CPAP Problems and How to Fix Them

Sleep Apnea, Solutions

CPAP Problems and How to Fix Them

CPAP is a very effective way to treat sleep apnea and snoring. When used correctly and fitted well, CPAP can dramatically reduce apneic events as well as greatly decreasing snoring volume and frequency.

Unfortunately, many users don’t get this far because the discomfort they feel makes them give up before CPAP can have a positive effect.

CPAP can be uncomfortable and does take some getting used to. It is also perceived as the most extreme type of snoring remedy, and many people don’t like the idea of this large, quite invasive device.

Here, we address the most common problems people have with CPAP, giving you advice on the best way to fix these issues. We also have some SnoreLab top tips on how to get the most from CPAP to snore less and sleep better.
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Side note: what is CPAP?

A CPAP device uses a mask to force air into your nose and throat to keep your airways open.

CPAP does not give you more oxygen. Instead, it introduces a current of normal air that creates positive pressure; this props open your airway to stop it from collapsing.

The CPAP machine links to the mask via a hose, and continuously gives positive pressure into your airway; hence the name “continuous positive airway pressure”.

Frequent CPAP problems and how to rectify them

Claustrophobia

CPAP masks, in particular full-face masks, can feel stifling and claustrophobic. This is particularly poignant when you are new to CPAP and could wake up forgetting you are wearing it, causing brief panic.

The best way to get beyond this is to get used to wearing your CPAP mask as much as possible before wearing it for a full night. An hour or so before bed, put on your mask and carry on with your evening; read a book, watch television; do what you would normally do.

You needn’t turn it on to start with, just get used to the feeling of having the device on your face. Shortly before you go to sleep, turn the device on to a low setting to accustom yourself to the sensation of the forced air.

If you really don’t like the sensation of having something over your face, consider the less invasive CPAP mask options like nasal cushions.

Leaking air

This is often due to a poor fit or an inappropriate mask type. A leaking CPAP is inefficient. This air should be stopping your sleep apnea and instead it is being lost to your surroundings. It can also dry out your eyes.

When initially being fitted for your CPAP device, make sure you get the fit right. Highlight any comfort concerns with the professional fitting it for you. Masks come in different sizes, so be sure to try a few. Also ensure you get the right type of mask for your circumstances. See SnoreLab’s guide to the different types of CPAP mask.

At home, to stop the mask leaking, adjust the various pads and straps to get it fitting comfortably and snugly (but not too tightly). Also make sure that the mask doesn’t come too high up on the bridge of your nose.

If you’re overweight and using CPAP, hopefully, your improved sleep will help you lose weight. If you do lose a lot, particularly around your neck and face, you may need to consult your healthcare provider to get a different mask.

Pressure sores

Pressure sores are painful skin blemishes caused by your mask rubbing. Preventing pressure sores comes down to getting the right fit. Ill-fitting masks can rub uncomfortably when they move around. They may have to be tightened too much to force a suitable fit. Remember to check that the mask fits correctly in your initial consultation. When wearing at home, try not to pull the straps too tight.

CPAP masks can also create uneven pressures on your face due to misalignment caused by your regular pillow. There are specifically designed CPAP pillows available that have ergonomically designed cutaways to comfortably accommodate CPAP masks.

If you continue to get pressure sores, consult your healthcare provider.

Dry mouth and nose

A dry mouth is often a result of breathing through your mouth too much. If you can comfortably breathe through your nose you should try to encourage it whilst you sleep. This is because your nose warms, humidifies and filters air before it gets to the rest of your airway and is the healthier way to breathe.

There are devices available to close your mouth and encourage nose breathing, including chin straps and SomniFix mouth strips. Read SnoreLab’s review of SomniFix.

If you struggle to breathe through your nose there are numerous remedies that can help. There are many reasons why you may not be able to breathe through your nose, so check out our guide to nasal blockage induced snoring and the appropriate remedies for each cause.

With a blocked nose, nasal CPAP fails to work. A full-face mask is a good option for people who struggle to breathe through their nose, but sometimes this air can dry out and irritate your airway. Humidifiers can help moisten your airways, helping you to breathe and sleep better. Some CPAP flow generators even come with an in-built humidifier.

