When I started my CPAP journey over ten years ago now, I was pretty lucky – I took to it like a duck to water. I had a few minor leak issues that tightening the straps fixed and some pressure alterations, but on the first night I used my CPAP machine, I slept better than I’d had in years.
For some people though, it can often take time to adjust to sleeping with a CPAP mask on your face all night. Many new CPAP users struggle with mask discomfort, leaks, irritation, and other annoyances that make it difficult to comply with therapy.
My own experience wasn’t entirely without struggles and I have experienced all of these issues below in some form or another.
The good news is that there are solutions to the most common CPAP mask problems, and with some troubleshooting and patience, you can overcome these hurdles and learn to sleep soundly with your CPAP.
Here are 8 of the most common CPAP mask issues and how to fix them. Don’t forget, as with most medical equipment, patience and persistence is everything – the payoff for reducing your sleep apnea symptoms is worth it.
- Finding the right mask fit is crucial for CPAP success and comfort. Work closely with your medical provider to find the mask style, size, and adjustments that are customized to your facial structure.
- Address air leaks immediately, as they can be very disruptive to sleep. Inspect your mask seal and straps for gaps where air escapes. Keep your mask cushion clean.
- Use protective cushions, gels, or liners to prevent skin irritation from mask pressure. Adjust straps to relieve any localized pressure points on your face.
- Give yourself time to adjust to sleeping with the CPAP mask. Use systematic desensitization to increase wear time gradually.
- Find sleeping positions that work with your mask and machine tubing.
Table of Contents
1. Discomfort from a Bad CPAP Mask Fit
An ill-fitting mask is one of the top complaints among new CPAP users.
Ok, straight up, when I first started CPAP, I think I tried 6 or 7 different mask models and brands to see which I preferred. I was lucky that my CPAP supplier had a solid weekly rental program for masks that let me try and test things.
Finding a properly fitted CPAP mask is one of the most critical steps to successful CPAP therapy, yet it’s also one of the top struggles for new users.
An ill-fitting mask often leads to discomfort or outright pain on parts of your face, headaches upon waking up, and a terrible night’s sleep, which defeats the whole purpose of CPAP treatment. The root cause of most CPAP mask discomfort is improper sizing and fit. CPAP masks come in a range of styles, shapes, and sizes to accommodate different facial structures. It’s crucial to work closely with your medical equipment provider to experiment with a few different mask options until you find the one that feels tailored to your face.
During your mask fitting appointments, focus on finding the right combination of headgear straps, sizing adjusters, and cushion seals that keeps your mask firmly in place but avoids overly tight pressure.
How should a CPAP Mask fit on my face?
You want it to feel snug yet comfortable on your nose, mouth, or entire face depending on mask type. Your provider should guide you through systematically adjusting straps, evaluating the fit and points of contact, and making incremental tweaks until you achieve a customized, secure fit.
It may take a few trials and errors over multiple fittings to get it right as you learn how to properly position and fasten your gear. Be patient with the process and keep communicating how each mask option feels on your skin.
2. CPAP Mask Air Leaks
It’s the leaks at the top of the mask near the bridge of the nose that get me… waking up and feeling this cold stream of air jetting into the corner of my eye. I hate that, I can’t lie.
One of the most annoying and disruptive CPAP problems is when air leaks out from your mask, preventing optimal pressure delivery during therapy.
These leaks manifest as an irritating hissing or whooshing sound that can make falling asleep incredibly difficult. The noise might remind you of air slowly seeping out of a balloon or a breeze rattling a loose window.
The sound usually starts softly but can reach an aggravating volume that interferes with your ability to rest. Your bed partner is also likely to complain about the disruptive noise keeping them up as well.
The other type of leaks are the ones I describe in the opening where you can feel the air escaping and blowing into your eyes or reducing the pressure in the mask. In my experience, because I have a high tolerance for tightness, I just tighten the straps on my mask. If you’re getting these kinds of leaks consistently and struggle with a tight mask, talk to your sleep specialist about getting a different fit.
