Common CPAP Side Effects & Prevention
By Patty - Certified Polysomnographic Technician
CPAP therapy for sleep apnea is generally well-tolerated, and most people find that the benefits of better sleep outweigh any side effects but even that trade-off is generally not necessary.
Simple actions can minimize and even eliminate such common CPAP side effects as:
- Eye irritation
- Skin irritation and red marks on the skin
- Upset stomach and bloating
- Dryness of the nose and throat
- Chest burning
Two Rules of Mask Selection to Prevent Many Side Effects
- The Goldilocks Rule - Not too big, not too small, but just right for you!
- The Golden Rule of CPAP - Do NOT over tighten!
A mask that is too tight irritates the skin and leaves red marks. When a mask is too loose, the machine increases the amount of flow to compensate. This may cause you to swallow air which leads to bloating or an upset stomach.
Eye irritation is a result of air blowing up through the top edges because the mask is not properly adjusted or fitted.
Your mask needs to be just right – not too tight and not too loose. The biggest mistake rookie CPAP users make is to overtighten the mask.
Overtightening often worsens leaks and sends you into the CPAP side effect vortex. Check out our CPAP mask sizing guide.
Modern masks are designed to fit well with a gentle seal. Do not mistake that gentle fit for a mask that is too loose. Contemporary CPAP machines fine tune therapy delivery to manage some degree of leaks as well.
A mask that leaks may be too big, but it may also be too small. Manufacturer size guides are a wonderful tool to get this right. If better size matching does not help, you may want to consider a different style or brand of mask that better matches your facial features.
CPAP mask cushion liners literally add a layer of protection to the skin, and they may also bridge a mask's fit from not quite right to just right. Chin straps are a handy adjunct if you are mouth breathing with a nasal mask. They also hold some of your facial muscles in place and may help optimize fit.
Establish a Cleaning and Maintenance Ritual
A clean face paired with a clean mask goes a long way to establishing a good fit each night. Dirt, sweat, and oils get in the way of a good mask seal.
Headgear stretches out over time. The plastic on the cushion gradually develops micro-cracks that might not be readily visible but impede a good fit as well.
- Wash your face before bed.
- Clean your mask every morning
- Wipe your mask off with CPAP cleaning wipes if the time between use is short.
- Replace the cushion and headgear on a regular schedule to keep them fitting and sealing.
Read more about CPAP Mask/Filter/Humidifier Cleaning Tips.
Humidify to Prevent Many Issues
Humidifying helps vanquish dryness, sore throat, dry cough, chest burning, and even skin irritation.
CPAP and BIPAP machines pull in air from the room and push it out to you at a high flow rate. Your nose and mouth normally warm and humidify air as you breathe in, but they cannot keep up with the flow from the CPAP device. Consequently, the air from the machine hits the rest of your airway quite dry.
A humidifier adds water vapor to the air before it arrives at you. If a cool water humidifier does not give you enough relief, use a heated humidifier with a heated circuit.
The combination of heat and humidification does a great job of saturating the air flow. The heated circuit minimizes the rate of air cooling between you and the heater - which keeps the water vapor from escaping before it reaches you.
Getting Used to CPAP Therapy
Everyone will go through a period of adjustment when they first start using CPAP device therapy. Here are a few tips to adjust more quickly and easily.
Always keep your diagnosis in mind. CPAP therapy will prevent you from episodes of stopping breathing - apneas - while you sleep. The therapy is necessary to prevent the head-to-toe effects of untreated sleep apnea. That is excellent motivation.
Stay open minded and focus on your breathing when you first begin. Remain confident that you are fine and that you can continue to breathe normally. If necessary, ease into it by using therapy for short periods, such as when watching TV.
Use daytime practice. It is easy to feel too tired at bedtime to risk interrupting your sleep routine. Using CPAP during the day, when sleep is not necessary, takes away that pressure and allows you to relax enough to be open minded.
The bonus is if you fall asleep while watching TV, you are using therapy! As soon as your brain realizes that the therapy is protecting the body from sleep apnea, you will get used to using therapy.
Experienced users say they cannot imagine sleeping without the therapy. You can start feeling that way, too, soon enough.
As we get into specific side effects of using CPAP, please feel free to watch the video below to learn how to stop some of the most common CPAP side effects:
Trouble Tolerating the Air Pressure
The CPAP machines, with the advanced technology, all have comfort features to assist people in acclimating to CPAP therapy. One feature is called Ramp. It allows for the start pressure to be lower and easier to tolerate for a desired amount of time.
The intention is that the end user becomes asleep or very sleepy before the required pressure begins. CPAPs have other comfort features, as well. We at Respshop can always help you with any of these features to help you be compliant in your therapy.
Q: Is it supposed to be hard to exhale with CPAP?
A: It is natural to feel the resistance to your exhalation when you first start therapy. You will adjust to this. There are comfort settings to assist with making you comfortable, too. EPR is a comfort feature to help if you are feeling uncomfortable exhaling. The pressure automatically lowers upon exhalation.
Q: Can using CPAP cause burping, bloating, or gas?
Upset stomach/bloating is often caused by air swallowing, which is called aerophagia.
