It can be one of the most frustrating early experiences in using continuous positive airway pressure (CPAP) to treat sleep apnea. You are committed to the treatment, perhaps with a little hesitance at first, but you find yourself being undermined in the night. You diligently put your CPAP mask on as you go to bed, but you wake up in the middle of the night and sure enough: it has come off. It may be lying on your pillow, blowing air purposelessly – or even across the room. How can you learn to keep your CPAP mask on at night?
Address Pressure, Mask Comfort Issues
Even though you may be asleep, you are still aware enough to recognize something pestering you. You may wake enough to remove the mask, without regaining full consciousness. Much like sleepwalking or sleep eating, you may not remember anything about your actions when you do fully awaken. This can be a deep-rooted source of frustration and aggravation, especially as you strive to be adherent to the treatment. The most likely cause of you pulling the mask off during sleep is due to improper pressure settings or problems related to mask discomfort.
If the pressure of the CPAP is too low or too high, you may remove the mask because you can’t get enough air or because of excessive leak. Air blowing around, especially into the eyes, can be quite disruptive. If your CPAP mask is too loose, this will be worsened. If the mask is too tight, there may be pain across the bridge of the nose, at the nostrils, or other pressure points on the face. If you are lying on your side and the mask is smashed into your face, this may be bothersome enough for you to remove it. It may be necessary to try a different size, style, or type of CPAP mask.
Make certain that your pressure setting is proper. Your durable medical equipment provider or sleep specialist can download the data card and evaluate whether the pressure setting is adequate. In addition, if there is excessive leak prompting the CPAP mask removal, this will become apparent in the data report. A few changes in the pressure setting or mask type may be all that are necessary to correct the issue.
In some cases, employing a pressure ramp may be helpful. By starting at a lower pressure as you fall asleep, you may be able to sleep more deeply before the pressure increases. This may prevent mask removal. In addition, the use of a heated humidifier and heated tubing may make the experience more comfortable by reducing mouth dryness and this can improve compliance.
Consider Sleeping Pills
Some sleep specialists will prescribe a short course of sleeping pills to help with the transition to using CPAP. This may seem odd at first brush, but it can actually be a reasonable course of action. Most people with untreated sleep apnea wake frequently during the night. This does not usually cause complaints of insomnia, but it can. Treatment with CPAP can make it harder to fall and stay asleep, a new experience for most people with excessive sleepiness as part of sleep apnea. The sleeping pills can minimize the awareness of the CPAP and make it less likely that the device will be removed. Common options could include Ambien, Intermezzo, Lunesta, Sonata, and others. It is typically not recommended for these sleeping pills be continued over the long term, as this is unnecessary in most cases.
Desperate times can call for some desperate measures. There are a few other options that are sometimes used anecdotally. Some people apply a chinstrap to help keep the CPAP mask on. Chinstraps are most often used to prevent mouth breathing with CPAP, but they may add another layer of protection to keep the mask on. If you have more things to remove, the theory goes, you might wake enough to realize what you are doing – and hopefully stop.
Some people use a small amount of paper or cloth tape across the edge of the CPAP mask and cheek. Therefore, if it is removed in the night, the pull of the tape on the skin will be painful enough to also cause an awakening.
Finally, the best option for most people is also the most obvious: just put it back on. If you wake up in the night and find the CPAP mask lying next to you, reapply it and restart the machine. You will gradually condition yourself to keep it back on. This will also increase your total amount of use, which will have its own advantages. So no matter if you find it off once or a half dozen times, when you wake up and realize it, put it back on.
If after making a few changes you are continuing to struggle to use your CPAP as much as you would like to, start by speaking with your equipment provider or sleep specialist to see what your best options might be to improve your ability to keep the mask on at night.
Kryger, MH et al. "Principles and Practice of Sleep Medicine." Elsevier, 5th edition.