PAP Therapy Problems and Solutions

Are you new to PAP therapy or getting used to the new equipment? PAP machine can be overwhelming and sometimes problems would still come up.

Being on a PAP machine does take some time to take effect but with patience, you will surely experience improvements in your sleep, health, and quality of life

Your first recourse is to contact your DME provider or you can also call your physician prescriber. MyApneaPath offers a free service for PAP problems & can suggest possible solutions.

Here are the most common problems and how to effectively deal with them.

Machine Problems

Older machines tend to produce a humming or vibratory sound. If you have an old machine, keep it as far away from you as possible or you can try using an earplug or noise canceling headphones. Fortunately, most new models of PAP devices are almost silent and you may opt to get an upgrade instead.


  • Check with your DME provider if you’re eligible for a new machine. Typically, insurance covers for a new one every 5 years or if your current machine is broken beyond repair.
Some patients, especially those with high pressure settings, have difficulty tolerating the pressure and this can be quite the hurdle.

  • Turn on the ramp feature. This allows you to start with a low pressure setting which is followed by a gradual increase until the recommended pressure setting is reached.
  • Turn the C-Flex/A-Flex/BIFLEX (Respironics) or EPR (ResMed) on which allows the pressure to decrease slightly upon exhalation.
  • Switch to a BIPAP machine.
It may take some time to get used to sleeping with your PAP machine. The more you use your CPAP, the easier it becomes.

  • Turn on the ramp feature.
  • Practice good sleep hygiene.
  • Try to use the PAP during the day while sitting on a chair or sofa while reading or watching TV to get used to the sensation of PAP.
If this is a common problem for you, try a hose management system. These are designed to keep your hose away out of arm’s reach, so you won’t find yourself waking up in a tangled web of hose.

  • You may want to use a ‘Top of the head’ mask. The tubing connects to the mask from a connection point that sits on top of the head as opposed to traditional CPAP masks that connect to the front of the mask.
  • Try hanging your tubing from your head board/bed head.
  • Try to use a CPAP pillow. Specifically designed with CPAP users providing space for your CPAP tubing to rest.
The length of a standard CPAP tubing is about 6 feet. Active sleepers who toss and turn are more apt to tug on the tubing and pull their machine off the bedside table. Most CPAP suppliers offer tubing in 10 feet lengths which give patients more freedom of movement.
When the temperature drops in the fall and winter, many patients experience water condensation in their tubing and masks. When the air blows through the wet tubing, it creates a loud gurgling sound.

  • Lower the humidity setting on your humidifier.
  • Insulate the tubing with a hose wrap or keep it underneath the covers.
Check your electric outlet to make sure it is working. Otherwise, make an appointment to bring your machine in to be evaluated by your DME provider. Oftentimes, the power cord just needs to be replaced.

Bacteria can quickly develop in the water chamber. All manufacturers recommend the use of distilled water. Each morning, empty any leftover water, rinse chamber and let air dry.

  • To remove the film, fill the water chamber with 1/3 white distilled vinegar to 2/3 tap water solution. Let soak for one hour. Rinse with clear tap water and air dry.
The device will function normally and safely without water in the tub, but it will no longer provide humidification.
Nasal congestion or changes in air pressure relating to CPAP can cause morning headaches for some CPAP users. If you have a cold, sinus infection or ear infection, it may be necessary to suspend the use of your machine until the symptoms clear. Talk with your sleep specialist if you experience ongoing headaches and ear pressure or pain with CPAP use.
The machine continues to lightly blow air for several minutes after turning it off to help cool the humidifier down and to avoid condensation. This process may take 20 minutes.

To eliminate rainout:

  • Lower the humidity setting or increase the tube temperature.
  • Use a hose cover/wrap.
  • Use a heated hose.
  • Try to keep the hose under blanket.
  • Make sure your climate control and tube temperature is set to auto so that it’s going to sense the room temperature.

One of the functions of the nose is to increase the amount of water in the air before going to your lungs. When large volumes of air pass through your nose, it dries out and may become very irritated. You may also note a sore throat.

  • Increase the humidity setting.
There may be occasions where it may take a few weeks for patients to feel the full benefit of using CPAP. If you are compliant but experience no improvements with CPAP use, contact your sleep specialist.
Snoring, choking, gasping like noises should be resolved with PAP use. If not, it could mean that your pressure setting is not adequate and needs to be increased.

