Overcoming the Challenges of Breathing on CPAP

Sleep apnea is a life threatening disorder that should be taken seriously. For most of us, sleep apnea is “for life”. CPAP treatment is the gold standard treatment and although it has its challenges, with proper follow up care, most patients can expect a resolution of restorative sleep and return to a fully energized lifestyle.

Proper follow up care is a team effort. The team is comprised of the prescribing physician and the CPAP equipment provider but the most important part of the team is you. You, the patient must take an active role to assist in the lifetime management of your sleep apnea disorder. No one cares more about your sleep health than you. It is important to take the lead and keep your team informed of your successes as well as your difficulties. Your healthcare team cannot help you if you do not keep them informed.

After the diagnosis, the first year will offer up the most challenges as you learn to use CPAP therapy each time you sleep, including daytime naps. Getting used to the continuous flow of air from CPAP (Continuous Positive Airway Pressure) is one of the challenges.

Helpful tips are as follows:


Ask your CPAP provider to explain RAMP to consider enabling this feature for your comfort. Ramp is a feature that allows the machine to initiate pressure at a low setting over a particular period of time with the goal of the machine reaching its full pressure as you are falling asleep. As an example, if your prescribed and optimal pressure is 10, ramp may be set to start at 6 and “ramp up” or increase slowly to 10 within 30 minutes. The ramp initial pressure and time are variable. Ramp may be enabled or disabled on your machine, so discuss this with your CPAP provider.

Expiratory Pressure Relief

Your machine may have a feature called CFLEX if a Respironics brand or EPR (Expiratory Pressure Relief) if a ResMed brand. Ask your CPAP provider to explain this option to consider enabling this feature for your comfort. Both offer the ability to reduce the CPAP pressure by 1, 2 or 3 pressure points lower as the machine detects when you begin to exhale. As an example, if your machine is set at 10, and using CFLEX or EPR at 3, the machine will always deliver 10 when you inhale, and then automatically reduce to 7 as soon as you begin to exhale. This is a helpful feature to most patients, but especially those challenged with mid to high range pressures of 10 or higher. Breathing over a constant flow of air pressure is one of the most challenging aspects of using CPAP therapy.


It’s hard getting used to sleeping with a mask strapped to our face delivering air that may feel like a hurricane force wind. It can be intimidating and cause some patients anxiety. Many of us retire to bed, put on our mask, turn the machine on and then lay there focusing on the feel of the mask, the noise of the machine and the air blasting at us. This can cause a feeling of claustrophobia, and even cause us to unconsciously “fight against” the delivery of air which may result in a choking sensation and panic.

When you retire, slip on your mask, turn on your machine and turn your focus totally away from the machine. Your goal is to let nature take its course and fall in to a natural rhythm of breathing. The RAMP feature will be very helpful to patients who struggle with this issue. Expiratory pressure relief is also helpful. They key is to turn your focus to something relaxing and pleasant. Using visualization techniques, create a safe and utterly relaxing place of your choosing, in your mind, and go there.

If you are especially challenged with this issue, practice using the machine during the day and while awake. Sit upright in a chair with mask and CPAP on while watching TV or doing some other activity to distract you. This will help you get comfortable wearing the mask on your face, and the distraction of watching TV will allow you to focus on something else rather than the air pressure.

CPAP Humidification

The air delivered by CPAP is the same temperature as your sleeping room environment. So if you are using air-conditioning in summer or keep your bedroom chilly during fall and early winter you may experience discomfort. The blast of air entering your nostrils may very well be 65 degrees and that can be a shock to the nasal lining and cause pain. In winter months, when we fire up our furnace, the heat can cause a drying affect in our household as well as our nasal lining! Using the addition of a CPAP humidifier with heat, resolves this common problem. To determine the best temperature, start at the lowest humidifier setting and only turn up the heat as needed. Remember, it is primarily the moisture we need, not a high heat.

The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. Contact your physician or health care provider when you have health related questions. Never disregard or delay medical advice because of information you have obtained on this site.