Common CPAP Side Effects & How to Prevent Them

CPAP therapy is widely considered the most effective treatment for obstructive sleep apnea. Besides being non-invasive, it provides various long-term health benefits, from better mental health to a reduced risk of severe illnesses.

That is, of course, if you stick to your therapy long enough. 

But that’s where the problem lies: despite the fact that CPAP machines are highly recommended by doctors, over 30%¹ of sleep apnea patients find it hard to continue their therapy or stop using their devices altogether. One of the reasons for this high nonadherence rate? The uncomfortable side effects of using a CPAP machine. In fact, about 3/4 of patients² suffer from at least one side effect.

CPAP strap marks on face, mask leaks, headache, dryness, bloating–these issues might sound familiar to you, whether you’re a long-time CPAP user or still transitioning to PAP therapy. So to help you get used to your device and become compliant with your treatment, we listed the six common CPAP side effects and ways to prevent them.

In This Article:

• Dry Eyes and Dry Mouth
• Skin Irritation
• Upset Stomach and Bloating
• Nasal Congestion
• Headaches and Sinus or Ear Pressure
• Claustrophobia
• Getting Used to CPAP Therapy

Often wake up with itchy eyes, chapped lips, or a sore throat? Dryness is one of the most common side effects of using a CPAP machine.

Eye irritation is typically caused by a CPAP mask leaking air into eyes. The reason behind dry airways is just as simple: all that airflow coming from your machine dries out your mouth and throat.

Luckily, the solutions are fairly simple as well:

Tip#1: Use a Humidifier and Heated Tubing

With the help of a humidifier, you can combat dryness by adding more moisture to the air from your device.

If you own a modern CPAP machine, it likely has a built-in heated humidifier. For a more consistent level of warmth and moisture, you should pair your humidifier with a compatible heated CPAP hose.

The best way to prevent dry airways with a humidifier is by setting it to adaptive or auto mode and let your machine’s algorithm optimize your humidification. If that doesn’t help or the feature isn’t available, you can try ramping up the humidity level and tubing temperature (if it’s adjustable). If the humidifier can be preheated, make sure to enable that feature before starting your therapy.

Tip#2: Check Your Mask for Leaks

Suffer from dry airways and dry eyes? Having the right CPAP mask size can do wonders for your therapy and compliance.

Assuming you already have a good mask fit, you need to ensure that your mask is free of leaks. That way, you can keep it from blowing air into your eyes and drying them out.

Read our guide on how to fix CPAP mask leaks for more info.

Tip#3: Use Mask Accessories

While the perfect CPAP mask is hard to come by, there are accessories that can provide you with a better fit:

• Chin strap – If you use a nasal mask but still breathe through your mouth, try adding a chin strap to keep your mouth from opening and drying out. Check out our guide on the best CPAP chin straps to learn more about what chin straps do and who should use one with their CPAP mask.
• Mask liners – These can optimize the fit and absorb oils and moisture between your face and mask cushion. Mask liners should be replaced daily.

Tip #4: Clean and Replace Your CPAP Mask Regularly

No matter how well-recommended or expensive your CPAP mask is, it won’t have a good seal if it’s worn or dirty with sweat, oils, and dust. To prevent mask leaks and dry eyes and airways, you should:

• Clean your mask and accessories every day
• Wash your face before going to bed
• Replace your mask headgear, cushion, frame, and other mask accessories regularly

Wondering when you should replace CPAP supplies and how to clean your CPAP mask? Our CPAP Equipment Cleaning and Replacement Chart explains how often you should clean your CPAP supplies and when to replace them.

Also known as CPAP dermatitis, skin irritation from CPAP use is one of the most uncomfortable CPAP therapy side effects. It comes in different forms, from lasting CPAP strap marks on face to redness and an itchy scalp.

What causes CPAP mask face marks and other CPAP dermatitis symptoms? It can be one or more of the following:

• The mask is dirty or needs to be replaced
• The mask is the wrong size
• Allergies to the mask material
• Moisture buildup inside the tube and mask
• Skin sensitivity

Here are our tips to prevent CPAP skin irritation and provide relief if you’re suffering from a CPAP rash:

Tip#1: Clean Your Face and CPAP Mask

If you don’t get rid of all the dirt, oil, and makeup trapped on your face and mask, skin irritation during sleep therapy is inevitable. So make it a point to practice good CPAP hygiene, clean your CPAP mask daily, and wash your face before bed. You should also replace your mask and accessories on a regular schedule or once they’re damaged.

Tip#2: Adjust Your Mask

If your mask is clean and comes in the right size, there’s no need to tighten the straps too much. An overtightened mask can cause CPAP strap marks on face, harm your skin, and even worsen leaks.

