Mayo Clinic help tips

This will be a long post but the information came (mostly) from the Mayo Clinic about problems people have with PAP therapy. Hope it helps!

By Mayo Clinic Staff Continuous positive airway pressure (CPAP) therapy is a common treatment for obstructive sleep apnea. It includes a small machine that supplies a constant and steady air pressure, a hose, and a mask or nose piece. Common problems with CPAP include a leaky mask, trouble falling asleep, and a dry mouth or nose. The good news is that if one CPAP mask or device doesn't work for you, you have other options. And most CPAP masks are adjustable, to help make them more comfortable for you. Here are 10 common CPAP problems and what you can do about them:

1. The wrong size or style CPAP mask Work closely with your doctor and CPAP supplier to make sure you have a CPAP mask that suits your needs and fits you. Everyone has different needs and face shapes, so the right style and size mask for someone else may not work for you. • Many mask styles are available. A range of CPAP masks are available. For example, some feature full face masks that cover your mouth and nose, with straps that stretch across your forehead and cheeks. These may make some people feel claustrophobic, but they work well at providing a stable fit if you move around a lot in your sleep. Other masks feature nasal pillows that fit under your nose and straps that cover less of your face. These can feel less cumbersome. Nasal pillows may work well if you wear glasses or read with the mask on, because some nasal pillow systems obstruct vision less than do full face masks. However, they may not work if you move around a lot in your sleep or sleep on your side. • Pay attention to size. Most masks come in different sizes. Just because you're a certain size in one mask doesn't mean you'll be the same size in another. CPAP masks are usually adjustable. Ask your doctor or CPAP supplier to show you how to adjust your mask to get the best fit. Manufacturer product instructions also can help show you how to do this. Remember, you have to find a mask best suited to YOUR face...you have to find one that's comfortable - no mask should ever cause pain or discomfort. No mask, if the right size and adjusted properly, should have to be tightened so that it causes skin irritation, or imbedded mask strap marks on your face, it should not leak. Most manufacturers say that their masks fit 80% of the population. It's probably true but that means 20% of us have difficulties. If you have problems with your mask, then maybe you are the one of those 20%. You buy a shirt in small, medium, large or extra large. That's often a no-brainer. Not the same for masks. Most mask frames are about the same size, its the inner cushion that comes in S, M, L sizes etc. So, if the mask frame is too large for your face and sits too high on the nose bridge, or lays on the sinus area, or presses the soft skin under your eyes, you get mask leak in to the eye area which you try to stop by pulling mask straps tighter and tighter until you get pain. If your upper lip is narrow, the bottom of the mask frame will lay on your top lip - cause pain from having to over tighten and/or leak. Remember that masks fit differently when you are standing, or sitting in a chair or on your bed. They may feel fine then, but once your machine is turned on to your pressure and you lay down in your sleeping position...all bets are off.
2. Trouble getting used to wearing the CPAP device To start, it may help to practice wearing just the CPAP mask for short periods of time while you're awake, for example, while watching TV. Then try wearing the mask and hose with the air pressure on, still during the daytime, while you're awake. Once you become accustomed to how that feels, shift to using the CPAP device every time you sleep — at night and during naps. Inconsistently wearing the CPAP device may delay getting used to it. Stick with it for several weeks or more to see if the mask and pressure settings you have will work for you.
3. Difficulty tolerating forced air You may be able to overcome this by using a "ramp" feature on the machine. This feature allows you to start with low air pressure, followed by an automatic, gradual increase in the pressure to your prescribed setting as you fall asleep. The rate of this ramp feature can be adjusted by your doctor. If this doesn't help, talk with your doctor about changing to a different type of device that automatically adjusts the pressure while you're sleeping. For example, units that supply bi-level positive airway pressure (B-PAP) or devices that have variable pressure contours are available. These provide more pressure when you inhale and less when you exhale.

4. Dry, stuffy nose A CPAP device that features a heated humidifier, which attaches to the air pressure machine, can help. The level of humidification is adjustable. Using a nasal saline spray at bedtime also can help. Your doctor may prescribe a nasal steroid spray if your dryness doesn't respond to heated humidity. It's also important that your mask fit well. A leaky mask can dry out your nose.

