Using Continuous Positive Airway Pressure to Treat Sleep Apnea

If you use continuous positive airway pressure (CPAP) to treat obstructive sleep apnea (OSA), you likely have a love-hate relationship with the device. On the one hand, you know that OSA is a serious condition with real health risks, and you probably feel better during the day when you use the device. On the other hand, you're forced to sleep all night wearing a mask attached to a hose and air machine.

This setup can be uncomfortable and unwieldy for you—and awkward and disruptive for your bed partner—so it's understandable why you might resist using it. But you ignore the device at your own peril: Left untreated, OSA puts you at increased risk for daytime drowsiness, impaired mental performance, and cardiovascular problems such as high blood pressure, irregular heart rhythms and stroke.

Use CPAP Consistently

A solid body of research indicates that CPAP works. A 36-study review published by the Cochrane Collaboration—an independent international group that conducts objective analyses of research—found that people with moderate to severe OSA who used CPAP reported feeling less sleepy and more physically and mentally healthy during the day than those who didn't use it.

CPAP users also had 17 fewer apnea episodes per hour of sleep, and some of them had lower blood pressure readings after beginning treatment. Yet despite CPAP's effectiveness and proven benefits, the American Sleep Apnea Association estimates that only about 50 to 60 percent of people use their CPAP appliance consistently.

For maximum effectiveness, you should use the device every night, and according to a 2007 study in the journal Sleep, most people will need to use it for seven hours nightly to derive the greatest benefit. Skipping just one night of treatment can reverse some of the health benefits gained from regular use.

Overcoming Obstacles To CPAP Compliance

Although your CPAP device may take some getting used to, it's clearly worth making an effort to use it consistently. Here are some common obstacles faced by CPAP users and tips to help overcome them:

You got off to a bad start. Studies suggest that CPAP-use habits are established very early in the course of therapy. But the first few nights can be difficult, with users experiencing less sleep than usual as they become accustomed to the device.

If you're just beginning CPAP therapy (or are hoping to start over and re-establish good habits), ask your doctor if taking sleep medication for a short time is an option. A 2009 report in the Annals of Internal Medicine followed 160 people with newly diagnosed OSA. About half took 3 mg of the sedative/hypnotic eszopiclone (Lunesta) every night for the first two weeks of CPAP use, while the others took a placebo pill.

The group who took Lunesta reported a larger improvement in daytime symptoms than did the placebo group; they were also significantly more likely to be using their CPAP appliance six months later.

The mask is uncomfortable. A CPAP mask should fit the face snugly enough to avoid air leaks, but not so tightly that it hurts or causes irritation or sores on your face. To ensure a proper fit, the masks come in several shapes and sizes.

In addition, some are full-face masks that cover your mouth and nose, with straps that stretch across your forehead and cheeks. Other masks feature nasal "pillows" that fit under your nose and straps that cover less of your face. Work with your doctor or CPAP supplier to find the mask that's right for your particular face shape and have them show you how to adjust it to get the best fit.

You feel claustrophobic. Some people find that wearing a mask is claustrophobic. Purchasing a lightweight or transparent mask or a mask with a nasal pillow can help with this problem. It also may help to start by wearing the CPAP mask for short periods of time while you're awake (while watching TV, for example).

Once you become accustomed to how that feels, start wearing the mask when you sleep (during naps and at night). Stick with it for several weeks or more, gradually increasing the amount of time you wear the mask. It can take between 30 and 90 days to adjust to using CPAP.

You have nasal congestion and/or a runny nose. Because the air from the CPAP machine can dry out your nose, your body will increase its production of mucus to compensate—which, in turn, can cause nasal congestion and a runny nose. Using a saline nasal spray at bedtime can help, but the best solution is to have a heated humidifier fitted to your CPAP's air pressure machine, so that the air that enters your nose is warm and moist. Ask your doctor or CPAP supplier about this.

You're self-conscious. There's no way around the fact that being attached to a face mask and air machine all night can make you feel self-conscious and potentially be a barrier to intimacy with your partner. But the symptoms of OSA (snoring and fatigue, for example) can also have adverse effects on your relationship, not to mention serious health consequences.

Acknowledging your feelings about CPAP treatment with your sleeping partner and your doctor right from the beginning is one of the best ways to elicit support and improve overall adherence. Otherwise, embarrassment may lead you to reject CPAP therapy.

Staying Motivated to Use CPAP

Time and patience are the keys to success in overcoming OSA. Using a CPAP device can be frustrating, but it's important to stick with it to avoid sleep apnea-related complications. If feeling healthier overall and more alert during the day aren't enough to keep you motivated, consider joining an online or in-person support group for CPAP users.

Education and support have been shown to increase compliance. For more information on groups in your area, go to www.sleepapnea.org and click on Support Groups.

Publication Review By: Peter B. Terry, M.D., M.A.

Published: 09 Aug 2011

Last Modified: 24 Aug 2011