CPAP therapy is the most effective treatment for obstructive sleep apnea (OSA), delivering pressurized air to keep the airway open during sleep. Many users expect snoring to vanish immediately. It is frustrating when snoring persists despite diligent use, suggesting the therapy is not fully optimized. This continued noise often indicates a breakdown in the therapy, which can stem from equipment issues or overlooked physical and environmental changes. Addressing the issue requires a methodical approach, starting with the device to restore the effective pressure needed to eliminate airway vibration.
Checking for Mask Leaks and Fit Issues
Air leaks compromise delivered pressure and are a primary reason for persistent snoring. The machine is calibrated to overcome airway resistance, but a leak allows pressurized air to escape, reducing the force that keeps the throat open. A leak rate above 24 liters per minute (LPM) indicates compromised therapy.
The mask fit is the most common source of air loss, often stemming from the headgear being either too loose or too tight. CPAP mask cushions inflate slightly to create a seal; over-tightening the straps flattens the cushion, preventing this expansion and causing air to escape. Adjust the headgear while lying down, aiming for a snug seal that does not leave deep marks upon waking.
Regular maintenance is necessary, as worn-out or dirty equipment leads to leaks. Facial oils and dirt degrade the mask cushion, preventing a proper seal against the skin. Cleaning the mask daily and replacing components like the cushion and headgear according to the manufacturer’s schedule is necessary.
If you are a mouth breather using a nasal mask, air escaping through your mouth severely reduces airway pressure and causes snoring. You may need to switch to a full-face mask or use a chin strap with a nasal mask.
Considering Physical and Environmental Factors
Even with a sealed mask, physical and environmental variables can alter pressure needs, causing snoring to return.
Sleep Position
Sleep position influences airway collapse. Sleeping on your back allows gravity to pull the tongue and soft palate backward, increasing airway resistance. The pressure setting adequate for side sleeping may be inadequate when you are on your back, leading to residual snoring. Promoting side sleeping using a body pillow or positional device is often an effective solution.
Nasal Congestion
Nasal congestion is a major barrier to effective CPAP therapy by obstructing the upper airway. Blockages caused by allergies, a cold, or chronic sinus issues force air through the mouth, leading to a pressure leak and snoring. Using a heated humidifier can moisten the air and reduce irritation. A saline rinse or nasal strips before bed can physically open the nasal passages.
Lifestyle Changes
Lifestyle factors contribute significantly to sleep apnea severity and pressure requirements. Alcohol or sedative medications consumed close to bedtime cause throat muscles to relax excessively, increasing the likelihood of airway collapse and snoring. Weight gain also increases tissue mass around the neck, altering the required pressure to keep the airway open. These changes indicate that your existing fixed pressure setting may no longer be sufficient.
When to Consult Your Sleep Specialist
When self-troubleshooting the mask and adjusting for lifestyle factors does not resolve the snoring, professional intervention is necessary. Persistent snoring indicates that the CPAP pressure is too low to prevent the partial collapse of the airway (residual apnea).
Review the data recorded by your CPAP machine, which tracks your Apnea-Hypopnea Index (AHI). If your AHI remains above the therapeutic target (typically less than five events per hour) despite full compliance, the underlying sleep apnea is not fully treated, and a pressure adjustment is likely needed.
If you suspect your pressure is inadequate due to weight changes or health status, contact your sleep specialist for a re-evaluation. Never attempt to change the pressure settings yourself, as this compromises therapy effectiveness. The specialist may recommend a new titration study to precisely determine the optimal pressure setting.
The specialist may determine that a standard CPAP machine is no longer the best option and discuss alternative devices:
- Auto-CPAP (APAP): Automatically adjusts pressure throughout the night based on real-time breathing needs.
- BiPAP (Bilevel Positive Airway Pressure): Delivers separate, higher pressure for inhalation and lower pressure for exhalation, effective for complex cases.
If snoring is accompanied by persistent nasal blockage, the specialist may refer you to an otolaryngologist (ENT). An ENT can rule out structural issues, such as a deviated septum or nasal polyps, which may require surgical evaluation.