5. Feeling claustrophobic While you're awake, practice by first just holding the mask 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 and hose on your face, without using the straps. Have the hose attached to the CPAP machine at a low-pressure setting (with ramp feature turned on). And, finally, wear the mask with the straps and with the air pressure machine turned on while awake. After you're comfortable with that, try sleeping with it on. Relaxation exercises, such as progressive muscle relaxation, also may help reduce your anxiety. It may help to get a different size mask or try a different style, such as one that uses nasal pillows. If you're still feeling claustrophobic, talk to your doctor or CPAP supplier.

6. Leaky mask, skin irritation or pressure sores A leaky or an ill-fitting mask means you're not getting the full air pressure you need, and you may be irritating your skin. It can also release air into your eyes, causing them to become dry or teary. Try adjusting pads and straps to get a better fit. If the device fits over your nose, make sure it doesn't sit too high on the bridge of your nose, which can direct air into your eyes. You may need to ask your supplier to help you find a different size mask, particularly if your weight has changed markedly. Or try a different style device like a nasal pillow or a mask with an inflatable cushion that contours to your face. If you develop skin deterioration or sores, such as on your nose, tell your doctor promptly.

7. Difficulty falling asleep This is a normal, temporary problem. Wearing the mask alone for some time during the day may help you get accustomed to how it feels. Using the ramp feature, which provides an automatic, gradual increase in the air pressure to your prescribed pressure setting as you fall asleep, also may help. And practice good general sleep habits — exercise regularly, avoid caffeine and alcohol before bedtime, and try to relax. For example, take a warm bath before you go to bed. Avoid going to bed until you're tired.

8. Dry mouth If you breathe through your mouth at night or sleep with your mouth open, some CPAP devices may worsen 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-style device that covers your mouth and nose also may work well for you. A CPAP-heated humidifier that attaches to the air pressure machine also may help.

9. Unintentionally removing the CPAP device during the night It's normal to sometimes wake up to find you've removed the mask in your sleep. If you move a lot in your sleep, you may find that a full face mask will stay on your face better. You may be pulling off the mask because your nose is congested. If so, ensuring a good mask fit and adding a CPAP-heated humidifier may help. A chin strap also may help keep the device on your face. If this is a consistent problem, consider setting an alarm for sometime in the night, to check whether the device is still on. You could progressively set the alarm for later in the night if you find you're keeping the device on longer.

10. Annoyed by the noise Most new models of CPAP devices are almost silent. But if you find a device's noise is bothersome, first check to make sure the device air filter is clean and unblocked. Something in its way may be contributing to noise. If this doesn't help, have your doctor or CPAP supplier check the device to ensure it's working properly. If the device is working correctly and the noise still bothers you, try wearing earplugs or using a white-noise sound machine to mask the noise. Time and patience key to success Using a CPAP device can be frustrating as you try to get used to it, but it's important you stick with it. The treatment is essential to avoiding obstructive sleep apnea-related complications, such as heart problems and daytime fatigue. Work with your doctor and CPAP supplier to ensure the best fit and device for you, and try making adjustments if you're experiencing some of the common CPAP problems. It may take several months to find the correct settings for you and to adapt to the mask. With time and patience, CPAP can positively affect your quality of life and health.

Thanks for posting, Ruby.

This article does cover many of the problems that came up and surprised me. Nice to know common solutions.

I am still working on step 1: finding a mask style and size that works. I gave one approach, ResMed Swift Fx nasal air pillows for Her, and a separate BreatheWear chin strap a full 30 days and could not get a good fit that lasted for the night. I started with small size pillows, then changed up to a medium size. I was better able to breathe with the M pillows, but still couldn't keep it aligned when I changed positions after about 3 hrs of sleep.