The source of these problematic leaks is usually an improperly fitted mask or loose headset. Carefully follow the manufacturer instructions for how to correctly position your gear and tighten all straps equally but not excessively tight.
Try inspecting your mask seal for any gaps or tears that could be causing the audible air leaks. If you continue hearing the annoying hissing or whistling despite your best efforts, consider switching to a different mask size or style that provides a better seal against your face.
3. Annoying CPAP Machine Noise
Air leaks may not be the only annoying sound you hear when using your CPAP machine.
The humming of the CPAP device or whooshing air sound can also disrupt sleep, especially for bed partners. It can take some time to get used to your machine’s general operating sounds.
If the noise is too great or too distracting, check your machine for issues.
First, clean or replace your machine’s air filters regularly to maximize performance and cut down on noise. Adjust settings like the ramp feature. If the noise persists, try using a sound-dampening hose cover, relocating the CPAP machine farther from your bed, or using earplugs.
Sleep apnea sufferers and their partners report that the sound of the CPAP machine actually can be beneficial and become soothing over time – almost like white noise in the bedroom at night.
We have white noise in our room (thanks, Google Home and Spotify “Rain and Thunder 10 Hour Playlist”) but the CPAP machine’s sound also acts as a white noise sound for my wife and me as well.
One last thing to think about. If your machine is getting older and you’ve used it consistently, it can eventually start to get louder as the mechanical parts internal to the machine move past their effective working life.
Lubrications break down, seals start to wear out, and things just stop working.
Most CPAP machines have a good effective working life of 5 years of daily use and you can often hear people getting 7 or 10 years, but if you’re finding the machine’s noise has amplified and you’re out past the 5 year mark, start considering some upgrades or alternatives.
4. Red Marks and Skin Irritation from your CPAP Mask
One of the most common physical effects of CPAP mask use is developing red pressure lines, irritation, or even rashes or sores on areas of your face that are in constant contact with the mask.
This issue arises because CPAP masks must be securely fastened to your face all night to deliver the proper air pressure. Having a foreign object pressed against delicate facial skin for 6-8 hours can cause some skin trauma such as imprints, redness, or chafing.
The main culprits are the straps and seal of the CPAP mask applying too much localized pressure against parts of your face.
The tight straps can dig into your skin, especially around the back of your head or upper cheeks. The plastics of the mask itself can rub or chafe areas like your nose or chin.
The friction and concentration of force on small areas of skin reduces blood circulation, which can also make the skin prone to injury.
To alleviate this, first try adjusting the tightness of straps and placement of the mask to relieve any pressure points. Use protective foam, gel, or silicone cushions that act as a soft barrier between your face and the mask at areas of frequent contact.
Overall, ensure the mask applies even pressure across your face rather than focused pressure spots. Your equipment provider can help adjust for optimal cushioning and fit.
For me, I get strap marks because I like the mask tight. That’s unavoidable but they go away within 20-30 minutes of waking up.
I’ve had a few rashes over the years, but one really nasty one. It was caused by using a facial moisturizer right before bed and not washing it off. The silicone rubbing against it while I slept caused it to heat up and it was almost like a small chemical burn.
I wash my face with just water every night before bed and give it a firm drying with a towel to removed any residual skin oils or anything on my face – I’ve not had an instance like that since.
5. Stuffy, Dry Nose or Mouth using CPAP
CPAP airflow can cause nasal, sinus, and throat dryness for some users. Be diligent about mask leaks which amplify these effects.
This one can get weird for some of us. I find if I’m congested before going to bed, the CPAP machine clears me up as it forces open my airways. This is a godsend if I have a head cold or the flu.
But other times, I’ll wake up clear of congestion but the dryness in my nasal passages leads to my nasal mucous membranes going into hyperdrive and suddenly I’m congested.
Use a humidifier to moisturize the air from your CPAP. Saline nasal spray, antihistamines, cough drops, and decongestants can also provide relief. If mouth breathing is the culprit, a chinstrap may help keep your mouth closed.
