Many people with sleep apnea use Continuous Positive Airway Pressure (CPAP) machines to sleep better. These devices help keep airways open and oxygen flowing during sleep. However, the CPAP itself can be uncomfortable or hard to get used to for some people, which may hinder sleep.
Because a CPAP can improve sleep apnea symptoms and overall health, it’s important to stick with treatment. In this guide, we’ll go over some ways to sleep better in your CPAP mask, as well as some CPAP alternatives. First, though, let’s discuss what exactly CPAP therapy is and how it works.
Sleep Apnea
Obstructive sleep apnea1 (OSA) is the most common form of sleep-disordered breathing. Oftentimes, people aren’t even aware that they have it, but rather, a partner voices concern over loud snoring. In other cases, the sleeper may seek answers as to why they have consistent daytime fatigue, only to find out they have OSA.1
OSA occurs when the airways collapse during sleep, blocking the air from getting through and rapidly dropping the oxygen levels in the body. Because of this drop in oxygen, the body will wake the sleeper up abruptly in order to get their oxygen levels back up and breathe normally again.1 As mentioned, oftentimes these “wake-ups” are not noticeable to the sleeper, and they are only aware of the side effects the next day.1
The most common symptoms include loud snoring with pauses in breathing multiple times throughout the night, excessive daytime sleepiness, waking during the night gasping or choking, morning headaches, trouble focusing, waking in the morning with a dry mouth or sore throat, and high blood pressure.1
Risk factors for OSA include obesity, weight gain, older age, smoking, chronic nasal congestion, enlarged tonsils or adenoids, diabetes, asthma, or a family history of sleep apnea.1
Having trouble with sleep apnea? Take a look at our list of best mattresses for sleep apnea.
How Many Are Diagnosed?
According to the American Medical Association2, an estimated 30 million people in the U.S. are living with sleep apnea, though only about 6 million of those people are formally diagnosed.
Get More Info: How and Why is Sleep Apnea Misdiagnosed?
While people of all ages and ethnicities can develop OSA, it’s most commonly seen3 in males under the age of 50, females over the age of 50, older populations, obese body types, and those who are of Black, Hispanic, or Asian descent.
What Is CPAP?
CPAP therapy is the most common treatment4 for obstructive sleep apnea and usually the first thing your doctor will recommend. CPAP stands for continuous positive airway pressure, and it involves blowing air into the nose and/or mouth to keep the airways open.4
The CPAP machine can be used to treat both obstructive and central sleep apnea. Though a CPAP is the most popular type of positive airway pressure machine, there are other types as well, including a Bi-level PAP, an Auto CPAP, and Adaptive servo-ventilation.4 Once your doctor has diagnosed you with sleep apnea, you’ll want to speak to them about finding the best treatment option for you.
How Does CPAP Work?
A CPAP machine takes in air from the room, filters, pressurizes, and humidifies it, and then delivers it through a tube and into a mask attached to your face. The machine provides a continuous flow of air to gently keep your tongue, uvula, and soft palate from shifting too far into your airway. This should help stabilize your breathing and improve your overall sleep quality.4
Your doctor will determine the pressure settings that you need, and these can be programmed into the machine. Some machines come with features like “ramp,” which can start you at a lower setting5 and gradually increase to keep you more comfortable. Some people prefer this because it gives you a chance to fall asleep before the maximum pressure is reached.
While this type of therapy isn’t a “cure” for sleep apnea, using a CPAP machine as prescribed can effectively treat the condition and help prevent many of the complications of sleep apnea.4 Typically, it is covered by insurance providers, though they may require that you show proof of compliance6 in order to continue your treatment.
View Our Guide: Top Rated CPAP Machines
What is CPAP Compliance?
Compliance is a term that you may have heard your doctor or respirologist mention before. Being “compliant” means that you are using your CPAP machine as prescribed6. “Noncompliance” is when you are not following your therapy recommendations, either by not wearing your mask regularly or not for long enough.6
Most people fall into a pattern of either compliance or noncompliance within the first week of therapy.6 However, according to 20 years of data7, up to 35 percent of patients who are prescribed CPAP therapy aren’t complying with treatment. In some cases, they only use their machine for a few hours each night, and in other cases, they stop using it altogether.7
People struggle with compliance for different reasons8. The mask may not fit well, they may need different pressure levels when sleeping on their back or side, they may struggle with anxiety wearing the mask, the forced air might make it difficult to fall asleep, or the noise from the machine might be bothersome. Some people seek help and try a different mask or adjust the settings while others may give up on CPAP therapy entirely.
