a deviated septum (your nose is crooked on the inside) you may have trouble using CPAP.  CPAP is usually applied through the nose. If during the day you often find yourself breathing through your mouth, CPAP may be difficult to use.  If the problem is allergies speak with your doctor about treatment. There are a number of good nasal steroid sprays and allergy medications that can treat your nasal congestion.  Individuals with a deviated septum or other structural problems in their noses may benefit from seeing an Ear Nose and Throat specialist if CPAP cannot be tolerated.  Finally, there are CPAP masks that fit over both the mouth as well as the nose.  People have used these with varying success but it may be worthwhile to try a “full face mask” before looking into more invasive or expensive alternatives.

What can I do about headaches or ear pressure?
Although treating sleep apnea usually eliminates morning headache, some CPAP users develop headaches on CPAP.  Others find that their ears develop pressure or pain in them.  Most of this relates to underlying sinus congestion due to allergies or to CPAP itself. It is much like traveling in an airplane when you have a cold. The congestion can block the ear canals and changes in air pressure can cause pain when air gets trapped. It is best to avoid using CPAP when you have a cold or sinus infection to avoid these problems.  Sometimes the congestion remains in the ears and sinuses after the acute symptoms of the cold are gone. If you develop headache or ear pain on CPAP, speak with you sleep specialist.  In the interim you may try decongestants or antihistamines. Check with your doctor before you take these medications. 

I take off my mask at night and don’t realize it. What can I do?
This can happen for a number of reasons: difficulty breathing through the nose mask discomfort or sleep disturbance.   If your nose is congested when you awaken read the two paragraphs addressing that in this paper. Speak with your home health provider if your mask hurts.  If these two problems don’t appear to explain why you are pulling off your mask, it may just be that you need some time to adjust to wearing a mask on your face at night. During an arousal, when you are not fully alert you may not remember that you now wear CPAP. It can be a scary thing to awaken with a strange thing on your face!  This should improve over time. It may help to take either Benadryl or Tylenol PM an hour before bedtime so that you are drowsy going to bed and so that it is less likely that you will awaken at night.  After a few nights you should adapt to wearing the mask.  Be sure to talk to your doctor before taking these medications, particularly if you have any medical problems.

There is air in my stomach! 
Occasionally, a CPAP user will experience air trapping in the stomach and awaken with stomach pain or gas.  Sometimes simply making sure that you sleep with your head aligned with your body can help with this. If you want to elevate your head in bed you should do that with a wedge pillow or with bricks under the headboard.  If you sleep with several pillows it may cause your head to tilt forward and block your airway.  Lowering the CPAP pressure can help but your sleep specialist may not want to do this if it reduces the effectiveness of your treatment.  Switching to bi-level pressure can be very helpful in these cases.

The CPAP air is too cold. 
This can be fixed with a heated humidifier. If you cannot get one you may try running the tubing under the covers, next to your body to warm the air.

The CPAP air is too hot.
This is more difficult to fix but it may help to lower your room temperature as low as possible.

My CPAP is too noisy.
It is most likely a lot less noisy than you’re snoring, but if noise is a problem you have several options.  Most new machines are quiet so this is rarely a problem. Check with your insurance company if you have an old machine. You may qualify for a new CPAP.  You can get an extra length of tubing so you can move the CPAP further away from the bed.  A fan or other source of “white noise” can also help to disguise the noise.

The CPAP tubing gets in my way.
Draping the tubing behind you and over the headboard helps with that. There is also a new device that attaches to the bed that holds the tubing up and rotates so that it can move with you.

I take off my mask at night and can’t be bothered to put it back on.
When you get up at night to use the restroom, for example, leave your mask on and just disconnect the tubing either at the mask or at the machine. This is easier than having to refit the mask during the night.

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