Positive Airway Pressure (PAP) Therapy Tips

When You Need Your PAP the Most

You may find that you're able to fall asleep initially with your PAP mask but you wake up during the night and have trouble falling back asleep. Don't give in to the temptation to remove the mask for the rest of the night. Sleep Apnea tends to be worse during REM sleep and you have most of your REM during the last third of the night. That means that the early morning hours are the most critical for PAP use.

Reducing Excessive Condensation

Rain out (the buildup of water in the mask or tube) is caused by large a difference between the temperature inside the tube and the outside the tube. If you use a heated humidifier and like to keep your bedroom temperature low, try putting the tube under the covers – this will prevent the build up of condensation. We sometimes recommend tube wraps for your CPAP tubing. These can be supplied by the equipment company. Note it is normal to have some condensation inside the mask when you wake up in the morning. Excessive moisture is only an issue if there is so much water building up that water is literally dripping onto your nose or there is water sloshing in the tube.

Tube Management

An easy way to keep the connector tube out of the way is to loop the tube through the headboard. If you don't have a headboard, you can wedge the tube between the mattress and the wall, but be sure to give yourself enough slack so the tube doesn't get pulled every time you switch positions.

Reducing Skin Irritations

A good way to reduce skin irritation is to have two masks so you can alternate them periodically to give your skin a break. Be sure to select different styles so the masks come in contact with different areas around the nose. Don't over-tighten the mask – it should fit just snugly enough not to leak when you switch position. Be sure you clean your mask regularly using soap free of dyes and perfumes.

Adjusting to PAP Therapy

Try not to get frustrated. PAP is an invasive device and it takes most people several weeks to get comfortable with the therapy.

Put Your Mask on Before Starting the Air

During your adjustment period to PAP therapy, be sure to secure your mask before turning on the air pressure. A well sealed mask is much more comfortable than a leaking mask.

Getting Used to the Air Pressure

New PAP users often find it strange to exhale against the positive pressure. Do your best to relax and just breathe normally. If you're having trouble adjusting, try reading a magazine or watching TV while wearing your PAP mask. You may find that with some distraction, you forget all about the mask.

Another technique is to use the ramp feature which starts the pressure at a lower level and slowly increases it to the therapeutic pressure over a period of time.

Getting the Right Mask

Using a PAP machine with an ill-fitting mask in impossible. There are many different mask styles available to fit all shapes and sizes. If you are consistently having trouble getting your mask to seal properly, contact your Durable Medical Equipment (DME) Company and tell them you may need a different size or style mask.


While you may be tempted to take a night off while you're adjusting to your PAP machine, the more consistently you use the machine, the faster you'll get used to the therapy, so do your best to keep the mask on all night, every night.

Permission to Take a Break

During the night if you find yourself battling with your mask or fighting to breath against the pressure then take a break. Take the mask off and get up for a glass of water or to use the restroom before trying again.

If you are extremely frustrated and unable to get comfortable even after taking after a break, it's okay to take the mask off for the rest of the night. Remember, removing the mask should be a last resort since the more often you do this, the longer it will take you to adjust to the therapy.

Mask Fitting Tips

Correct Mask Fit
Ideally your mask should be fit by a trained sleep technologist or respiratory therapist, however sometimes a mask can fit perfectly in the lab but once you get home, things change. The mask should be snug, but not so tight that it feels glued to your face. There should be some give so that, as you move during the night, the mask will shift with you to maintain the seal. For most nasal mask styles, there should be enough slack in the headgear to allow you to pull the mask about an inch away from your skin.

Fixing a Mask Leak
Most mask leaks can be fixed by pulling the mask away from the face and "reseating" the mask. If that doesn't fix the problem, you need to find the source of the leak. Usually, if a nasal mask is leaking, it's because the strap kitty corner to the leak is too tight or the strap closest to the leak is too loose. Sometimes the best approach is to check the tension of the straps and try to get them equal.

CPAP Pillows
Some people benefit from a specially designed pillow that will make it easier to sleep in a side position. This pillow will also reduce the tendency of the CPAP mask to become dislodged by movement.

Changing styles can help resolve feelings of claustrophobia. Switching to a nasal pillow style or as counterintuitive as it may sound, a mask that covers both your nose and mouth may be more comfortable. Also, try holding the mask in place with your hand for a few minutes before putting on the head gear. Your sleep specialist can provide a number of desensitization techniques for you.

Heated Humidification
PAP therapy can cause dryness and the cold air from the machine can irritate the sinuses. Adding heated humidification can reduce dryness and decrease congestion to minimize mouth breathing. However, setting the heated humidification too high can lead to excessive condensation or rain out.


For a list of helpful links and websites, visit our Resources section.

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