Pressure Too High

  • Use the ramp feature.
  • Turn on the C-Flex/A-Flex/BIFLEX/EPR.
  • Switch to an auto CPAP.
  • Switch to a BIPAP machine.
  • Consider a full face mask which allows you to breathe through both the nose and the mouth instead of one concentrated breathing cycle through your nose only.

Pressure Too Low

  • Turn the ramp feature off.
  • Be sure to check for high mask leaks to ensure air is not escaping and you are getting enough pressure.

Aerophagia occurs when the air delivered by the CPAP enters the esophagus and stomach rather than the lungs. This can lead to painful stomach bloating, gas and belching.

Possible Causes:

  • The CPAP pressure may be higher than you require.
  • The CPAP pressure may be too low and inadequate to resolve the apnea event and in your effort to get more air into the lungs, you gulp air in quickly.
  • You may have nasal congestion from a cold, flu or allergies. When your nose is stuffy, you may not be able to receive the CPAP pressure you need so you gulp air by mouth.
  • You may be a mouth breather. As your mouth falls open during sleep, air intended to enter the lungs may escape via the mouth. This may cause apnea events to not be resolved resulting to choking sensations and gulping air in quickly.
  • You may have difficulty exhaling against the pressure. This may cause anxiety, panic and a feeling of choking which may cause you to hyperventilate. This can result in quick gulping of air.


  • Adjust the pressure setting.
  • Switch to a full face mask if you’re a mouth breather or use a chin strap.
  • Turn the C-Flex/A-Flex/BIFLEX (Respironics) or EPR (ResMed) on which allows the pressure to decrease slightly upon exhalation.
  • Switch to a BIPAP machine.

The air released by the CPAP machine is generally cool and very dry which can cause nasal dryness, irritation and congestion.

  • The best method to alleviate this discomfort is turning the heated humidifier on and adjust the setting as needed. This will add moisture and reduce nasal symptoms.


  • Congestion can be common in the winter and during allergy season and it is not always a result of using CPAP therapy. Contact your healthcare provider if congestion persists.
Occasionally, CPAP treatment causes irritation to the nasal lining which results in sneezing. This may settle down on its own. If it does not, then nasal sprays which reduce the inflammation may be given.

If you have allergies, chronic sinus problems or a deviated septum, you may have trouble using PAP. If during the day you often find yourself breathing through your mouth, PAP may be difficult to use.

  • If the problem is allergies, contact your primary care doctor about treatment. Nasal sprays and allergy medications can be given.
  • Individuals with a deviated septum or other nasal structural problems may benefit from seeing an ENT specialist.
  • A full face mask may be considered.

Taking the mask off and putting it back on can be cumbersome especially for someone who uses the bathroom several times a night.

  • For nighttime bathroom breaks, instead of taking the mask off and putting it back on again, you can simply disconnect the mask from the tube/hose.

No air should be directed up in to the eye area with a properly sized and fitted mask.

  • This might indicate leak in the top area of your mask. Gently tighten the top mask straps taking care not to overtighten. This leak might also indicate a worn mask cushion that needs replacing.
  • Some people naturally sleep with their eyes partially open which can cause dryness or irritation. They may benefit from wearing an eye mask. If swelling or irritation is chronic or persistent, consult with your sleep or primary care physician.

This happens when you breathe through your mouth at night or sleep with your mouth open.

  • If you’re wearing a nasal mask or nasal pillow mask, you may benefit from wearing a chin strap.
  • You may benefit from switching to a full face mask.
  • Increase the humidity setting if you’re still having dry mouth with chin strap use/full face mask use.
All masks have exhalation ports to allow the escape of carbon dioxide. The higher the pressure setting, the harsher this escape flow will be. Some masks have better air diffusion features than others. Some patients resolve by side sleeping with their backs turned to their bed partner to avoid a distracting air flow.

Often, side or stomach sleepers find that the head sinks in to their bed pillow which causes the blockage of mask exhalation ports and causes unwanted mask frame movement (pushed off center) causing mask leak and pressure point soreness.

  • If this is an issue, CPAP bed pillows (a specially made bed pillow designed for CPAP users) can be purchased.

Check your electric outlet to make sure it is working. Otherwise, make an appointment to bring your machine in to be evaluated by your DME provider. Oftentimes, the power cord just needs to be replaced.