Tip#3: Use CPAP Mask Liners

CPAP mask liners are an easy solution for skin irritation. They act as a barrier between the mask cushion and skin, reducing pressure points that can cause redness, irritation and CPAP mask marks on face. They also improve CPAP mask seal and help keep your mask cushion clean by absorbing facial oils. When shopping for CPAP mask liners, make sure to choose ones made of natural cotton fibers.

Tip #4: Use Skin Products

If your CPAP is giving you a rash, there are numerous creams and ointments you can use to relieve CPAP skin irritation. We’ll provide some recommendations but regardless of which skin cream you choose, make sure it doesn’t contain petroleum or paraffin. These oil-based products damage silicone, which is the what most mask cushions are made of.

Over-the-counter topical steroids: OTC steroids reduce inflammation and are available as creams, gels, ointments and lotions. Hydrocortisone from 0.5% to 1% is the only topical steroid available over the counter, so if you need anything stronger, you’ll need to see a doctor.

Barrier creams: If your skin is cracked, barrier creams are a good choice. They improve your skin’s natural protective barrier, trapping in moisture. They also soften dry skin and heal cracked and damaged skin. Most barrier creams contain paraffin, so always check the ingredients. We recommend using barrier creams made of 100% lanolin, or sheep wool oil. You can find lanolin cream in the baby aisle at pharmacies and big-box stores. They are sold as lanolin nipple cream for treating sore and cracked nipples.

Moisturizers: A good moisturizer provides quick relief for dry, chapped skin. CeraVe is an affordable brand that you can find at any big-box store and your local Walgreens or CVS. It’s facial moisturizers come in a couple different types so make sure to choose the one that’s best for your skin type. If you’re not sure what your skin type is, start with a lightweight moisturizer for normal to dry skin. Picking a moisturizer that’s too heavy can clog your pores and cause breakouts.

Before using any skin medication or facial product, make sure to wash your face with a facial cleanser. And if you’re prone to acne and breakouts, lanolin may be too greasy for your skin.

Tip #5: Rotate Different CPAP Mask Styles

To let different parts of your skin breathe, consider getting another CPAP mask style and alternating between your masks. If you have a full face mask, for instance, you may want to use a nasal mask every other night.

Tip#6: Get Rid of Excess Condensation

Too much moisture is another cause of CPAP dermatitis. If condensation often builds up in your mask and tubing, turn down the humidity level, use a tubing wrap, or get a heated CPAP hose.

Swallowing air from CPAP, also known as aerophagia, can cause stomach discomfort and bloating. Aerophagia usually happens because of the following:

• CPAP pressure is too high or too low. The higher the pressure is, the more likely you are to swallow air. Too little pressure, on the other hand, won’t effectively prevent apnea events when you’re gasping for air.
• Mouth-breathing caused by nasal congestion or by using a nasal mask without a chin strap.

Tip#1: Use an Auto CPAP

Own a standard CPAP? Ask your provider if you can switch to an auto CPAP machine.

This kind of PAP device monitors your breathing pattern and automatically adjusts the pressure level according to your needs, reducing the airflow when high pressure isn’t needed. Because of its advanced algorithm, it’s easier to get used to and can provide CPAP aerophagia relief.

Tip#2: Use the Ramp Function

Instead of blasting the maximum pressure upon starting therapy, the ramp feature allows the device to lower the starting pressure and slowly increase it over a certain period. Most CPAP machines come with a ramp function, so consider using it to prevent aerophagia and stomach issues. 

Watch our how ramp works video to learn more about why ramp can help you fall asleep easier.

Tip#3: Adjust the Pressure Level

Lowering your CPAP pressure is one fastest ways to stop aerophagia. However, if you lower the pressure too much, you risk increasing your breathing events during sleep. Always speak to your doctor before making pressure changes.

Tip#4: Change Your Sleeping Position

Sometimes, simply changing positions can reduce air swallowing. If you’re a back sleeper, sleeping on your side might help prevent aerophagia and breathing obstructions. If that doesn’t work, rotate to the other side or experiment with other sleeping positions. 

The side effects of using a CPAP machine are, without a doubt, unpleasant. Some of the most uncomfortable of these are having a stuffy or runny nose and even getting nosebleeds.