I am now about 3 1/2 weeks into using my 2nd style, Optilife head gear with a built in chin strap and nasal air pillows. Much better fit. No problem with air pillows being dislodged at night. But within a few days I started having nose pain in the AM, noticed when removing the air pillows and continuing for a couple of hours. I think the nasal air pillows were pushing up on the cartilage in my nose, Ouch! When I tried to make the air pillows a looser fit, I have a lot of noisey air blowing around, although the data on my CPAP machine shows no major leak. Confusing. This is more streamlined and easier to put on with just 2 straps over my head vs. 4. I also changed to a shorter hairstyle to avoid the tangled mess with my hair and the straps.

I mostly sleep side to side, and I am now using a CPAP Contour Pillow to keep my head in alignment. That part is working well.

I think it might be time to try a new approach. Any suggestions on what else might work, based on what I have explained? It seems like this is kind of an expensive "hit or miss" approach to finding an interface that works for me. I might be able to use this OptiLife nasal air pillow some of the time, but I think I need to take a break for awhile due to the daily nose pain.

Suggestions are welcome. Thanks.

It is expensive, and it is frustrating, and until we have custom 3-D printed masks, it is something many of us have had to just deal with. You are not alone in it.

I recently read someone was selling some sort of salve for leaks and to help reduce sores. Since I think the mask interfaces are silicon and I am not a chemist, I imagine some ingredients would help degrade that material. Having said that, I wonder about a mix of beeswax and coconut oil -- a nice mix of tack and slide...

Also -- machines HAVE alarms in them that can be activated or not -- in my experience, many DMEs forget to ask you if you want it on or off, and default setting seems to be "off." This may not be true for some of the less-expensive models, but every respironics or ResMed machine I have had did have the alert.

Leaks: I recently learned that machines tolerate a certain range of air leaks and compensate for them in their operating algorithms (which are different at each company). So while the air feels like the wind is all going in your eyes (not good!) or just not in your trachea, it may still be within acceptable limits.
I'd mention it to the doc, but mostly be concerned about keeping it out of my eyes.

Also, as I mentioned elsewhere, some people do well with "mask liners," which you can make yourself or buy online. I tried once but it didn't help me. These liners supposedly are helpful with maintaining seals and reducing sore spots.

Persist. Think of a cloud of your "apnea colleagues" hovering with you on the nights you want to chuck it out the window... We're with you!

I knew it! It all sounded so easy.

Well I'm not a quitter, and I want to get the benefits of real sleep. At 65 years old, its about time I learned about it, but having gone through the overnight testing hooked up to the gear etc, I left the clinic that morning, at 5am when they booted us out, feeling like I had benefited from the few hours that I wore the full face mask (the first few hours were with no mask). So after going through the orientation with the sales rep for my CPAP full mask (its a Fisher Price) I was pretty confident that the one I chose would be fine. Wrong. I have all the above problems, mainly that when I start getting relaxed, my jaw tends to slack open and leaks, loud leaks (to me AND my wife) all kinds of sounds from hissing air right next to my ears to weird blubbering from my mouth escaping threw the rim of the mask. It happens right when the flow is ramped up of course; lots of air. I'm set a 7 to 14 and its quite a lot once its ramped up which is supposed to be what I need to combat the apnea. I have not had a decent sleep and have yet to go the full night. I end up giving up about 3 to 4 hours in.

It seems my contract (medicare/hmsa) will be a rental agreement, month to month, and I have to show at least 4 hours a night (on the micro chip) for the first 30 days or they will void the contract if not penalize me somehow. ALSO I had to leave with the mask SHALL NOT be exchanged for another optional style for at least 6 months. Looks like I have to make the best of the full face (with forehead brace) but I don't think I can make up for the lost hours enough to get 4 hours in each night.

At this point I am weighing how much I am potentially going to gain from this endeavor... or not.

I want to mention that I have exhausted various attempts to fidget with the mask liner, removing the mask and reseating it etc to minimize or stop the leaks but again, its mostly when I start dozing that my jaw slacks. I live in Hawaii where it gets warm at night and I don't look forward to wearing even more gear (chin strap), as that would probably be a next step.

