When things go wrong with PAP

PAP is the most effective treatment for obstructive sleep apnea. It is, however, only a treatment. It has no benefit if it isn’t used. Current research estimates that the compliance rate for PAP (how many people use PAP more than a few months) is approximately 60 percent. One reason for this may be that PAP users often experience disagreeable side effects and simply stop using their appliance. Many of these side effects can be eased if a health professional is told about them or if the PAP user is taught how to manage them.

Mask discomfort.

This problem usually arises because either the patient adjusts the headgear too tight or because the mask does not fit properly. A PAP mask should fit the face snuggly to avoid air leak but not so tight that is feels uncomfortable or causes pain. If a mask has to be pulled tightly to prevent leaks it does not fit properly! Call your sleep specialist or home health provider, report that your mask does not fit well, and ask to try another size or style mask. There are many masks made by many makers, and not every nose can wear every mask. Don’t let anyone tell you that a sore on your nose is to be expected!

Nasal congestion.

irritation or runny nose that seems to be caused by PAP therapy. Your nose is your airway’s humidifier. It warms and moistens the air that you breathe. If the PAP begins to dry your nose, your body will increase the production of mucus in the nose to add more moisture to the inhaled air. Unfortunately, this may cause nasal congestion and a runny nose. In some cases the dryness will cause irritation, burning and sneezing. These symptoms can be alleviated by the use of a humidifier with your PAP device. Some sleep specialists order a passover (cold water) humidifier with the initial PAP order. If you do not have one of these, speak with your sleep specialist. If you already have a humidifier and still experience these symptoms you may need a heated humidifier. This is a water pan that sits on a heating unit and is attached to PAP machine just like the passover humidifier. Heating the air and the water will allow the air to carry more moisture as it travels to your nose (just like the summer air is more humid than winter air). In almost all cases this resolves nasal congestion and irritation caused by PAP therapy.

Difficulty breathing through your nose.

If you have allergies, chronic sinus problems or a deviated septum (your nose is crooked on the inside) you may have trouble using PAP. PAP is usually applied through the nose. If during the day you often find yourself breathing through your mouth, PAP may be difficult to use. If the problem is allergies, speak with your doctor about treatment. There are a number of good nasal steroid sprays and allergy medications that can treat your nasal congestion. Individuals with a deviated septum or other structural problems in their noses may benefit from seeing an ear, nose, and throat specialist if PAP cannot be tolerated. Finally, there are PAP masks that fit over both the mouth as well as the nose. People have used these with varying success, but it may be worthwhile to try a full-face mask before resorting to more invasive or expensive alternatives.

Headache or ear pressure.

Although treating sleep apnea usually eliminates morning headache, some patients get headaches on PAP. Others find that their ears develop pressure or pain in them. Most of this relates to underlying sinus congestion caused by allergies or PAP itself. The experience is similar to that experienced traveling in an airplane when you have a cold. The congestion can block the ear canals and changes in air pressure can cause pain when air gets trapped. It is best not use PAP when you have a cold or sinus infection to avoid these problems. Sometimes the congestion remains in the ears and sinuses after the acute symptoms of the cold are gone. If you develop headache or ear pain on PAP, speak with you sleep specialist. In the interim you may try decongestants or antihistamines, but check with your doctor before you take these medications.

I take off my mask at night and don’t realize it.

This can happen for a number of reasons: difficulty breathing through the nose, mask discomfort, or sleep disturbance. If your nose is congested when you awaken, read the two paragraphs addressing that in this paper. Speak with your home health provider if your mask hurts. If these two problems don’t appear to explain why you are pulling off your mask, it may just be that you need some time to adjust to wearing a face mask at night. During an arousal, when you are not fully alert, you may not remember that you now wear a sleep mask. It can be a scary thing to awaken with a strange thing on your face! This should improve over time. It may help to take an over-the-counter sleep aid an hour before bedtime so that you are drowsy going to bed and so that it is less likely that you will awaken at night. After a few nights you should adapt to wearing the mask. Be sure to talk to your doctor before taking these medications, particularly if you have any medical problems.

Air in the stomach.

Occasionally, a PAP user will experience air trapping in the stomach and awaken with stomach pain or gas. Sometimes simply making sure that you sleep with your head aligned with your body can help with this. If you want to elevate your head in bed you should do that with a wedge pillow or by tilting the whole mattress. If you sleep with several pillows it may cause your head to tilt forward and block your airway. Lowering the PAP pressure can help, but your sleep specialist may not want to do this if it reduces the effectiveness of your treatment. Switching to bilevel pressure or C-Flex may be very helpful in these cases.

The air is too cold.

This can be fixed with a heated humidifier. If you cannot get one, you may try running the tubing under the covers next to your body to warm the air.

The air is too hot.

This is more difficult to fix, but it may help to lower your room temperature as much as possible.

PAP is too noisy.

It is most likely a lot less noisy than your snoring, but if noise is a problem you have several options. Most new machines are quiet so this is rarely a problem. Check with your insurance company if you have an old machine. You may qualify for a new PAP. You can get an extra length of tubing so and move the PAP machine farther from the bed. A fan or other source of “white noise” can also help to disguise the noise.

The tubing gets in my way.

Draping the tubing behind you and over the headboard helps with that. There is also a new device that attaches to the bed that holds the tubing up and rotates so that it can move with you.

I take off my mask at night and can’t be bothered to put it back on.

When you get up at night, leave your mask on and just disconnect the tubing either at the mask or at the machine. This is easier than having to refit the mask.