Aerophagia occurs when air from the CPAP machine goes into the esophagus. It is more likely to occur when the set CPAP pressures are high or if the mask does not seal well.
In either case, the machine uses high flow rates that can lead to air swallowing and stomach discomfort.
Q: How do I relieve gas and bloating related to CPAP use?
Tips to ameliorate or resolve stomach discomfort:
- Use the ramp feature while falling asleep to keep pressures (and flow) lower during this period where you likely do not have any airway obstruction yet.
- Ask your doctor about using an AutoPAP machine—AutoPAP (APAP) prevents higher than necessary pressures throughout sleep by matching the pressure to your need.
- If you've recently lost weight, you may simply need less pressure—ask your physician about a repeat sleep study or about using APAP.
- Experiment with different sleeping positions — lying flat often helps reduce air swallowing; sometimes, just changing positions does as well.
Shortness of Breath
Q: Can using CPAP cause breathing problems?
If you are short of breath using CPAP, that could be due to one or more of the following factors. The ramp air pressure may be too low. Once you raise the ramp air pressure, you should no longer have shortness of breath.
If you are feeling anxious, you might feel shortness of breath, and will feel like you need to take quick brief breaths. At this time breathe normally, take big deep breaths, and relax.
The machine's function may not be at top performance. Sometimes the mask may not be giving you enough air pressure.
When exhaling, you may not release enough carbon dioxide. Then, the pressure goes up and can make you feel tired.
This could also be the motor function or other technical problems. If it is a technical problem with a machine or if you cannot quite figure it out, just give us a call.
Headaches and Sinus or Ear Pressure
Headaches are a common symptom of sleep apnea. Persistent headaches after starting sleep therapy could indicate that your machine settings are not optimized for you. Speak to your provider if you think that is the case.
Q: Can CPAP cause nasal or sinus congestion?
The pressure from the CPAP device can aggravate sinus congestion caused by chronic allergies as well, triggering headaches and sinus/ear pressure. Ask your provider about sinus medications that might alleviate these symptoms.
Some people get migraines from trigger point sensitivity. Cloth masks are an often overlooked alternative well worth trying.
Stuffy Nose, Dry Nose, or Sore Throat
Q: Can CPAP use cause dry nose, mouth, or throat or other irritation issues?
Some people will have the so-called “CPAP nose” - a reaction to the air pressure in the airway which usually manifests itself in dry nose and other symptoms of irritated nasal passages, such as dry mouth, throat, or sinuses.
This will go away in due process as your body becomes accustomed to CPAP therapy. But the best way to begin solving this issue is to start using a humidifier, as we discussed above.
Dryness can easily be prevented by turning up your humidification level. You should also consider heated tubing.
Q: I have heated tubing. I still wake up with an extremely dry mouth. I have tried various settings. The local suppliers are no help. Is there a solution?
A: If you use a nasal mask, you may want to try adding a chinstrap to prevent mouth opening that can lead to dry mouth. If you are using a nasal mask, are your machine's climate control settings set to manual or adaptive? If adaptive doesn't help, try changing it to manual and increasing humidity all the way up to 7 or 8. Keep tube temperature low.
Please watch this video for tips on how to prevent nose irritation issues:
Please read the article Do I really need to use a humidifier with my CPAP? to learn more about CPAP humidifiers.
If you get dry or watery (teary) eyes while using CPAP, this could be a mask fitting issue. The air could be blowing directly into your eyes. To relieve this eye irritation, try adjusting your mask fit, including pads and straps, to settle into a better fit.
People who tend to feel closed in benefit from masks that take up a small footprint on the face. In general, people with claustrophobia should look for minimalist hybrid-style masks.
Any mask that has a part that comes up between the eyes should be avoided by anyone who is claustrophobic.
- Nasal cradle and nasal pillow masks are good choices.
- Hybrid over the mouth/under the nose masks are a good substitute for traditional full face masks.
CPAP use does not have an inherent infection risk. Infections related to CPAP use are avoidable with simple steps
- Clean your mask every day.
- Use only sterile or distilled water in the humidifier.
- Clean the humidifier chamber daily and use fresh water each night.
- Do not share your CPAP equipment with others.
- Consider placing a viral and bacterial filter between the air outlet and the CPAP tubing.
- Clean and replace the internal filters on your CPAP machine at the interval recommended by the device manufacturer - more often if you have allergies or pets.
Check out our CPAP Maintenance and Cleaning Schedule.
CPAP use can sometimes cause skin irritation, such as irritated scalp, itchy skin, or other issues, some of which are commonly referred to as "CPAP dermatitis."
Skin irritation as a result of CPAP use can be caused by one or more of several factors:
- The mask is the wrong size
- The mask is on too tight
- The mask needs to be replaced
- Moisture buildup inside the tube and mask.
- If moisture is the problem, you will need to turn down the humidity level and/or get a heated tube.
- Skin sensitivity
Watch this video for tips on how to keep your skin health under your CPAP mask:
Keep in mind that masks with foam cushions and cloth masks can help patients with sensitive skin. Switching to a different style mask like a nasal pillow, is another solution.