Trouble Tolerating CPAP?  Here’s some reasons why…

By Clinton Marquardt - Sleep & Fatigue Specialist

May 29, 2015

cpap, CPAP problems

There are lots of reasons why you might be struggling with CPAP.  I’m going to talk about the most common ones.  The list is not exhaustive and you can find a lot more information about CPAP in the Resources section of my Web site.

The first reason is a big one for this time of year, it’s allergies. If you have allergies, CPAP can make your symptoms worse. It’s almost like you are getting a concentrated blast of allergens delivered right into your respiratory system through your CPAP mask.  The best thing to do, is to start by controlling the allergens. This means removing anything from your bedroom that you know you are allergic to, like wool blankets, flowers and your pets.  Get them out. It also means cleaning your CPAP unit and tubing frequently and well. Ask your CPAP supplier for detailed instructions on cleaning your system.

Next, clean your bedroom much more frequently. Dust, vacuum and wash your bedding at least once a week. The more frequent the better.  Then make sure your CPAP unit isn’t close to any allergens. Keep it on the night stand beside your bed, not on your floor. Ask your CPAP supplier for extra filters and start changing them more frequently. Also ask about in-line fine particulate filters, these go in the unit between the humidifier and the rest of the system.

Now start experimenting with your CPAP humidification system. Make sure you only use distilled water in the system. Try CPAP with and without humidification and with and without heated humidification; you might find it easier to tolerate it one way or the other. In general, humidification is better. But sometimes too much humidity can irritate your nasal mucosa and sinuses. You’ll have to find the right level for you. Just make sure there is no condensation build up in the mask, this is too much humidity.

The last thing to try on the allergy side is an antihistamine. Try it last because many antihistamines will have an effect on your sleep. Some can make it hard to get the right amount of each stage of sleep and will leave you feeling fatigued even after an 8 hour night. Oral and nasal antihistamines work faster, usually within an hour. Nasal steroids, which can help with allergies, can take weeks to become effective.

Another reason you might be having trouble tolerating CPAP is bedroom temperature.  Sleep is usually better at a slightly cooler temperature.  But if you drop your room temperature too much, your CPAP will be blowing cold air. Try bringing your bedroom temperature up a degree or two or use the heater on your CPAP humidifier.

Nasal dryness can be another contributor to CPAP frustration.  Humidification can help here too. If it doesn’t, try a saline nasal spray before bed, nothing medicated, just plain old saline.

Other nasal problems can also make CPAP difficult to tolerate.  Nasal congestion can be reduced by dealing with allergies as discussed or by using a nasal opening dilator like Breathe Right Strips.  Don’t use a decongestant medication with anything like pseudoephedrine in it. It’s a stimulant and it will wreck your sleep. Nasal mucosa irritation can be reduced by playing with CPAP humidification levels, using a saline spray or by applying a small amount of ointment in your nostrils before bed. Try something greasy like Boroleum or Vaseline. They last longer and provide more protection compared to water-based creams.

If redness, dryness or irritation marks are showing up on your face, your mask may be to blame.  Talk to your CPAP provider about a more suitable option, preferably a hypoallergenic one made of silicone.  Not only can mask allergies make it difficult to tolerate CPAP, but so can the fit of your mask. Leaky fitting masks can be irritating. Try tightening the straps, but just a little. Your mask should be comfortable and not too tight. If you really need to buckle it down to get a good seal, it’s time to try a different mask. Consider using a forehead spacer to take pressure off the bridge of your nose or switch to nasal pillow CPAP mask.

The last common contributor to CPAP frustrations is mouth opening. Everything else works fine, but your mouth keeps drooping open, especially during REM sleep, and you lose your CPAP air and often wake up. Chin straps can solve the mouth opening, but then many people report that their lips “pop”.  CPAP air accumulates inside the cheeks until the pressure pops their lips open and wakes them up.  If you don’t want to change to a full-face mask (and perhaps suffer from a dry mouth) consider CPAP headgear with a chinstrap.

If I’ve missed a CPAP frustration or a solution, please contribute by submitting a comment.


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