Why Do I Feel Like I Can’t Breathe With My CPAP Mask On?

Putting on your CPAP mask should help you breathe more comfortably while you sleep. But for some people, the opposite seems to happen.

You put the mask on, start the machine and suddenly become very aware of your breathing. The airflow may feel strange, the mask may feel restrictive, or you may have the uncomfortable sensation that you simply can’t get enough air.

If you’ve experienced this, you’re not alone.

Feeling like you can’t breathe with your CPAP mask on can be particularly unsettling when you’re new to treatment. It can even make you want to take the mask off before you’ve had a chance to fall asleep.

The good news is that there are several possible reasons for this sensation, and many can be addressed with the right adjustments.

However, genuine difficulty breathing should never be ignored. If you are experiencing severe or sudden breathing difficulty, chest pain, fainting, blue or grey lips, or another medical emergency, seek urgent medical attention.

For less urgent CPAP-related breathing discomfort, let’s look at what could be happening.

Why can CPAP make it feel like you can’t breathe?

The first thing to understand is that CPAP changes the way breathing feels.

Normally, you breathe without thinking about it.

Once you put on a CPAP mask, you’re suddenly aware of airflow, pressure and the sensation of breathing against the machine.

That unfamiliar feeling can make your breathing feel unnatural, particularly during your first few nights.

But discomfort can also have a practical cause, such as an unsuitable mask, nasal congestion, excessive pressure, a ramp setting or difficulty breathing through your nose.

Finding the cause is the important part.

1. You’re still getting used to the sensation of CPAP

If you’ve only recently started CPAP, the airflow may feel unusual.

Your machine is delivering continuous positive airway pressure rather than allowing you to breathe exactly as you normally would.

Your brain can take some time to get used to this sensation.

You may find yourself consciously thinking:

“Am I breathing properly?”

“Why does the air feel so strong?”

“Can I breathe out normally?”

This increased awareness can make breathing feel more difficult than it actually is.

For many new users, the sensation becomes less noticeable as they become accustomed to the equipment.

2. Your mask may be too tight

A mask needs to seal against your face, but tighter doesn’t always mean better.

If you’ve been tightening the straps to prevent air leaks, you may end up with unnecessary pressure on your face.

An overly tight mask can feel restrictive and uncomfortable.

It may also cause:

  • Facial pressure
  • Soreness
  • Skin irritation
  • Pressure marks
  • Difficulty relaxing
  • Increased awareness of the mask

If your mask only feels comfortable when it’s extremely tight, it’s worth having the fit checked.

The problem could be the size, shape or style of the mask rather than the amount of tension in the straps.

3. Your mask may not be the right type for you

There are several different CPAP mask styles.

Nasal masks

These sit over the nose and are designed for people who can comfortably breathe through their nose.

Nasal pillows

These sit around the nostrils and provide a smaller, more minimal interface.

Full-face masks

These cover both the nose and mouth.

If you’re struggling to breathe through your nose, a nasal mask or nasal pillows may feel particularly difficult.

On the other hand, a full-face mask may feel too bulky for someone who is comfortable breathing through their nose.

There isn’t one universally “best” CPAP mask.

The right choice depends on your breathing habits, sleeping position, facial shape, comfort preferences and individual circumstances.

4. Your nose could be blocked

Nasal congestion is one of the most common reasons people struggle with nasal CPAP masks.

If your nose is blocked because of:

  • A cold
  • Allergies
  • Hay fever
  • Sinus problems
  • Dryness
  • Another nasal condition

then breathing through a nasal mask can become uncomfortable.

You may feel as though the CPAP isn’t giving you enough air when the real problem is that your nasal passages are restricted.

Depending on the cause, measures such as appropriate humidification, saline nasal products or treatment for allergies may help.

If nasal congestion is persistent, speak with your doctor or pharmacist.

5. Your mouth may be opening during sleep

If you’re using a nasal mask and your mouth opens while you sleep, you may experience what’s commonly referred to as a mouth leak.

You might wake up with:

  • A very dry mouth
  • A dry throat
  • Air escaping from your mouth
  • Increased mask leaks
  • Interrupted sleep

You may also feel that your CPAP isn’t working properly.

If this happens regularly, speak with your CPAP provider.

The solution isn’t necessarily to immediately switch to a full-face mask. Your provider can help work out why you’re mouth breathing and what options may be appropriate.

6. You’re struggling to breathe out against the pressure

Some people find that breathing out against CPAP pressure feels uncomfortable.

You’re receiving a continuous flow of pressurised air, so exhaling can feel different from normal breathing.

