Baton Rouge Clinic Health Library

Diseases & Conditions:

Tolerating the CPAP with Sleep Apnea

Published: 04, 2005

Only about 50% of all patients prescribed CPAP tolerate it. There are multiple reasons patients have for not wearing CPAP, but first, you must remember that sleep apnea is a serious medical condition requiring treatment. In many patients, it has significant short and long-term complications. It is not just snoring and feeling sleepy.

Symptoms of sleep apnea include falling asleep while at work or school. Productivity at work and school can suffer and sleep apnea patients are three times more likely to have automobile accidents. Sleep apnea can also cause depression, irritability, learning problems and memory problems. These patients have an increased incidence of high blood pressure and may have an increased risk for heart attacks and strokes. Sleep apnea contributes to weight gain and sexual dysfunction. Treatment, therefore, is essential in many patients.

There are many reasons for having difficulty with CPAP. Some patients are claustrophobic and the mask aggravates this condition. This can usually be overcome by gradually trying CPAP, initially while awake for short periods of time and slowly increasing the time on CPAP. Use of nasal pillows or a nasalaire device can help, as they do not cover the nose.

The initial pressure, especially when high, can cause problems. Most CPAP machines have a ramp feature that will gradually increase the pressure over 30 minutes, thus allowing you to fall asleep prior to the higher pressure beginning.

If you have nasal congestion or obstruction, CPAP can be difficult to adjust to. Treating the underlying nasal problem (allergies, infection or structural abnormality) frequently will allow the patient to utilize CPAP.

Excessive dryness of the nose and mouth can occur. This is worse during the cold, dry months. A humidifier can be added to the CPAP machine to relieve this.

If your mask fits poorly, facial pain can develop,. There are now many different sizes and shapes of masks to fit different shaped faces. Make sure you are comfortable with your mask and if not, request a change.

Some persons have trouble keeping their mouth closed, resulting in an annoying air leakage. A chin strap or full face mask can help with this problem.

Other options include a bi-level device that delivers a higher pressure with inspiration. Surgical approaches have, in general, been less than optimal. Most have at best a 50% success rate and you may well still need CPAP afterwards. There currently are no good medications for sleep apnea treatment.

There are other potential reasons, aside from the above, for having difficulty with CPAP. If you cannot adjust with the suggestions above, I recommend you follow-up with a physician familiar with sleep apnea and its treatment to explore other possibilities.

Mark K. Hodges, MD, FCCP
Specializing in Pulmonology Medicine / Critical Care

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