Difficulties with CPAP treatment

Difficulties with CPAP treatment

What is CPAP therapy?

In severe and some moderate sleep apnea, CPAP therapy is the primary treatment combined with weight management.  CPAP, or Continuous Positive Airway Pressure, means constant overpressure in the airways and it keeps loose upper airways open. Continuous use is recommended and operating hours should be at least four hours a night. The more the CPAP device is used, the better the treatment response.

Monitoring the progress of treatment takes into account the quality of sleep, resolution of symptoms, benefit and commitment to treatment, weight management and treatment-related problems, and the condition of the device and accessories.

Sleep apnea weight loss and weight management

Weight loss and weight management are the basis of treatment in patients with a body mass index of 25 to 29.9 BMI. Tthe goal is to reduce weight by 5-10%, but patients are encouraged to lose even a small amount of weight. Weight loss is important for long-term prognosis. For example, a nutritionist, weight loss groups or a very low energy diet (VLCD) can be used to help with weight loss and weight management.

Problems with sleep apnea treatment

CPAP therapy is not always easy for the patient. Many patients experience a variety of side effects during treatment that, at worst, can cause the patient to cancel treatment. Problems can also reduce the effects of treatment and therefore the situation should be addressed as soon as the problem is detected.

The main problems caused by the treatment are:

  • The airflow generated by the device, which dries the mucous membranes of the nose and throat.
  • Improper treatment pressure.
  • Improper adjustment of the mask, causing the mask to leak or press.

It is good for the patient to know that solutions to problems can often be found either:

  • By treating the patient’s symptoms, such as irritated nasal mucosa or conjunctiva.
  • Adjusting the mask.
  • By changing the mask model to another.
  • By adjusting the treatment pressure.
Difficulties with CPAP treatment

Nasal problems with CPAP therapy

Nasal and pharyngeal problems are common in patients using CPAP therapy. The air-dried mucous membranes swell and their blood circulation increases.

Nasal and pharyngeal symptoms experienced by patients include:

  • Congestion and vasomotor rhinitis.
  • Nasal bleeding and dry mucous membranes.
  • Pain in the nose and around the nostrils.
  • Dry throat.
  • Pain in the throat area.

Air leakage through the mouth is a common problem. Up to 40% of patients inhale orally during treatment.

Air leakage through the mouth increases nasopharyngeal problems because the moist air coming from the lungs due to the leak exits the mouth without wetting the nasal mucosa.

Treatment and prevention of nasal problems when using a CPAP device

Nasal problems can be treated and prevented in different ways.

The easiest way to treat air-dried mucous membranes is to increase their moisture either:

  • By salt rinsing, for example by rinsing with a jug.
  • Moisturizing nasal sprays or nasal oil.

A separate humidifier is usually available for the CPAP device and is now commonly used.  On new devices, the humidifier is included automatically.

For severe clogging symptoms, anti-clogging sprays can be used for a week. These sprays are not suitable for longer use. In addition to other nasal treatments, cortisone-containing sprays and oral antihistamines may be used to treat chronic rhinitis and congestion, according to the doctor’s instructions.

If the problems are due to air leakage through the mouth, changing the mask from a nasal mask to a full face mask can help. Used properly, the full face mask completely eliminates the problems caused by air leakage.

Skin problems when using a CPAP device

About half of sleep apnea patients experience various skin problems. Skin symptoms skin irritation and mild pressure ulcers. Ulcers and skin irritation are most common in the cartilaginous and bony area of the base of the nose.

  • Sweating, the use of cosmetics and other poor skin hygiene increase the risk of getting skin irritation on the mask area. Bearded men should take care of good hygiene during treatment.

Skin problems are almost always caused by the CPAP mask.

  • Mask adjustments may be incorrect.
  • The mask has been washed carelessly.
  • Inadequate care of the skin under the mask.

Patients may feel allergic to the mask material, but rarely this is the cause of skin problems. Studies show that less than 5% of patients with skin symptoms suffer from allergies. In other patients, the problems are due to other reasons. A silicone-free mask is chosen for allergic patients.

Eye problems during CPAP treatment

Mask leakage either due to excessive tightness or slackness may cause eye irritation to the patient. Air blowing from the leaking mask into the eyes dries the eyes and irritates the conjunctiva of the eyes. If prolonged, this can lead to inflammation of the patient’s eyes.

