For many people with sleep apnea, a CPAP device is a lifesaver. It keeps the airway open, reduces daytime sleepiness, and improves overall quality of life. But beyond the usual complaints of mask leaks or dry mouth, there are subtler complications that can erode CPAP comfort and adherence over time. We’ll dive into these “hidden” CPAP complications and share tips to manage them.
1. CPAP Complications: Aerophagia (Swallowed Air and Bloating)
One of the more surprising CPAP complications is aerophagia — the unintentional swallowing of air during use. This can lead to uncomfortable symptoms: abdominal bloating, burping, even mild stomach pain. It occurs when pressurized airflow pushes into the esophagus rather than the airway.
Often, users experiencing this may not connect their gastric discomfort to the CPAP machine. Over time, persistent aerophagia can detract from sleep comfort and may even cause you to wake up during the night. To reduce aerophagia, discuss lowering the pressure slightly, enabling exhalation relief (if your machine offers it), or switching to a model that better matches your breathing pattern.
2. Pressure Sores, Skin Irritation & Facial Discomfort
Many CPAP users focus on leaks or mask fit, but few expect pressure sores or skin irritation on the nose bridge, cheeks, or forehead. Continuous pressure, friction, or misfitting masks can cause redness, indentations, calluses, or open sores. Some users even develop contact dermatitis from the cushion materials.
These complications can make the mask feel harsh on the skin, prompting users to loosen straps (which in turn leads to leaks). A mask liner, padded strap covers, or switching mask styles (such as to nasal pillows) can ease pressure. Always inspect your skin regularly, and if raw spots appear, pause use and seek an alternate mask style.
3. Dry Eyes and Eye Irritation
If your CPAP mask leaks around the top edge, it can channel airflow toward your eyes. The result? dry, irritated eyes, stinging, tearing, or redness. This is less commonly discussed but can significantly impact comfort, especially for users wearing contacts or with sensitive eyes.
To combat this, ensure your mask seal is snug, and consider masks with a better upper-edge design. You might also apply a small amount of sterile eye lubricant before bed (if approved by your sleep specialist) to protect your eyes overnight.
4. Difficulty Exhaling & Discomfort While Breathing Out
Modern CPAP machines push a constant air pressure to keep airways open, but for some users—especially those requiring higher pressures—exhaling against that pressure feels unnatural and uncomfortable. This subtle tension can disturb sleep and reduce overall comfort.
Many newer CPAP or APAP models include expiratory pressure relief (EPR) or pressure relief modes, which slightly reduce pressure during exhalation. Ask your provider whether your machine supports this feature. Another option is to use a bi-level device (BiPAP) that differentiates the inhale and exhale pressures.
5. Subclinical Nasal Symptoms: Congestion, Rhinorrhea, Nosebleeds
Beyond obvious nasal dryness, some CPAP users suffer from milder, persistent nasal issues: chronic congestion, runny nose (rhinorrhea), occasional nosebleeds, or nasal crusting. These complications are often dismissed as allergies, but they may result from the continuous flow of air irritating the nasal lining.
Adding or adjusting a heated humidifier, using saline nasal sprays, or using a nasal barrier cream (if safe) can minimize these effects. Also ensure your mask fits cleanly without leaks—leaky airflow can exacerbate nasal irritation.
Why These “Lesser” Complications Matter for CPAP Adherence
Comfort is critical. Even if a user understands that CPAP therapy is medically beneficial, persistent discomfort from these hidden issues can lead to skipped nights or abandonment altogether. Studies show that non-adherence is a major barrier to CPAP efficacy.
If you experience any of these complications, address them early. Don’t accept discomfort as a necessary evil.
Tips to Maintain CPAP Comfort Amid Complications
- Regular mask fitting reviews: As weight, facial structure, or dental alignment changes, mask fit should be reassessed.
- Use accessories wisely: Mask liners, strap pads, chin straps, or gel cushions can reduce pressure and friction.
- Leverage technology: Use devices with ramp settings, EPR, or auto-adjusting pressure modes.
- Humidification matters: Proper humidifier settings can reduce nasal and throat irritation.
- Clean your gear thoroughly: Bacteria, mold, or allergens in a mask or hose can exacerbate irritation and nasal issues.
- Report issues early: Before minor skin soreness becomes a full-blown sore, report it to your sleep provider.
In sum, CPAP therapy’s success isn’t just about preventing apneas — it’s about comfort night after night. By understanding and managing these lesser-known CPAP complications (aerophagia, pressure sores, eye irritation, exhalation discomfort, nasal symptoms), you stand a better chance of staying consistent with use. Talk with your sleep specialist or equipment provider—they can help you fine-tune settings or switch mask styles so your CPAP supports restful, comfortable sleep rather than disrupting it.
