Continuous Positive Airway Pressure (CPAP) therapy is a common treatment for obstructive sleep apnea, a condition where breathing is repeatedly interrupted during sleep. The CPAP machine works by delivering a steady stream of pressurized air through a mask to keep the upper airway open and prevent collapse. This pressure setting, measured in centimeters of water (cmH2O), is determined during a sleep study to be the lowest level required to stop these breathing events. While this setting is designed to be therapeutic, a pressure that is too high can cause significant discomfort and reduce a person’s willingness to continue the treatment. Recognizing signs of excessive pressure is the first step toward achieving comfortable and effective therapy.
Physiological Indicators of Excessive Pressure
One direct physical sign of excessive pressure is aerophagia, the unintentional swallowing of air. When pressure is too high, air is forced into the esophagus and stomach instead of solely into the lungs. This causes gas, severe bloating, burping, and abdominal discomfort upon waking. This gastrointestinal distress can be highly disruptive and lead to a feeling of fullness.
High airflow can also exacerbate issues with moisture in the upper airway. Users might experience excessive dry mouth or a parched throat, even when using a heated humidification system. This dryness occurs because the large volume of pressurized air overwhelms the body’s natural ability to humidify the air. It can also force the mouth open, leading to mouth-breathing.
Forcing air past the mucous membranes of the nasal passages can lead to severe nasal irritation, congestion, or nosebleeds. While some dryness is common, a persistent burning sensation suggests the pressure is creating a harsh environment, especially if humidification is not optimized. Users may also wake up feeling anxious or overwhelmed, sensing they are fighting against the incoming air. This feeling of being unable to exhale normally can trigger a panic-like response.
Mask and Device Performance Signs
Excessive pressure significantly compromises the mask seal, leading to a noticeable increase in air leaks. The sheer force of the air attempting to escape makes it difficult to maintain a consistent seal against the face. These leaks often result in loud hissing or venting noises, which can wake the user or their bed partner.
A common physical complaint is difficulty with exhalation, even on modern machines equipped with pressure relief features. The incoming flow of air may feel insurmountable, like trying to breathe out against a strong wind. Struggling to push air out is a strong indication that the prescribed pressure level is higher than the user can comfortably tolerate.
The high force of the air can also cause the mask to shift, slide, or lift away from the face during sleep. This slippage is a direct consequence of the pressurized air pushing the mask out of position, not solely due to poor mask fit. Furthermore, the overall noise level from the machine or the mask vents may be noticeably louder than expected, which is a physical sign of the high rate of airflow moving through the system.
Steps to Address Suspected High Pressure
If symptoms suggest the pressure is too high, avoid making adjustments to the machine settings independently. The prescribed setting is determined by a medical professional based on clinical data. Changing it without oversight could compromise the effectiveness of the sleep apnea treatment. Adjusting the pressure incorrectly might cause the airway to collapse again.
Users should schedule an appointment with their prescribing physician or sleep specialist to discuss the symptoms. Only a qualified medical professional can safely evaluate the need for a pressure change, often recommending a new titration study to determine the optimal setting. The specialist will review the machine’s compliance data, which is a record of the therapy’s effectiveness.
The Apnea-Hypopnea Index (AHI) is a key metric in this data, measuring the number of breathing events per hour. If a user’s AHI is consistently within the acceptable range (typically five events or less per hour), the provider may agree to safely reduce the pressure slightly to improve comfort. The provider may also suggest enabling or increasing the expiratory pressure relief feature, which momentarily lowers the pressure during exhalation to make breathing out easier.
In the short term, users can troubleshoot equipment issues by ensuring the mask is fitted correctly and that the humidification level is appropriate for the current pressure setting. Checking and replacing old filters or worn-out mask cushions can also help maintain efficiency and comfort. However, any long-term solution or pressure adjustment must be guided by the medical team to ensure the therapy remains both comfortable and clinically effective.