This sensation is often more noticeable when you’re awake and concentrating on your breathing.

Some CPAP machines have comfort features designed to make exhalation feel easier.

If you find the pressure particularly difficult to breathe against, speak with your CPAP provider rather than changing your pressure settings yourself.

There may be a comfort setting or other adjustment that can be considered.

7. The starting pressure may feel uncomfortable

Some CPAP machines use a ramp feature.

Ramp gradually increases the pressure towards the prescribed treatment level while you’re falling asleep.

For some people, this makes the transition into sleep more comfortable.

However, if the starting pressure is too low for you, you may feel as though you’re not getting enough air while waiting for the pressure to increase.

If you regularly feel air hungry when you first put your mask on, tell your CPAP educator.

They can check your settings and determine whether your current setup is appropriate.

Don’t change your prescribed pressure yourself.

8. The mask may be leaking

A significant leak can create a strange sensation of airflow around your face.

You may hear a constant hissing noise or feel air blowing towards your eyes.

A leak can also make it harder to relax because you’re continually aware that something doesn’t feel right.

Check that your mask is positioned correctly.

If leaks continue despite adjusting the mask according to the manufacturer’s instructions, have the fit checked professionally.

A different mask size or style may be a better solution than repeatedly tightening the straps.

9. Anxiety or claustrophobia can make the sensation stronger

For some people, the biggest challenge isn’t the airflow itself.

It’s the feeling of having something covering their face.

If you experience claustrophobia or anxiety, putting on a CPAP mask can initially feel overwhelming.

You may become very aware of your breathing, heartbeat and the mask around your face.

This can create a cycle:

Mask goes on → you feel anxious → you focus on your breathing → breathing feels unnatural → anxiety increases → you want to remove the mask.

If this sounds familiar, try introducing the mask gradually while you’re awake.

A simple way to get used to your mask

Instead of putting the mask on for the first time when you’re already tired and trying to fall asleep, spend some time with it while you’re awake.

For example:

  1. Sit somewhere comfortable.
  2. Put the mask on without immediately trying to sleep.
  3. Start the machine.
  4. Breathe normally for a few minutes.
  5. Watch television or read while wearing it.
  6. Focus on relaxing rather than monitoring every breath.
  7. Gradually increase the amount of time you wear it.

This can help your brain become familiar with the sensation.

If wearing the mask causes significant distress, speak with your healthcare professional or CPAP provider for further advice.

10. Your sleeping position could be affecting the mask

Your mask can behave differently depending on how you sleep.

If you sleep on your side, your pillow may push against the mask.

This can cause:

  • Mask movement
  • Leaks
  • Facial pressure
  • Increased awareness of the mask
  • Changes in how the airflow feels

A different pillow or mask design may help.

You don’t necessarily need a specialised CPAP pillow, but if your current pillow is constantly pushing your mask out of position, it’s worth discussing your options with your CPAP provider.

What should you do if you feel like you can’t breathe?

Start by working out when the problem occurs.

If it happens immediately after putting the mask on

The issue may be related to anxiety, the mask fit, the starting pressure or simply adjusting to the sensation.

If it happens when you’re trying to breathe through your nose

Check whether your nose is blocked or irritated.

If you wake with a dry mouth

Mouth breathing or mask leakage could be contributing.

If you’re struggling to breathe out

Talk to your CPAP provider about your comfort settings and the pressure sensation.

If the mask feels physically restrictive

Have the fit and mask style assessed.

Understanding when the problem occurs can provide useful clues.

Don’t simply tighten the mask

If your first reaction to a leak is to pull the straps tighter, you’re not alone.

But this can create a new problem.

CPAP masks are designed to seal against the skin in a particular way. Excessive strap tension can distort the cushion and create discomfort.

If your mask is constantly leaking, have the fit checked rather than continually tightening it.

Don’t change your CPAP pressure yourself

If your CPAP feels too strong or too weak, you may be tempted to change the pressure.

It’s important to resist making significant changes without professional guidance.

Your prescribed CPAP settings are part of your sleep apnoea treatment.

If the pressure feels uncomfortable, your CPAP provider or sleep specialist can assess the situation and determine whether adjustments are appropriate.

What if the problem is only happening at night?

Sometimes a person can breathe comfortably while awake but feel as though they can’t breathe once they lie down with their CPAP mask.

This can happen for several reasons.

Your nasal passages can become more congested when lying down, while anxiety can also become more noticeable when you’re trying to fall asleep.

Your mask may also move when you change position.

