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How to Set the Pressure on Your CPAP Machine

A CPAP machine is one of the most commonly prescribed1 treatments for those with sleep apnea. It delivers a continuous flow of air pressure to keep the airway from collapsing during sleep, ultimately keeping your oxygen levels steady throughout the night.1 

Your machine must deliver the right amount of pressure, specifically for you, or else it could be ineffective. In this article, we’ll discuss how you’ll determine your particular pressure setting, signs that your setting is too low or too high, different factors that can impact your pressure setting, side effects of using the wrong CPAP pressure setting, and auto-adjusting devices. 

If you’re using a CPAP machine for sleep apnea and feel like your settings are not working for you, be sure to contact your doctor as only medical professionals should change CPAP pressure settings. 

Determining the Correct Pressure Setting for Your CPAP Machine 

To determine your CPAP pressure settings, you’ll first need to undergo a CPAP titration study2. This study is similar to an overnight sleep study to diagnose sleep apnea. However, in a titration study, you’ll be using a CPAP device. 

A sleep specialist will gradually increase the CPAP’s air pressure until they observe your breathing and oxygen levels becoming normal. They’ll stop at the lowest pressure setting that allows for normal breathing, record this number for your CPAP prescription, and then the pressure setting is programmed into your at-home CPAP machine. 

The settings are measured in centimeters of water pressure3 (cm H2O). Most people with sleep apnea fall between 5 to 10 cm H2O, though yours might be more or less than this.3 Your setting will depend on the severity of your sleep apnea, also known as your apnea-hypopnea index (AHI). 

AHI is the combined average number4 of apneas and hypopneas that occur each hour of your sleep. An “apnea” is when your breathing stops5 during sleep. A “hypopnea” is when breathing becomes shallow, which keeps you from taking in enough oxygen.5

According to the American Academy of Sleep Medicine6, those with mild sleep apnea have about 5 to 15 events per hour (including both apneas and hypopneas). Moderate sleep apnea is considered 15 to 30 events per hour, and those with severe sleep apnea have more than 30 events per hour.6 

Generally, people with more severe sleep apnea will likely require higher pressure settings. Most modern CPAP machines will also keep track of your AHI, which can then let the doctor know whether or not your CPAP machine is doing its job or whether pressure settings need to be adjusted. 

Never adjust your CPAP’s pressure settings on your own. Though your pressure requirements may change over time (due to age, weight fluctuations, or even allergies), you’ll need to discuss this with your sleep specialist to get expert help changing your machine’s pressure settings. 


Signs Your CPAP Machine’s Pressure Needs Adjusting

As mentioned, most modern CPAP machines track the number of apneas and hypopneas you’re experiencing through the night. If your machine is calibrated correctly, this number should be less than five7 (but may not necessarily get to zero).

However, even without looking at your AHI, there are some signs you may notice if your machine’s pressure is too low or too high. 

Signs CPAP Pressure Is Too Low

If your pressure is set too low, you’ll likely still experience sleep apnea symptoms8 like fatigue, insomnia, dry mouth in the mornings, headaches, heavy snoring, choking or gasping for air in the night, or problems with blood pressure9

Signs CPAP Pressure Is Too High

CPAP machines with pressure settings that are too high10 may lead to difficulty exhaling, discomfort in the nose, mouth, or airway, nasal congestion, mask leaks, sore throat, or gas, bloating, or stomach pain. People whose pressure is too high might also end up removing the mask at some point during the night because of the discomfort.

How to Know CPAP Pressure Is Correct

Your pressure is probably okay if you notice an improvement in your sleep and a cessation of symptoms like snoring, gasping for breath, and next-day fatigue. You can also pay attention to the machine’s AHI monitor – if it is below five (or your ideal number given to you by your doctor), your setting is probably working for you.7 

This doesn’t mean that it won’t take time to get used to your CPAP machine. Experts say that it could take several weeks11 to get used to sleeping with your CPAP. To help in this transition, you can practice wearing it during the day when you’re not sleeping. 

Learn more: 9 Tips for Sleeping Better with CPAP


What Can Affect the Pressure Setting of Your CPAP Machine?

A patient’s CPAP pressure setting will depend on the severity of their sleep apnea. However, other factors, some of which might change over time, could also influence this. 

  • Allergies Allergies that cause nasal congestion or coughing can make using a CPAP more difficult. If this is the case, your doctor might want to tweak your pressure settings. If you find that the CPAP itself is causing you congestion, make sure that the mask is snug and not leaking any air. Also, machines with humidifiers could help alleviate congestion.11 
  • Facial StructureCertain facial characteristics12 are linked to the severity of sleep apnea. For example, a wider and flatter mid to lower face, a shorter and smaller jaw, and more soft tissue or fat in the neck can help predict the severity of sleep apnea.12 
  • Obesity The more overweight a person is, the more severe13 their sleep apnea tends to be, which can correlate to higher pressure settings. However, researchers found significant AHI improvements14 in people with obstructive sleep apnea who experience loss of tongue fat following weight loss. 
  • Deviated SeptumThe septum15 is the bone and cartilage that runs down the center of the nose and nostrils, separating the nose into two sides. When the septum is “deviated,” it is crooked, and this can make breathing difficult. A higher CPAP pressure setting may be required for those with a deviated septum.
  • Sleep positionSleeping on your back can make sleep apnea worse16 because gravity allows the airway to further collapse and the tongue to fall backward. Those who sleep on their backs may need a higher pressure setting because of this.