Hi @MichaelJ. I tried the mask for two weeks and had the identical same problem. Couldn't sleep because of the leaks/noise, etc. I would recommend you ask your CPAP supplier if you could try the full nose pillow. It's so comfortable, leak free, and provides all the air I need to get a full nights sleep. Good luck!

thanks for the suggestion and recommendation ACC, I contacted my sales provider and they said I can change it out to a pillow (?) yay! Any suggestions on best type? He said I'd have to try a few different...

Hi Michael. It would be great if you could actually schedule a time to meet with your equipment provider. They could properly fit you and have you lay down with the mask on to make sure you are comfortable and do not have mask leak. You might also be able to try on different masks while you are there and decide what works best!

Thanks Dan,' I am supposed to bring my CPAP machine it to use for the trial. I'll make sure its ramps up for the test as that when it counts.

I don't mean to take over the thread here but because this one led me to the Nose Pillow I'll continue and ask for some help with the NPillow. The first night I used it was a big success! I could never have gotten to sleep at all with the full face mask due to jaw slacking causing leaks all over the place. I also use a chin strap now, which should also help with the full mask, but I appreciate the smaller profile of the Npillow. It does take getting used to; exhaling through the nose seems a bit difficult. At first I can't get enough of an exhale and have to use my mouth to release a full breath, which is not the most comfortable because the air is whooshing out through the mouth too. Funny, I recall waking in the early morning and with mouth closed it was so smooth that I had to check twice just to see if it was on! I mean I was inhaling and exhaling with such ease. So the next night I went to bed and had so much trouble getting a good exhale, and being bothered by the mouth exhales that I got a bit panicked and had to just give up in order to guarantee a good rest.

I've been experimenting during the day with it and yes it seems that I have to be very relaxed in order to stay with a nasal in/out breathing. I have to mouth exhale to get sufficient oxygen. I still can't get that relaxed nose exhale without having to force it somewhat (through the nose exhales).

I do have a history of allergies and nasal issues, but I take a cortisone nasal inhaler which works very well. Can someone tell me if I'm doing right, and do you mouth exhale some or just strictly nose in/out?

@Michaelj Thanks for posting, MichaelJ. It is not uncommon for PAP users to feel as you describe. Most new users feel they cannot relax enough to have nasal only exhalations. In time, becoming more accustomed to the equipment-- and many times during sleep when unaware--many users find the mouth exhalation gradually subsides. There are exceptions, of course, but this has been my experience with patients.

Thanks for that affirmation @TheresaS. I was worried I had some kind of lung weakness or nasal problem. I shall endeavor to relax into it and judiciously use mouth breathing. I'll have more to say eventually but I'm thinking that relaxing is key. If you have any sort of anxiety it doesn't help whatsoever and tends to make you gasp for air! I also will add for the benefit of those new nasal pillow users that at first the air feels alarmingly cold on the nasal passages (and throat when you mouth breath) but exhaling through the nose warms it up nicely. Sayonara.

@MichaelJ

Whether the culprit be a little anxiety, or just becoming accustomed to a new treatment, relaxation can be a challenge for some. I am a former sleep technician, and this is what I taught my patients to do when they were starting out with positive airway pressure (PAP)

"Take some big, deep breaths, completely relax. Put the mask on your face as you turn the CPAP unit on… Relax…Close your eyes, clear your mind of all other thoughts... Keep your lips closed, but don’t tense them…. Let the pressure being delivered via the CPAP fill the back of your throat…"

"IMAGINE your upper airway - being kept open by the pressure… Breathe with it, not against it………Breathe slowly…Concentrate…Relax..."

My problem is the soreness that develops in my upper lip just in front of my front teeth. It feels like there is broken glass in my lip. I clean my mask with a cleaning kit weekly and use the disinfectant spray every night. A new mask makes the symptoms go away after one night. About a week later they are back. I have been tested for herpes and my dentist says he can see the irritation. Sometimes it looks like a little row of white bumps. I use Fluconazole Ointment before putting on my mask and that helps a little. I have tried vaseline but that doesn't work as well as the ointment. When the outbreak occurs, Desonide cream will help clear it up. I used a Resmed S9 with a Liberty Full Face Mask. I change cushions every two weeks only because Montgomery Medical sends 6 cushions with every order.