Is Your CPAP Pressure Too High?

CPAP therapy should improve your sleep, not make it harder, so discomfort can be a sign that pressure settings need adjustment. Pressure that’s too high can cause symptoms like difficulty exhaling, mask leaks, dry mouth, or bloating, all of which can interfere with restful sleep.

If you consistently experience these uncomfortable symptoms, Trusted Source MSD Manuals First published in 1899 as a small reference book for physicians and pharmacists, the Manual grew in size and scope to become one of the most widely used comprehensive medical resources for professionals and consumers. View Source ask your doctor to check your CPAP pressure settings. Below, you’ll learn symptoms and side effects of high CPAP pressure settings and when to tell your provider about them.

How CPAP Pressure Settings Are Determined

The CPAP setting controls how much pressure the machine pushes into your upper airways to keep it open Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source . Some CPAP machines use fixed-level pressures. Another option called auto-titrating positive airway pressure (APAP), detects apnea events during sleep and raises or lowers pressure as needed. 

Typical CPAP pressure ranges from 4 to 20 centimeters of water (cm H20), but the average is around 9 cm H20 Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source . The precise pressure you need is determined by a sleep specialist based on your clinical assessment or during a CPAP titration sleep study. 

During this test, your specialist will analyze the minimum amount of pressure you need to lessen pauses in your breathing (with a goal apnea-hypopnea index or AHI <5), normalize oxygen levels to >90%, reduce snoring, and decrease nighttime waking.

Symptoms of CPAP Pressure Being Too High

When your CPAP pressure is too high, the symptoms can look similar to typical CPAP side effects. These may include: 

• Discomfort from the sensation of pressure (making it hard to breathe out against the pressure)
• Dry nasal passages, mouth, and throat
• Air leaks and mouth breathing
• Nasal congestion Trusted Source Medscape Medscape is on online destination for healthcare professionals worldwide, offering expert perspectives, drug and disease information, and professional education. View Source
• Runny nose
• Morning bloating or gassiness
• Nosebleeds

Some discomfort is expected when you first start using a CPAP machine, and users have described claustrophobia, difficulty breathing, and trouble falling asleep Trusted Source Medscape Reference Medscape is on online destination for healthcare professionals worldwide, offering expert perspectives, drug and disease information, and professional education. View Source . Higher pressures (over 12 cm H20) can cause even more discomfort Trusted Source Medscape Reference Medscape is on online destination for healthcare professionals worldwide, offering expert perspectives, drug and disease information, and professional education. View Source .

Typically, adding humidification to your CPAP can fix a dry mouth and nose, and this is a widely recommended option for all CPAP users. But if your symptoms continue even with added humidity, you should let your healthcare provider know.

If high nasal CPAP pressure causes air to leak out through your mouth, your provider may suggest a chin strap or switching to a full-face mask Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. View Source . In some cases, it may be important for the provider to simply lower the pressure setting. If these interventions fail, they may want to do another sleep study to recalibrate your pressure settings or explore bilevel therapy Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. View Source . 

Side Effects of CPAP Pressure Being Too High

Excessive CPAP pressure can cause injury to the lungs , problems sleeping Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source , and other symptoms associated with air leaks Trusted Source Medscape Medscape is on online destination for healthcare professionals worldwide, offering expert perspectives, drug and disease information, and professional education. View Source . High CPAP pressure settings may cause side effects like: Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source

• Barotrauma: Lung injuries like the rupture of alveoli (small air sacs in the lungs) Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. View Source . The lungs may also feel overworked, leading to discomfort in the accessory breathing muscles of the ribcage.
• Aerophagia: Pressurized air can sometimes be swallowed, causing frequent belching, bloating, and abdominal pain, often noted in the morning Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source . It can even be possible to start vomiting air.
• Mouth leak: Air leaks from the mouth can lower pressure reaching the airways and lessen the positive effects of CPAP therapy. As the mouth is open, the jaw and tongue can shift back and cause the throat to further collapse.
• Sleep fragmentation: Continuous or sporadic mouth leaks can interrupt sleep. 
• Conjunctivitis: Air leaks from a CPAP mask can cause eye inflammation or dryness. 
• Complex (treatment-emergent central) sleep apnea (CSA): A different kind of sleep apnea, CSA is caused by changes in your respiratory drive (signals from your brain about when to breathe) that may occur in response to therapy Trusted Source MSD Manuals First published in 1899 as a small reference book for physicians and pharmacists, the Manual grew in size and scope to become one of the most widely used comprehensive medical resources for professionals and consumers. View Source . This is more likely to occur when excessive CPAP pressures are used.

What to Do if Your CPAP Pressure Is Too High

If you think your CPAP pressure may be too high, don’t change any settings on your own. First, tell your sleep specialist what’s going on, and they can assess the problem and direct you on the next steps. They may suggest adjusting your pressure settings, checking for mask leaks, or using comfort features such as ramp or pressure relief to improve tolerance.

If these changes don’t fix the issue, they may recommend a pressure re-titration study Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. View Source . During your follow-up sleep study, your sleep technologist will see how it’s working in real time Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. View Source .

If difficulty tolerating the pressure as you fall asleep bothers you the most, a pressure ramp may offer some relief. This function starts you off at a lower pressure while you fall asleep, then later increases the pressure to therapeutic levels Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. View Source .

When to Talk to Your Doctor

It takes time to get used to a new CPAP machine Trusted Source National Heart, Lung, and Blood Institute (NHLBI) The NHLBI is the nation's leader in the prevention and treatment of heart, lung, blood and sleep disorders. View Source , but if you continue to experience uncomfortable symptoms, let your provider know. Trusted Source MSD Manuals First published in 1899 as a small reference book for physicians and pharmacists, the Manual grew in size and scope to become one of the most widely used comprehensive medical resources for professionals and consumers. View Source They can help you troubleshoot your CPAP settings and make any adjustments needed. Most modern devices have integrated modems that wirelessly transmit data so that your doctor can access it remotely to change your settings.

Most CPAP pressure symptoms don’t require urgent medical attention, but if you feel stomach pain or bloating after using your CPAP, stop using your machine and call your provider right away Trusted Source National Heart, Lung, and Blood Institute (NHLBI) The NHLBI is the nation's leader in the prevention and treatment of heart, lung, blood and sleep disorders. View Source .