The most difficult adjustment to make when beginning to use continuous positive airway pressure (CPAP) is learning to breathe out against the pressure. Fortunately, there are some helpful adjustments that can be made. First, if you find this most troublesome as you are falling asleep, the machine's pressure can be set to start lower and then slowly increase as you are falling asleep (sometimes called a ramp function). In some circumstances, a bilevel, BiPAP, or cflex setting that alternates between an inhalation and exhalation pressure can be helpful. If this problem persists, it might be that the pressure setting is simply too high for you.