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Pressure Discomfort Troubleshooting

Are you experiencing inadequate pressure or pressure discomfort? Proper CPAP pressure levels are required to eliminate the conditions associated with sleep apnea, including snoring, and breathing cessation. If you are consistently experiencing discomfort during CPAP use or not noticing improvements in your sleep, then your CPAP pressure settings may be inadequate.

Common signs that your pressure settings may need to be adjusted include loud snoring, mask leaks, persistent fatigue, gas pains and difficulty inhaling or exhaling while using your PAP machine.

Here are the steps to help troubleshoot PAP pressure discomfort.

Have there been any recent changes to your therapy?

Have you recently started using a new model of PAP machine or a different style of mask? When switching to a new mask style it may take time to adjust.

For example, when switching from a Full-Face Mask to a Nasal mask the airflow will feel different as it is concentrated just around your nose, instead of around your nose and mouth. This can lead to the feeling that your machine pressure is too high. If your device has a “Mask Type” menu option, be sure to change it to reflect the new mask style.

Continue to use the mask nightly in order to grow more accustomed to it. If after some time you still find that the mask is uncomfortable, consider switching to a different model or type of mask (PAP Masks).

If you have recently started using a new PAP device, familiarize yourself with your new device’s comfort features listed below. All PAP machines offer various comfort features to help ease pressure discomfort:

  1. EPR or “Expiratory Pressure Relief” is an advanced comfort option on ResMed devices that will reduce the pressure from your CPAP when you exhale, making it easier to breathe out and help your therapy feel as natural as possible. Most other PAP manufacturers have this type of feature on their devices under different a name (e.i. c-Flex). Check your manual to find out whether this feature is available and what it is called on your particular device. Choose the appropriate level of pressure relief for your comfort (EPR of 3 is the most common) – the higher the number, the more the pressure will be decreased every time you exhale.
  2. Ramp: Many CPAP machines have a “ramp” feature. When you turn the machine on, instead of delivering full pressure right away, the machine will gradually increase the pressure from a lower value to your prescribed pressure. This allows you to fall asleep faster and more comfortably. Many PAP machines allow you to adjust the ramp feature for a set amount of time (usually between 5 and 45 minutes), or to set this feature to Auto which allows the machine to slowly ramp up to your prescribed pressure as it senses you are falling asleep.
  3. Response: Some individuals are sensitive to the pressure changes associated with their APAP prescription. Some APAP machines have different response modes available. The so-called “Soft” response on ResMed units, for example, will provide a slower, gentler pressure increase during therapy.

Follow the instructions found in your machine’s user manual to learn how to turn on the EPR, Ramp and Response features. If you are unsure how to change these settings on your device or if you need more help with your pressure discomfort, book an appointment with one of our Clinical Support Specialists Here.

Check your machine with a manometer for pressure accuracy.

Your machine is set up to deliver a prescribed amount of pressure during your sleep. If your PAP unit is not giving you the pressure it was programmed to give, the result could be not only discomfort with the pressure, but apnea that is not being controlled.

Your CPAP provider can test the pressure using a pressure manometer to determine if the device is calibrated properly. Before testing, ensure a clean (ie. Not clogged), manufacturer recommended filter is inserted in the machine. (Filters)

If the manometer shows any pressure deviation than the allowable tolerance (usually +/- 1 cmH2O, depending on the device), consider replacing your PAP device as it may be faulty.

*** Review CPAPmart’s Return and Warranty Replacement policies HERE.

Check the air tubing for blockages.

If any of the following issues are happening, then the air tubing of the device may be blocked:

  • There is a discrepancy between the total usage hours shown on the machine and how many hours you believe you are using the device
  • There is an error message related to air tubing blockages appearing on the device
  • The device pressure remains the same regardless of the device settings.

The Fix:

  1. Clean the machine tube daily with a SOFT bristle brush and allow the tube to completely dry before using the device.
  2. Consider reducing the humidity level on the device to prevent condensation from forming. If you are using the new ResMed AirSense 11 device, keep the Climate Control setting on AUTO and bring the Tube Temperature down to match your room temperature.
  3. Contact the device manufacturers Customer Support team to troubleshoot the exact cause of the blockage. Be sure to have any error messages recorded in case they are requested by the team member.

Other common problems and solutions with pressure discomfort.

Stomach distension / Gas pains / Flatulence

  • If using a Full Face mask, try switching to a nasal mask with a chin strap. Full face masks tend to require higher pressures to keep the airway open, which can lead to you swallowing this excess pressure, which in turn can lead to abdominal bloating and pain.
  • Adjust the EPR/c-flex (see above) to a higher setting. The pressure required to keep your airway open when you inhale may be too high for you to handle when you exhale.
  • If you are on a constant pressure device (ie. CPAP), talk to your doctor about switching to an APAP or automatic pressure device. Most CPAP devices are set to the highest pressure setting that is required to eliminate your apneas. Your pressure requirements change through the night though and constant pressure may be too high during your non-REM or non-supine sleep.

Daytime fatigue symptoms still present / Snoring still occurring

  • Make sure your machine is set to the Standard response and is not in the Soft response mode. While the Soft response mode is more comfortable, the slower reaction time and increase in pressure can lead to additional apneas.
  • Make sure your unit is calibrated properly and is set to your prescribed pressure. If you do not have a manometer or have access to one, take your unit to your local PAP vendor to be checked.
  • If you have noted a “tube blocked” error, follow the procedures listed above.
  • Discuss your symptoms with your doctor. Sleep apnea can get worse as you age, and you may be due for another sleep study to re-assess your pressure requirements.

Need more help? Try booking a video consult with one of our Clinical Support Specialists for further assistance.

Download a copy of this information HERE