CPAP machines: Tips for avoiding 10 common problems

Continuous positive airway pressure (CPAP) therapy is a common treatment for obstructive sleep apnea (OSA). This condition occurs when the throat muscles relax and block the airway. People with OSA repeatedly stop and start breathing while sleeping. A CPAP machine uses a hose connected to a mask or nosepiece to deliver constant and steady air pressure to help you breathe without interruption while you sleep.

Common problems with CPAP include a leaky mask; trouble falling asleep; a stuffy, runny or dry nose; and a dry mouth.

If you have any of these problems in the first two weeks of starting CPAP therapy, call your healthcare professional or CPAP supplier. Remember that if your first mask or machine doesn't work for you, there are many other types of masks and machines to try. Most CPAP masks can be adjusted to help make them more comfortable. Your care team can help you adjust your mask and machine. Getting the right fit, mask and machine early on increases your chance of long-term success with CPAP therapy.

Here are 10 common CPAP problems and what you can do about them:

The wrong size or style of CPAP mask may feel uncomfortable. Air leaks happen when the masks don't fit correctly. Air leaks can cause dry eyes, dry or stuffy nose, dry mouth, skin irritation, and pressure sores. Some CPAP machines let your care team see how the machine works even while you're at home. This technology is called remote monitoring. Remote monitoring will notify your care team of an air leak without you even having to call. If you think your mask is a bad fit, contact your care team or CPAP supplier within the first few days.

• Try a different mask. There are many types of CPAP masks available. For example, a full-face mask covers the mouth and nose, with straps that stretch across the forehead and cheeks.

  Full-face masks may make some people feel claustrophobic. These masks can work better for people who breathe through their mouths while sleeping. They also provide a stable fit for people who move around a lot during sleep.

  Nasal pillow masks have pillows or cushions that fit under your nose. They deliver air directly through the openings to the nose, called the nostrils. Nasal cradle masks also deliver air directly to the nostrils. These mask types can be comfortable and improve fit.

  Nasal pillow masks and nasal cradle masks are good for people who wear glasses or read with the mask on. These masks don't block the eyes as much as full-face masks do. They also work for people with mustaches or beards and people who feel claustrophobic.

  Nasal pillow and nasal cradle masks may not work as well if you move around a lot during sleep or have difficulty breathing through your nose, as can happen if you have a cold or allergies that cause a stuffy nose.

• Pay attention to size. Most masks come in different sizes. Just because you're a certain size in one type or brand of mask doesn't mean you'll be the same size in another. Most CPAP masks and their straps can be adjusted.

  Ask your healthcare professional or CPAP supplier to show you how to adjust your mask to get the best fit. Manufacturer product instructions also can show you how to do this. A properly fitting mask shouldn't be uncomfortable, cause pain or have any sounds of leaking air.

First, try wearing just the CPAP mask for short periods of time while you're awake, such as while watching TV. Then try wearing the mask and hose with the machine turned on during the day while you're awake.

Once you get used to how that feels, start using the CPAP machine every time you sleep, including during naps. Using the CPAP machine only every now and then may delay getting used to it. Stick with it for several weeks or more to see if your mask and pressure are right for you.

Some CPAP users don't like the pressure of air blowing into their nose or mouth. To help with this, some CPAP machines have a "ramp" feature. This setting allows you to start with low air pressure. The machine then automatically and slowly increases the air pressure to your prescribed setting as you fall asleep. Your healthcare professional can adjust the rate.

If this feature doesn't help, talk with your healthcare team about changing to a machine that automatically and constantly adjusts the pressure while you're sleeping. One type, called a bilevel positive airway pressure (BPAP) machine, delivers more pressure when you breathe in and less when you breathe out.

Check to make sure your mask fits well. A leaky mask can dry out your nose. If you have to tighten the straps often to prevent air leakage, the mask does not fit properly. Changing from a nasal mask to one that fits over both mouth and nose also could help with stuffiness in the nose, called congestion.

Many CPAP machines come with a heated humidifier, which attaches to the air pressure machine. This helps prevent dry nose or congestion. You can adjust the level of humidification. Using a nasal saline spray at bedtime also can help your symptoms. Your care team may prescribe medicines for congestion to help you breath freely through your nose.

Practice using your mask while you're awake. First, just hold it up to your face without any of the other parts. Once you're comfortable with that, try wearing the mask with the straps.