Mask Problems

It is not uncommon to feel anxious or claustrophobic when wearing a CPAP mask. Getting used to wearing a CPAP mask takes time and requires patience as you adjust to the therapy.

  1. Practice wearing your mask while you’re awake. Without any of the others parts attached, hold the mask up your face. Once you’re comfortable with that, try wearing the mask with the straps. Take small steps to get used to the mask.
  2. Next, try holding the mask with the hose connected but without using the straps. Turn the machine on at the lowest pressure setting.
  3. Finally, wear the mask with the straps and with the air pressure turned on while awake. After you’re comfortable with that, try sleeping with it on.

Helpful Tips:

  • Try relaxation exercises to help reduce your anxiety about wearing your CPAP mask.
  • Use it while you’re watching TV or reading a book to help you get used to the feeling of not only the mask but also the sensation of the air pressure.
  • It may help to get a different mask style such as a nasal pillow which has minimal contact with the skin.

Your mask should not cause pain or discomfort if sized correctly and fitted properly.

  • Make sure you are not overtightening your mask.
  • It’s also possible that the mask cushion is worn out and needs to be replaced.
  • You may benefit from getting mask liners or pads.
  • You may need a different mask type/style.

You may note leaking air from around the mask or difficulty getting a good seal. This may be due to:

  • Incorrect adjustment: Tighten or loosen the headgear to get a good seal.
  • Incorrect assembly: If you took your mask apart to clean it, make sure it was reassembled correctly.
  • Incorrect mask size: Request your DME provider to comfort fit you to make sure you have the right size.
  • Incorrect mask type: People with facial hair or narrow nose bridges may find that some masks work better for them than others. Contact your DME provider to find the style that is best for you.
  • Worn out mask: General wear and tear over time and residues from oils, moisturizer and makeup can compromise the effectiveness of the mask seal. Call your DME provider to request for a new mask.

When you first start PAP therapy, it is normal to sometimes wake up to find out that you’ve removed the mask in your sleep. You may have a natural aversion that may last up to a few weeks while you are getting used to the therapy.

If, after a few weeks, you find that you are still pulling off your CPAP mask in your sleep, your aversion to the mask is most likely related to discomfort.

  • Make sure that the mask is fitted correctly and that there are no leaks. Check your air pressure and try wearing your mask during the day to see if there are any adjustments that need to be made.

Usually an allergic reaction to a CPAP mask will occur the same night you wear it.

  • If you’re allergic to your CPAP mask, stop using it immediately and use other options that uses gel instead of silicone.
  • Check whether your mask is an old version made with latex. The majority of the CPAP masks in the market today are made from silicone, and a few are made from some type of gel material. Almost all are latex free.
  • Regularly clean your CPAP mask with mild soap and water to get rid of infectious pathogens.
The plastic swivel piece which was attached to the old mask may be stuck in the rubber cuff of the tube. Remove the extra piece in order to attach the new mask.
Masks have exhalation ports to allow the escape of carbon dioxide when we exhale. When routinely cleaning your mask parts, check these ports (which looks like a tiny cluster of holes) and make sure they are not soiled and clogged. When clogged, they can cause the mask to make a whistling noise. Use a needle or toothpick to keep the holes free flowing.

You may note leaking air from around the mask or difficulty getting a good seal. This may be due to:

  • Incorrect adjustment: Tighten or loosen the headgear to get a good seal.
  • Incorrect assembly: If you took your mask apart to clean it, make sure it was reassembled correctly.
  • Incorrect mask size: Request your DME provider to comfort fit you to make sure you have the right size.

Other Problems

If you travel a lot and find lugging your CPAP machine around to be inconvenient, consider purchasing a travel CPAP. They’re specifically designed to be lightweight and portable, easing all of your travel concerns.


  • Travel PAPs are not covered by insurance.
Many new CPAP users may experience vivid dreaming or nightmares during the start of their CPAP therapy. This is an indication of increased REM sleep and is a positive sign that your sleep apnea is being treated. Excessive dreaming and nightmares are usually short-lived and will subside.

CPAP compliance measures how many hours and nights you use your therapy. Most insurances require that you use your machine at least 4 hours a night for at least 70% of the nights.

  • Any day that you don’t use the machine affects compliance, that’s how it’s calculated.

If these don’t help, get in touch with our PAP Specialist to further assist you. Book your appointment with your preferred date & time and our Specialist will be glad to call you.