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August 2020 |  Reviewed by:  Andrea Matsumura, MD and Seema Khosla, MD

What is CPAP therapy?

CPAP therapy is the leading treatment for sleep apnea. CPAP stands for continuous positive airway pressure. CPAP therapy keeps your airway open by gently providing air through a mask you wear while you sleep. This splints the airway open and eliminates the breathing pauses caused by sleep apnea. When you sleep with a CPAP machine, you will no longer snore or make choking noises in your sleep. You will be able to sleep through the night without your body waking up from a lack of oxygen.

When you use CPAP each night, you can prevent or may even reverse serious health problems linked to sleep apnea such as heart disease and stroke. Your memory and mood may also improve. The quality of your sleep will improve, which, for some people, means you will feel more rested and alert during the daytime. Your partner might even sleep better because you will stop snoring.

A CPAP system is a small air compressor with flexible tubing and a mask. Most machines are about the size of a tissue box, lightweight and relatively quiet. You can keep the CPAP machine on your nightstand or at the side of your bed.

The tubing connects the CPAP machine to your mask. The tubing is long enough to allow you to move around or turn over in your bed.

The CPAP mask may cover only your nose or both your nose and mouth. Another option is to use nasal pillows, which fit in your nostrils. Some other masks fit snugly under your nose. No matter what type of mask you use, it is important that it fits well and is comfortable. The mask must make a seal in order to keep your airway open through the night. A good mask seal will prevent air leaks and maintain the right level of air pressure.

Your sleep doctor will determine the amount of air pressure needed for CPAP to treat your sleep apnea. The doctor may recommend a CPAP titration study to calibrate your air pressure setting. Most CPAP units also come with a timed pressure “ramp” setting. This starts the airflow at a very low level, so you can fall asleep comfortably. The machine slowly raises the pressure while you sleep until it reaches the right level to treat your sleep apnea.

CPAP is a lifestyle change. It works best when used all night, every night. You also should use CPAP when you are napping. Just one night without treatment can have a negative impact on your blood pressure. Your body will feel better the more you use CPAP.

What are the benefits of CPAP?

CPAP may prevent or reverse serious consequences of sleep apnea. Treating sleep apnea  can help protect you from serious health risks. Using CPAP to treat your sleep apnea can also improve many parts of your life.

Heart disease prevention

By treating your sleep apnea, you can reduce your risk of heart disease. Sleep apnea is linked to a variety of heart problems because it causes you to stop breathing many times each night. These breathing pauses cause changes in your blood pressure and can reduce your blood oxygen levels. This puts an enormous strain on your heart.

People with untreated sleep apnea have a higher rate of death from heart disease than those without sleep apnea or those with treated sleep apnea. Using CPAP therapy over an extended period of time can protect you from heart problems and reduce your chance of dying from them. These heart problems include:

  • Congestive heart failure
  • Coronary artery disease
  • Irregular heartbeat

Stroke prevention

If you have sleep apnea, consistent CPAP use can reduce your risk of stroke, one of the leading causes of death and long-term disability. A stroke is a sudden loss in brain function. It occurs when there is a blockage or rupture in one of the blood vessels leading to the brain. People with untreated sleep apnea are two to four times more likely to have a stroke.

Diabetes prevention

Using CPAP to treat your sleep apnea can improve insulin sensitivity. Sleep apnea is related to glucose intolerance and insulin resistance, both factors in type 2 diabetes. Untreated sleep apnea increases your risk of getting type 2 diabetes.

Motor vehicle accident prevention

CPAP can help you become a safer driver by reducing your daytime sleepiness. Untreated sleep apnea makes you more likely to be involved in a deadly crash. Many people with sleep apnea have a hard time staying awake and concentrating while driving.

Improved daytime alertness

Sleepiness and daytime fatigue are common symptoms of sleep apnea. CPAP can restore your normal sleep patterns and increase your total time asleep by eliminating breathing pauses in your sleep. This will help you wake up feeling more refreshed and boost your energy throughout the day.

Improved concentration

Untreated, severe sleep apnea can damage your brain tissue. As a result you may have trouble concentrating. You also may suffer from memory loss. Using CPAP may improve your ability to think, concentrate and make decisions. This also can improve your productivity and decrease your chance of making costly mistakes.

Improved emotional stability

Untreated sleep apnea increases your risk of depression. CPAP can help improve your mood, reduce your risk of depression and improve your overall quality of life.

Eliminate snoring

By keeping your airway open as you sleep, CPAP reduces or eliminates the sound of your snoring. While you may not notice, your bed partner will benefit from a quieter sleep environment.

Lower medical expenses

By improving your health, CPAP therapy may reduce your overall medical expenses. Sleep apnea can lead to more health problems and more doctors’ visits. Treatment for serious health risks linked to sleep apnea such as heart disease, stroke and diabetes can be costly.