Forced air is very uncomfortable

Some CPAP users can’t tolerate the level of air coming through the mask. This can be helped in several ways:

  • Get the air pressure setting right – setting your CPAP at high pressures is typically more uncomfortable than running the device at lower pressures.
  • Ease yourself in – like getting used to the mask itself, try getting used to the sensation of forced air. Turn the device on before you go to sleep to get used to the feeling. There are some more sophisticated CPAP devices available that have a ramp feature, where the machine slowly and automatically increases the pressure.
  • Choose the right type of mask – direct contact masks like nasal pillows can feel especially uncomfortable at higher pressures as there is nowhere else for the air to go. If you need to run your CPAP at high pressures, consider a full-face mask.

Removed mask by accident

To stop your CPAP mask coming off during the night, make sure it fits correctly and that the straps are sitting in the correct orientation.

Dislodging your mask could also be down to the mask type and its design. Full face masks are less likely to come off. If you are a side sleeper your pillow could be pushing the mask out of place. Consider looking for a specifically designed CPAP pillow with cutaways that accommodate CPAP masks.

You may also involuntarily pull the mask off whilst you sleep if it is causing you breathing difficulty. Make sure that you can breathe clearly through your nose if you are using any devices that keep your mouth closed.

Can’t sleep

Alongside practicing good sleep hygiene, you should also practice using the mask whilst awake so you are comfortable with it once you try to sleep.

Good sleep hygiene dictates that in the run up to bedtime, you should not be eating and instead do some gentle, non-stimulating activity like reading. This is a great time to wear your CPAP device and get yourself used to the mask.

Noise

Sound from the machine might also prevent restful sleep. Most CPAP machines are nearly silent. If you find that yours is making excessive noise, it might be because the flow generator’s air filter is dirty. Make sure you read your unit’s instructions and keep on top of the required maintenance.

Try to keep the flow generator unit as far away from your head as the hose’s length will permit.

If the noise persists despite cleaning, the unit could be faulty. Return it to the provider to get it checked over.

Facial hair

Beards and moustaches can inhibit the seal that is formed around the edges of the CPAP mask. If you are as attached to your facial hair as it is to you, and shaving simply isn’t an option, make sure you pick the right type of mask.

Nasal cushions are the most appropriate type for people with facial hair. This is because the seal is formed on the nostrils as opposed to other areas of your face.

Top tips for getting the most out of CPAP

Given these frequent problems that CPAP users come up against, here are our tips for making sure that your CPAP device is having the desired effect:

  • Get the right mask for you – nasal masks, nasal cushions and face masks all have their good and bad points, and are suitable for different people. Read SnoreLab’s guide to the different types of mask to decide which one is best for you.
  • Fit your mask properly – during your initial fitting, make sure you let your healthcare provider know if it feels unduly uncomfortable or doesn’t fit correctly. Find out the best way to adjust the straps and make sure to seek a change if your face shape changes significantly due to weight loss.
  • Practice – everything gets easier with practice and CPAP is no different. Whilst it might seem weird at first, remember it will get better. Getting used to wearing the mask and feeling the air current whilst you are awake is a great way to ease yourself into using CPAP.
  • Treat your blocked nose – it is particularly important to clear your nose if you are using a nasal mask or nasal cushion. Your device will not work effectively if your mouth falls open whilst using these types of CPAP. Check out SnoreLab’s guide to nasal snoring remedies.
  • Keep on top of maintenance – as well as regularly cleaning the flow generator’s filter to prevent noise, also check for mold that can form (particularly if using a humidifying flow generator) and wash the straps to keep them clean and fitting well.
  • See the big picture – remember, CPAP isn’t designed to make you feel uncomfortable, it is there to help you. Use SnoreLab to help remind yourself of this fact, as you should start seeing your Snore Scores drop, meaning you are well on your way to healthier, more peaceful sleep.

6 Common Myths About Sleep Apnea

Science, Sleep Apnea

6 Common Myths About Sleep Apnea

1. All loud snorers have sleep apnea

Most snorers don’t have sleep apnea. But most people with sleep apnea snore.

There is a positive correlation between snoring intensity and the severity of obstructive sleep apnea; that is, the louder you snore, the more likely you are to suffer from sleep apnea [1]. However, this does not mean that if you snore loudly you definitely have sleep apnea.

