In the realm of obstructive sleep apnoea (OSA) management, CPAP (short for Continuous Positive Airway Pressure) therapy is the gold standard. Whilst its benefits are undeniable, some users do find adapting to therapy challenging. 

Common side effects experienced when using a CPAP machine include: 

• Dry throat, 

• Mask leak, 

• Restrictive tubing and more

Dr Phua Chu Qin, Consultant from the Department of Otolaryngology (Ear Nose & Throat) at Sengkang General Hospital (SKH), a member of the SingHealth group, shares tips on to how to use a CPAP machine better for a more restful and better quality sleep.

6 Tips for sleeping better with a CPAP machine

1. Choose a mask that's right for you

There are various mask designs to suit different needs. Common mask designs include the nasal pillow, nasal mask and full face (oronasal) masks.

Nasal pillow

 
Nasal pillows are lightweight masks that snuggles underneath the nostrils, suitable for patients who have claustrophobia or do not like many items on their face. It can be useful for patients with moustache or facial hair.

Nasal mask

Nasal mask is a triangular mask that covers the nose from nostrils to nose bridge. It provides snug and secure mask fit for most patients, and reducing the chances of mask leak. In Singapore, local patients responds best to nasal mask followed by nasal pillow.

Full face mask

 
Full face (oronasal) mask covers a wider area of nose and mouth, thus can be useful for patients who are habitual mouth breathers. However, given the larger perimeter of the full face mask, it is more liable to leaks. Sometimes it may take a few trials of different masks before finding one that best suits you.

For patients who need to get out of bed for toilet at night, it can be useful to look for mask designs that have a clip on feature to the tubing. This allows for easy detachment of tubing and putting it back on after you get back from the toilet.

When purchasing a mask, it can be helpful if you can try the mask on, with the CPAP machine attached and turned on, whilst lying down to get a more realistic feel of how the mask would feel like when you go to bed. 

Sleep technologist can be great help in recommending suitable masks for you. The ultimate goal is to find a effective yet comfortable mask to sleep with daily.

2. Optimise CPAP pressure adjustments

Common positive airway pressure (PAP) therapy prescribed to patients are usually AutoPAP, which are usually set between a range of 4 - 15 cmH20, but automatically adjusts and provides a pressure required to overcome your airway obstruction during sleep. 

Patients can set a ramp time on the CPAP machine (about 10 - 45 mins), for the therapy to start from a lower pressure then gradually increase to the optimal pressure. This makes it more comfortable for patients to ease into therapy whilst trying to fall asleep.

When you feel the pressure is too high

Some patients may feel the pressure is too high for them to breathe out. Most CPAP machine allows for a pressure relief setting (eg. Expiratory pressure relief, EPR), which sets for a lower pressure when you breathe out, making it more comfortable.

When you feel the pressure is too low

Conversely, some patients may feel as if they are suffocating or cannot get enough air when using the CPAP. This can be because the pressure set is not high enough to overcome the airway obstruction and can be rectify by setting a higher starting pressure eg. Between a range of 8 - 15cmH2O, instead of the usual 4 - 15cmH20.

With regards to the change of PAP pressure, it can be useful to seek Sleep Technologist or your doctor’s advice prior to making changes, as pressure change can affect your therapy.

For instance, some patients might set too low a pressure for comfort, which then fails to eliminate sleep apnea. Thus, any changes made require monitoring and follow up after, to ensure that therapy remains effective.

3. Use regularly to acclimatise or get used to CPAP

During the initial period of using CPAP, patients can find it difficult to adjust their breathing to the pressure blowing into their faces. Some patients can also find the mask straps and tubing frustrating or affecting their comfort. 

It can be helpful to persist with therapy to give yourself some time to acclimatise to breathing in and out with the CPAP on, or having something on your face during sleep. Some patients can take up to 2 - 4 weeks of regular use of CPAP (at least 4 hours per night) before reaping benefit from the therapy (more restful sleep and feeling more energetic during the day).

Another way to acclimatise is to have the CPAP therapy on when you are awake. 

