Cpap Masks: Uncomfortable Nights, Poor Sleep Quality

Continuous Positive Airway Pressure (CPAP) is a common treatment for obstructive sleep apnea (OSA). It involves wearing a mask that fits into the nostrils, underneath or over the nose, or over the nose and mouth, and delivers pressurised air to keep the upper airway open during sleep. While some patients report life-changing improvements, others struggle with discomfort, skin irritation, claustrophobia, and difficulty tolerating the mask. This paragraph aims to explore the challenges of sleeping well with a CPAP mask and provide strategies for improving sleep quality.

CPAP mask discomfort

CPAP, or Continuous Positive Airway Pressure, is a common treatment for obstructive sleep apnea (OSA). It involves wearing a mask that fits into the nostrils, underneath or over the nose, or over the nose and mouth. The mask is attached to a machine via tubing, which delivers pressurised air to keep the upper airway open during sleep.

While CPAP can be life-changing for many, with improvements in sleep quality, mood, and energy levels, it can also present some challenges for new users. One of the most common complaints is mask discomfort. Here are some tips to help alleviate CPAP mask discomfort and make the treatment more bearable:

Finding the Right Fit

The most common problem with CPAP treatment is a mask that doesn't fit properly. An ill-fitting mask can cause issues such as air leaks, skin irritation, and discomfort. It is important to work with your doctor or a CPAP specialist to find the right type and size of mask for your face. There are various styles available, including nasal masks, nasal pillows, full-face masks, hybrid masks, and helmet masks. You may need to try out different masks to find the one that suits your face shape and provides a good seal without being too tight.

Adjusting the Settings

Ensure that the straps of your mask are adjusted correctly. The mask should be tight enough to create a seal but not so tight that it leaves red marks on your skin. Stand in front of a mirror and make subtle adjustments to get a good seal and a comfortable fit. When lying down, your face contour changes slightly, so it is important to test the mask in this position as well.

Accessories and Add-ons

If you are experiencing skin irritation or marks from the mask or straps, there are various accessories available to improve comfort. These include mask strap pads or strap covers, padded mask liners, and gel pads for the nose. If you are prone to nasal congestion or dryness, consider using a CPAP heated humidifier, which can help add moisture to the air you breathe.

Practise During the Day

To get used to the feel of the mask, try wearing it for short periods during the day while you are awake. This will help you determine if any adjustments are needed and make it easier to fall asleep with the mask at night.

Improve Sleep Hygiene

Ensure that you are maintaining good sleep hygiene practices. This includes going to bed only when you are tired, improving your sleep environment by keeping it dark, quiet, and at a comfortable temperature, and avoiding stimulants like alcohol, coffee, and mobile phones before bed.

Relaxation Techniques

A busy or worried mind can make it difficult to fall asleep, especially with the added element of a CPAP machine and mask. Practise relaxation techniques 1-2 hours before bed, such as taking a bath or doing relaxation exercises. Avoid stressful activities or discussions that can increase alertness and make it harder to fall asleep.

Remember, it takes time to get used to CPAP treatment. Don't be discouraged if you don't adjust immediately. With some patience and persistence, you can optimise your treatment and start reaping the benefits of improved sleep and overall well-being.

Claustrophobia

There are several ways to overcome this issue and get used to wearing a CPAP mask. Firstly, it is important to familiarise yourself with the mask. Hold it, examine it, and take it apart if you like. Then, try holding the mask up to your face for short periods of time, gradually increasing the duration. Once you are comfortable with this, try wearing the mask while awake and doing distracting activities, such as watching TV or reading a book. You can then try hooking the mask up to the CPAP machine and turning it on while you are awake, again gradually increasing the duration.

It is also important to choose the right type of mask. There are three main types of CPAP masks: nasal pillow masks, nasal masks, and full-face masks. Nasal pillow masks are often preferred by those with claustrophobia as they are lightweight and sit just under the nostrils, with minimal contact with the face. Nasal masks cover from the bridge of the nose to just above the lip and may also be a good option for those with claustrophobia as they do not cover the mouth. Full-face masks cover the nose and mouth and can be more difficult for those with claustrophobia to get used to, but newer versions are being developed that are lighter and less cumbersome. It is important to try different types of masks to find the one that works best for you.

Other tips to improve your comfort with CPAP masks include:

• Practising deep breathing exercises or meditation to help you relax and reduce anxiety before and during CPAP use.
• Visualising a calming and comfortable place while using the CPAP mask to distract yourself from the sensation of the mask.
• Reminding yourself of the benefits of CPAP therapy, such as improved sleep quality and overall health.
• Using a CPAP machine with a humidifier to reduce dryness and improve comfort.
• Using soft mask liners to improve comfort and reduce irritation.

Dry mouth

Medication or Other Conditions

It is important to rule out other causes of dry mouth before blaming the CPAP machine. The Mayo Clinic lists six potential non-CPAP causes that should be discussed with a doctor:

• Oral medications that list dry mouth as a side effect
• Nerve damage (as a result of an injury or surgery)
• Tobacco or methamphetamine use
• Other health conditions, such as Sjogren's syndrome and HIV/AIDS, which can cause dry mouth
• Stroke and Alzheimer's disease can cause a perception of dry mouth, even though the salivary glands are functioning normally

Non-Heated Air

If the air from the CPAP machine is causing dry mouth, adding moisture through a heated humidifier and/or heated tubing may help. These devices feed moisture into the air you breathe to prevent dryness. The heat level can be adjusted to provide more or less moisture, but too much can create condensation in the air tube, a condition called "rainout" or "washout."

