Finding it hard to get used to your CPAP or bilevel therapy? You're not alone.

Studies have shown the majority of people will be using their device consistently within the first month of therapy^2,3. However, keep in mind that everyone is different and it can take a little time and practise to get comfortable. Learning to use your therapy equipment is about getting into good habits, staying positive and practising. It also helps to have some support from your doctor, your family and a therapy app.

While you may become more accustomed to using CPAP over time so it feels easier for you, that doesn’t mean it will become less effective over time. It’s like wearing glasses – you don’t necessarily need stronger lenses just because you’ve been wearing them several years. However, your CPAP pressure may need adjustment over time due to changes in weight, ageing, or the development of other health conditions. This will be done and set by your healthcare professional. Remember if you stop using CPAP because you think your sleep apnoea is better, your symptoms will return.

A CPAP (continuous positive airway pressure) machine delivers constant and steady air pressure to you via a mask to help keep your upper airway open while you sleep. This treatment is often used for people with obstructive sleep apnoea (OSA), preventing the airway from collapsing or becoming blocked during sleep. CPAP is considered the gold standard treatment for OSA, helping to reduce symptoms such as snoring and daytime fatigue, and improving overall sleep quality.⁴

Some people report feeling better and less tired after just one night, while others may take a little longer. If you have a good mask seal and have been using your therapy equipment consistently, you should notice benefits such as a reduction in morning headaches, forgetfulness, poor concentration and tiredness^5,6. Some other benefits of CPAP therapy, such as a reduced risk of stroke⁷, aren’t immediately obvious but are good to think about if you need motivation!

In addition to acclimatising to your air pressure or mask, like any medical treatment CPAP comes with side effects that can make it hard to get used to. These include nasal congestion, a dry nose or mouth, or feeling claustrophobic⁸. However, as we’ve seen on this page, there are lots of things you can do to help combat these. If it’s noise that’s making it hard for you to sleep with CPAP, take a look at the following question and answer…

If your equipment is noisy, it’s possible that some parts aren’t connected properly. This can result in air leaking out, causing a sound. The first important step is to work out where the noise/leak is coming from: the device itself, heated humidifier, CPAP tubing or mask. Then check everything is connected properly, run the device for a few minutes and listen for a change in noise. If it persists, refer to your mask and/or device user guide for fitting and setup instructions – you may also need to contact your device manufacturer’s customer service department or healthcare provider in case the machine needs repair.

Feeling bloated since starting CPAP therapy could be due to ‘aerophagia’, which occurs when you swallow air that then accumulates in your stomach and intestines. Sleeping on your side instead of your back during therapy may decrease aerophagia. Sleeping on your side may also reduce the pressure level needed to keep your airway open when using an PAP machine, reducing bloating caused by swallowing air. As an added benefit, sleeping on your side is widely considered to help reduce the airway blockages that characterise obstructive sleep apnoea.⁹ Using a different mask type may also help, so speak to your healthcare provider for personalised advice. They may be able to make adjustments to your therapy that can be beneficial in managing and reducing bloating.¹⁰

Put simply, the longer you use your device at night, the more benefits you should see¹¹. Studies have shown that when people use their PAP device for two to three hours each night they still experience benefits12 – but these benefits increase with each extra hour they used the device, up to seven hours¹². The general advice is to use the device for at least four hours⁷ a night, while using it for more than six hours can have benefits for your cardiovascular system⁷. Of course, as discussed earlier, you can build up to this usage level gradually – so take it slow and steady if you need to.

As explained above, you don’t necessarily have to use your CPAP all night long: the recommended usage time is around four to six hours per night. However, optimal results are often seen when the device is used for the entire duration of sleep, which typically ranges from six to eight hours per night.^11,13

If you’re finding it difficult to get through a whole night of therapy, you could try going back to basics and starting wearing your mask for shorter periods and then increasing the amount of time gradually. Some of the other tips in this article may also help. If you are still finding it hard to stay on therapy for prolonged periods, speak to your doctor.

The good news is you can sleep in any position you like when on therapy – however, some masks are more suitable for people who move a lot during the night or sleep on their stomach more than others. Our Starting with the right CPAP mask page will guide you through the options available.

Yes. As described above, you can practise using your CPAP device and mask while you are awake. Some devices can also be paired with an app that allows you to test different pressures to help you acclimatise to them before using overnight.

If you use a nasal or pillows mask, sleeping with your mouth open during PAP therapy isn’t ideal, as it can allow some of the pressurised air you breathe in to escape before it reaches the lungs, making treatment less efficient – known as ‘mouth leak’. This shouldn’t be an issue if you use a full face mask, as this covers your mouth so air can’t escape. If mouth leak occurs, your device might try to push more air out to keep to the prescribed pressure, which could make therapy less comfortable for you. If you still seem to have mouth leak during nasal CPAP therapy, contact your doctor so they can check for nasal obstruction or congestion¹⁴. If the problem persists, they may suggest you use a full face mask.

Don’t worry – there are masks that have been specially designed to fit the needs of active sleepers like you. Consult our page about masks for details.

As explained above, there are motivational apps you can use to help you get used to therapy and solve teething troubles by yourself¹⁵. These apps can also help you stick to therapy once you get into your PAP routine. Some people also find comfort accessories such as CPAP pillows can also help improve their therapy experience.