For instance, prior to bed time, some patients might enjoy some bedtime reading or watching tv as a way to wind down. During this wind down, as you are doing something else (reading, watching tv), it can be useful to put your masks and turn the CPAP therapy on to help you ease into therapy better. 

In addition to using CPAP during bed time, we encourage patients to use their CPAP during daytime naps as well.

4. Get professional medical help

Beyond the masks and pressure changes, there are adjuncts which patients can use to help use CPAP better. 

For mouth breathers, a chin strap can be used to ensure that the mouth is closed or you can tape you lips with simple tapes during sleep. 

If nose congestion occurs when using CPAP, a nasal spray from a doctor may help. Some patient may need some nasal surgery to relief nasal obstruction so they can use CPAP better.

Some patients may have some initial troubles falling asleep with the CPAP therapy. These patients can benefit from a short and limited course of sleeping pills to help them get over the initial acclimatising period and help them use CPAP therapy better after.

If you have any problems, it is best to discuss with your doctor who can help you troubleshoot the situation and provide solutions.

5. Properly maintain your CPAP masks, tube, humidifier and machine regularly

For CPAP masks, it can be useful to wipe daily or at least weekly with wet wipes to remove any sweats, dust or irritants. Alternatively, rinsing it under running water with gentle soap can also help. 

CPAP tubing can be rinsed around once a month with water and some soap/disinfectant. Humidifier chamber can be rinsed with water every time you refill the chamber.

Masks and tubings are liable to wear and tear. Whilst masks manufacturers advice for more regular mask replacements, in general, most masks can last about 1 - 2 years. 

Hence, patients can monitor for signs of wear and tear. If masks are starting to show poor seal causing leak, it would be advisable to change. CPAP tubings can last longer. CPAP tubing can be changed when there are tears, holes or tubing becomes unhygienic.

6. Humidification

Some patient may have problems with dry nose or dry mouth with CPAP therapy use. In these instances, a trial with humidification (can be purchased as an add on for the CPAP machine, or might already come with the CPAP machine) can be helpful. Most CPAP machine also have different levels of humidification (levels 1, 2, 3) to allow patients to tailor it to their needs.

In some patients, dry mouth from therapy can be because of leakage of air through the mouth during sleep. In this instance, it can be helpful to see your Sleep Technologist for troubleshooting. Some patients may need chin strap or mouth tape to ensure mouth stays closed during therapy. Some patients may need a change to full face mask, and some may benefit from myofunctional therapy to help reduce mouth leaks.

In conclusion:

It is important to understand that it takes time to get used to the mask and CPAP therapy. Just like getting a new pair of glasses, you may need a few days to get used to it. The only way to get used to it is to wear it often. 

It may sometimes help if you put the mask on and start CPAP therapy before (bed as you are winding down), to slowly breathe, sync and ease into therapy. By incorporating these tips into your routine and seeking support when needed, we hope you can reap the benefits of effective CPAP usage and transform your sleep quality.

The Sleep Medicine Unit of Sengkang General Hospital (SKH) is a multidisciplinary sleep team helmed by ENT Surgeons, Respiratory physicians, orthodontist, psychiatrist, psychologist and sleep technologist dedicated and specialising in diagnosis and management of wide range of sleep disorders including obstructive sleep apnea, snoring, insomnia, obesity hypoventilation syndrome, circadian rhythm sleep disorders, narcolepsy, parasomnias and other sleep related movement disorders.

The Department of Ear Nose and Throat (ENT), Head and Neck Surgery at SKH provides a wide range of specialist services focusing on a wide range of ear, nose, throat, sleep apnea and head and neck cancer conditions.

Ref: H24

Related articles:

8 Easy Exercises to Stop Snoring

Snoring: What to Do and When to See a Doctor

When is Snoring Considered Obstructive Sleep Apnoea (OSA)?

Obstructive Sleep Apnoea (OSA): How to Manage

Obstructive Sleep Apnoea (OSA): Why It Increases Heart Disease Risk