An apnea episode is defined by a period of no sound whatsoever. This is the part where your breathing has stopped. Therefore, sound profile alone is not a good predictor of sleep apnea and its severity.

 

SnoreLab’s insights into screening for, diagnosing and treating obstructive sleep apnea.

Read

2. Everyone with sleep apnea snores

This is less of a myth, and more of an almost-truth: up to 95% of people with obstructive sleep apnea snore [2]. It is rare to find someone with obstructive sleep apnea who doesn’t snore, though it does happen [3].

Importantly, you needn’t be a loud snorer to suffer from sleep apnea. Remember that an apnea episode is often characterised by a lengthy period of silence. You could still be suffering from sleep apnea even if your Snore Score is low.

This SnoreLab user has found an apnea episode (notice the long period of silence). However look at the chart – they are not a loud snorer!

 

 

However, central sleep apnea is not commonly associated with snoring.

Central sleep apnea is caused by the brain’s failure to regulate proper breathing during sleep. Here, the blockage is neurological as opposed to in your airway [4].

3. Only men get sleep apnea

Men are more likely to snore and have sleep apnea, but women can still suffer from both. It is estimated that twice as many men than women have sleep apnea [5]. Despite this, eight times more men are diagnosed with the condition.

The incorrect assumption of yesteryear was that for every sixty men who had sleep apnea, only one woman did. This false statistic came from a combination of heightened social stigma associated with female snorers and the fact that sleep apnea presents differently in women.

Sleep apnea’s severity is measured by counting the number of times breathing stops or is severely reduced during sleep. Women are less likely to experience complete airway collapse therefore tend to have a lower AHI score.

However, it is important to note that women aren’t necessarily experiencing less obstruction. Instead, they show more frequent episodes of longer, partial obstruction that can still cause the fatigue, daytime sleepiness and other health issues associated with sleep apnea [6].

 

Still, in a battle of the sexes, when it comes to snoring, men come out on top. SnoreLab’s article on the snoring differences between men and women.

Read.

4. I’m not overweight so I won’t get sleep apnea

Indeed, obesity is one of the strongest risk factors for developing sleep apnea, where 41% of people with a BMI over 28 have the condition [7]. However, because there are other risk factors associated with sleep apnea, you don’t have to be overweight to suffer from it.

Sleep apnea can also be caused by your genetics; whether that be a family history of sleep apnea or the shape of your airway. Chronic nasal congestion, drinking alcohol or taking sleeping pills, and even simply entering the menopause all confer an increased risk of developing sleep apnea.

5. Children don’t get sleep apnea

Despite snoring and sleep apnea commonly being associated with older people, studies have found that up to 4% of children experience sleep apnea, with some 12% of parents reporting that their child frequently snores [8].

Similar to the profile of adults with sleep apnea, overweight children and boys are more likely to develop the condition.

An increasing amount of research suggests that 25% of attention deficit disorder cases are linked to sleep fragmentation associated with sleep apnea [9].

Childhood obstructive sleep apnea is often due to the adenoids – glands in the back of the throat that disappear in adulthood, thankfully along with the apneas. Surgical removal of both the adenoids and tonsils often resolves childhood sleep apnea.

 

More about snoring’s link with age

Read

6. I’d know if my breathing stopped in the middle of the night

Not being able to breathe is an uncomfortable experience, so you’d think you’d remember it. Plus, the pauses in breathing that characterize sleep apnea are only relieved when your body kicks into action to open your airway, briefly waking you up. This awakening however, is below the threshold of conscious recognition; commonly referred to as a microarousal.

In some very severe cases of sleep apnea, patients have as many as one-hundred breathing pauses per hour, some as long as thirty seconds at a time. Yet they perceive a night of constant sleep and wonder why they feel so tired in the morning. Susan, a SnoreLab user thought that she may have mild sleep apnea at worst, her sleep study results showed she in fact had very severe sleep apnea. You can read Susan’s story here.

Whilst you are unlikely to identify your own apnea episodes, a partner can definitely be disturbed by them. If you are concerned about potential sleep apnea, ask your partner if they’ve ever heard your breathing stop in the middle of the night.

