CPAP Side Effects: The Complete Guide to Managing Them
CPAP therapy works. The evidence is overwhelming. But that doesn't mean it's always comfortable, especially at first.
The good news: almost every side effect has a solution. Here's the complete guide.
Aerophagia (Swallowing Air)
What it feels like: Bloating, gas, stomach discomfort, burping
Why it happens: Air goes down your esophagus instead of just your lungs
Solutions:
- Sleep with head elevated (wedge pillow or adjustable bed)
- Enable EPR/pressure relief on exhale
- Ask your doctor about lowering pressure (if AHI allows)
- Avoid eating 2-3 hours before bed
- Try sleeping on your side instead of back
When to escalate: If severe and persistent, BiPAP may work better than CPAP
Dry Mouth and Throat
What it feels like: Cottony mouth, sore throat, hoarse voice in the morning
Why it happens: Air dries out your oral and throat tissues, especially with mouth breathing
Solutions:
- Increase humidifier setting
- Add chin strap if using nasal mask
- Switch to full face mask (covers mouth)
- Use heated tubing to prevent condensation
- Saline spray before bed
- Keep water by your bedside
What doesn't work: Breathing through your nose harder won't help if you naturally mouth breathe during sleep
Nasal Congestion and Irritation
What it feels like: Stuffy nose, runny nose, sneezing, nosebleeds
Why it happens: Continuous airflow can irritate nasal passages
Solutions:
- Heated humidification (essential)
- Saline rinse before bed (Neti pot or squeeze bottle)
- Nasal moisturizing gel
- Check for allergies (to mask materials)
- Ensure mask isn't directing air into eyes/nose inappropriately
For nosebleeds specifically:
- Max humidity
- Petroleum-free nasal moisturizer
- Room humidifier if ambient humidity is low
- Consider heated tubing
Skin Irritation and Pressure Marks
What it feels like: Red marks, sores, rashes, acne along mask contact areas
Why it happens: Pressure, friction, and trapped moisture/oils
Solutions:
- Loosen mask straps (most people overtighten)
- Clean face before bed (remove oils)
- Clean mask cushion daily
- Use mask liner or barrier
- Try different mask style with less facial contact
- Replace worn cushions promptly
For persistent sores: See your provider. You may need wound care and a mask change.
Claustrophobia and Anxiety
What it feels like: Panic, difficulty breathing, need to remove mask, feeling trapped
Why it happens: Psychological response to face covering and forced air
Solutions:
- Practice wearing mask while awake (watching TV, reading)
- Try minimal-contact masks (nasal pillows)
- Use ramp feature to start with very low pressure
- Relaxation techniques before bed
- Cognitive behavioral therapy for sleep (CBT-I) if severe
- Short-term sleep aid during adjustment (physician-approved)
Important: Don't force it. Gradual desensitization works better than pushing through panic.
Difficulty Exhaling
What it feels like: Fighting the machine to breathe out, uncomfortable pressure
Why it happens: Continuous pressure can make exhaling feel labored
Solutions:
- Enable EPR (ResMed) or Flex (Philips) - reduces pressure on exhale
- Try APAP instead of fixed CPAP (adjusts to your breathing)
- BiPAP may be appropriate if CPAP pressure is high
Note: This feeling often improves as you acclimate. Give it 2-3 weeks.
Noise Disturbance
What it feels like: Machine noise keeping you or partner awake
Why it happens: Motor noise, air leak noise, mask noise
Solutions:
- Check for and fix air leaks (biggest noise source)
- Clean or replace filters
- Ensure machine on stable, flat surface
- Use white noise to mask CPAP sound
- Modern machines are very quiet - if yours isn't, it may need service
- Position machine lower than bed (reduces perceived noise)
Eye Irritation
What it feels like: Dry eyes, watery eyes, conjunctivitis symptoms
Why it happens: Air leak from top of mask blowing into eyes
Solutions:
- Adjust mask position (usually needs to sit lower)
- Tighten top strap first
- Check cushion size
- Replace worn cushion (deforms over time)
- Sleep masks can help protect eyes
Tooth and Jaw Pain
What it feels like: TMJ symptoms, tooth pain, jaw soreness
Why it happens: Chin strap too tight, grinding teeth, mask pressure on jaw
Solutions:
- Loosen or remove chin strap
- Check mask style isn't putting pressure on jaw
- Address teeth grinding separately (mouth guard)
- Full face mask may distribute pressure better
The Adjustment Timeline
Most side effects improve over time:
| Timeframe | What to Expect |
|---|---|
| Days 1-7 | Peak discomfort, multiple issues common |
| Weeks 2-3 | Many issues resolve with adjustments |
| Month 1-2 | Significant improvement for most |
| Month 3+ | Most users comfortable, residual issues rare |
If a side effect isn't improving after 2-3 weeks of trying solutions, contact your provider. Don't suffer silently.
When Side Effects Mean Something Bigger
See your doctor if you experience:
- Chest pain or pressure
- Severe shortness of breath
- Worsening sleep quality despite good compliance
- Significant weight changes
- New or worsening symptoms
These could indicate the need for pressure adjustments, different therapy, or evaluation of other conditions.
Dealing with side effects? Message your care team through the Drift portal. We'll help you troubleshoot. [Log in →](/patient/login)