In short
- CPAP is the leading treatment for sleep apnea and works best when used all night, every night, including naps, according to the AASM.
- When adherence is defined as more than 4 hours a night, 46% to 83% of people with obstructive sleep apnea have been reported to be nonadherent, a 2008 review found.
- The same 2008 review says the decision to embrace CPAP happens during the first few days of treatment.
- A 2016 review of 82 studies found behavioral interventions improved CPAP use by about 1 hour a night on average.
- The AASM recommends educational support when CPAP is started, and suggests behavioral and troubleshooting help during the first weeks.
- The AASM says the most common CPAP problems happen when the mask doesn't fit properly.
Getting used to CPAP takes a little time, and most of the early problems have simple fixes. The first weeks are about finding a mask that seals and feels comfortable, using the ramp and humidifier settings, practicing while you're awake, and calling your sleep team as soon as something isn't working. People who get that help early are more likely to keep going, and CPAP only helps on the nights you use it.
What does a CPAP machine do?
Research: moderate (what this means)A CPAP machine blows a steady stream of mildly pressurized air through a tube and mask to keep your airway open while you sleep. The American Academy of Sleep Medicine (AASM) calls CPAP the leading treatment for sleep apnea and says it splints the airway open, stopping the breathing pauses that sleep apnea causes.
The machine itself is a small air compressor, about the size of a tissue box, with flexible tubing and a mask. NHLBI says some people notice better sleep, less snoring and less daytime sleepiness soon after starting. The AASM says CPAP works best when used all night, every night, and during naps too.
Why do the first weeks with CPAP matter so much?
The first weeks with CPAP matter because that's when most people decide whether it's for them. A 2008 review in the Proceedings of the American Thoracic Society says the decision to embrace CPAP occurs during the first few days of treatment.
Sticking with it is a common struggle. The same review found that when adherence is defined as more than 4 hours of use a night, 46% to 83% of people with obstructive sleep apnea have been reported to be nonadherent. A 2016 review of 82 studies, covering 1994 to 2015, put the overall nonadherence rate at 34.1% and found it hadn't improved much over two decades.
There's also good news in those numbers. The 2008 review found that using CPAP for more than 6 hours a night was linked to less sleepiness, better daily functioning and memory returning to normal levels. The 2016 review found behavioral support improved use by about 1 hour a night on average. The AASM's 2019 guideline recommends education when CPAP starts and suggests behavioral, troubleshooting and remote-monitoring support during the early period, so ask your sleep team what they offer.
How do you choose and fit a CPAP mask?
Choosing a CPAP mask comes down to how you breathe and what feels comfortable. The AASM says the most common CPAP problems happen when the mask doesn't fit properly, and that no matter which type you use, it should seal well and feel comfortable. There are three common types.
| Mask type | What it covers | May suit you if |
|---|---|---|
| Nasal mask | The nose only | You breathe through your nose. The AASM says it's the most common type. |
| Full-face mask | The nose and mouth, or under the nose and over the mouth | Air leaks out of your mouth with a nasal mask, or your nose is often congested |
| Nasal pillows | Soft silicone tubes that sit in the nostrils | You have leaks, or don't like the feel of a mask over your nose and face |
Sources: AASM and a 2016 review in the Journal of Thoracic Disease.
Fit is about balance. The AASM explains that a mask that's too big needs tight straps, which can irritate the skin or cause sores. A mask that's too small won't seal, so air leaks from the edges and may blow into your eyes. Either problem may mean a different size, a different style or new headgear. Soft strap covers can cut down on rubbing, and a pillow shaped for a CPAP mask and tubing can help if the mask shifts when you turn.
At the titration study, the AASM says to tell the technologist if the mask is uncomfortable or leaks. The same applies at home. Your equipment supplier or sleep team can refit you, and swapping masks in the first weeks is normal. Our guide to what happens at a sleep study explains how your pressure was set.
How does the ramp setting help?
The ramp setting helps by starting the air at a low pressure when you go to bed and slowly raising it while you fall asleep. The AASM says that if the pressure feels too high as you're trying to sleep, ramp mode lets you drift off before it reaches the prescribed level.
If the pressure still feels wrong once ramp is done, or you keep waking up with air rushing, tell your sleep team rather than changing settings yourself. NHLBI says some people need help adjusting pressure or need a machine with multiple or auto-adjusting pressure settings. The AASM says changes in pressure and device type may be needed during the first few months.
Should you use the humidifier?
Most people find the humidifier helps. The AASM says a humidifier attached to CPAP reduces dry nose and sore throat by adding cool or heated moisture to the air, and that many machines come with one built in. It suggests using it if you have a dry mouth, throat or nose.
The research is mixed on whether humidity helps people stick with CPAP. A 2016 review in the Journal of Thoracic Disease says recent reports suggest no positive effect on adherence but fewer side effects, particularly nasal symptoms. For mild congestion, the AASM suggests a saline nasal spray and turning the humidity up.
What helps with CPAP claustrophobia?
Practicing with the mask while you're awake is the simplest way to ease CPAP claustrophobia. The AASM suggests using CPAP for short periods during the day while you watch TV or read, so the mask feels more natural by bedtime.
A step-by-step method called desensitization builds on that idea. A 1993 case report in Sleep described a man with sleep apnea who had failed CPAP because of claustrophobia. After desensitization therapy, he was able to use CPAP through the night, and he was still using it regularly 6 and a half years later. That's a single case, so it can't tell you how often the approach works, but a 2020 teaching guide in MedEdPORTAL describes CPAP desensitization as a simple, brief treatment and sets out the technique for clinicians.