This question is often asked in sleep apnea screening questionnaires which you can do here.

CPAP: A Guide to the Different Types of Mask

Sleep Apnea, Solutions

CPAP: A Guide to the Different Types of Mask

What is CPAP?

CPAP stands for “continuous positive airway pressure”. A CPAP device uses a mask to force air into your nose or mouth to keep your airway open. It is very effective in treating sleep apnea, a condition where the airway repeatedly closes during sleep.

Contrary to popular belief, CPAP does not give you more oxygen, it simply establishes a current of normal air that props open your upper airway to prevent it from collapsing.

Normal breathing works via negative pressure, where expansion of the chest creates low pressure that then acts like a vacuum to suck in air. Conversely, by using CPAP, the constant flow of air creates high, positive pressure that forces outwards and pushes the airways open.

What makes a CPAP device?

There are three main components to any CPAP machine:

  • Flow generator
  • Hose
  • Mask

The generator pushes air through the hose, to the mask and into your airways.

Whilst the generator and tube are much the same (with some subtle variations and features unique to each product such as humidifiers), the mask is the part that varies the most. When being fitted for a CPAP device, it is important to consider the type of mask that is best for you.

The importance of a correct fit

Compliance is a big problem when it comes to CPAP treatment, with many users giving up after only a few nights. So whilst CPAP can be very effective in treating snoring and sleep apnea, it is only useful when it is actually being worn.

There are many reasons that make people stop their CPAP treatment, but most complain of discomfort. One study found that over a period of three years, 91% of users had abandoned their CPAP treatment [1].

Therefore, getting the right mask for you is vital to ensure you get the most out of CPAP.

 

SnoreLab’s guide to troubleshooting problems with your CPAP device.

Read

Nasal masks

This mask is dome shaped and forms a seal around the nose. Shapes vary so there are many options to suit different face shapes. Because air is not being introduced directly into the nose, the airflow feels a bit more natural. This also allows for higher pressures to be used, ideal for people with severe sleep apnea.

However, as the name suggests, nasal masks only work through the nose. Nasal masks are not effective if you breathe through your mouth whilst you sleep. Many devices address this by coming with a chin strap to prevent your mouth falling open. This option is therefore not suitable for people who suffer from allergies or have chronic sinusitis.

Air leakage is a potential problem with nasal masks; the seal formed by the padding can be compromised if you have facial hair. Some users also complain of discomfort from the straps on the head or pressure on the bridge of the nose. You can often mitigate this with proper fit and adjustment.

Nasal mask pros

  • Many different shapes for optimal fit
  • Higher pressures possible, therefore suitable for severe sleep apnea
  • Less claustrophobic than full face masks

Nasal mask cons

  • Potential air leakage with facial hair
  • Difficult to wear before bed or with glasses on
  • Not suitable for mouth breathers and people with nasal congestion

Nasal cushions

Also known as a nasal pillow, this type of mask rests on your top lip and uses two cushioned prongs that fit directly into your nostrils. This is the smallest and most simple of all CPAP masks so is popular with people who find other masks claustrophobic and uncomfortable.

Nasal cushions are less cumbersome than alternatives and cover less of your face. This is ideal if you want to wear the mask for some time before bed. With its slimmer design, you needn’t alter your nightly routine where other masks would be in your field of vision and prevent you from wearing glasses.

Nasal cushions are also beneficial for those who have more facial hair, as the seal is only formed on the nostrils.

Because the air is forced directly into your nose, high pressures can be uncomfortable. This means nasal cushion masks are less appropriate for people with severe sleep apnea. The direct airflow can cause nasal dryness and discomfort.

Again, the device only works for nasal breathers. If you have a tendency to breathe through your mouth when asleep but can still breathe properly through your nose, nasal pillows can still be effective when used with a device that holds your mouth closed.

Nasal cushion pros

  • Less claustrophobic
  • Can be worn comfortably whilst awake
  • Less prone to air leakage
  • Suitable for people with facial hair

Nasal cushion cons

  • High pressures can be uncomfortable, therefore is less suitable for severe sleep apnea
  • Can cause nasal dryness
  • Not suitable for mouth breathers

Full-face masks

These masks are larger, covering the nose and mouth, so are ideal for mouth breathers. If you have experienced discomfort with a chinstrap, or frequently have a blocked nose, full-face masks could be the answer.

