Erica Dehmel, BHSc, RRT – May 2016

Most people using CPAP therapy have woken at least once through the night to find they have removed their CPAP mask in their sleep.

It’s a common occurrence during the first couple of weeks of CPAP use.  It’s almost the same as waking up to notice you have ripped the blankets off in your sleep:  You don’t remember doing it or why, your body was just uncomfortable, and needed to eliminate the source of the discomfort. Your CPAP mask is the same: your body is viewing it as a foreign object, and you will take the mask off without realizing it. Sometimes, you’ll find it neatly tucked away with your CPAP device and tube. Sometimes you will have to search around for it, as it was tossed across the room in your sleep. If this occurs once or twice, it’s nothing to be concerned about. Just put the mask back on when you realize you’ve removed it and get back to sleep.

However, if this seems to be happening multiple times a week over an extended period of time, you should try to determine the cause.

In my experience, someone who removes their mask in their sleep repeatedly will have one of three CPAP-related problems that can cause inadvertent mask removal.

  1. Possible problem: Mask discomfort. The mask is quite often the “weak link” with therapy. Maybe it’s shifting out of place when you move from side to side in your sleep, causing an air leak. Or maybe after a couple of hours of wearing the mask, there’s a pressure point somewhere that’s bothering you that you don’t realize is an issue.  Whatever the case may be, addressing the issue may prevent the mask removal from occurring.
    • Possible Solutions:
      • Visit your clinician to determine if there is a significant mask leak occurring. If so, review your mask fitting technique and see if there are any adjustments you can make to improve your comfort and fit.
      • If adjustments to your current mask don’t work, consider trying a different mask. Your clinician will help you determine alternative masks that may address the discomfort you are having.
      • If your equipment is over 6 months old, it may be starting to break down. This can cause mask leaks or skin irritation that can lead to inadvertent mask removal in your sleep over time. Bring your mask to your follow up appointments with your clinician to ensure the mask is not wearing out.

TIP: Make sure you clean your mask weekly, if not daily. Oils in your skin will collect on the mask seal over time, which can cause the equipment to wear out quicker.

  1. Possible problem: Inappropriate humidification setting. Humidification is an important part of CPAP therapy. Your nose is your body’s natural humidifier: it will take the air you breathe in and ensure it reaches the right humidity level before it enters your lungs. With CPAP, you’re getting a lot more air than you normally would throughout the day. Sometimes it’s too much air for the nose to humidify, which can lead to issues such as dry mouth, congestion, and nosebleeds. Most people using a CPAP device use humidification to prevent this; however, if your humidity isn’t at the right setting, it could be why you’re removing the mask in your sleep.
    • Possible Solutions:
      • Increase your humidity level. You may not have any of the symptoms of dryness, but your body may be telling you to remove the mask due to the air feeling too dry. Ask your clinician how to increase your humidification setting if you aren’t sure how to do this with your device.
      • If you notice a lot of water building up in your mask or tubing, that water may be “spraying” at you through the night and could be the cause of the mask removal. If you sleep in a cold room (particularly during the winter months), make sure your tube is kept warm. This can be achieved by using the heated tube feature on your device (if your CPAP has that capability); by purchasing or making a tube cozy or sleeve to insulate the tube; or by keeping the tubing under the blankets with you. If your room isn’t all that cold, try decreasing your humidity level. Again, check with your clinician if you’re unsure how to do this with your device.
  1. Possible Problem: Pressure. The whole purpose of the CPAP device is to build up pressure in your throat to “splint” it open, which prevents the snoring, and more importantly the sleep apnea. A lot of people use automatic CPAP devices, which means their CPAP device will start off at a low pressure and automatically increase when it senses your throat starting to close. While it’s very effective therapy, the pressure increases may be causing you to remove your mask.
    • Possible Solutions:
      • If you have tried addressing mask and humidification issues and continue to remove the mask in your sleep, see your clinician to determine if the pressure is causing the inadvertent removals.
      • If you are just starting out on CPAP therapy, it’s normal to remove the mask at higher pressures in the first few weeks; this typically resolves itself with long term use.
      • If you have been using CPAP for a long time, and suddenly start removing the mask due to pressure increases, your clinician may be able to make adjustments to address this discomfort.
      • If you are aware of the pressure increase in your sleep, either turn your machine off and restart it to reduce the pressure, or try using your “ramp” button if your device has this capability. Ask your clinician how this works with your particular device.

TIP: Keep in mind that if the pressure is building, it is likely increasing for a reason: your throat is closing and the machine is trying to do its job. Reducing the pressure too much will not control your sleep apnea. Your clinician will determine what the appropriate settings should be to address your OSA, but they can make adjustments in some cases to improve your comfort with CPAP.

Whatever the cause may be, removing the CPAP mask inadvertently through the night disrupts your therapy. Long term, consistent CPAP use for the entire night is essential in feeling the most benefit to CPAP therapy, and in improving your overall health. Whenever an issue like this arises, it’s important to discuss it with your clinician to ensure you’re getting the best possible outcomes with your CPAP therapy.