The continuous positive airway pressure machine, commonly known as a CPAP machine, is the front line defense against sleep apnea, a condition that causes dangerous pauses in breathing while sleeping. Sleep apnea has been linked to an increased risk of diabetes, stroke and heart attack so treating it is vitally important to your health. If you have been diagnosed with sleep apnea, your doctor may have recommended that you use a CPAP machine regularly (each night) to ensure uninterrupted breathing and a good night’s sleep. Although it is a highly effective treatment, studies show that approximately one-third of patients don’t adhere to CPAP treatments. They stop using the device after a short time because they report is as being uncomfortable and/or too bulky. So, finding the right model might not just make it easier to wear but also incents the wearer to continue using it.

Most common types of CPAP machines
A CPAP machine uses a pump to push air into a person’s airway via a mask or nose insert during sleep. The continuous flow of air holds the nose and/or mouth open while sleeping and prevents the airways from closing. This, in turn, prevents abrupt pauses in breathing that wakes up the brain while sleeping (sleep apnea).

One issue that often stops many people from using CPAP machines is the difficulty of adjusting to air being forced into the nose and mouth and the noise that it creates. Many newer CPAP machines offer features that make them quieter and much easier to use. Some have settings that allow a lower, gentler air pressure at the beginning of the night while falling asleep. The pressure then gradually increases to the level needed during the night. Consumer Reports says that other models “adjust automatically to patterns in your breathing, increasing or decreasing air pressure throughout the night as needed.” These features make it easier to fall asleep and stay asleep with the CPAP machine on.

When trying to find the right CPAP model, one of the most important factors is the mechanism through which the air pressure is delivered. There are three different types:

  1. Full face mask: covers the mouth and the nose and seals tight to the cheeks. It is the best option for people who have trouble breathing through their nose while sleeping.
  2. Nasal mask: covers only the nose. It can have a more comfortable flow of air that doesn’t feel as forced as the air pressure pushed through the full mask.
  3. Nasal insert (also called nasal pillows): These small plastic pieces rest just below the nose and are the smallest apparati by which a CPAP machine delivers air flow. They tend to work well for those who don’t need high volume air flow to treat sleep apnea and for those who find a mask claustrophobic.

Most healthcare professionals recommend getting used to a CPAP machine gradually. They suggest using it while watching TV to become accustomed to the feeling of the mask and the air flow. Don’t be discouraged if it takes a little bit of time to get used to it.

CPAP side effects
Although you may sleep better with the CPAP machine, you may also experience common side effects caused by the forced air. They can include:

  • Dry mouth
  • Nasal congestion
  • Skin irritation and/or rash near the seal of the mask

If you experience any of these symptoms, make sure the machine is operating properly and is providing enough humidity. Make sure the mask fits properly and is not too loose or too tight. It must maintain enough of a seal to force air into the airways properly, but should not consistently cause irritation, sores or a rash. A sleep specialist or technician from the company that provided the machine can check your mask or nasal insert to make sure it fits properly.


Choosing the right CPAP machine

First, get a prescription from your doctor
Your sleep specialist or ENT doctor will need to diagnose you with sleep apnea first. This can be done with an overnight sleep study or a home sleep test.

Choose the right type of CPAP device
You can choose from a CPAP, BiPAP, APAP, ASV, or UAS machine. You can buy generic or brand name and, since most CPAP machines are interchangeable and you can use your prescription for multiple years, you can experiment with different ones along the way.

CPAP, or continuous positive airway pressure machine
Pushes pressurized air through a mask into the airways. The air pressure prevents the throat muscles from closing.

BiPAP, or bilevel positive airway pressure machine
It’s similar to a CPAP in that it pushes pressurized air through a mask into the airways thereby preventing the throat muscles from closing. Whereas a CPAP features a single pressure to exhale against, the BiPAP has two pressure settings: one for inhalation (IPAP) and a lower air pressure for exhalation (EPAP).

APAP, or auto positive airway pressure
Similar to a CPAP machine, the APAP looks just like the CPAP. The difference is that the APAP doesn’t rely on a single air pressure; rather, it reads your breathing patterns throughout the night and automatically adjusts the air pressure to your needs.