However, this can be an issue if you are a pilot, drive for a living, or have an insurance carrier that tracks compliance.6. Most modern CPAP machines have advanced tracking features that monitor usage. This data can be tracked with precision and automatically sent to your doctor, insurer, or employer.6
While not complying with treatment may cause issues with keeping your job or having your machine covered through insurance, it could also lead to negative health and well-being effects.6
Dangers of Sleep Apnea Left Untreated
In the early stages of sleep apnea, forgetfulness, irritability, and daytime grogginess are among the most common side effects in adults, whereas hyperactivity, snoring, and bedwetting are commonly seen in children.3 These symptoms could significantly impact the ability to function at work or school, not to mention the ability to drive a car.
Research shows9 that adults with sleep apnea are at least twice as likely to be involved in a car accident than those without it. However, the study also found that this risk could be reduced by as much as 70 percent by regularly using CPAP therapy as prescribed.9
Additionally, if left untreated, sleep apnea can place a significant strain on the heart and other organs in the body increasing the risk of developing serious health conditions, including heart disease, stroke, blood clots, and even sudden cardiac death.4
This is why adhering to your CPAP treatment plan is so important. If you are struggling to get comfortable with treatment – as many people do – you might try a different type of mask before throwing in the towel on your CPAP entirely.
Understanding Different Mask Types
There are a variety of CPAP masks, so you can choose the type that is best suited for you. You may need to try out some different styles before you know which one works best. Your healthcare provider and CPAP mask supplier should be able to help you in this process.
These are some of the most popular mask styles10:
- Nasal pillow mask: This mask could be a good option if you often get claustrophobic because it only covers your nose and fits at the nostrils. It should also allow you to wear your glasses, have a full field of vision for reading or watching television and shouldn’t interfere too much with facial hair.10
- Nasal mask: The classic nasal mask is a bit larger and more cumbersome than the nasal pillow mask, but it can be a good choice for those who need a more pressure. It fits entirely around the nose, rather than just the nostrils, so it can also work well for those who move around a lot.10
- Full face mask: This mask covers both the nose and mouth, which is beneficial for those who struggle to breathe solely through their nose throughout the night.10
- Oral mask (or hybrid): The oral mask, also known as a hybrid, delivers air through the mouth only. It can be good for those who breathe solely through their mouth at night or who wear glasses.10
Visit Our Guide: Highest-Rated CPAP Masks
Tips For Sleeping With a Mask
Getting used to sleeping with a mask and forced air will probably take some time, so remind yourself to be patient with the process. It’s unlikely that you’ll be able to sleep a solid eight hours the first night you’re trying CPAP therapy, so taking baby steps can be key to long-term success.
For example, experts recommend11 wearing your mask during the day while you’re awake for short periods of time before you try sleeping in it, just to get used to it. Once you’re used to how this feels, you can start using it while you’re sleeping. According to the Mayo Clinic, you should use it every time you sleep, including naps, so you can get used to it more quickly.11
When you’re ready to go to sleep in your mask, there are some things you can do to make the process as comfortable as possible.
Ensure the Right Fit
The first step will be choosing the right type of mask for your face and sleep needs. Your doctor, sleep technologist, or CPAP supplier are the best people to help you in this process.11
Once you’ve chosen a mask, the next step is to schedule a fitting where you’ll choose the right size and adjust the headgear according to the shape of your head and face. If the mask is too tight, you’ll be uncomfortable and wake up with lines on your cheeks where the straps were. If the mask is too loose and is leaking air, it may dry out your nose and eyes and irritate the skin.11
Remember, a mask that fits properly should not feel uncomfortable or cause you pain.11
RAMP
If you find yourself struggling to tolerate the forced air or struggle to fall asleep, starting off at a lower pressure setting may help. Many machines have a built-in feature called “ramp” that allows you to fall asleep at the lowest pressure and automatically increases to the pressure prescribed by your physician.11
If your machine doesn’t have this setting, it may be worth looking into switching to a machine that does. Over time, many people adjust to therapy enough that they no longer need to use “ramp,” but, in the beginning, it can be very helpful.
Use Nasal Spray or a Humidifier
Your CPAP machine pulls air from your bedroom, so if you have the air conditioner on or the heat running during the winter months, the hot or cold air could be uncomfortable and irritating to the airways.
If you find yourself suddenly waking with a runny nose or even the occasional nosebleed, humidified air may help.11 Many CPAP machines include a heated humidifier, but if yours does not, you can place a separate humidifier nearby to humidify the air the CPAP is pulling in. Likewise, using a nasal saline spray before bedtime may help to prevent the nostrils from overdrying.11
Adjustable Base Bed
Similar to sleeping with a wedge pillow, an adjustable base bed elevates the head of the bed, which may help to minimize snoring. A 2017 study12 even showed that sleeping with the head elevated can significantly reduce symptoms of obstructive sleep apnea.
More recently, a study13 found that combining oxygen delivery through a nasal cannula with an elevated upper body was the best treatment for reducing the severity of obstructive sleep apnea. Though the study looked at nasal cannulas and not CPAP machines, it does seem the combination of oxygen and head elevation can deliver positive results.
