Sleep Care

Troubleshooting CPAP

Continuous Positive Airway Pressure (CPAP) is beneficial to many people in resolving the symptoms associated with their sleep apnea and disruptive snoring.  From time to time, however, problems can develop that are often easily remedied.  Studies have found that CPAP wearers who educated themselves about basic troubleshooting had greater success and compliance with CPAP long-term.

Below are some common difficulties CPAP users run in to and some suggested solutions for each.  As a general guideline, it is helpful to have the contact information for a durable medical equipment (DME) or homecare company available—their experienced staff can be a valuable resource in correcting some of these problems.

Redness, Irritated Skin, Facial Sores

Dry Mouth in the Morning

Nasal Congestion, Dryness, Nosebleeds

Moisture Accumulating on the Face

Claustrophobia

Pressure Feels Too High: Sensation of Drowning or Unable to Catch Breath

Mask Comes Off or Becomes Loose During Sleep

Mask Leaks or Whistles

Continued Snoring While Wearing CPAP

Redness, Irritated Skin, Facial Sores

These are often signs that a mask may be strapped on too tightly—most masks are designed to produce the best seal with the mask secure on the face, but not tight.  Try loosening the headgear for the mask.  Rubbing a small amount of Vaseline, or a similar jelly-like substance, around the edge of the mask that contacts the skin can also help alleviate irritation.

In some situations, a different style of mask may help.  For example, if you are using a nasal mask (triangular shaped mask that fits only over the nose), switching to a nasal pillow style mask may be beneficial.  This can be particularly helpful for people who sleep on their side and press their head into the pillow.  Contact your DME or homecare company to talk about trying a different mask style.

p>Dry Mouth in the Morning

Waking up with a dry mouth and throat is generally the result of sleeping with an open mouth while wearing a nasal or nasal pillow style mask, which will allow air to blow out of their mouth, causing the mouth to dry out over the course o

Typically, the addition of a humidifier will resolve dry mouth symptoms.  If a passover or cool humidifier is being used, switching to a heated humidifier (which adds a higher level of water moisture to the air) is a good next step to try.

Some medications can also cause mouth dryness.  If this is the case, consult with your physician about possibly changing to a different medication if desired.

Nasal Congestion, Dryness, Nose Bleeds

Similar to mouth dryness, the addition of a humidifier, or switching to a heated humidifier from a passover model, can usually resolve these symptoms.  Using a saline nasal spray or decongestant before putting CPAP on at night can also be beneficial.  For people with fine nasal features or a thin nose, switching to a different style of mask may be helpful—for example, some people find a nasal pillow style mask, which delivers the air pressure directly inside their nostrils, dries their nose out faster than a more standard nasal mask, which simply delivers the air towards the nose.

Moisture Accumulating on the Face

In this situation, decreasing the level of humidity added to the air will likely resolve the problem.  For patients who sweat easily at night, using the passover (cool air) humidifier instead of a heated model is helpful.  Also, try having a small fan on a nightstand or dresser to keep the head cool during the night.  A smaller style of mask (i.e., switching from a full face mask to a nasal pillow mask with a chin strap) may also be beneficial.

Claustrophobia

Switching to a smaller mask type (particularly a nasal pillow style mask) is often the best remedy for a feeling of claustrophobia or being smothered.  If you’re having difficulty adjusting to the mask, ask your doctor about ordering a desensitization session—these can be done in a relaxed lab setting during the daytime, when a variety of masks and pressures can be tried without having to go through the anxiety-inducing process of being hooked-up to wires and equipment necessary when doing a titration at night.

Pressure Feels Too High: Sensation of Drowning or Unable to Catch Breath

This often occurs for people who have severe apnea and require a high pressure to breathe normally while asleep—but find the pressure is too high to be comfortable when awake or trying to get back to sleep.  In this situation the use of a “ramp” feature is very helpful, and most CPAP machines have a “ramp” button on them designed to lower the pressure for a period of time (usually at least 15-20 minutes) to allow a person to get back to sleep.

Pressures can also feel too high for individuals who have had a significant health change, such as weight loss.  Consult your doctor if this is the case.  A repeat CPAP titration may be recommended to see if the pressure needs to be lowered.  For some people, a trial of BIPAP may also be suggested.  Compared to CPAP, which uses one continuous air pressure, BIPAP uses two different air pressures—a higher pressure when inhaling, and a lower pressure when exhaling.  Patients with hypoventilation, difficulty exhaling, and some cardiac or neurological conditions often find BIPAP easier to use than CPAP.

Mask Comes Off or Becomes Loose During Sleep

Try tightening the headgear a little before going to sleep—but not too tight!  If the problem persists, contact your DME or homecare company about getting a different brand or style of mask the fits the face more securely—sometimes a different brand of mask, despite being the same style as what you may currently be using, can be shaped just differently enough to provide a more secure fit during the night.

Some people find that they simply aren’t able to wear a mask the entire night, despite trying several different brands and styles.  In this situation, it is important to wear the mask as long as possible each night—it may be necessary to start off with fewer hours at first while getting adjusted to sleeping with CPAP.  Most studies show that people will receive a significant improvement to their sleep and overall health when wearing CPAP for a minimum of four hours a night.

Mask Leaks, Whistles During the Night

These typically occur because the mask seal is getting broken during the night.  Adjusting the mask for a better fit or trying a different style of mask often will resolve these problems—contact your DME or homecare company to do this.  Adding a humidifier can sometimes improve a mask’s seal.  For individuals experiencing these issues with an old mask, it may be time to replace the mask, as the material masks are made of will break down over time, which can cause leaks and whistling.  Most insurance plans will pay for a replacement mask every six months; check with your provider for details.

Continued Snoring While Wearing CPAP

This is often a sign that the pressure may be a little low—consult with your doctor about changing the pressure; they may order a retitration in the sleep lab to double-check the pressure.  This is particularly indicated for patients with a significant health change, such as weight gain, since they’ve starting using CPAP.

Some individuals do still snore despite their pressure adequately resolving all of their sleep apnea symptoms.  In these situations, a referral to an Ear Nose Throat (ENT) specialist may be helpful to determine if there are any structural issues in the airway that may be complicating how effectively CPAP is able to work.