One way to build on the AASM's daytime practice tip at home is to move in small steps, going on only when the current step feels easy. This is our suggested sequence, not a tested protocol, so ask your sleep team to adjust it for you:
- Hold the mask to your face without the straps, with the machine off.
- Hold it in place with the machine on and ramp at its lowest pressure.
- Wear it with the straps for a few minutes while reading or watching TV.
- Wear it for a longer daytime session, then for a nap.
- Wear it to fall asleep at night.
If anxiety is strong, ask your sleep team about a behavioral sleep medicine specialist. The AASM says nasal pillows may help if you don't like the feeling of a mask over your nose and face.
What if CPAP gives you a dry mouth or a stuffy nose?
Dry mouth on CPAP usually means air is escaping through your mouth. The AASM suggests a humidifier for dry mouth, throat or nose, and says a mask style change is sometimes needed. A full-face mask may help if you have leaks with a nasal mask. Our guide to dry mouth with CPAP covers heated humidification, chin straps and mask changes in detail.
A stuffy or runny nose is another common side effect. NHLBI lists congestion, runny nose, dry mouth and nosebleeds among the side effects of CPAP and says your provider can help relieve them. If your nose is often blocked, see how to sleep with a stuffy nose and talk to your doctor before trying medicines.
How else can you make CPAP part of your routine?
A steady routine makes CPAP easier. The AASM suggests putting CPAP on at the same point in your bedtime routine each night and using it for every nap, because using it less often reduces the benefits and makes it harder to adjust. It also suggests cleaning the mask, tubing and headgear once a week at a set time. NHLBI says to clean the mask and tube every day and replace parts on schedule, so follow the instructions for your equipment.
If you have trouble remembering, the AASM suggests a support group or someone you trust to hold you accountable. Many machines also record nightly use, and NHLBI notes your provider and insurer may check that data to confirm the machine is working.
When should you call your sleep team?
Call your sleep team whenever a problem keeps you from using CPAP, rather than quietly giving up. The AASM says to contact your sleep doctor as soon as possible if you have problems with the mask, straps, pressure or air temperature. They may suggest a new mask, a variable-pressure machine or a heated humidifier.
Call promptly if:
- you pull the mask off in your sleep most nights
- you have skin sores, red marks that don't fade, or air blowing in your eyes
- the pressure feels too strong or too weak
- you still snore or feel sleepy during the day on CPAP
- you've gained or lost a noticeable amount of weight, since a 2016 review found body mass index is one of the strongest predictors of the pressure you need
NHLBI adds one safety rule: if you have stomach discomfort or bloating, stop using the machine and call your provider right away.
Snoring that continues on CPAP is worth a call of its own. Our article on snoring with CPAP explains the common causes. For a wider view of where CPAP fits, see sleep apnea treatment options, and if you've wondered whether other products can replace it, our comparison of nasal strips vs CPAP explains why they can't.
This article is general information, not medical advice.
Read next
- Dry mouth with CPAP: why it happens and how to fix it
- Should you still be snoring with CPAP?
- Sleep apnea treatments explained
Common questions
How long does it take to get used to a CPAP machine?
It varies from person to person. NHLBI says getting used to CPAP takes time and patience. A 2008 review found that people's decision to stick with CPAP tends to form in the first few days, so it's worth getting help early rather than waiting for problems to sort themselves out.
How many hours a night should I use CPAP?
All night, every night, and for naps too, according to the AASM. Research often counts more than 4 hours a night as the minimum for adherence, and a 2008 review found that use for longer than 6 hours was linked to less sleepiness, better daily functioning and memory returning to normal levels.
What is the ramp setting on CPAP?
Ramp starts the air at a low pressure when you go to bed and slowly raises it to your prescribed level. The AASM says it lets you fall asleep before the pressure reaches its set level, which helps if the full pressure feels like too much at bedtime.
What CPAP mask is best for beginners?
There isn't one best mask. The AASM says the nasal mask is the most common type, a full-face mask may help if air leaks through your mouth, and nasal pillows may suit people who don't like a mask over the nose. The right one is the mask that seals well and feels comfortable.
How do I stop feeling claustrophobic with a CPAP mask?
Practice wearing it while awake. The AASM suggests using CPAP for short periods during the day while you read or watch TV. A step-by-step approach called desensitization helped a patient with CPAP claustrophobia in a published case report. Your sleep team can also try a smaller mask such as nasal pillows.
When should I call my doctor about CPAP problems?
Call if the mask, straps, pressure or air temperature are causing problems you can't fix, if you keep pulling the mask off at night, or if you still feel sleepy. NHLBI says to stop using CPAP and call your provider right away if you have stomach discomfort or bloating.
Sources
- CPAP
- CPAP
- CPAP titration study
- Adherence to continuous positive airway pressure therapy: the challenge to effective treatment
- Trends in CPAP adherence over twenty years of data collection: a flattened curve
- Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine clinical practice guideline
- Use of in vivo desensitization to treat a patient's claustrophobic response to nasal CPAP
- Improving CPAP adherence for obstructive sleep apnea: a practical application primer on CPAP desensitization
- When continuous positive airway pressure (CPAP) fails
About this article
- Research
- 9 published sources, listed above.
- Evidence
- Moderate. How we rate it
- Last checked
- October 14, 2026
- Funding
- Paid partner of Titan Recovery. Their ads are labeled.
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* This content is for informational and educational purposes only and is not medical advice. It is not intended to diagnose, treat, cure or prevent any disease or health condition. Talk to a qualified healthcare provider about your health.