You got tested and now you need CPAP. Oh boy. Everyone you’ve talked to seemed to like CPAP but you’re NOT a fan. Here are a few reasons why:

  • Expectations

It takes time to adapt, usually about 2-3 weeks. If sleepiness was not your primary issue then CPAP is likely not going to help with feeling more awake. Most patients who ‘love’ CPAP are those who initially had sleepiness as a complaint. Your physician may have insisted you get tested due to other medical conditions that can worsen when sleep apnea is not treated. If sleepiness led you to get tested, then using it throughout your night (more than 7 hours for the average adult) will help.

  • Adapting

The idea of strapping a mask on your face before sleep is a turnoff. Some people take to it well, while many others struggle, especially in the first few weeks. Short term use of sleep aids (sleeping pills) for 3-4 weeks may help. Remember, you have sleep apnea not awake apnea! This means only put on CPAP when you are sleepy and are ready for bed. Otherwise, you will be too aware of small issues with the mask, pressure, humidity etc.

Check out our video about Managing CPAP Intolerance!

  • Home Sleep Study

The insurer mandated combination of home sleep study followed by an Auto-CPAP works well for most patients with sleep apnea. However, there are other sleep conditions that cause sleep problems and are not well treated with CPAP. You may need an in-laboratory sleep study (ugh), which provides more clinical information and allows for accurate CPAP settings.

  • Sleep Condition

At times the condition under which a sleep study is performed is different from how you sleep on a regular basis. Examples include the number of pillows used for the study, alcohol consumption, medications, and weight gain (or loss), which can affect CPAP therapy. The examples listed may lower or increase CPAP needs. Auto-CPAP devices should help overcome this issue.

To find out more about sleep disorders and how they can affect your overall health, and quality of life, check out our sleep disorders page.

  • Mask Fit

There are a variety of masks available for different facial shapes and features. Most patients adapt well to a nasal interface (either a nasal mask or nasal pillow), which is better tolerated compared to the full-face mask (covers mouth AND nose). Your best bet is to have your equipment provider (the DME, not the manufacturer) provide you with an alternative mask or visit their office with a full range of masks to select from. If you’re still not satisfied, then search online for a mask. Some sleep labs will conduct a PAP nap (may be covered by insurance), which is a test run of the chosen mask on your CPAP settings at their facility to assess fit and comfort.

  • Humidity

Your friendly DME should show you how to adjust the humidity (moisture in your mask). If dry mouth is an issue, you can increase the setting. At times water condensation is an issue, you can decrease the humidity level. If you live in a temperate climate, a climate control hose protects against moisture being lost when air is transferred from the machine to the mask. The humidifier tank should require a refill every day or every other day. Always use distilled water to maximize your device. See my blog post on ‘Waking up with a dry mouth on CPAP’ for more details.

  • Claustrophobia.

This depends on the severity of your claustrophobia. For many it is a matter of getting accustomed to CPAP, while for some it is a terrifying thought. Start with using the smallest mask interface; usually a nasal mask or pillows – pay attention to the headgear straps. Put on the mask without a hose or machine attached, well before bedtime. This means you get to play Darth Vader in a cheap sequel. Read, watch TV or walk around the house with the mask on. Otherwise short term use of anti-anxiety medications may help.

  • CPAP Settings.

The new generation of CPAP devices come with comfort settings, however, these settings may actually make sleep difficult for some. Ask your DME or contact to evaluate and troubleshoot.

These are some of the many issues which may stand between you and a good night of sleep on CPAP. While CPAP may not be the best option for all sleep apnea patients, it is the most effective.

Written by Dr. Avinesh Bhar, MD MBA

Board certified Sleep and Pulmonary Medicine


Whatever your sleeping disorder is, do not wait for it to get worse. With our board-certified pulmonary and sleep doctor, you can get evaluated and treated without having to leave the comfort of home.

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