Do I Need to Reduce My CPAP Pressure?

Problems Breathing, Mask Leak, and Weight Loss May Prompt Pressure Changes

A man needs lower pressures for his CPAP
A man needs lower pressures for his CPAP. Getty Images

If you are using continuous positive airway pressure (CPAP) to treat your obstructive sleep apnea, you may wonder at some point: Do I need to reduce my CPAP pressure? Whether you are first starting treatment, or some of your risk factors for sleep apnea have changed, learn some reasons why you may need your pressure lowered.

Early Use of CPAP Therapy

After diagnosis is made, CPAP may be the preferred treatment for you.

The equipment can be prescribed based on use during an in-center titration sleep study. Alternatively, a CPAP may be ordered with empiric settings: the sleep doctor selects these and once your response to therapy is determined, the device may be further adjusted. Though a single fixed pressure can be used, many times a range of prescribed pressures with a self-adjusting AutoCPAP is preferred.

There are times when it is necessary to lower the pressures of the CPAP machine. Some of these changes are needed to improve comfort or to optimize the therapy response. A few may need to occur early in treatment, but some could be required when other risk factors for sleep apnea have changed.

The most common reasons you may need to reduce your CPAP pressure include:

  • Discomfort Breathing Out

When you first start using CPAP therapy, there is a period of adjustment that occurs. It may not feel natural to breathe out against the pressure.

Though it is easy to breathe in, you may find it difficult to breathe out. This may improve over time but it may also provoke insomnia. In some cases, ramping from a lower initial pressure or a feature to allow easier exhalation can be helpful. It may be necessary to reduce the pressures overall. In rare cases, bilevel therapy – in which one pressure is used to breathe in and a lower pressure is used to breathe out - may be needed.

  • Air Swallowing (Aerophagia)

It may sound a little strange, but air swallowing can be a sign of CPAP pressures that are too high. Rather than supporting the upper airway, the excessive air can enter the stomach via the esophagus. As a result, burping, farting, and bloating can become problematic. If you wake and your stomach is completely filled with air, like a balloon, this may be due to aerophagia. Reduced pressures may help to alleviate this. In addition, other treatments for aerophagia like the use of medication for heartburn or GERD, sleeping wedge pillows, and bilevel therapy may also be helpful.

  • Excessive Mask Leak

If you are struggling with the fit of your CPAP mask, lower pressures can sometimes be helpful. If there is too much air pressure, the excessive air escapes around the edges of the mask or out of the mouth. This may be exacerbated by a poorly fitting mask. Leak is usually worse with larger full-face masks and may be reduced by using a nasal or nasal pillows mask. In some cases, it can be important to lower the CPAP pressure to optimize the mask seal and reduce leak and even dry mouth.

  • Developing Central Sleep Apnea

Some people will start to experience central sleep apnea, in which breath holding occurs, as a response to CPAP therapy. If central apneas did not account for the majority of your breathing disturbances prior to starting CPAP, but now they contribute to more than 5 events per hour, it may represent complex sleep apnea. This sometimes resolves in time. It may require a change to ASV therapy. In other cases, it may be alleviated by simply lowering the CPAP pressure.

  • Significant Weight Loss

One of the largest contributors to sleep apnea risk is excessive weight. If you are able to lose at least 10 percent of your body weight through diet and exercise, you may lower the CPAP pressure that you require. If you start to have problems with air swallowing, mask leak, or difficulty breathing out against the pressure, this is likely to be helpful.

  • Other Changes in Health and Substance Use

There are potential changes that could affect the CPAP pressure you require. If you have environmental allergies, optimized treatment with medications or nasal sprays could reduce you pressure requirements by improving airflow through the nasal passage. In addition, surgical changes – including tonsillectomy, nasal septoplasty, and soft palate or tongue surgery – may alter your CPAP therapy requirements.

Moreover, substance use can impact the risk of sleep apnea. If you smoke, snoring and sleep apnea may worsen. Alcohol use near bedtime can cause muscle relaxation and contribute to sleep apnea. Medications, including muscle relaxants and benzodiazepines, may worsen sleep apnea. If you discontinue use of any of these substances, your sleep apnea risk may decline and your pressure needs may also reduce.

How to Change Your CPAP Pressure

If you suspect you may need to reduce your CPAP pressure, start by visiting with your sleep doctor. After review of your CPAP data, a determination can be made on how best to change your pressure settings. As this is a prescribed therapy with multiple variables to consider, it is not recommended that you make these changes on your own. Moreover, these changes cannot be made by your equipment provider without a doctor’s order.

Source:

Kryger, M.H. et al. "Principles and Practice of Sleep Medicine." ExpertConsult, 5th edition, 2011.

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