FAQ about CPAP treatment for Sleep Apnea

Frequently Asked Questions About Continuous Positive Airway Pressure (Cpap) Treatment

Positive Airway Pressure (PAP) machines that keep your respiratory passage open when you sleep, can be very effective in treating sleep apnea. If you have obstructive sleep apnea, your upper airway collapses again and again as you sleep. Positive airway pressure (PAP) devices give you just the right amount of pressurized air needed to prevent this collapse. Properly set and used whenever you sleep, PAP machines can eliminate your apnea and snoring so that you get a good night’s sleep.

Various PAP machines and masks are available, allowing each person to find the combination of equipment that works best. The pressurized air comes through a mask, which fits securely over your nose. Some patients will find that PAP works best for them when using a mask that fits over the nose and mouth or in the nostrils. Most people first try PAP machines that deliver a continuous fixed amount of pressurized air called continuous positive airway pressure (CPAP). Some people prefer two-level PAP machines (commonly referred to as Bi-PAP), which deliver more pressurized air with breathing in and less with breathing out. Self-adjustable PAP (commonly referred to as Auto-titrating CPAP) will provide pressurized air only when apnea occurs.

Your PAP machine needs to be carefully adjusted to provide just the proper amount of pressurized air you need in all body positions, no matter how deeply you sleep. To determine the amount of air pressure right for you, your doctor will plan a CPAP titration study either at home or in the sleep center.

Obstructive sleep apnea can usually be completely controlled with PAP, but you must use it whenever you sleep. Getting used to sleeping with a PAP machine may take time for some patients, but a significant number get used to it quickly because they notice the benefits. While at first you may find it inconvenient or troublesome, you shouldn’t abandon it without a good try. It can really help you.

Nasal discomforts

Nasal stuffiness or congestion is the most common side effect of PAP therapy, and is often a nasal reaction to airflow from the PAP device. More than half of patients experience some increased nasal stuffiness when they first begin PAP treatment. These symptoms often disappear within a month of use.

Specially designed humidifiers will greatly reduce nasal symptoms

Nasal itching, runny nose, nosebleeds and nose dryness are other frequent nasal problems reported by PAP users. In general, PAP – related nasal symptoms are treated with the techniques given below.

Nasal symptoms are helped by applying a few sprays of nasal saline solution (a combination of salt and water) in each nostril before using PAP. This solution may be directly obtained from pharmacy without a prescription. Oral antihistamines and decongestants may also be useful to control PAP-related nasal discomfort. It is best to discuss with your doctor before using any such medications. Decongestant nasal sprays may help, but should only be used for a few days since regular nightly use can be habit-forming and can lead to increased nasal congestion.

PAP devices can be connected to specially designed humidifiers that will greatly reduce nasal symptoms. Humidifiers add moisture to the pressurized air PAP devices use. All humidifiers can add cool moisture, and some can add heated moisture. If a cool air humidifier fails to relieve your nasal symptoms, consider trying a heated humidifier. PAP humidifiers will need to be prescribed by a healthcare professional, and should be carefully maintained according to the manufacturer’s instructions to avoid nasal and sinus infections.

Mouth discomforts

PAP devices may cause dryness and pain in the throat. Often the discomfort is caused by air blowing through an open mouth. A chinstrap to keep the mouth closed or a mask that covers the nose and mouth can eliminate this complaint. Humidifiers for PAP machines can also help control mouth discomforts.

Mask air leaks

Symptoms of mask air leak are red eyes, loss of beneficial effects of PAP, and return of snoring or apnea. Air leaks are most often the result of a poorly fitted mask. Sometimes a different mask or a mask of a different size is needed. If you continue to experience significant air leaks despite using a chinstrap, consider a mask designed to fit inside your nostrils (nasal pillows), or one that covers your nose and mouth. Remember, if your mask and PAP therapy worked well for you in the beginning, you should check to see whether your mask is worn-out or torn. Contact your PAP equipment supplier and ask for help.

Noise of the machine

Newer PAP machines are much quieter than older models, but all make some sound. Placing the machine under the bed or on the floor usually solves this problem. Again, the PAP supplier can provide advice and assistance.

Sore, dry, or red eyes

These problems can result from an air leak from your mask. Try reapplying the mask and readjusting the headgear. If the problem continues, contact your PAP supplier to determine whether you need to try a different mask size, nasal pillows, or a different headgear.

Redness on the face where the mask contacts the skin

If you develop reddened areas or sores on or above the bridge of your nose or on your forehead, first check to see whether your mask is pressed too tightly to your face. Your mask needs to be fitted and adjusted to eliminate air leaks without undue pressure on your skin. Sometimes spacers and air cushions can help ease the pressure points. If you need to loosen your mask so much that leaks develop, ask your PAP supplier whether your mask is the right type and size and is properly adjusted.