Because CPAP devices deliver dry, pressurized air, they can irritate your nose and cause nasal congestion. The good news is that this CPAP side effect can be prevented in two easy ways:

Tip#1: Use a Humidifier

Heated humidification is a quick solution to most airway-related CPAP therapy side effects. Turning up your device’s humidity level and/or using heated tubing can help open up your nasal passage and keep it from getting irritated, which leads to nasal congestion. Since CPAP humidifiers add moisture to the dry air from the machine, it works similarly to a room humidifier that heats up water into water vapor. They can be built into the CPAP machine or added on separately. There are also waterless humidifiers you can use with with travel CPAPs that, as the name suggests, does not require any water.

Still wondering if you really need to use a humidifier with your CPAP? Check out our CPAP humidifier guide for more information on how a CPAP heated humidifier works, what waterless humidifiers are and how to maintain a humidifier.

Tip#2: Stick to a Cleaning Routine

From air filters to your CPAP mask and water chamber, there are various CPAP supplies you need to clean and replace regularly. While this sounds tedious, the importance of cleaning your CPAP supplies cannot be emphasized enough. Keeping them clean can keep allergens at bay and prevent nasal congestion and other side effects.

Tip#3: Try a Nasal Spray

Using saline nasal sprays can provide quick relief for a stuffy nose. You can also ask your provider about nasal medications to prevent this symptom. 

Morning headaches are a common symptom of sleep apnea. But if this symptom continues after starting sleep therapy, it can be caused by:

• Pressure settings that are too high
• Mask that is too tight
• Nasal congestion (see the previous section for tips on prevention)

Sometimes, headaches from CPAP use are accompanied by the uncomfortable feeling of sinus or ear pressure. For this problem, you can try the following:

Tip#1: Lower the Pressure Level

Lowering your prescribed pressure will likely prevent a CPAP sinus headache or ear pain. Again, if you need to make changes to your pressure settings, remember to always consult your provider first.

Tip#2: Adjust Your CPAP Mask

A headache from CPAP headgear is easy to prevent. If your headgear is adjustable, you can loosen the strap and see if that works. If not, you might have to look for a better-fitting mask.

Tip#3: Use a Cloth Mask

Some CPAP users get headaches from trigger point sensitivity. This is what cloth CPAP masks are designed for. Rather than using silicone or gel cushioning, these masks are made with cloth lining and inflate like a balloon, creating a soft, leak-free seal. 

Do you feel like you’re suffocating or being smothered whenever you put on your CPAP mask? Those prone to claustrophobia might find it hard to stick to their therapy. Feelings of claustrophobia are often worsened by a full face mask, which covers both the nose and mouth. So to overcome this CPAP side effect, you should try these solutions:

Tip#1: Switch to a Different Mask Style

CPAP users with claustrophobia may benefit from the following masks:

• Nasal cradle masks
• Nasal pillow masks
• Full face masks with over-the-mouth/under-the-nose cushions like the ResMed AirFit F30i. This kind of mask does not have a forehead support that’s commonly seen in a traditional full face mask.

Tip#2: Practice Using Your Mask

Another way to avoid feeling claustrophobic is by using your mask during the day. Wear your CPAP mask without the tube for short periods while you’re awake. By increasing your tolerance to your mask, you will slowly become most accustomed to wearing it at night.

If you’re experiencing one or more of the mentioned side effects, you’re not alone. Everyone will go through a period of adjustment when they first start using a CPAP device. Plus, many people struggle with one or more adverse reactions to therapy.

That said, you should never let these uncomfortable CPAP side effects discourage you. Always remember why you started your therapy in the first place to stay motivated.

Before going to bed, follow the tips above to put an end to those unpleasant symptoms once and for all. Then, when you put on your mask and turn on your machine, try to relax and keep an open mind. If you’d like more CPAP tips for beginners, check out our Mastering CPAP Therapy guide. In it you’ll find a checklist that will help you get used to CPAP faster.

Preventing most CPAP machine side effects is as easy as using a heated humidifier, changing the prescribed settings, choosing the right mask, or getting certain CPAP supplies and accessories.

If you still have trouble adjusting to your therapy, our medical team on RespShop is here to help. Contact us via chat, call, or email for one-on-one support.

1. Rotenberg, B., Murariu, D., & Pang, K. P. (2016). Trends in CPAP adherence over twenty years of data collection: a flattened curve. Journal of Otolaryngology – Head & Neck Surgery, 45(1), 43. https://doi.org/10.1186/s40463-016-0156-0
2. Ghrairi, H., Khalfallah, I., Abid, N., & Loukil, M. (2018). L’observance du traitement par pression positive continue : étude prospective de 103 patients suivis au service de pneumologie de Nabeul-Tunisie [Adherence to treatment with continuous positive airways pressure]. Revue des maladies respiratoires, 35(5), 531–537. https://doi.org/10.1016/j.rmr.2017.07.024