CPAP: a primer for newbies

Some practical advice on understanding and using CPAP therapy for sleep apnea

If you have been prescribed continuous positive airway pressure (CPAP) to treat your obstructive sleep apnea, you might be slightly hesitant before beginning therapy. The most common question rears up, such as: how can I get myself to do this?

The good and bad news

The bad news is that it may take a bit of effort to adapt to the CPAP machine. However, the good news is many folk adapt fairly quickly (i.e. within several weeks or sooner). And by following a couple of simple recommendations, you may discover that it is easier than you expect.

A positive mindset

It is essential to have a positive approach in mind when considering CPAP. Start with the attitude that there may be a few initial hurdles to get over, but you will be able to make adjustments on the fly, and ultimately make your CPAP treatment work for you.

Keep in mind the benefits that await you; better sleep leads to improved concentration, mood and energy, in turn improving your overall health and well being.

Choose your equipment wisely

One of the most important decisions when embarking on CPAP treatment for the first time is your choice of a supplier. You may be handed a list of companies by your sleep doctor. Call around and decide the best place to visit. Remember, these suppliers are businesses, so be certain that you get good customer service.

Additionally, even though most people get treated with CPAP, you may alternatively be prescribed machines that deliver bilevel (or BiPAP or VPAP) or more advanced settings. Another key responsibility of the equipment provider is to fit you with a good CPAP mask.


All about CPAP masks

Selecting a CPAP mask is a critical step in beginning CPAP treatment, and complete success or failure can hinge on this decision. So it is best to select a mask that fits your specific needs. You will want to place attention to the anatomy of your face, including the particular shape of your nose and how easily you can breathe through it.

If you are male, the presence of facial hair might influence the mask choice. Additionally, you might want to consider if you are likely to breathe through your mouth whilst asleep as this may lead to mask leaks.

Existing medical conditions like a deviated septum, a broken nose and claustrophobia (to name a few) may also influence your choice of mask.

When everything has been accounted for, it is wise to select the smallest mask that you can tolerate. This will reduce the overall surface area and, therefore, decrease air leaks and visibility of pressure marks.

A good analogy is to remember that CPAP masks are like a pair of shoes: once size cannot fit all. If possible, try the mask on in the store or take it home on a trial basis.

If it doesn’t work out, ask to return it in the first month for a replacement option, as most reputable manufacturers will let you have a trial period to see if your mask is suitable.

Ease yourself into sleep

Once you’ve made your equipment choices, it’s time to consider the practicalities of using your CPAP at home. The first time will probably feel unnatural and uncomfortable to sleep.

The good thing is, with CPAP, you can ease yourself into a night’s sleep by practicing a little before using it at night. Doing this might mean setting up the machine in another part of the house where it’s comfortable.

If you’re in any way claustrophobic, first get used to the mask; simply hold it up to your nose or mouth with the machine off. If this creates anxiousness, try to take slow and deep breaths against the blowing air.

If you find it necessary, simply pull the mask back off. Gently extend the amount of time you hold it to your face gradually, allowing anxiety to dissipate. When you feel ready, apply the headgear straps that hold the mask in place.

Adjust the straps to get an even tension around your nose. Continue to breathe slowly and deeply until you feel comfortable.

Connecting your CPAP mask

Next, connect the mask to the tubing and CPAP machine. Once this is complete, turn on the device. At this point, assure that there is no air leaking into your eyes, the sides of the face, etc. After any minor adjustments you need to make for a good sealed fit, it’s time to turn your attention to the CPAP machine.

Most often, the device starts at a lowered setting and gradually increases the air pressure (this is called Ramp) the longer you use it.

Using the Ramp feature

The use of Ramp allows you to fall asleep easily, but it will also help you to practice with it. If the pressure starts to get too high, you can reset it or even turn the machine on and off to lower it again. General settings on most units range from five (5) to forty-five 45 minutes, with most units adjusting in increments of five minutes (i.e., 5 min ramp, 10 min ramp, etc.).

Practice makes perfect

When you’re ready, take slow and deep breaths with the mask and CPAP pressure blowing. You will find that the air pressure fills up your lungs, which is easy to breathe in. As you breathe out, you will feel a measure of resistance.

You will also hear or feel the air escaping from the exhalation ports on the mask, which are on the front panel of most, if not, all masks. This resistance will be a little uncomfortable; however keep at it: it will get easier.


Try to focus on taking full, even breaths. For masks that fit slightly up or around the nose you must keep your mouth closed as you breathe.

Be mindful that if you open your mouth with a nasal oriented mask, you will feel the air rush out of your mouth (following the path of least resistance), and there will be no benefit. A full-face or total-face mask however, will allow you to breathe any way you wish.

Once you establish a comfortable breathing pattern, perhaps after a few minutes or hours, focus your attention on something pleasant.

Suggestions range from watching a little television or a movie, reading a book or magazine, listening to some music, or using the Internet.

Pleasantly distract yourself and keep using the CPAP for 20, 30 minutes or longer. This practice will help you to associate the CPAP with something that you enjoy doing, and you will be more relaxed when you use it at bedtime. If you need more time to adjust, extend this period or try again later.

And with a little success comes…

You should find that by spending a little time adjusting to your CPAP it will be easier to use it at night. If you are still struggling at night, spend a little more time practicing during the day when you’re awake, as much as you need.

Most people will find that after a few days and nights of persistence, using CPAP gets easier and you’ll start to feel the benefits, eventually achieving the deep sleep you desire.

If you run into difficulties, get help early from your provider, Durable Medical Equipment Company, supplier or sleep support team.

Prompt interventions that correct early problems will ensure that the therapy is successful for you over the long term. With early support, careful mask selection, and a little practice, you can get used to CPAP treatment for your sleep apnea.

Image credit:CPAP (Wikimedia Commons)

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