Troubleshooting Guide for CPAP Problems

Tracy R. Nasca

I am having trouble falling asleep on CPAP

If your CPAP pressure feels overwhelming at the beginning of the night, your machine may have a feature called ramp which can be set to start your pressure at a lower setting and “ramp up” over a period of time. Call your cpap supplier to ask if your machine has this feature and if it is enabled for use.

I don’t like using CPAP and wearing the mask to bed, what can I do?

Practice makes perfect. To help get used to wearing the mask during sleep, practice by wearing it during the day while sitting in a chair watching television or reading. This will distract your focus from the mask to a positive, familiar activity. CPAP use will become a habit and part of your routine.

Why am I still snoring?

Snoring, choking, gasping like noises should be eliminated during CPAP use. If not, it could mean that your machine pressure is not adequate. Call your cpap supplier to find a solution.

Air in tummy, painful stomach bloating and gas

The medical term for this common CPAP issue is Aerophagia. It occurs when the air delivered by your CPAP enters the esophagus and stomach rather than the lungs. It can occur when your CPAP pressure is set too low or too high. It can also occur if you are a mouth breather but not wearing a full face mask. Consult your physician if the problem is chronic and persistent.

Bed pillow problems with side or stomach sleeping

Often, side or stomach sleepers find that the head sinks in to their bed pillow which causes the blockage of mask exhalation ports and risk of dangerous CO2 (carbon dioxide) rebreathing. Others find their pillow causes unwanted mask frame movement (pushed off center) causing mask leak, pressure point soreness or bruised cheek bones. To resolve, purchase PAPillow, a specially made bed pillow designed for CPAP users and for any side or stomach sleepers.

Mask Problems

Skin irritation, sores and bruises from mask

No mask should cause pain nor discomfort if sized correctly and fitted properly. If irritation or sores are developing, chances are you are over tightening your mask. Your mask cushion may be worn out and need replacing. Mask liners called RemZzz’s might also resolve skin irritation and mask leak.

I like my mask choice, but still get occasional facial sores or leaking.

Your cpap supplier should offer products that might be helpful if you otherwise like your mask. One is the Gecko nasal pad. It is an easy to use gel pad that is placed across the nose bridge and under the mask. It helps with leak in the upper part of the mask frame and is beneficial to patients who have a narrow nose bridge or who are prone to cuts or irritation to the nose bridge. Another product patients find helpful are SoreSpot CPAP Skin Protectors. They are a unique liquid-filled bandage that minimizes friction and helps prevent skin irritation. Check out RemZzz’s full face and nasal mask liners. They are applied directly to the silicone mask cushion to help absorb facial moisture and oils, and prevent skin irritation and pressure marks as well as to reduce noisy mask leak.

I wake up without my mask on, but have no memory of removing it during sleep

This is a common occurrence, especially during the early adjustment period of CPAP use. Chances are, you removed the mask due to discomfort or leak. This would indicate that your mask choice is not the best for your face, or that it is not fitted properly.

I am claustrophobic and cannot get used to the nasal mask

Patients who experience claustrophobia usually find that the small size and simplicity of nasal pillow masks more tolerable. There is an adjustment period for most patients as they get used to sleeping with any mask on the face. While your goal is to be able to sleep all night on CPAP, using it as long as you can tolerate it each night is better than nothing. Try to increase usage over time until you reach your goal.

My eyes are swollen or irritated

No air should be directed up in to the eye area with a properly sized and fitted mask. This might indicate leak in the top area of your mask; gently tighten the top mask straps taking care not to over tighten. This leak might also indicate a worn mask cushion that needs replacing.

Some people naturally sleep with their eyes partially open which can cause dryness or irritation; they benefit from wearing a simple fabric eye mask. If swelling or irritation is chronic or persistent, consult with your sleep or primary care physician.

I use a Nasal Pillow mask and my nostrils are sore

Skin irritation can quickly occur when the nasal pillows are not inserted properly. Try rotating the barrel that holds the nasal pillow inserts to a more comfortable angled position of the pillows in to the nostrils. After best positioning, if leak occurs at the nostril opening, size up.

My mask is making a whistling noise

Most masks have exhalation ports (look for a tiny cluster of holes) that allow the escape of our CO2 (carbon dioxide). When routinely cleaning your mask parts, these tiny holes must be checked to make sure they are not soiled and clogged by body oil or bedding lint. When clogged, they can cause the mask to make a whistling noise. Use a sewing needle or toothpick to keep the holes free flowing.

My bed partner is bothered by the air flow of the exhalation ports from my mask

All masks have exhalation ports to allow the escape of CO2 (carbon dioxide). The higher the machine pressure setting, the harsher this escape flow will be. Some masks have better air diffusion features than others. Check with your Corner Team member to discuss a resolution. Some patients resolve by side sleeping with their backs turned to their bed partner to avoid a distracting air flow.

Machine Problems

My CPAP machine is not working

Make sure the electric plugs to the wall and to the machine are firmly in place. Check your electric outlet to make sure it is working. Otherwise, make an appointment to bring your machine in to be evaluated by your cpap supplier.

My CPAP machine is too noisy; it keeps me / my bed partner from sleeping.

Today’s machines are nearly silent, so unless you are hypersensitive to noise ( try ear plugs), this would indicate a problem. Check the machine filters. They should be changed monthly or when visibly discolored to help keep the machines running smoothly. There will be a slight audible noise if you are using a Bi Level machine as the pressure transitions between inhalation and exhalation settings. There will be a slight audible noise if you use an AutoCPAP as the machine changes inhalation pressure. If your machine is otherwise noisy, there may be a machine defect. Make an appointment to bring your machine in to be evaluated by your cpap supplier.

I get tangled in my CPAP tubing during the night

Try placing the tubing behind your head near the top of your pillow, or positioned behind the headboard bed post. Most cpap suppliers offer an inexpensive Tubing Lift to help with tube positioning for better sleep. Easy to use, the small frame is held in place between the box spring and mattress. The lift holds the tubing above the head allowing for better freedom of movement.

I keep pulling my CPAP machine off the night stand.

The length of standard CPAP tubing is about 6 feet. Active sleepers who toss and turn are more apt to tug on the tubing and pull their machine off the bedside table. Most cpap suppliers offer tubing in 10 foot lengths which give patients more freedom of movement especially when coupled with a Tubing Lift.

Humidifier Problems

CPAP is causing dry mouth, dry throat, runny nose, stuffy nose, sneezing

A CPAP humidifier or temperature adjustment may usually resolve all of the above issues. Start with the lowest heat setting and turn up as needed for more moisture. Biotene spray or oral rinse products may help with dry mouth. Chronic nasal lining dryness may be helped with Ocean or other simple saline spray solutions. Both are available over the counter at your pharmacy. Consult with your physician if the problem persists.

Water in CPAP tubing

Excess condensation can form in the CPAP tubing when the temperature of your bedroom is cooler than the air coming from your machine. Most cpap suppliers offer inexpensive, insulating hose covers to resolve this common problem.

White or pink film in humidifier water chamber

Bacteria can quickly develop in the water chamber. All manufacturers recommend the use of distilled water. Tap water may be used on occasion. Each morning, empty any leftover water, rinse chamber and let air dry. To remove film, fill chamber with 1/3 white distilled vinegar to 2/3 tap water solution. Let soak for one hour. Rinse with clear tap water, air dry.

Water spill

Always remove water chamber unit from machine before filling with distilled water. Spilling water in to the machine may compromise the interior circuits, damage the machine and void the warranty.

Mask Fit and Adjustment Tips

Mask leak is one of the most common challenges for patients. To assure the best fit and adjustment, when retiring to sleep, sit on your bed and place mask on the head/face with straps loose. With machine turned on and air blowing, lay down with your head on the pillow in your normal sleeping position. Slowly tighten your mask straps just until you get a good seal, being careful not to needlessly over tighten. The final step is to “seat” your mask. After straps are adjusted, pull the mask out and away from your face (about 2 inches) and gently lay back on face. This allows the dual mask cushions to inflate which will assure the best seal possible and comfortable fit. Mask fit varies with sleeping position, so if you fit for side or stomach sleeping, you will need to readjust if you roll to your back. This is why many patients train themselves to sleep solely on side or stomach (same mask fit) versus back sleeping which has a different mask fit.

Mask fit tips

Full Face – Mask users with forehead pads/brace: tighten upper strap first, then follow with lower strap positioning and fit.

Mask Headgear – Masks come with a “one size fits most” head gear. Larger and smaller strapped headgear may be available by special order.

Nasal Pillow Mask – Place mask on face and position headgear and place side straps above the ears. Gently slip nasal pillows in to the nostrils making sure to rotate the angle of the pillow barrel for a comfortable fit. The pillows are meant to lie just inside the nostril opening, not to be aggressively inserted. Proper placement should not cause the tip of the nose to be raised.

The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. Contact your physician or health care provider when you have health related questions. Never disregard or delay medical advice because of information you have obtained on this site.