Getting a CPAP or PAP prescription is often described as the “easy part” of treating sleep apnea — the harder part, for a lot of people, is actually keeping the mask on all night. Falling asleep fine but waking up with the mask off, or finding breathing comfort gets worse as the night goes on, is an extremely common experience in the first days and weeks of therapy. Here’s a general look at what tends to help.
Why the adjustment period is genuinely hard
According to the American Academy of Sleep Medicine (AASM), it’s normal for it to take several weeks to fully adjust to PAP therapy, and many people experience some discomfort — from mask fit issues to a feeling of air pressure being unfamiliar — before it starts to feel routine. The Sleep Foundation similarly notes that persistence through the early adjustment period is one of the strongest predictors of long-term adherence, since comfort and tolerance genuinely do tend to improve with time and the right settings.
Common friction points, and general approaches
Mask fit and type. A poorly fitted mask is one of the most frequently cited reasons people remove their mask overnight, often without fully waking up or remembering it. Nasal pillows, nasal masks, and full-face masks all distribute pressure differently, and what’s comfortable is highly individual. Most sleep medicine clinicians and DME (durable medical equipment) providers recommend trying a different mask style if the current one is a persistent problem — this is a routine, expected part of PAP setup, not a sign of failure.
Pressure comfort settings. Many modern PAP machines include ramp features (starting at a lower pressure and gradually increasing) and expiratory pressure relief settings that make exhaling against the airflow feel less effortful. According to AASM, these settings are commonly adjusted by a sleep physician or equipment provider based on how a patient responds, and asking about them is a normal part of the follow-up process.
Air leaks and dryness. A mask that leaks air into the eyes or makes noise can disrupt sleep and increase the urge to remove it. Built-in or add-on humidifiers, along with correctly sized cushions, are commonly recommended to address dryness in the nose, mouth, or throat that can make the mask feel worse as the night goes on.
Claustrophobia or a sense of unfamiliarity. It’s common to feel some anxiety about a mask covering part of the face. The Sleep Foundation suggests wearing the mask for short periods while awake — reading, watching TV — to build familiarity before relying on it for a full night’s sleep.
When to loop in your sleep team
If discomfort persists after trying different mask types and adjusting settings, that’s worth bringing back to your prescribing physician or DME provider rather than assuming it’s something you have to push through indefinitely. Ongoing air leak, unresolved pressure discomfort, or ongoing waking with the device off are all common, addressable issues that a sleep specialist can help troubleshoot — including reviewing your specific sleep study findings, since the right approach can depend on factors like your apnea type and severity.
The bottom line
Struggling in the first week or two of PAP therapy is extremely common and doesn’t mean the treatment isn’t working or that it won’t get easier. Most comfort issues are addressable through mask changes, pressure adjustments, and humidification, and giving therapy a genuine trial period — while staying in touch with your sleep provider about what isn’t working — is generally the path that leads to long-term success.
This article is for general educational purposes and is not a substitute for personalized medical advice. If you’re having trouble tolerating PAP therapy, talk with your sleep physician or equipment provider about adjusting your setup.
— Gemifys
