How to Keep Your CPAP Mask Straps on at Night

It can be one of the most frustrating early experiences in using continuous positive airway pressure (CPAP) to treat sleep apnea. You are committed to the treatment, but you find yourself being undermined in the night. You diligently put your CPAP mask on as you go to bed, but you wake up in the middle of the night, and sure enough: it has come off. It may be lying on your pillow, blowing air purposelessly, or even across the room. How can you learn to keep your CPAP mask on at night?

Mannequin wearing a CPAP mask
Brandon Peters, M.D.

Address Pressure, Humidity, and Mask Comfort Issues

Even though you may be asleep, you are still aware enough to recognize something pestering you. You may wake enough to remove the mask, without regaining full consciousness. Much like sleepwalking or sleep eating, you may not remember anything about your actions when you do fully awaken. This can be a source of frustration and aggravation, especially as you strive to be adherent to the treatment. The most likely cause of you pulling the mask off during sleep is due to improper pressure settings or problems related to mask discomfort. If it annoys you, you will take it off.

If the pressure of the CPAP is too low or too high, you may remove the mask because you can’t get enough air or because of an excessive leak. Air blowing around, especially into the eyes, can be quite disruptive. If your CPAP mask is too loose, this will be worsened. If the mask is too tight, there may be pain across the bridge of the nose, at the nostrils, or on other pressure points on the face. If you are lying on your side and the mask is smashed into your face, this may be bothersome enough for you to remove it. It may be necessary to try a different size, style, or type of CPAP mask.

Make certain that your pressure setting is proper. Your durable medical equipment provider or sleep specialist can download the data card or access it remotely and evaluate whether the pressure setting is adequate. If sleep apnea persists due to a low setting, you will wake because of difficulty breathing and may remove the mask. In addition, if there is excessive leak prompting the CPAP mask removal, this will become apparent in the data report. A few changes in the pressure setting or mask type may be all that is necessary to correct the issue.

In some cases, employing a pressure ramp may be helpful. By starting at a lower pressure as you fall asleep, you may be able to sleep more deeply before the pressure increases. This can also be reset in the middle of the night, which may prevent mask removal.

In addition, the use of a heated humidifier and heated tubing may make the experience more comfortable by reducing mouth dryness, which can also improve compliance.

Consider the Temporary Use of Sleeping Pills

Some sleep specialists will prescribe a short course of sleeping pills to help with the transition to using CPAP. This may seem odd at first blush, as many people with sleep apnea are too sleepy and may not have insomnia, but it can actually be a reasonable course of action. Most people with untreated sleep apnea wake frequently during the night or experience early morning awakenings. This does not usually cause complaints of insomnia, but it can, especially in women.

Treatment with CPAP can make it harder to fall and stay asleep, a new experience for most people with excessive sleepiness as part of sleep apnea. The sleeping pills can minimize the awareness of the CPAP machine and make it less likely that the device will be removed. Common medication options include Ambien, Intermezzo, Lunesta, Sonata, and others.

It is typically not recommended for sleeping pills to be continued over the long term, as this is unnecessary in most cases.

As sleep quality improves with CPAP therapy, it may also be important to reassess your total sleep needs. Most people only need 7 to 9 hours of sleep to feel rested. Excessive time in bed may contribute to insomnia. If you are struggling, look at your average total sleep time by subtracting out the time you are spending awake and reduce the time in bed to better reflect these actual sleep needs.

Additional Options: Chinstraps, Tape, and Reapplying the Mask

Desperate times can call for some desperate measures. There are a few other options that are sometimes used. Some people apply a chinstrap to help keep the CPAP mask on. Chinstraps are most often used to prevent mouth breathing with CPAP, but they may add another layer of protection to keep the mask on. If you have more things to remove, the theory goes, you might wake enough to realize what you are doing and hopefully stop.

Some people use a small amount of paper or cloth tape across the edge of the CPAP mask strap and cheek. Therefore, if it is removed in the night, the pull of the tape on the skin will be painful enough to also cause an awakening.

In addition, the use of mittens or even oven mitts might prevent meddling fingers from removing a mask in the night.

Finally, the best option for most people is also the most obvious: just put it back on. If you wake up in the night and find the CPAP mask lying next to you, reapply it and restart the machine. You will gradually condition yourself to keep it on. This will also increase your total amount of use, which will have its own advantages.

No matter if you find your mask off once or a half-dozen times, when you wake up and realize it, put it back on. It's important to keep it on until morning to get the maximal benefit.

A Word From Verywell

If, after making a few changes, you are still continuing to struggle to use your CPAP as much as you would like to, start by speaking with your equipment provider or sleep specialist to see what your best options might be to improve your ability to keep the mask on at night.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Sleep Apnea Association. Troubleshooting guide for CPAP problems.

  2. Brooks R. Top 10 most common CPAP mask problems and discomfort (& how to solve them). American Association of Sleep Technologists.

Additional Reading
  • Kryger, MH et al. Principles and Practice of Sleep Medicine. Elsevier, 6th edition, 2017.

By Brandon Peters, MD
Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist.