Do you have difficulties with this therapy, which is sometimes a challenge? Our CPAP guide can ease your path and help you rest better at night.
CPAP machines are the most common form of sleep apnea treatment, but they can be uncomfortable and difficult to adjust to at first.
By Lindsey Konkel
Updated by Daphne Yao
If you’ve been diagnosed with obstructive sleep apnea (OSA), which causes numerous brief pauses in breathing while you sleep, your doctor has likely recommended continuous positive airway pressure (CPAP) as a treatment. ).
With CPAP, the main treatment for the disorder, a mask-like device that is connected to an air pump is usually used. The pump pushes air into your airways and keeps them open while you sleep.
The use of CPAP can significantly reduce the number of breathing pauses during the night. But about a third of CPAP users don’t stick to their treatment, according to a 2016 review of studies published in the Journal of Otolaryngology – Head & Neck Surgery. According to the review, users often cited issues of discomfort, convenience, and claustrophobia as reasons for stopping CPAP use.
Therapy can be challenging. When David Levey, 60, of Mequon, Wisconsin, started using CPAP about 15 years ago, he found it unpleasant. “I was sleeping on my side and the pillow was moving my mask out of place,” says Levey. So instead of sleeping through the night, he would repeatedly wake up with air from the device blowing into his eyes.
But it is important to control sleep apnea. Without treatment, it can cause excessive daytime sleepiness, says Dr. Raj Dasgupta, a clinical associate professor of medicine at USC Keck School of Medicine in Los Angeles. And that, in turn, can cause you to fall asleep at inappropriate times; for example, while eating, driving, or talking to other people.
A 2015 Swedish study published in the journal Sleep found that untreated sleep apnea doubles the risk of a car accident. And according to the National Transportation Safety Board, undiagnosed sleep apnea may have played a role in two commuter train accidents, one in Hoboken, New Jersey, in 2016 and another in Brooklyn, New York, in 2017, which, together , caused more than 200 injuries and one death.
In the long term, sleep apnea also puts a strain on the heart, increasing the risk of high blood pressure, arrhythmia, heart failure, and stroke.
“Patients sometimes ask if they could die from not receiving sleep apnea treatment. The short answer is ‘yes,’” says Dasgupta.
Whether your doctor has recommended you use CPAP or you’ve had problems with the treatment, here’s how to get the most out of this therapy.
How CPAP machines work
According to the American Academy of Sleep Medicine, there are currently approximately 5.9 million diagnosed cases of OSA among American adults. In people with this disorder, the muscles in the neck and throat relax during sleep, causing the soft tissue in the back of the throat to collapse, preventing air from reaching the airways. This causes a series of partial or complete pauses in breathing, sometimes hundreds of them each night.
CPAP, which sends enough air into the upper airways to keep them open, has been the cornerstone of treatment for moderate to severe OSA since the 1980s.
Prescription treatment has been shown to improve sleep quality, reduce daytime sleepiness, help normalize blood pressure, and alleviate other related health risks.
For example, a study published in 2018 in the Journal of the American Heart Association of more than 40,000 Danish adults with sleep apnea found that those not using CPAP had a 38% increased risk of heart failure than those who used it.
CPAP can not only be effective, but the machines are now easier to tolerate, quieter, and less bulky than older devices.
Many of the newer CPAPs allow you to start the night with a lower air pressure and gradually increase that pressure after you fall asleep. This can reduce the feeling that air is coming in through your nose or mouth.
Some CPAP units even automatically adjust to your breathing patterns, increasing or decreasing air pressure throughout the night as needed.
How to choose a CPAP machine
Finding a CPAP mask that is comfortable enough to allow you to sleep is essential. (You’ll also need to consider factors such as the severity of your OSA and the air pressure setting your doctor has recommended to keep your airways open during sleep.)
But this can take time. According to Dr. Steven Feinsilver, a sleep medicine specialist at Lenox Hill Hospital in New York, even with these advances, using a CPAP machine can be awkward and uncomfortable. “Most people don’t end up sticking with the first device they try. Some people try two or three before finding the one that works best for them,” he says.
That was the case for Hb Alumisin, 33, of New York, who tried two masks before settling on a third option: nasal pillows (see below), for her mild sleep apnea.
“The masks were heavy and difficult to wear, but the pads are comfortable and less annoying,” he says.
When you adjust it (which can be done at home or at a sleep center), “try on the masks at the doctor-recommended air pressure settings you plan to use to see how it really feels when the machine is on,” advises Dasgupta
And make sure any device you’re considering fits tight enough to form a seal where it should, Dasgupta says, but not so tight that it leaves marks on your face.
There are three main types of CPAP masks available:
nose pads “Pillows” are small plastic plugs that are placed just below the nostrils and direct airflow into the nostrils. Nasal pillows are the smallest and lightest option and require minimal contact with the wearer’s face.
According to the American Academy of Sleep Technologists (AAST), the pads may work best for people who need a low to moderate air pressure setting and may be a good choice for people with a lot of hair. facial or feel claustrophobic when wearing a larger mask.
However, they can cause nasal irritation and discomfort, especially at high pressures, since air is drawn directly into the nostrils. Some users report nosebleeds or a dry nose. Mouth breathers may not get as much benefit from this type of mask because it applies pressurized air only to the nostrils.
nose mask. This mask covers the face from the bridge of the nose to the top of the upper lip, creating a seal over the nose but not the mouth. The AAST recommends nasal masks for people who want more natural airflow than with nasal pillows.
“Some people prefer the mask to the cushions because the air is not as concentrated. Spread over a larger surface area, it can feel more comfortable,” says Edwin Valladares, a CPAP user who works as a sleep technician and director of the USC Keck Medicine Sleep Disorders Center.
The nasal mask may not be the best for mouth breathers or those who have trouble breathing through their nose due to allergies, sinus obstructions, or medical conditions such as a deviated septum. For some people the mask causes irritation or discomfort on the bridge of the nose.
Full face mask. This type of mask covers both the nose and the mouth, forming a seal over both airways. A full face mask may be a good option for people with allergies or medical conditions that make it difficult for them to breathe through their nose while sleeping. It may also be useful for those who need a higher pressure setting but find it more comfortable than a nasal mask, according to the AAST. But its bulkiness can be a drawback for some people.
Tips for using a CPAP machine
According to Dr. James Rowley, medical director of the Sleep Disorders Center at Detroit Receiving Hospital, it can take two to three weeks for a patient to feel comfortable sleeping on CPAP, and four to six weeks before it begins to really see the benefits.
A gradual introduction to CPAP works best for many people, Feinsilver says. Start by using CPAP 20 to 30 minutes before you go to bed. “Put on your mask, turn on the machine and watch TV or read a book,” he says. After a few days, he tries to sleep with the device. “If you don’t fall asleep in an hour, take it off and try again the next day,” says Feinsilver.
If the mask you found suitable during fitting becomes uncomfortable after a few nights or is difficult to fit, contact your sleep medicine physician or medical equipment provider. You may need advice on how to fit it or a different style of mask.
And if after two or three weeks of trying it you feel like CPAP isn’t working for you, “talk to your sleep doctor about what else you can do, but don’t give up,” Rowley says.
Some people may take longer to adjust. David Levey, for example, estimates that it took him two to three months to become fully comfortable with his CPAP, and he had to switch from side sleeping to back or back to prevent his device from slipping out of place.
“Getting used to sleeping on my back was the hardest part of adjusting to CPAP, but once I did I woke up feeling much more rested,” he says.
Common Side Effects of CPAP Machines
The side effects of CPAP use can often cause discomfort. Here’s how to manage the most common CPAP-related complaints:
Dry mouth. An uncomfortably dry mouth can occur when a full face mask fails to form a tight seal on your face or with a nasal mask or nasal pillows if you breathe through your mouth, Rowley says.
What should you do? If you wear a full mask, have your sleep medicine specialist or sleep technician check the fit. If you are a mouth breather, ask if a chin strap can be added to your nasal mask or nose pillow devices to keep your mouth closed while you sleep.
Nasal congestion. It may be because the air is directed towards the nose.
What should you do? Most newer CPAP machines come with a built-in humidifier; You can adjust the humidification level to relieve nasal congestion. If that doesn’t help, talk to your doctor. “Most CPAP-related nasal congestion can be treated with an antihistamine or steroid nasal spray,” explains Rowley.
Acne. Some CPAP users report redness, itching, or a rash where the mask touches the skin. According to the AAST, an allergic reaction to a CPAP mask is rare, and these skin problems are almost always related to inadequate mask hygiene.
What should you do? “Wash the entire mask and humidifier chamber with soap and water at least once a week,” Rowley says. (Get more CPAP care tips here.) And while some researchers have theorized that CPAP might increase the risk of respiratory infections like pneumonia, studies so far have failed to find a link.
Sleep Apnea Treatment Alternatives
There are also other treatment options such as mouth guards, called mandibular advancement devices, which help keep the airway open, and surgically implanted devices that send electrical impulses to the nerve that controls the muscles of the upper airway.
If you’re overweight, losing a few pounds can also help reduce the severity of your sleep apnea.
And remember: “Treating your sleep apnea will not only help you sleep better, but you may also live longer,” says Feinsilver.
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Consumer Reports has no financial relationship with the advertisers on this site. Consumer Reports is an independent, nonprofit organization that works with consumers to create a fair, safe, and healthy world. CR does not endorse products or services and does not accept advertising. Copyright © 2023, Consumer Reports, Inc.