Side Effects of Having the Wrong CPAP Pressure 

If your CPAP machine has the wrong pressure settings, the short-term side effects might include snoring, headaches, trouble sleeping, fatigue, difficulty breathing through your mask, congestion, sore throat, and stomach problems.8,10

Long-term, though, a CPAP with the wrong pressure settings can result in more serious complications. This is because the machine will be less effective at actually treating your sleep apnea. Symptoms of untreated sleep apnea include a higher risk for vehicular and workplace accidents, high blood pressure and heart problems, type 2 diabetes, metabolic syndrome, liver issues, and complications with certain medications or surgeries.8 

Auto-Adjusting Machines

There’s also the option of an APAP machine, which is an auto-adjusting17 positive airway pressure device. Unlike a CPAP, which delivers one continuous level of air pressure, an APAP measures your respiratory events during sleep and automatically adjusts its pressure accordingly.17 

Some people find that an APAP is preferable because it automatically adjusts to factors such as weight fluctuations, having a cold, drinking alcoholic beverages, or sleeping in a different position.17.If your doctor determines APAP therapy is a viable option for you, they will provide a set pressure range for the device.

If you find that any positive airway pressure device negatively impacts your sleep, you might also discuss alternative CPAP treatment options with your doctor. However, never discontinue your CPAP therapy or start a new treatment without consulting your doctor.


Frequently Asked Questions

How do I set the pressure on my CPAP machine?

Your doctor or sleep specialist will set the air pressure on your CPAP machine. They will provide you with a prescription for your CPAP settings and the manufacturer will use this information to calibrate the device.

Can I change the pressure on my CPAP machine?

You should not adjust the pressure on your CPAP machine. Instead, if you feel like your pressure needs adjusting, contact your doctor and set up an appointment. They can take a look at your device and adjust your pressure settings as needed.

Is changing the pressure on my CPAP machine dangerous?

Yes, attempting to change the pressure on your own CPAP machine can be dangerous. Selecting a setting that is even slightly too high or too low can negatively impact your health, so always contact your doctor or sleep specialist if you feel like your pressure setting needs to be changed.

Natalie G.

Natalie G.

Writer

About Author

Natalie is a content writer for Sleep Advisor with a deep passion for all things health and a fascination with the mysterious activity that is sleep. Outside of writing about sleep, she is a bestselling author, improviser, and creative writing teacher based out of Austin.

Combination Sleeper

References:

  1. “CPAP Machine”. Cleveland Clinic. Last modified November 9, 2021.
  2. “CPAP Titration”. NorthShore University Health System. Webpage accessed November 22, 2023. 
  3. Pinto, Vanessa.L., Sharma, Sandeep.“Continuous Positive Airway Pressure”. National Library of Medicine. Last modified July 24, 2023. 
  4. Asghari, Alimohamad., Mohammadi, Fatemeh. “Is Apnea-Hypopnea Index a proper measure for Obstructive Sleep Apnea severity?”. Medical Journal of the Islamic Republic of Iran. 2013.  
  5. “Obstructive Sleep Apnea”. Johns Hopkins Medicine. Webpage accessed November 22, 2023. 
  6. “Obstructive Sleep Apnea”. American Academy of Sleep Medicine. 2008.
  7. Ravesloot, M.J.L., de Vries, N. “Reliable Calculation of the Efficacy of Non-Surgical and Surgical Treatment of Obstructive Sleep Apnea Revisited”. Sleep. 2011.  
  8. “Sleep Apnea”. Mayo Clinic. Last modified April 6, 2023. 
  9. Bangash, Amna., et al. “Obstructive Sleep Apnea and Hypertension: A Review of the Relationship and Pathogenic Association”. Cureus. 2020. 
  10. Repasky, David. “Is Your CPAP Pressure Too High? How to Tell and How to Fix It”. CPAP.com. Last modified August 31, 2023. 
  11. “CPAP machines: Tips for avoiding 10 common problems”. Mayo Clinic. Last modified November 29, 2023.  
  12. Eastwood PhD, Peter., et al. “Predicting sleep apnea from three-dimensional face photography”. Journal of Clinical Sleep Medicine. 2020.  
  13. Jehan, Shazia., et al. “Obstructive Sleep Apnea and Obesity: Implications for Public Health”. National Library of Medicine. 2017.  
  14. Wang, Stephen H., et al. “Effect of Weight Loss on Upper Airway Anatomy and the Apnea–Hypopnea Index. The Importance of Tongue Fat”. American Journal of Respiratory and Critical Care Medicine. 2019.
  15. “Deviated septum”. Mayo Clinic. Last modified September 14, 2021. 
  16. “Choosing the Best Sleep Position”. Johns Hopkins Medicine. Webpage accessed November 22, 2023. 
  17. Perin, Christiano., Genta Rodrigues, Pedro. “Less may be more: CPAP vs. APAP in the treatment of obstructive sleep apnea”. Jornal Brasileiro de Pneumologia. 2021.