For many people with obstructive sleep apnea, a CPAP device is life-changing: better sleep, fewer apneas, improved daytime energy. But while most discussions focus on getting started, the long-term CPAP use story hides some subtler, overlooked risks. These “silent” complications may impact comfort, health, or willingness to continue therapy over years.
Your CPAP device is a crucial bridge between diagnosis and restful sleep—but if it’s misused, poorly maintained, or just worn for too long in one mode, it can quietly contribute to problems. Below, we explore risks you should know about, and steps you can take to protect yourself.
Chronic Skin Irritation, Pressure Sores & Facial Changes
One of the most common long-term CPAP use risks comes from sustained contact pressure. Over months and years, mask leaks and repeated strap tension can lead to skin irritation, redness, indentations, or even pressure ulcers at the nasal bridge, cheeks, or forehead.
These problems worsen if a user consistently overtightens to compensate for leaks. Fabric breakdown, friction, and exposure to sweat/moisture raise the risk. Some sensitive users may develop contact dermatitis from mask materials.
To reduce risk:
- Rotate mask styles or cushion types so no one spot is under constant load
- Use mask liners or gel pads to cushion contact areas
- Inspect your skin nightly and rest mask contact if raw spots appear
- Replace cushions or headgear regularly to maintain a soft, even seal
Infection Risk, Mold & Bacterial Growth
Although the risk is low, long-term CPAP use can raise the possibility of infection if equipment hygiene is neglected. The chamber, tubing, or mask can become a breeding ground for bacteria, mold, or fungi—especially in humidifiers or when water is left stagnant.
Case reports exist linking improperly cleaned CPAP systems to respiratory infections (bronchitis or pneumonia).
Middle Ear Pressure Changes & Discomfort
Long-term CPAP use can also influence ear pressure. Pressurized airflow can transmit into the Eustachian tube, causing ear fullness, pressure changes, or even discomfort in the middle ear. Over time, this repeated pressure can strain the Eustachian tube’s function for some users.
While not everyone experiences this, if you notice persistent ear congestion, popping, or discomfort, it’s a signal to recheck your CPAP settings or mask fit.
Psychological Fatigue & Declining Adherence
Over time, discomfort, minor irritation, or mask frustrations may lessen the positive emotional association with CPAP. What once felt beneficial may begin to feel burdensome. This mental or psychological fatigue is a real long-term CPAP risk — and ironically, it raises the chance that users will skip nights, lower usage, or abandon therapy altogether.
Certain mask-related side effects (mask leaks, pressure discomfort, skin irritation) have been statistically linked to non-adherence and residual sleepiness in long-term users.
Staying motivated means regularly evaluating your comfort, adjusting gear, and engaging your sleep provider when symptoms creep in.
Why These Risks Matter for Long-Term Results
These overlooked risks do more than cause discomfort; they can undermine the very goals of CPAP therapy. When users reduce usage, skip nights, or feel burdened, the protective benefits — lowered cardiovascular risk, improved cognition, reduced daytime sleepiness — may not fully materialize.
A review of CPAP side effects highlights that though many are “minor,” their cumulative burden influences long-term adherence and quality of life.
In conclusion, long-term CPAP use delivers tremendous benefits. By staying attentive, maintaining your device, rotating mask choices, and addressing issues early, you can preserve both your health and confidence in CPAP therapy for the long haul.
