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Continuous Positive Airway Pressure, CPAP, although simple in concept, is by far the greatest invention in sleep medicine. This has benefited many patients and has been a profound life-improving experience for many. For CPAP therapy to be successful one should understand that CPAP in itself can be a source of sleep disturbance. It is crucial that the benefit of CPAP outweighs intrusion on sleep.

Proper CPAP intervention requires:

• Patient education regarding obstructive sleep apnea (OSA) as well as an understanding of medical complications related to an untreated condition. The patient needs to understand how and why CPAP therapy works.
• Proper fitting of the mask and headgear is crucial. Accurate fitting of the proper mask is similar to fitting a dress shoe. If it doesn’t fit correctly, the patient will never wear it. Once the proper mask is chosen and fitted correctly, CPAP adaptation becomes much easier.
• Appropriate CPAP titration: One of the more common flaws is to prescribe less pressure, thinking that this would improve compliance. However, under-titration of the CPAP will make the intrusion of the CPAP worse on the patient, as the patient’s sleep is even more severely interrupted with an improperly titrated CPAP.
• Keeping the nose open: CPAP works by applying air pressure through the nose. This also applies to full-face mask. By treating nasal congestion and allergies appropriately the patient can fully benefit from CPAP therapy. The proper level of heated humidity is also crucial in keeping the nose open. Sometimes there may be anatomical anomaly that will require an ENT evaluation.

CPAP Desensitization Technique

• Gradual initiation of CPAP therapy is one accepted desensitization technique. Rather than immediately implementing CPAP therapy at the prescribed pressure, first become familiar with the mask and machine.
• Try using CPAP during the daytime for short periods of time, such as 10–15 minutes to start. While sitting upright on a comfortable chair, hold the unstrapped mask loosely against your face for brief periods until you can breathe while holding the mask in place for one minute or more.
• After you are comfortable with the mask in place, strap the mask on and make sure it is comfortable (not so tight that it hurts and not so loose that leaks irritate the eyes).
• Once you can breathe with the mask strapped on, start adding a low level of CPAP by utilizing “ramp” and gradually increase to the prescribed setting.

This may feel uncomfortable but realize this is a normal reaction for everyone. It is natural for all patients to need time to adjust to sleeping with a CPAP mask on his or her face. It will take time before you can get adjusted to positive pressure in the airway.

• If you feel acute discomfort at any time, feel free to back off and start again.
• Always try to relax and feel loose during initial phase of CPAP and remember frustration is normal for many beginning CPAP users.
• Once you feel comfortable, start using CPAP regularly during sleep.
• Always try to relax and feel “loose” during the initial phase of CPAP and remember some frustration is normal for many beginning CPAP users.
• Once you feel comfortable, start using CPAP regularly during sleep.
• Always remember that the purpose of the CPAP is to help you. The more you try using it, the sooner you will be successful.
• Feel free to call our Sleep Lab with any questions or issues you may have.

We at Pacific Sleep Lab are dedicated to the highest level of patient care. We spend a considerable amount of time on patient education and CPAP adjustment. Patient satisfaction and successful outcomes have been the reward for our hard work. Do not hesitate to contact us if we may be of any further assistance.