What are the side effects of CPAP?

CPAP therapy has relatively minor side effects. Most of these problems can be fixed through simple adjustments.

Strap marks or skin sores

These marks or sores are often due to a poor mask fit. By adjusting or changing the type of mask that you use, you can eliminate them. Make sure your mask straps aren’t too tight. It also may be helpful to buy soft CPAP strap covers to reduce the rubbing of the straps against your skin.

Dry nose and sore throat

A humidifier attached to your CPAP unit reduces dry nose and sore throat by providing cool or heated moisture to the air. Sometimes a mask style change is necessary to prevent dry nose, mouth or sore throat.

Nasal congestion, runny nose and sneezing

Using a saline nasal spray can ease mild nasal congestion. Increasing the humidity in your device may help. Talk with your doctor about medications for congestion, runny nose or sneezing if it affects your ability to use your CPAP device.

What are the variations of PAP therapy?

Types of PAP therapy

There are several forms of positive airway pressure (PAP) therapy other than CPAP. All forms of PAP therapy keep your airway open as you sleep by providing a stream of air through a mask that you wear.

APAP

Autotitrating positive airway pressure (APAP) therapy automatically raises or lowers your air pressure as needed during the night.

BPAP

Bilevel positive airway pressure (BPAP) devices have two alternating levels of pressure. There is a certain pressure when you inhale that drops when you exhale. If you have a problem using CPAP or APAP, your sleep doctor may recommend BPAP. Your doctor also may recommend using BPAP if you have sleep apnea along with another breathing disorder.

Types of masks

There are three common types of CPAP masks. No matter what type of mask you use, it is important that it fits well and is comfortable.

Nasal mask

This mask only covers your nose. This is the most common type of CPAP mask.

Full face mask

This mask may cover your nose and mouth or may sit under your nose and cover your mouth. This type of mask may help if you have air leaks when using a nasal mask.

Nasal pillows

This mask uses soft silicone tubes that fit directly in your nose. This may help if you have air leaks or don’t like the feeling of a mask over your nose and face.

Humidifiers

Humidifiers for CPAP can help reduce side effects from the treatment and make it easier for you to breathe through your mask. Some people may have nasal irritation or drainage from using CPAP. A humidifier can reduce these side effects by providing cool or heated moisture to the air coming from the CPAP unit. Many CPAP units come with a humidifier connected to the machine.

What are tips for CPAP?

It may take some time for you to become comfortable using CPAP therapy. Follow these tips to improve your quality of sleep with CPAP:

Begin using your CPAP for short periods of time during the day while you watch TV or read.

This will help you get used to wearing your mask. It will feel more natural when you are trying to fall asleep.

Make CPAP part of your bedtime routine.

Use CPAP every night and for every nap. Using CPAP less often reduces its health benefits and makes it harder for your body to adjust to the therapy.

Make small adjustments to increase your level of comfort.

Adjust your mask straps and headgear until you get the fit right. You also can try using a special bed pillow that is shaped for a CPAP mask and tubing.

Make sure your mask is a good fit.

The most common problems with CPAP occur when the mask does not fit properly. If the mask is too big, the straps holding it to your face will need to be pulled tightly. This may irritate your skin or lead to sores as the straps rub against your face. You can buy soft CPAP strap covers to reduce the rubbing of the straps against your skin. A mask that is too small will not seal properly and air will leak out through the edges. The air may blow into your eyes. If you are having either problem, you may need a different mask or headgear.

If the pressure feels too high as you are trying to fall asleep, use the “ramp” mode on your CPAP unit.

The ramp mode will start your device on a low-pressure setting and gradually increase the pressure over time. You should be able to fall asleep before the air pressure reaches its set level.

Use a saline nasal spray to ease mild nasal congestion.

Nasal congestion can be a problem with CPAP treatment. A nasal spray can help with nasal or sinus congestion.

Use a humidifier if you have a dry mouth, throat or nose.

Many CPAP devices have a heated humidifier. It ensures that you are breathing warm, moist air through your mask.

Schedule a regular time to clean your equipment.

Clean your mask, tubing and headgear once a week. Put this time in your schedule so that you don’t forget to do it.

If you are having problems remembering to use your CPAP every night, find someone to help.

Consider joining a support group or asking someone you trust to hold you accountable for using your CPAP.

If these adjustments do not work, talk to the staff at your sleep center.

The staff are prepared to help you adjust your CPAP. This may be at your doctor’s office or at your durable medical equipment office where you picked up your PAP and you get your mask and supplies for PAP. You may need a different type of mask or machine, or you may need an adjustment to your air pressure setting. Some people need more support and time to become used to PAP therapy. If you need more tips or help, please reach out to your sleep center.

If you think you may have sleep apnea or need CPAP, talk to your medical provider or use the sleep center directory to find an accredited sleep center near you.