If redness occurs wherever the mask touches your skin, loosen the headgear slightly, but not so much as to cause an air leak. If you think you might be allergic to a mask, try applying a paper tape (Micropore™ or Band-Aid™) over areas where the mask touches your skin. If that eliminates the problem, contact your PAP supplier to find out whether a different mask or nasal pillows might be beneficial. Fortunately, modern PAP masks are made of materials designed to minimize allergic responses.

Too much air

Especially when first using PAP, some people complain that the pressure of air through the nose seems too high. To avoid this sensation, doctors usually prescribe a ‘pressure ramp’. The ramp starts the machine at a very low pressure and gradually raises it to the right amount over a period of minutes. Using lower pressure at the beginning may help you fall asleep more easily. Most PAP machines will allow you to adjust your ramp time. Many people find they prefer longer ramp times (10 to 20 minutes) when they first start using PAP. As you get used to PAP, or if the air pressure doesn’t bother you, set your ramp to shorter times so you get the full benefits of the correct PAP pressure from the beginning.

Should I try two-level PAP (BiPAP™)?

If you have trouble breathing out against the continuous air pressure of CPAP, a two-level PAP machine may help you. These machines sense when you breathe in and out, and deliver one pressure of air when you breathe in, and (usually) a lower pressure when you breathe out.

You should consider using two-level PAP if you find that the air pressure with CPAP feels too high or that you are working too hard to breathe out. A lower pressure when you breathe out may feel more natural to you, particularly if you are using a fairly high air pressure when you breathe in. In general, the two-level PAP machines are larger, heavier and more expensive that CPAP devices. If you were not tested in the sleep laboratory on a two-level PAP device, you will probably need another sleep study to determine the correct air pressures for you.

Should I try Auto PAP?

PAP devices that raise air pressure only when they sense problems with breathing were approved for use in America in 1996. By increasing air pressure intermittently, it is believed that PAP treatment of sleep apnea may be made more comfortable and effective. If air pressure-related complaints limit your use of CPAP or two-level PAP, you should consider asking your doctor about self-adjustable or Auto PAP.

Cleaning PAP devices

Regular cleaning is essential to assure proper function and safety of PAP devices. The method and schedule for cleaning hoses and masks and for changing filters may be different for each PAP device, so you should refer to the manufacturer’s instruction manual for details about the maintenance of your PAP equipment. Improper care of PAP devices, filters, mask and hoses can lead to nasal and sinus problems (congestion, infection, etc.).

Can I travel with this machine?

Most PAP machines available today come equipped with transformers, which allow them to be used with different (100v to 230v) voltages when you travel to foreign countries. Current PAP models are lightweight and portable. A travel case for the device and accessories often comes with the machine, or can be purchased from the manufacturer. Some manufacturers also make a battery power option available. Airport x-ray devices do not harm PAP machines. Your healthcare professional can provide you with a letter describing the nature and purpose of your PAP machine for security personnel unfamiliar with the equipment.

High altitudes can affect the performance of your PAP machine. You should consult your healthcare professional or PAP supplier if your travel plans call for sleep at altitudes much higher or lower than those at home.

Should I wear my dentures?

Some people with dentures find that if they sleep without their upper dentures, the PAP mask does not fit properly and air leaks develop. Try sleeping with your upper dentures to eliminate this infrequent but difficult problem. If you have no upper teeth, consider trying a mask that fits inside or just under the nose.

Can I use it when I have a cold?

You may find your PAP more difficult to use when you have a cold. You may need more humidity, or a decongestant. If you develop nasal, sinus, or ear pain when using your machine, this could be a sign of a developing infection. Contact your healthcare professional for further specific advice.


Some people experience feelings of claustrophobia, difficult breathing, choking, or suffocation when first using PAP. Let your doctor or PAP machine supplier know about these feelings. Spend some time practicing with your PAP machine during the day while awake and watching television or reading. You may need to start by wearing the PAP device for only a few minutes at a time and gradually increase the time you spend breathing with it until you feel comfortable. At first, some people fight the pressure and tend to hyperventilate. Practice to just breath normally with the mask. If you don’t like the mask over your nose, try a mask that fits in or just under the nose. If you find the air pressure is too high, consider a longer ramp time or two-level or self-adjustable PAP. If these measures fail, consider learning a relaxation technique, either from a self-help book or a tape, or from a professional trained in relaxation methods (e.g., a psychologist). Some amount of this discomfort during the initial therapy is not unusual. PAP can work for you if you give it a chance.


Most of the common complaints about PAP relate to how the mask fits and to drying of the airway. The remedies we have suggested should solve the majority of these problems. If your symptoms continue or recur, consult your healthcare professional or PAP equipment supplier. PAP helps most people with sleep apnea, but feeling comfortable with it requires time. Once you have become familiar with PAP, you will find it to be a great help.