Next, try holding the mask with the attached hose on your face, without using the straps. Turn on the CPAP machine, perhaps with the ramp feature turned on. Next, try wearing your mask with the straps on, and turn on the CPAP machine. Once you are used to wearing the mask with straps and the CPAP machine running while you are awake, try sleeping with the mask strapped on and with the machine running.

Relaxation exercises, such as deep breathing or meditation, or talk therapy may help with anxiety related to CPAP use.

If you're still feeling claustrophobic, talk with your healthcare professional or CPAP supplier. It may help to get a mask size or try a different style, such as one that uses nasal pillows.

A leaky mask or a mask that doesn't fit right means your CPAP machine can't deliver the correct air pressure. An air leak or a mask that doesn't fit well could irritate your skin. The mask also can direct air into your eyes, causing them to become dry or teary.

Try adjusting the mask's pads and straps to get a better fit. If the mask fits over your nose, make sure it doesn't sit too high on the bridge of your nose, which can cause air to blow into your eyes.

You may need to ask your CPAP supplier to help you find a different size or type of mask, particularly if your weight has changed a lot. Have your care team check your mask fit every year. Checking your mask for cracks, breaks or stiffness also can help you find possible leaks.

Tell your care team if you have skin irritation or sores. Petroleum-free skin moisturizers, mask wipes and CPAP mask liners can all help. Washing your mask and face daily can prevent infections and skin irritations. Ask your care team to show you the best way to clean your CPAP mask and machine.

Wearing just the mask for some time during the day may help you get used to how it feels. This may make it easier to fall asleep at night.

Machines with the ramp feature that slowly and gradually increases the air pressure to your prescribed pressure setting as you fall asleep may make you more comfortable at bedtime.

Following good general sleep habits also is helpful. Exercise regularly and avoid caffeine and alcohol before bedtime. Try to relax. For example, take a warm bath before you go to bed. A white noise machine may help.

If you breathe through your mouth at night or sleep with your mouth open, some CPAP machines may worsen dry mouth. Air leaks also can cause dry mouth. A chin strap may help keep your mouth closed and reduce the air leak if you wear a nasal mask.

A full-face mask covering your mouth and nose may keep your mouth from becoming dry. A CPAP heated humidifier that attaches to the air pressure machine and a heated tube also may help. Ask your care team about special mouthwashes, gels and sprays designed to keep your mouth moist.

It's not unusual to wake up sometimes to find that you've removed the mask in your sleep. If you move a lot in your sleep, you may find full face mask stays on your face better.

You may have removed your mask while sleeping because you were uncomfortable. Consider trying a different type of mask that may fit you better. CPAP users often accidentally remove their masks while asleep. Checking your mask's fit with your care team may make it more comfortable and help you keep it on while you sleep.

Some people pull off the mask when they have a stuffy nose because they feel like they can't breathe. Getting a better mask fit, possibly with a chin strap, and adding a CPAP heated humidifier may help you breathe more easily through your nose.

If removing the mask is a consistent problem, consider setting an alarm for a time during the night so you can check whether the mask is still on. You could set the alarm later each night if you find that you're keeping the mask on longer.

Most new models of CPAP machines are almost silent. But if you find that your machine's noise is bothersome, first check to make sure the machine's air filter is clean and clear of anything blocking the flow of air, such as dust. Ask your healthcare professional or CPAP supplier how to properly clean your mask and hose.

If cleaning doesn't help, have your care team or CPAP supplier check the machine to ensure it's working properly. If the machine is working correctly and the noise still bothers you, try wearing earplugs or using a white noise machine to mask the noise. Placing the CPAP machine as far away from the bed as possible also may help make any machine noise less noticeable. Ask your healthcare professional or CPAP supplier if extra tubing is available and right for your machine.

Using a CPAP machine can be frustrating as you try to get used to it, but it's important that you stick with it. Using your CPAP machine correctly and as prescribed can reduce your risk of issues related to sleep apnea, such as:

• Heart conditions.
• High blood pressure.
• Feeling overly tired or sleepy during the day.
• Falling asleep while driving.
• Snoring that affects your relationship with your partner.

Work with your care team and CPAP supplier to get the best mask fit and device for you. Regular visits to your healthcare professional are important and can help troubleshoot any problems and adjust settings, if needed. It can take a while to find the correct settings and get used to the mask.

With time and patience, CPAP can positively affect your quality of life and health.