ASV, or adaptive servo ventilation
Typically, the ASV is the last line of defense for OSA treatment and is prescribed only if the BiPAP machine is not effective. Like the BiPAP, it adjusts to your differing breathing patterns throughout the night but also maintains your blood oxygen levels. The intent is for the user to not have to struggle to maintain a respiratory rate while sleeping.

UAS, or upper airway stimulation device
There are new ways to treat sleep apnea and they are a welcome relief for those who cannot adjust to using a CPAP, BiPAP, APA, or ASV machine. The Food and Drug Administration (FDA) has approved a new method of treatment called an upper airway stimulation device (UAS). Studies have shown UAS to be highly effective for treatment of moderate to severe sleep apnea.

The UAS device is inserted surgically, under general anesthesia, just below the skin as an outpatient procedure. Like a CPAP machine, it keeps the airways open during sleep. The Cleveland Clinic describes how the UAS device works: “Controlled by a remote or wearable patch, its system includes a breathing sensor and a stimulation lead powered by a small battery. During sleep, it senses breathing patterns and delivers mild stimulation to the tongue and throat to keep the airway open.”

If you have difficulty using a CPAP machine regularly, ask your Ear, Nose, Throat (ENT) specialist about UAS.

Choose a mask
Once you and your doctor determine the right type of machine with appropriate air pressure levels best suited to your breathing patterns, your next step is to choose a CPAP mask. There are 4 types of CPAP masks:

  1. Nasal pillows: tiny tubes that look like earbuds that are placed directly into the nostrils
  2. Nasal masks: cover the nose to the upper lip bridge; form a seal around the nose
  3. Full-face masks: cover the nose and mouth (and part of the face with straps that keep the mask from moving)
  4. Oral masks: only cover the mouth; form a seal against the inner and outer lip. Recommended usage with a heated humidifier to alleviate discomfort.

Special add-ons
Rainout reduction kit
If you like sleeping in a cold room, you may find that condensation builds on the inside of the hose. A rainout reduction kit will target and mitigate the effects of condensation.

How to clean your CPAP machine
When you get the CPAP machine, read the manufacturer’s instructions for proper care and operational guidelines. It’s important to use only distilled water in the machine because tap water may contain minerals that can build up and impede its function.

Cleaning the machine regularly will ensure you aren’t breathing in bacteria, especially after recovering from a cold or flu.

You will need to wash three parts regularly:

  1. Mask or nasal inserts: daily washing is best. The National Sleep Foundation recommends soaking them in a solution of one-part vinegar to three-parts warm water and then letting them air dry.
  2. Water chamber: can be cleaned with soap and warm water or the same vinegar/water solution as used to clean the mask. Rinse it thoroughly before adding distilled water. The chamber also contains filters that should be replaced according to manufacturer’s instructions.
  3. Hose: clean it weekly with soap and warm water, then rinse thoroughly.

If you don’t want to clean the machine yourself, you can purchase a machine that cleans the mask and hose automatically with activated oxygen. An online search for “automatically clean CPAP” will bring you to a wide selection of options.

Can CPAP machines help you to lose weight?
As we mentioned earlier, untreated sleep apnea can contribute to many chronic diseases including diabetes and heart disease. On the other hand, treating sleep apnea through the regular use of a CPAP machine can contribute to good health and may also help you lose weight. A 2019 study published in Endocrine News found that adults with obesity and sleep apnea lost more weight when using CPAP machines regularly.

Researchers found that those who used their CPAP lost more weight in 4 months (an average of 5.7 pounds) than patients who did not use a CPAP. Authors of the study believe that is because high quality sleep supports the function of the neuroendocrine system that influences metabolism, energy, hormones, reactions to stress and almost every organ and cell in our bodies.

Another study focused on those who had given up wearing their CPAP. A sleep expert at National Jewish Health in Denver, Colorado decided to show patients videos of themselves sleeping and struggling for air. (The videos were taken with patient permission during their sleep studies in the hospital’s sleep lab.) One patient who watched a video of himself struggling to breath while asleep described it as “seeing myself basically drowning in my bed.” The study found that the technique was so powerful that patients who watched a video“ used a CPAP mask almost twice as long as those who didn’t watch a video at all.”

Sleep apnea is a condition to be taken seriously and treated regularly. With the availability of CPAP machines and other advanced treatments, there is no need to risk developing chronic disease, or as one patient said, “drowning in bed” while trying to breathe.