CPAP machines use pressure to make sure you receive a continuous flow of air while you sleep. The pressure is needed for effective therapy, a CPAP blowing hard or transmitting excessive pressure can pose a health risk and not just a sleepless night.
An improperly sealed or loose mask can make a CPAP blow hard. High-pressure settings can also cause it to blow harder than your usual preset level. In rare circumstances a voltage surge can result in excessive compression of the air stream (leading to high pressure).
This article explains all the potential reasons why your CPAP could be blowing high pressure, along with easy troubleshooting tips.
How A CPAP Should Work
CPAP machines have a motor that pulls the surrounding air inside. This air should then be compressed to adjust the pressure according to the preset value. The pressure level is determined primarily by how prone a person is to developing obstructive sleep apnea (OSA).
A humidifier and heater warm the air and increase its moisture content, making it easy for you to breathe in. Lastly, the processed air is transmitted via a tube and an oxygen mask.
Most CPAP devices come with air filters that remove contaminants from the entering air stream before it encounters the motor.
Factors That Determine CPAP Pressure
Several factors are considered by doctors and sleep therapists to evaluate the correct CPAP pressure for you:
AHI
AHI or Apnea-Hypopnea Index is used to assess the severity of your obstructive sleep apnea (OSA). The AHI scale indicates the frequency of OSA episodes over an hour of sleep.
Here’s what an AHI value says about OSA:
| Apnea-Hypopnea Index | Severity Of OSA |
| 5 to 15 | mild |
| 15 to 30 | moderate |
| 30 or more | severe |
The goal of CPAP therapy is to keep the AHI level lower than 5.
If you are finding that your CPAP events per hour are increasing, Plentiful Air has information that can help you available here.
Anatomy
Your upper airway anatomy is the primary factor in the pathogenesis of obstructive sleep apnea. In sleep apnea, muscles of the upper respiratory tract are abnormal in tone (increased tonic genioglossus activity), which causes the tongue and uvula to fall back against the soft palate when the person is sleeping.
This leads to abrupt difficulty (or severance) of breathing while sleeping. The episodes are generally repetitive, occur at irregular intervals throughout the night, and usually last 10 to 20 seconds. Snoring, chronic fatigue and headache are general signs of OSA.
When determining your required CPAP pressure, doctors check exactly which part of the upper airway has an abnormal tone to assess the risk of OSA.
Sleeping Position
Your sleeping is a critical determinant of the efficiency of CPAP therapy.
Studies show that supine posture (laying on your back) is bad for sleep therapy.
Sleeping on your side is the best position for sleep apnea because it minimizes the effect of gravity on the airway.
If you’re used to sleeping in your back, you might need higher CPAP pressure.
Reasons Why Your CPAP Pressure Is High
Here are all the possible reasons why your CPAP pressure feels high:
1. Pressure Settings
The CPAP machine allows you to adjust pressure levels. Check the preset pressure level first before checking any other cause. Especially if you have had a power outage as your machine may have reset.
Ideally, a CPAP machine should only be calibrated by a doctor or sleep specialist. Consult your doctor, and request a titration study to determine a suitable pressure level for you if needed.
2. Mask
If you turn your CPAP machine on before lying down, you can feel high pressure when wearing the mask. It’s always best to put the mask on before turning on your CPAP.
Remember that a properly sealed mask is crucial for effective and comfortable CPAP therapy. CPAP masks are supposed to prevent even pressurized air from leaking outside. They only have small openings to vent exhaled carbon dioxide outside.
A mask that is improperly sealed masks can create a feeling of high pressure, as your machine adjusts for the leak..
Here’s some tips to helps set it up:
- Place the mask on when sitting.
- Turn the machine on.
- Lay down and pull the straps to tighten the seal.
- Pull the mask a few centimeters away from the face for a few seconds. This inflates the outer layer.
- Lower the mask down.
If the pressure still feels high and you notice air leaking through the mask, you may need to buy a smaller mask. Here are the three types of CPAP masks you can consider:
- Nasal Pillow Masks: They are specially designed for claustrophobic individuals. Their minimal design and lightweight structure enable them to rest easily against nostrils. These masks deliver low pressure and can be a good choice for people who don’t have severe sleep apnea.
- Nasal Masks: Nasal masks cover the entire nose. They generate higher pressure as compared to nasal pillow masks. Mouth breathers can also use a nasal mask with a chin strap.
- Full Face Masks: These masks cover the entire face and can feel uncomfortable. They transmit the highest pressure of all the different types of oxygen masks.
3. Malfunctioning Motor
Malfunctioning motors are a rare cause of CPAP machines blowing high pressure, but they do happen. Electrical problems, and especially voltage surges, can cause the motor to pull in more air.
The motor may then generate abnormally intensive compression force, causing your CPAP machine to blow hard.
Motor repair is generally hard, and there’s a high chance you would need to replace it. But CPAP motors are expensive, and it’s usually easier and cheaper to buy a new device if your warranty is no longer valid.
CPAP Alternatives: APAP and BiPAP Machines
If you find your problem is just how CPAP therapy feels to you in general, you can talk to your doctor about switching to APAP or BiPAP machines.
APAP
APAP stands for Automatic Positive Airway Pressure. Unlike CPAP machines that generate constant pressure throughout the process, APAP devices have sensors that detect your breathing pattern, number of sleeping hours, and frequency of apnea episodes.
Based on this, the device pressure is automatically adjusted.
BiPAP
While higher CPAP pressure helps in case of severe OSA conditions, it does not feel comfortable while exhaling. BiPAP machines counter this issue.
They deliver higher pressure when you inhale but reduce the air pressure when you breathe out.
What Happens If My CPAP Air Pressure Is Too High?
CPAP air pressure that is too high can make it difficult for you to breathe properly. It also leads to general discomfort, dryness in the mouth and throat, and difficulty sleeping. Air may also leak out of the mask, rendering the CPAP therapy ineffective.
Is It Supposed To Be Hard To Exhale With CPAP?
Initially, getting used to CPAP machines (especially with high pressure) can be difficult and make exhaling feel harder than usual. However, if the issue persists for a long time, you can try the machine’s exhalation relief settings or talk to your doctor about adjusting the pressure.
If you are having a hard time exhaling when on CPAP therapy, here’s what you can do:
- Some CPAP machines have relief settings that reduce the pressure when the user is exhaling. Remember to ask your physician beforehand.
- Check with your doctor /sleep specialist if your condition allows you to adjust overall CPAP pressure to a lower level.
- Get an automated CPAP machine. It has special sensors that detect your breathing pattern and accordingly set the pressure.
You can also consider buying a high-end device like ResMed AirSense 10. It comes with a Ramp feature that gradually increases the pressure, allowing you to ease into the process.
What Is The Average Pressure For A CPAP Machine?
CPAP pressure is usually set to 10 cmH2O on average, with a general range being 6 to 14 cmH2O.