CPAP (Continuous Positive Airway Pressure) is the best treatment for sleep-disordered breathing, including sleep apnoea and snoring. It involves sleeping with a mask over the nose (or nose and mouth) which has a constant pressure of air being pumped through to the upper airway, acting as a splint to hold the throat open and allow for normal breathing function throughout a night’s sleep. There is a high tolerance rate for CPAP and usually once a sufferer of sleep apnoea has a full night on the treatment and realizes the positive effects it has on their life, the hassle of sleeping with a mask is quickly forgotten. CPAP does sometimes introduce challenges, of which we’ll cover the most common. 
Oral leak:
- If using a nasal mask, an open mouth will reduce the effectiveness of the CPAP therapy during sleep. Either taping the mouth closed or using a chin strap to hold the jaw up can help to alleviate oral leak, however;
- The best way of tackling oral leak is to use a full face mask that covers the mouth as well as the nose.
Mask leak:
- Air escaping from around the mask cushion is annoying to the user and reduces the effectiveness of CPAP therapy.
- Correctly positioning the mask on the face and tightening the straps is usually enough to fix the problem.
- If adjusting and tightening the mask doesn’t solve the problem, or in order to achieve a good mask seal the mask has to be uncomfortably tight, a change in mask to one more suited to your face may be required.
Water/condensation:
- Condensation can build up in a CPAP tube when the relatively warm, moist air inside the tube meets the walls of the tube which are cooled by the room air, especially on colder nights. This phenomenon is called ‘rain out.’
- Some machines have adjustable settings for humidity and tube temperature, in which case turning the humidity down and/or tube temperature up is usually enough to solve the issue.
- Any other method of keeping the tube warm (purchasing an insulated CPAP tube sleeve or keeping the tube under the bed covers) or reducing moisture in the tube (dehumidifier for the room or removing any humidification device from the machine) will also help keep condensation to a minimum.
Extreme anxiety:
- It’s normal to be apprehensive about sleeping with a mask on your face. PTSD, claustrophobia or other mental disorder can make it even harder.
- Finding the right mask is one of the most important parts of starting CPAP therapy. People with claustrophobia, for instance, may not be the best candidates for a full face mask. Nasal pillows are often recommended in such cases as they are the smallest and least obstructive mask type of CPAP mask.
- Wearing the mask while watching TV or engaging in any other sedentary activity while awake during the day can help increase familiarity and therefore reduce anxiety when it comes time to sleep with the mask on.
- Sometimes the anxiety is initially based on fear of not being able to quickly take the mask off in the night. Choosing a mask that is less securely fastened can help, as does becoming more familiar with how to take the mask off so it can be done even in the pitch-black.
Taking the mask off at night:
- It’s surprisingly common for CPAP users to wake up in the morning and find they have taken the mask off at some point during the night, not always remembering when or why.
- The causes are often discomfort due to having the wrong mask, the mask too tight, air leak (oral or mask), humidification setting, tube temperature settings or general anxiety about waking up with something on the face.
- There’s not always an easy solution. Sometimes it’s a matter of finding a more comfortable mask, other times addressing the anxiety, perhaps by talking to a sleep psychologist, is the only way to improve the matter.
- Remember, using CPAP for part of the night is far better than not using it at all. Even four hours use can be enough to have a noticeably higher quality sleep.
Trouble tolerating pressure:
- Starting with a low pressure while awake can make CPAP easier to get used to and fall asleep on. If using an automatic machine, set a low minimum pressure and if on a fixed pressure machine, utilise the ramp function that will start on a low pressure and slowly built up to your set pressure.
- Most CPAP machines have some form of exhalation pressure relief, which reduces the set pressure when the machine detects the user is breathing out, making the therapy easier to tolerate.
- CPAP pressures are generally decided based on clinical data, but can leave the user struggling to get comfortable if the pressure is particularly high. Sometimes it’s actually better to reduce the set pressure even if it results in a slight increase in respiratory obstructions if it means the user is able to sleep throughout the night.
Not getting enough air:
- Although more common to have issues with too much pressure, some people new to CPAP therapy struggle with lower pressures.
- The issue is usually improper breathing technique, sucking too much air in and not exhaling enough, or breathing too quickly. Once someone is used to the idea of CPAP, breathing on it is completely natural and even for new users once they’re asleep there’s little issue, but anxiety or over-thinking their breathing can cause people distress when starting the therapy.
- The CPAP machine does most of the work when you are breathing in, so there’s less need to suck in, just wait for your lungs to naturally fill and then gently breath out against the pressure.
Feeling Bloated:
Generally only occurring for new-comers to CPAP therapy who require high pressures and a full face mask, some people inadvertently swallow the pressured air from the CPAP device, leaving them feeling bloated and gassy.
Most cases are rectified by:
- reducing the maximum treatment pressure by one or two units.
- the maximum treatment pressure can sometimes be reduced even more without sacrificing treatment efficacy by swapping from a full face to a nasal mask. In some people, the full face mask can push the jaw back, partially blocking the throat.
- increasing the expiratory pressure release setting to make it easier to breathe out (eg EPR up to 3).
CPAP is a highly effective and safe treatment option for sleep disordered breathing, but some people more than others find it difficult to use. It is an unfortunate fact that some people are unable to tolerate the therapy, but if you suffer from moderate to severe sleep disordered breathing, it’s worth giving CPAP the best possible chance, it can substantially improve the quality and length of your life. Starting on CPAP can be a challenge, but you don’t have to do it alone. Home Sleep are experts in CPAP therapy, bringing many years’ worth of experience to help give you the best chance of successful CPAP adherence. We understand the importance of caring for the person, not just their disorder.