(I Can't Get No) Satisfaction (From CPAP)

Obstruvctive Sleep Apnea (OSA) is a common disorder, and a highly under-diagnosed one. 
 

Continuous positive airway pressure (CPAP) is the first-line treatment for the majority of patients with OSA.

CPAP is associated with multiple salutary effects including improvement in daytime sleepiness, reduction in blood pressure and improvement in diabetic control. However, poor adherence to CPAP can be a major impediment to effective therapy of this disorder.

 
There are several reasons why people may have difficulty using CPAP. We will discuss some of those issues, and some solutions here. We will update this page as warranted.

If you have a problem not covered here, please leave a comment, and we will try to suggest solutions. Another great resource to learn more about sleep apnea, and share your good and bad experience with others, is the website myapnea.org. It is also a research portal, which "allows consenting members to participate in research with the aim of improving sleep apnea care and treatments."

"Machine forces in air with too much pressure" or "I have difficulty breathing out against the high pressure"

 Try using CPAP when awake. Take deep breaths in and out with the machine, and visualize it opening the back of your throat, inflating your lungs, making you breathe better. Visualize how your body is getting more oxygen, making your heart and brain and rest of the body happier.

Several machines have features such as ramp (pressure starts at a low level, and slowly builds up over next few minutes) that may make tolerating the pressure easier.

Sometimes doctors can try lower settings and increase the pressure as you get used to it. Ask your doctor if that is appropriate for you. 

Some people who require very high CPAP pressure, but can't get used to it, may qualify for a machine called BPAP (Bi-Level Positive Airway Pressure; Bi-level means 2 pressures: A higher level of pressure is delivered when you breath in and a lower level of pressure when you breath out). Some other people may do well with APAP (AutoPAP/ Autoadjusting CPAP/ Automatic Positive Airway Pressure) machine. Rather than stayng at one fixed presure, machine can vary the pressure being delivered based on your needs.

"The mask leaks around the rim" or "Mask hurts the face or causes sores or pressure marks" or "Straps are too tight, cause pressure marks or are very uncomfortable"

There are several mask types available such as:

Nasal (covering nose only)
Full Face (covering nose + mouth)
Nasal Pillows (inserted into nostrils)
Oronasal Hybrid (nasal pillows + oral interface)

And they come in several different sizes. If one does not fit you well, another kind might. Ask you CPAP supplier or your doctor.  

Sometimes putting a strip of medical tape or a commercially available nasal pad can reduce facial irritation and sores, and may decrease the mask leak in some people. Similarly, strap covers may reduce pressure marks or sores from the straps.

Use of certain moisturizers may reduce chafing or dryness or pressure sores from the mask or straps. Remember petroleum-based or silicone-based products may damage your CPAP mask, so avoid those.

"My nose gets congested" or "My mouth/nose gets too dry"

Check whether you have a heated humidifier. Try increasing or decreasing the humidity settings for optimum comfort. 

Leaks from mask can also cause the nose to dry out. Try above steps if you perceive a significant leak. 

 

Nasal saline drops (available over the counter) can helps dry nose.

If you have problem with nose allergies/ nose congestion/ post nasal drip, ask your doctor if allergy pills and/or nasal steroid spray might help. Other nose sprays and medications can help too.

"I feel more bloated when I use my machine"

Ensure the mask fits properly. A poor fitting mask can lead to air going in the stomach, or "Aerophagia."

If you sleep with your mouth wide open, and are using a nasal mask, consider a full face mask or chin straps. 

Sometimes decreasing the CPAP pressure, or using AutoPAP, a machine with fluctuating pressure, may help. Ask your physician if that is appropriate. 

Consider adding a pillow. Sometimes changing the angle at which air is being blown in your mouth works. 

Some people feel relief with simethicone or charcoal tablets, or antacids. 

"I have claustrophobia when I use the device"

Anxiety and claustrophobia may make it difficult to use CPAP. 

Try holding the mask against your nose/ face in the daytime till you are comfortable with it. 
Then try using CPAP when awake. Just take deep breaths in and out with the machine, and visualize it opening the back of your throat, inflating your lungs, making you breathe better. Visualize how your body is getting more oxygen, making your heart and brain happier. 

Deep breathing, meditation and relaxation exercises can help. Autosuggestion (the machine is a part of me; using this machine, I am becoming healthier, more energetic, less sleepy and less irritated) helps some people.

If above don't work, your doctor can help. Therapies like Cognitive Behavioral Therapy (CBT) or some medications may make it easier to use CPAP

"I take off the mask in the middle of the night without realizing it."

 Ensure that the mask fits tightly, you have become comfortable with the pressure (put it on in daytime if needed), and don't have issues with dry nose or nose congestion. 

Autosuggestion (telling yourself that the CPAP is helping your body and mind, and you will keep the mask on all night) before going to sleep also helps some people.


Shaq Attacks Sleep Apnea
Myapnea.org: Patient-powered research