If you can breathe comfortably during the day but repeatedly struggle once you’re wearing CPAP at night, keep track of exactly what you’re experiencing.

That information can help your CPAP provider troubleshoot the problem.

When should you contact us?

You don’t have to struggle through uncomfortable CPAP therapy.

Contact our team if:

  • Your mask feels too restrictive.
  • You regularly feel as though you’re not getting enough air.
  • You can’t breathe comfortably through your nose.
  • You’re experiencing frequent mask leaks.
  • You wake with severe dry mouth.
  • You repeatedly remove the mask during sleep.
  • You’re unable to fall asleep because of the CPAP.
  • You aren’t sure whether your mask is the right type or size.
  • You have ongoing concerns about your pressure settings.

A professional mask fitting and therapy review can help identify problems that aren’t always obvious when you’re trying to troubleshoot the equipment yourself.

When is breathing difficulty an emergency?

CPAP discomfort is one thing. Genuine breathing difficulty is another.

If you experience severe or sudden difficulty breathing, chest pain, fainting, confusion, blue or grey lips or skin, or other serious symptoms, seek urgent medical attention.

Don’t assume that a serious breathing problem is simply a CPAP issue.

If you have an underlying heart or lung condition, or you develop new or worsening breathing symptoms, contact your healthcare professional promptly.

Getting comfortable with CPAP can take time

If your CPAP mask makes you feel like you can’t breathe, don’t assume that you have to give up.

For many people, the problem can be traced to something that can be addressed — such as mask fit, nasal congestion, mouth breathing, pressure comfort or simply getting used to the sensation.

The goal isn’t to force yourself to tolerate an uncomfortable setup.

The goal is to find a CPAP setup that allows you to breathe comfortably and use your therapy consistently.

Need help with your CPAP mask?

If you’re struggling with your CPAP mask, Breathewell can help.

Getting the right mask and fit can make a significant difference to your comfort and confidence with CPAP.

Our team can help you look at issues such as mask fit, leaks, comfort, nasal breathing and choosing a mask that better suits your individual needs.

You don’t have to keep fighting with a mask that isn’t working for you.

Contact Breathewell on 07 3193 5400 to discuss your CPAP needs and find out how we can help.

The bottom line

Feeling like you can’t breathe when you put your CPAP mask on can be frightening, particularly when you’re new to therapy.

But there can be many explanations, from simply adjusting to the airflow to nasal congestion, an uncomfortable mask, mouth breathing or difficulty exhaling against the pressure.

Rather than repeatedly taking your mask off or changing your CPAP settings yourself, try to identify what is actually causing the problem.

The right mask, a proper fit and professional support can make CPAP much easier to tolerate.

And if you’re experiencing genuine or severe breathing difficulty rather than simply discomfort with your CPAP equipment, seek appropriate medical attention.

Frequently asked questions

Why does my CPAP mask make me feel like I can’t breathe?

The sensation can have several causes, including adjusting to the airflow, an uncomfortable mask, nasal congestion, anxiety, mouth breathing, leaks or difficulty exhaling against the pressure.

Is it normal to feel like I can’t breathe when I first use CPAP?

Some people find the sensation of CPAP unusual when they first start treatment. However, persistent or significant breathing difficulty shouldn’t simply be ignored. Speak with your CPAP provider if you’re struggling.

Why can’t I breathe out with my CPAP?

CPAP provides continuous positive airway pressure, which can make exhaling feel different. Some machines have comfort features that may make exhalation easier. Speak with your provider rather than changing your prescribed pressure yourself.

Why do I feel like I’m not getting enough air from my CPAP?

A number of things can cause this sensation, including nasal congestion, mask leaks, starting pressure settings or difficulty adjusting to CPAP. A professional review can help identify the cause.

Should I tighten my CPAP mask if it is leaking?

Not necessarily. Overtightening can cause discomfort and may even affect the seal. If your mask continues to leak, have the fit checked.

Can anxiety make CPAP feel like it is hard to breathe?

Yes. Becoming very focused on your breathing or feeling claustrophobic can make the airflow feel more uncomfortable. Gradually getting used to the mask while awake may help some people.

Should I change my CPAP pressure if I feel like I can’t breathe?

Don’t change your prescribed pressure without professional guidance. Contact your CPAP provider or sleep specialist so they can assess your equipment and treatment.

Who can help me if I can’t get comfortable with my CPAP?

A CPAP provider can assess your mask fit, equipment and comfort issues. If you have ongoing or unexplained breathing symptoms, your doctor or sleep specialist should also be involved. You can contact our team on 073193 5400.

Leave a reply