Severe Mask Leak

Even if your CPAP machine has humidification, a severe mask leak can still cause dry mouth and reduce the effectiveness of sleep apnea treatment. This is a leading reason why 45% of former CPAP users quit their therapy. A mask leak can be caused by an ill-fitting mask, being on a bilevel machine, or being a mouth breather who is using a nasal or nasal pillows mask.

Mouth Breathing

Some people using CPAP machines exhale through the mouth rather than the nose. Exhaling through the mouth during sleep can dry it out. Keeping the mouth closed with a chin strap or adhesive strips can reduce mouth breathing and relieve dry mouth.

Poorly Fitting Mask

A CPAP mask that is too loose or too tight can contribute to dry mouth and reduce the treatment's effectiveness.

Decreased Flow of Saliva

The high pressure in the mouth created by CPAP can block the flow of saliva, which normally keeps the mouth moist.

Other Causes

Using a CPAP machine is not the only cause of dry mouth while sleeping. Obstructive sleep apnea itself, even when a person is not using CPAP, can increase the risk of dry mouth. Dehydration, advanced age, salivary gland problems, diabetes, anxiety, HIV infection, and the use of tobacco, marijuana, or methamphetamine can all contribute to mouth dryness.

Incorrect pressure settings

If the pressure settings on your CPAP machine are incorrect, you may experience a range of adverse side effects. The pressure settings should be determined by a sleep specialist, and they are typically the lowest amount of pressure needed to keep the airway open.

Signs of incorrect pressure settings

• Discomfort is the strongest indicator that your pressure setting is too high. This can include struggling to exhale, dryness in the nose and mouth, or a burning sensation in the throat.
• Air leaks from your mask can be a sign that the pressure is too high.
• Aerophagia, or swallowing air, can be caused by pressure that is too high. This can result in bloating, gas, stomach cramps, and excessive burping.
• Apnea-Hypopnea Index (AHI) above five events per hour can indicate that the pressure is too high.
• Feeling tired or fatigued during the day may be a sign that the pressure is too low.
• Frequent and loud snoring, gasping, choking, or lapses in breathing, and waking up unrefreshed can be signs that the pressure is too low.

What to do if you suspect incorrect pressure settings

If you suspect that the pressure settings on your CPAP machine are incorrect, it is important to consult with your doctor or healthcare provider. They may suggest a new titration study to evaluate the correct pressure level for you or recommend switching to an auto-adjusting CPAP machine (APAP).

Adjusting your CPAP pressure

It is not advisable to adjust your CPAP pressure yourself. Any adjustments to your CPAP pressure should be made by a professional after your healthcare provider has determined the correct pressure setting.

Factors affecting CPAP pressure settings

Several factors can affect the required pressure settings for CPAP machines, including:

• Sleep apnea severity: The CPAP settings are calibrated to resolve all breathing disruptions, so pressure levels must be established to match the severity of sleep apnea.
• Mask type: Different masks have different pressure capabilities, and pressure levels may need to be adjusted to account for air leaks.
• Body weight: Obesity can exacerbate breathing disruptions during sleep, and pressure levels may need to be modified in response to changes in body weight.
• Sleeping position: Sleeping on your back can worsen OSA, and pressure settings may need to be adjusted to eliminate breathing disruptions in different sleeping positions.
• Facial anatomy: Pressure levels may need to be adjusted to account for certain aspects of facial anatomy that can impact breathing during sleep and the delivery of air from the CPAP machine.
• Use of sedatives or alcohol: Substances with sedative effects, including alcohol, may contribute to disrupted breathing, and higher CPAP pressure may be required to treat OSA effectively.
• Nasal congestion: Congested or irritated nasal passageways can create added resistance to the stream of air from the CPAP, and air pressure levels may need to be adjusted.
• Altitude: Air pressure is affected by altitude, so CPAP pressure may need to be modified based on location.

Congestion

Firstly, congestion can be caused by insufficient humidification. If you don't have a humidifier paired with your CPAP device, this could be causing your congestion. Adding a humidifier to your setup can help to alleviate this. If you already have a humidifier, try adjusting the temperature or humidity level—you may need to increase it to add more moisture to your nasal passages. This is especially important if you travel often, as you may need to adjust your device depending on your altitude or environment.

If you have a cold or influenza, using a CPAP machine can be more difficult. A runny nose can make it hard to breathe through a nasal mask, and the discharge of mucus can contaminate the mask, introducing the risk of secondary infection. A stuffy nose can also result in mouth breathing, which reduces the effectiveness of CPAP therapy, especially if you use a nasal or pillow mask. In this case, a full-face mask that covers the nose and mouth can be a more comfortable option.

Dirty air filters in your CPAP device could also be causing congestion. Be sure to change the filter regularly. You can also try over-the-counter nasal rinses to help alleviate congestion by eliminating allergens in the nasal tract.

If you have allergies, these could be causing your congestion. Try taking antihistamines or using a neti-pot or saline spray to reduce congestion and irritation in the nasal passages. Nasal steroids are also available to help with allergy-related congestion.

Frequently asked questions