Higher pressures are more tolerable with full-face masks as the air isn’t being sent directly into your airway. Being able to use high pressures makes this mask ideal for those with severe sleep apnea.

The added weight of a full-face mask means it has a tendency to loosen during the night, particularly if you are a restless sleeper. However, there are several straps that can be adjusted to get an optimum fit. This mask is ideal for people who sleep on their back.

Due to the increased area in contact with your face, there are more potential areas for air leakage, especially for those with facial hair. Leakage that occurs out of the top of the mask can sometimes dry out and irritate your eyes.

The bulk of a full-face mask makes it difficult to wear before you sleep as it interrupts your field of vision and makes it difficult to wear glasses.

Full-face mask pros

  • Ideal for mouth breathers
  • Suitable for people who sleep on their back
  • High pressures are tolerable, therefore is suitable for severe sleep apnea

Full-face mask cons

  • Potential air leakage
  • Bulky, so can move during the night
  • Difficult to wear whilst awake

How do I know which CPAP mask is right for me?

How a CPAP mask feels is different for every individual. General comfort and feelings of claustrophobia are subjective and dependent on the materials, design and fit of the mask.

When in consultation about using CPAP, it is important tell your doctor about all aspects of your sleep and nightly routine to decide on the best mask for you. Remember to try different types and make sure you get an optimum fit with the adjustments available.

Use this table to decide which CPAP mask is best for you:

Sleep Apnea: Screening, Testing and Treatment

Science, Sleep Apnea, Solutions

Sleep Apnea: Screening, Testing and Treatment

Sleep apnea is a serious condition where your airway repeatedly closes during sleep, depriving you of oxygen until you gasp awake.

The combined effects of disturbed sleep and repeated bouts of low oxygen cause lots of problems for your physical and mental health. Despite this, many sufferers remain undiagnosed.

But how do you get diagnosed?

There are several steps towards understanding and addressing sleep apnea:

  1. Signs – know how to spot potential sleep apnea.
  2. Questionnaires – answer some questionnaires to assess your risk.
  3. Diagnosis – undergo a sleep study.
  4. Treatment – start treatment appropriate for the severity of your condition.

Signs of sleep apnea

Loud snoring alone does not necessarily mean you have sleep apnea. If you can’t tell where loud snoring ends and sleep apnea begins, ask yourself or your partner if you have any of the following:

  • Very loud snoring, with periodic silence followed by choking/gasping
  • Headaches and a sore throat in the morning
  • Excessive sleepiness in the daytime
  • Lack of concentration
  • Mood swings and changes in behaviour

Side note: Can SnoreLab identify sleep apnea?

This is a question we get asked a lot. Some users have discovered sounds in their recordings that indicate apnea events, and then found them useful in subsequent medical consultations. But, it is important to note that SnoreLab is not a tool for sleep apnea screening. It is our goal to create a system to identify risky periods in your session using the tell-tale sign of silence followed by gasping or choking. That said, once we have created this, it will not be diagnostic. This is because sleep apnea is characterised by more than sound profile alone and requires a sleep study to be properly assessed.

Screening questionnaires

If you are showing the signs of sleep apnea, before getting more in-depth diagnostic tests, it is useful to assess your risk using some screening questionnaires.

Epworth Sleepiness Scale

Feeling excessively sleepy during the day is a key symptom of sleep apnea. Therefore, it is a good idea to measure your fatigue by using the Epworth Sleepiness Scale [1]. This questionnaire gives you a numerical score based on your self-assessed likelihood of falling asleep in certain scenarios. A score of sixteen or higher shows that you are very sleepy during the day.