Another benefit of an adjustable bed is it gets you a little closer to your machine, giving you extra room on your hose for moving around.
Anxiety Treatment
Some people report feelings of anxiety and claustrophobia when wearing their CPAP mask, which makes them less likely to comply with treatment.11
If you are prone to anxiety, experts recommend baby steps with a mask. First, just start by holding it up to your face when you’re awake and doing things around the house. Once you get comfortable with that, you can add on the straps.11
Next, you can try holding the mask to your face with the attached hose, without any straps. Turn on the machine. Once you feel comfortable with that, try this with the straps on too. The final step will be trying to sleep with the mask on.11
If you’re still feeling anxious or claustrophobic with the mask, you might talk to your doctor about getting a different style of mask that is smaller.
Learn More: Anxiety and Sleep
Expiratory Pressure Relief
Similar to the ramp feature, expiratory pressure relief14 (EPR) is another optional setting that may increase your comfort. While most CPAP machines deliver airflow at a steady pressure rate, expiratory pressure relief lowers pressure while you exhale, helping to alleviate feelings of breathlessness.14
Most machines will reduce the pressure by one, two, or three points during exhalation, making it easier to release your breath.14 This may increase compliance for patients who struggle with adjusting to forced air.
Change Your Sleep Position
Your sleep position is an important factor in treating OSA. Sleeping on the back can make symptoms worse15, because this position allows the tongue to fall back, blocking the airways. Instead, experts recommend side sleeping as it can help prevent the airway from collapsing.15
If you already sleep on your side or plan to, you should tell this to your medical provider when choosing your mask. Some masks work better for side sleeping than others.
If you are a side sleeper, take a look at our list of best mattresses for side sleepers.
Bumper Belts
As mentioned, back sleeping can make sleep apnea worse.15 However, for many die-hard back sleepers, transitioning to sleeping on their side is not so easy. In this case, a bumper belt might help you sleep on your side and ultimately reduce your symptoms of sleep apnea.
A bumper belt16 is a device designed to comfortably keep you on your side. Research shows that it is effective at preventing even heavyweight sleepers from rolling onto their backs during the night, and it is effective at reducing symptoms like snoring in patients with positional obstructive sleep apnea.16
Elbow Adapters
Once you’ve gotten used to CPAP therapy and can fall asleep at night, another problem you may encounter is waking to your machine’s alarm signaling that airflow is blocked. This is often because of a kink in the hose.
An elbow adapter could help with this. The adapter is an L-shaped piece that can guide your CPAP hose to help keep it from getting kinked.
Possible Alternatives for CPAP
If you have tried CPAP therapy and it is not working for you, you may be wondering if there are any other treatment options. While CPAP is considered one of the most effective treatments for sleep apnea, there are some other options you can consider
Lifestyle Changes
- Change your sleeping position – As mentioned, back sleeping is the worst sleep position for sleep apnea.15 If you are a back sleeper, try training yourself to sleep on your side and see if this improves your sleep apnea.
- Cut back on alcohol – Alcohol and certain medications act as sedatives, which may make symptoms of snoring and sleep apnea worse.3 In fact, consuming alcohol increases the likelihood of sleep apnea by 25 percent17.
- Quit smoking – Research has found that smokers are more likely18 to develop obstructive sleep apnea and tend to have more severe forms of the disorder. If you are a smoker and have sleep apnea, quitting could help you get better.
- Weight loss – Obesity is the number one risk factor19 for developing sleep apnea. This is because obese people tend to carry excess weight around the neck and even at the base of the tongue, which narrows the airway.19 Research shows that losing even just 10 percent of your body weight could make a huge impact on reducing the number of apneic episodes you have at night.19
Read More: Obesity and Sleep
Oral Appliances
Oral appliances are specialty dental devices that are designed to correct anatomical problems that may be contributing to sleep apnea.
For example, a short or recessed jaw20 might be contributing to your sleep apnea. Using a device that shifts the jaw forward may help keep the airways open21. Other devices may hold the tongue in place to prevent it from falling back and blocking the throat during sleep.21
Surgery
In some cases, when all other treatment options have been exhausted, your doctor may recommend surgical options22. During surgery, some of the tissue in the back of the throat or at the base of the tongue is removed to create more space for airflow.22 In many cases, the surgeon also brings the tongue forward and may even insert a nerve stimulator that is designed to keep the airways open.22
For sleep apnea in children, one of the most common forms of surgery is the removal of the tonsils and adenoids. This is usually the first treatment doctors recommend for children and is often enough to stop snoring and apneic episodes in kids altogether.3
Check Out Our Guide: Top 10 CPAP Alternatives to Relieve Sleep Apnea
Questions For Your Doctor
Is anxiety medication right for me?