Treatment of eye problems during CPAP therapy

Adjusting the mask to the correct tightness is the primary treatment for eye problems.

  • The fit of the mask is ensured and, if necessary, the fit is increased with adjustments and sometimes the mask can be sealed with a flexible membrane.
  • With the right adjustments, the air leakage between the mask is completely stopped. It is easiest to check the correct adjustments at the reception of a nurse familiar with sleep apnea.

Skin care is part of the treatment of eye problems because dry skin can interfere with the fit of the mask. However, excessive greasing and the use of oily creams should be avoided as they can also reduce the tightness of the mask and increase air leakage between the mask. Very irritated and dry eyes can be treated with moisturizing and soothing eye drops. For inflamed eyes, your doctor will prescribe antibiotic treatment.

Difficulties with CPAP treatment

Other problems caused by CPAP treatment

CPAP treatment can cause other problems, for example, mental symptoms such as mask-induced claustrophobia and panic disorder, in which the patient experiences severe anxiety and fear in the situation. If the symptoms are severe, treatment cannot be carried out. Some patients swallow air in their stomachs during treatment and it causes stomach pain, nausea and flatulence.

In particular, speaking during treatment increases air ingestion and aggravates symptoms. Disruption caused by the device, either to the patient himself or to loved ones, can sometimes reduce compliance.

  • Noise or discomfort from the mask can disrupt the night’s sleep and cause the patient or loved ones to wake up constantly at night.
  • A broken night’s sleep increases daytime fatigue and feeling of exhaustion.

Other problems may include increased or decreased operating hours of the device and problems with the treatment pressure. The treatment pressure can be either too high or too low. In these situations, the following should be taken into account:

  • Why has the need for therapeutic pressure changed?
  • Why is the device used more or less than before?

Things that affect the situation include, for example, the patient’s altered weight, other fatigue-causing diseases such as heart or thyroid disease or poor balance of care for diabetes, or the discomfort caused by the device.


Care instructions

Nasal congestion or dryness

Rinse with common salt
Moisturizing sprays
Humidifier for CPAP device
Corticosteroid drops

Bleeding from the nose

Rinse with common salt
Moisturizing sprays
Use of nasal oil

Chronic rhinitis

Oral antihistamine
Cortisone spray

Air leakage from the mouth

Mask change to full face mask

Skin lesions and ulcers

Check mask settings
Improving skin hygiene
Repeating the mask washing instructions

Eye irritation, drying

Ensuring that the mask fits
Moisturizing and caring eye drops

Mental symptoms

Changing the mask model
Psychiatric medication for severe symptoms
Postponement of treatment initiation

Gastrointestinal symptoms

Avoidance of talking during treatment
Avoid carbonated drinks in the evenings

The sound of the device is disturbing

Verifying device operation
Checking for air leaks, the sound may be due to a leak

Increased operating hours

Other fatigue-causing diseases?

Reduced operating hours, less than 4 hours per night

Finding out the cause: treatment discomfort, mental problems, family relationships, depression, central sleep apnea that is not well affected by CPAP treatment?

Too little treatment pressure, snoring during treatment

Increasing the treatment pressure
Determining the causes, air leakage through the mouth, the patient’s weight gain?

Increased daytime fatigue

Determining the adequacy of the treatment pressure
Other diseases causing fatigue

CPAP device and mask maintenance

Bleaching or moisturizing, aromatic or antibacterial products are not recommended as a washing liquid for the device, as they brittle the silicone of the mask or the odor / color may adhere to the silicone parts. Fragrance-free and dye-free detergent, not soap, is recommended for washing the CPAP device.

Daily maintenance

Weekly maintenance

Monthly maintenance

Air hose:

Removal and storage in a dry and clean place.

Air hose:

Washing with soap, good rinsing and drying as straight as possible.

Air hose: Visual inspection for wear and tear.


Washing the pillow with mild soap, good rinsing and drying out of sunlight.


Washing the straps with a mild soap solution.

Mask: Visual inspection for wear and tear.


Tank removal, emptying and good rinsing.


Dismantle the tank, wash with a mild dishwashing detergent solution, rinse and dry out of sunlight.


Visual inspection of condition. In case of cracks, replace with new one.


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