 

Assess your sleep apnea risk with

the Epworth Sleepiness Scale

STOP-Bang questionnaire

The STOP-Bang questionnaire [2] is the favored screening tool in the medical profession [3]. It is straightforward, highly effective and considers more than tiredness alone. It is a set of eight questions with yes/no answers in a handy acronym, where each letter refers to a sleep apnea risk factor:

  • S – snoring
  • T – tired
  • O – observed breathing cessation during sleep
  • P – pressure, specifically high blood pressure
  • B – body mass index greater than 35
  • A – age
  • N – neck size
  • G – gender

 

Assess your sleep apnea risk with the STOP-Bang questionnaire

the STOP-Bang questionnaire

Berlin questionnaire

Similar to the STOP-Bang questionnaire, the Berlin questionnaire looks at several factors but clusters them into three categories [3]:

  1. Snoring – frequency, volume and observed apnea
  2. Tiredness – fatigue after sleep, tiredness throughout the day, sleeping whilst driving
  3. Cardiovascular fitness – blood pressure and BMI

If for two or more of these categories, you score two or above, you are at high risk of sleep apnea.

Diagnosis – sleep studies

Despite there being some prominent indicators of sleep apnea, getting reliably diagnosed means undergoing a sleep study.

The Apnea-Hypopnea Index (AHI)

It is the purpose of a sleep study is to identify and quantify sleep apnea, giving you a severity score. This score depends on how many times you experience the characteristic low-oxygen events. The apnea-hypopnea index (AHI) is this measurement [4], counting how many times you experience apnea or hypopnea in an hour:

  • Apnea episode – complete airflow blockage for at least ten seconds.
  • Hypopnea episode – at least 50% reduction in airflow for at least ten seconds.

Your AHI score relates to the severity of sleep apnea which is helpful when deciding how to treat it:

  • 0-5 events per hour – normal
  • 5-15 events per hour – mild sleep apnea
  • 15-30 events per hour – moderate sleep apnea
  • 30+ events per hour – severe sleep apnea

Polysomnography at a sleep clinic

Because snoring sound alone is not a reliable indicator of sleep apnea, other qualities need measuring too. This is done via a procedure is called polysomnography (poly = many, somnus = sleep, graph = drawing/measurements) and is usually conducted by a trained professional at a sleep clinic.

Sleep might not seem likely once you have been wired up and attached to the various monitors. But by observing eye movements, brain activity, muscle activation, airflow, oxygen levels and heart rate, you can construct a detailed image of what is happening to your body whilst you sleep, and gain insight into your sleep apnea.

 

What happens in a sleep study

Find out more

Home tests

Although they are reliable, polysomnography tests in sleep clinics are impractical and expensive. Further, if you are lucky enough to get a referral for one, you’re likely to be waiting a while. Smaller scale tests done at home are therefore increasing in popularity.

Home testing uses portable devices with fewer parts, but importantly with enough measurements to get a good picture of your sleep apnea. Generally, they consist of:

  • Chest strap – monitors heart rate and chest expansion
  • Finger clamp sensor – uses infra-red to examine blood oxygen through your finger nail
  • Nasal tube – tracks your breathing
  • Audio unit – listens to your snoring patterns

If you are deemed to be at risk of sleep apnea, these kits can be supplied by your doctor. After performing the test at home, you return the kit for the results to be analyzed and a score to be generated.

Read Susan’s story, a SnoreLab user’s account of having a home sleep study to diagnose her severe obstructive sleep apnea.

Treating sleep apnea

The steps you take to improve your sleep apnea depend on the severity of your condition. If you suffer from mild to moderate sleep apnea, the techniques and consumer remedies you use to reduce normal snoring can still be very effective. Similar to so many other health issues, weight loss cannot be recommended enough.

If your condition is at the severe end of the scale, you are likely to be prescribed a device that keeps your airways open at night. This is called CPAP which stands for “continuous positive airway pressure”.

The device consists of a mask you fit over your face and an attached unit that draws in air. By introducing air into your throat and increasing air pressure, the soft parts of your throat are prevented from collapsing and causing obstruction.

With SnoreLab’s insights, you can read about the different types of CPAP mask and solving common issues with CPAP.

Conclusion

If you’re a loud snorer and find yourself feeling sleepy throughout the day, you may be suffering from sleep apnea without even knowing it. Being aware of the signs and using questionnaires is useful to assess your risk, after which it might be a good idea to present to your doctor.

With in-depth sleep studies that can be done at a specialist clinic or at home, you make that important step away from the masses of un-diagnosed people to become someone who understands their condition and knows what to do about it.

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