If you are struggling with using your CPAP mask because of anxiety or feelings of claustrophobia, it may be worth considering treatment options to help you feel more relaxed about therapy. Seeing a psychologist or psychiatrist, who can help you develop coping skills to manage your anxiety, is a good place to start.
A psychiatrist may recommend anxiety medication for you. However, sedatives can worsen sleep apnea.3 Therefore, you’ll want to be transparent with your psychiatrist to stay safe while sleeping.
Are the alternatives to CPAP possible for me?
CPAP therapy is often the first treatment your doctor will recommend, but if you are worried about adjusting to sleeping with a mask on your face, it may be worth exploring other options.
Ask your doctor about which CPAP alternatives may work best for you. Depending on the severity of your apnea, lifestyle changes like sleeping on your side or losing weight may be enough to improve your symptoms.
Conclusion
If you’ve been diagnosed with sleep apnea, chances are you’ll be prescribed CPAP therapy at some point. It may take some time to get used to, but it might just save your life. Remember, leaving sleep apnea untreated can result in serious health complications.
Thankfully, there are many options to help increase your comfort while using a CPAP device. If you’re struggling with compliance or you just can’t seem to make it work, speak with your doctor about options before giving it up. The fix may be as simple as switching out your mask style or getting a better fit. If CPAP still does not work for you, there are alternative treatment options that you can explore with your provider.
References:
- “Obstructive sleep apnea”. Mayo Clinic. Last modified July 14, 2023.
- Berg, Sara. “What doctors wish patients knew about sleep apnea”. American Medical Association. 2022.
- “Sleep Apnea”. Cleveland Clinic. Last modified November 15, 2022.
- “CPAP Machine”. Cleveland Clinic. Last modified November 9, 2021.
- Repasky, David. “Everything You Need to Know About the CPAP Ramp Function”. CPAP.com. Last modified August 8, 2023.
- Repasky, David. “Why CPAP Compliance is Important & Tips on Improving Your Therapy”. CPAP.com. Last modified May 4, 2023.
- Rotenberg, Brian W., Murariu, Dorian., Pang, Kenny P. “Trends in CPAP adherence over twenty years of data collection: a flattened curve”. National Library of Medicine. 2016.
- Pogach MD, Melanie. “I can’t tolerate CPAP, what can I do?”. Harvard Health Publishing. 2020.
- “Risk of motor vehicle accidents is higher in people with sleep apnea”. American Academy of Sleep Medicine. 2015.
- “Slide show: Which CPAP masks are best for you?”. Mayo Clinic. 2023.
- “CPAP machines: Tips for avoiding 10 common problems”. Mayo Clinic. 2021.
- Souza, Fábio José Fabrício de Barros., et al. “The influence of head-of-bed elevation in patients with obstructive sleep apnea”. National Library of Medicine. 2017.
- Sakaguchi, Yuichi., et al. “Combination Therapy of High-flow Nasal Cannula and Upper-body Elevation for Postoperative Sleep-disordered Breathing: Randomized Crossover Trial”. National Library of Medicine. 2022.
- Repasky, David. “CPAP Machine Settings: Pressure, Ramp, EPR, CFLEX, Auto-Start”. CPAP.com. Last modified July 31, 2023.
- Howland, Jason. “Mayo Clinic Minute: What is the best sleeping position?”. Mayo Clinic. 2023.
- Matthews, Les., Fortier, Normand. “The Rematee Bumper Belt(®) positional therapy device for snoring and obstructive sleep apnea: Positional effectiveness in healthy subjects”. National Library of Medicine. 2013.
- Simou, Evangelia., Britton, John., Leonardi-Bee, Jo. “Alcohol and the risk of sleep apnoea: a systematic review and meta-analysis”. National Library of Medicine. 2018.
- Bielicki, Piotr., Trojnar, Anna., Sobieraj, Piotr. “The impact of smoking status on obstructive sleep apnea (OSA) severity”. European Respiratory Journal. 2018.
- “Losing Tongue Fat Improves Sleep Apnea”. Penn Medicine. 2020.
- Cielo, Christopher M., et al. “Evolution of Obstructive Sleep Apnea in Infants with Cleft Palate and Micrognathia”. National Library of Medicine. 2016.
- “Oral Appliance Therapy for Obstructive Sleep Apnea”. Cleveland Clinic. Last modified March 30, 2020.
- “Surgical Alternatives to CPAP”. University of Michigan Health. Webpage accessed August 25, 2023.
Raina Cordell
RN, RHN, Certified Health Coach
About Author
Raina Cordell is a Registered Nurse, Registered Holistic Nutritionist, and Certified Health Coach, but her true passion in life is helping others live well through her website, www.holfamily.com. Her holistic approach focuses on the whole person, honing the physical body and spiritual and emotional well-being.
Combination Sleeper