Also, drink lots of water. I keep a water bottle beside my bed. I have a bit mouthful before I put my mask on and do a quick 3 second gargle at the back of my throat before swallowing it. If I wake up in the middle of the night, I go through that routine again – it helps hydrate me, but it’s also like a pattern that helps me fall back to sleep.
6. Feelings of Claustrophobia
The feeling of claustrophobia when using a CPAP mask is one of the first things people complain of when they get their machine.
It’s totally natural to feel weird about wearing something on your face overnight, especially something that effects your breathing patterns. This feeling of confinement from wearing a mask can be anxiety-provoking. It may even put you off wearing your CPAP mask altogether. But you’re not alone – the majority of first-time users of CPAP technology feel the same way.
Here are some ways that sleep apnea sufferers can help overcome these feelings of claustrophobia:
- Try systematic desensitization by slowly increasing your mask-wearing.
- Wear your CPAP mask while awake and doing relaxing activities, then during daytime naps, and finally overnight.
- Practice controlled breathing exercises if you feel panicked. Consider a nasal pillow mask for a less confined experience.
I was very lucky, I never dealt with this, but some people I know who have sleep apnea and have tried CPAP have almost universally complained about it. The ones who kept at it and gamified it by trying to wear the mask more and more each night were the ones who inevitable ended up adjusting quickest and getting the best results.
7. Difficulty Finding a Comfortable Sleeping Position
It’s challenging for some people to drift off while wearing their CPAP mask, especially if you’re struggling to find a comfortable sleeping position.
I know it can be tricky figuring out how to sleep comfortably with that CPAP mask on your face, and I definitely struggled when I first got the machine as a traditional tummy sleeper. I found the CPAP machine tubing could get in the way as well.
It always takes some time getting used to something pressed against your skin all night long. The good news is there are some tricks to finding positions that work for side, back, and stomach sleepers.
First, make sure to adjust your mask fittings. Loosening the straps a bit can reduce pressure on your face so the mask rests gently. Position the strap anchors so they don’t pinch anywhere. Try putting an extra cushion under the back strap to lift the mask off your neck and reduce contact.
If you’re a side sleeper, a contoured pillow can help elevate your head so the mask doesn’t smash your face.
Stomach sleepers might turn their head to one side, using a soft pillow to cradle their face comfortably. Don’t be afraid to try out pillow configurations and head angles until you find what feels best for your body
Pro tip: I found a position on my tummy where my arm is up and my forearm/wrist area rests against the top of the mask frame as I sleep, essentially holding it in place and removing any leaks at the top of the nasal bridge area. Find your position!
8. Unintentional Removal of your CPAP Mask at Night
Some CPAP users find that they’re unconsciously ripping off their mask while asleep.
Finding your CPAP mask suddenly missing when you wake up can be frustrating and concerning. But don’t worry – with a few simple tricks, you can outsmart your nighttime mask removal habit.
The key is making your mask feel so comfortable that you forget it’s even on your face once you drift off.
Easier said than done, I know.
Start by switching to a soft, flexible full face mask which wraps gently around your nose and mouth. This makes it harder for “sleep-you” to peel it off compared to smaller nasal pillows or masks.
Next up is perfecting the fit so there are no gaps or rubbing that make you want to rip that thing right off. Make sure the frame and straps are adjusted so the mask sits lightly on your skin. The mask should feel like a second skin – you shouldn’t feel air blowing on your eyes or any pinching sensations.
Add a chinstrap too to keep your mouth from falling open during sleep, which can displace the mask and break the seal. The strap gently keeps your lips together and jaw in place.
Pro tip: Use the CPAP Heated Humification
And here’s a pro tip – use heated humidification with your CPAP! The warm, moist air makes the mask much more comfortable and less drying. This prevents the mask from feeling irritating or suffocating, so you’ll be less inclined to remove it.
With these simple fixes, your mask will start feeling like an extension of your face rather than a foreign object. Before you know it, you’ll wake up surprised that your mask stayed on all night.
Be patient through the adjustment period. Visit your equipment supplier frequently for mask tweaks until you have excellent fit and comfort. With time, CPAP can become a normal part of your bedtime routine so you can finally get some restful sleep.
