Continuous Positive Airway Pressure (CPAP) therapy treats obstructive sleep apnea by delivering pressurized air through a mask to keep the airway open during sleep. The therapy’s effectiveness depends on achieving a proper seal and comfortable fit. An improperly applied mask will leak air, reducing the prescribed pressure and causing discomfort that leads to poor adherence. Understanding the precise sequence for fitting and adjusting the CPAP mask is the first step toward maximizing treatment success.
Preparation and Component Check
Before the mask touches the face, ensure all equipment is ready and optimized for the best possible seal. Confirm the CPAP machine is plugged into a reliable power source and placed on a stable surface near the bed. If your unit uses humidification, fill the reservoir with distilled water up to the marked line to prevent mineral buildup and ensure moist airflow during the night.
Proper mask hygiene is essential. Wipe the silicone cushion or nasal pillows daily to remove facial oils and makeup, as these residues compromise the seal and cause irritation. Finally, connect the tubing to the machine’s air outlet, leaving the mask end disconnected, and position the long hose conveniently near your sleeping area.
Step-by-Step Mask Donning
The initial placement of the mask should be done with the headgear completely loosened, focusing on securing the seal interface first. For nasal pillow masks, gently insert the pillows into the nostrils, ensuring they sit comfortably without stretching the nasal opening. With a nasal or full-face mask, hold the cushion firmly against your face, making sure the seal rests correctly below the bridge of the nose and above the chin.
While holding the cushion in this correct position with one hand, use the other hand to pull the headgear over the back of your head. The goal during this step is placement, not tightness, so the straps should remain slack. For masks with lower and upper strap attachments, ensure the straps are positioned correctly—the lower straps should rest below the ears, and the upper straps should sit above the ears. Once the headgear is settled, the cushion or pillows should be centered without pressure or distortion.
Securing and Initial Adjustment
With the mask resting loosely on your face, the next step is to connect the tubing to the mask’s swivel elbow or port. After the connection is secure, it is time to lie down in your typical sleeping position, as the shape of your face changes when you are reclined and relaxed. Now, initiate the therapy by turning on the CPAP machine to activate the air pressure.
The adjustment process must be gradual and even to avoid creating pressure points or leaks. Start by adjusting the lower or side straps first, pulling each side equally until the mask maintains a light seal against the pressure. Next, gently adjust the top or forehead straps only as much as necessary to stabilize the mask and prevent it from shifting. A good rule of thumb is to tighten the straps only until the air leak stops, ensuring the mask is secure but not uncomfortably pressing into the skin. Over-tightening is a common mistake that causes discomfort, red marks, and often exacerbates leaks by deforming the cushion.
Resolving Comfort and Seal Issues
Addressing Air Leaks
After initiating the pressure, a small leak check is necessary to confirm the seal in the sleeping position. Minor air leaks felt near the eyes or cheeks can usually be resolved with a slight, incremental tightening of the strap directly opposite the leak. If a major leak persists, remove the mask completely, reposition the cushion interface, and then re-don and re-adjust the straps.
Managing Pressure Discomfort
Discomfort with high air pressure, especially when exhaling, is a frequent complaint for new users. This feeling can be mitigated by engaging the Expiratory Pressure Relief (EPR) or similar exhalation relief features on the machine, which temporarily lower the pressure upon sensing a breath out. If the initial blast of air is overwhelming, the ramp feature can be used to start the therapy at a lower, more comfortable pressure that gradually increases to the full prescribed setting.
Environmental Adjustments
Addressing issues like immediate nasal congestion or dry mouth involves adjusting the humidifier temperature or heated tubing settings. Find a moisture level that is soothing for the airway to ensure comfort throughout the night.