Spending the First Night Using CPAP Therapy to Treat Sleep Apnea

How to Obtain Your Equipment and Successfully Start Treatment

cpap machine
Brandon Peters, MD

Once you are diagnosed with sleep apnea, settling into bed to spend the first night using your continuous positive airway pressure (CPAP) can be a little intimidating. What should you expect when you first use CPAP therapy? How do you set it up? What initial hurdles may there be to overcome? Learn about the initial experience of being treated with CPAP and how to get successively started on the right path.

Obtaining Your CPAP Equipment

Most people who use CPAP will first be evaluated by a healthcare provider in a sleep clinic and undergo a sleep study to diagnose the severity of their sleep apnea. After reviewing the results and various treatment options, many will elect to use CPAP, as it is the gold standard treatment. In order to obtain the equipment, several decisions must be made.

One of the first important considerations is how to determine the proper pressure setting for the machine. This setting may be determined empirically (your healthcare provider selects a pressure or range of pressures based on your estimated needs), or with a second night in-center titration study. With a titration study, a sleep tech can adjust the pressures upward to ensure that your apnea is resolved, and that you no longer snore. This study may be recommended for people who have more complicated health problems, especially those with central apnea from heart failure, narcotic medication use, or a stroke. This condition may require bilevel therapy to resolve.

Your healthcare provider will then generate a written prescription for the CPAP equipment. You may be prescribed a fixed pressure CPAP, AutoCPAP (APAP), bilevel (sometimes called BiPAP or VPAP), or even a more sophisticated therapy such as adaptive servoventilation (ASV). The prescription may specify a brand, or it may be kept generic—good for any of the manufacturers such as ResMed, Respironics, Fisher & Paykel, or others. The sleep healthcare provider can also prescribe heated tubing, chinstraps, and specific CPAP masks.

Once you have your prescription, you will take it to a durable medical equipment (DME) provider. Much like a medication prescription that you can take to any pharmacy you choose, you're also free to take your CPAP prescription to any DME provider that you select. These providers are not typically associated with sleep clinics, as this may represent a conflict of interest for certain insurances like Medicare. However, it's advisable to select a DME company with knowledge about sleep equipment, and your healthcare provider may be able to give you recommendations about preferred companies in your area.

You will schedule a visit with your DME provider to obtain the CPAP. During this encounter, which may take up to an hour, you will be introduced to the machine. Expect some education on the basic use and cleaning and maintenance of the device. You will also be fitted with a CPAP mask and will use it briefly. You should choose a mask that is comfortable, and if you're not happy, ask to see and try other options. You will be given the supplies and support to get started, but then you’ll take your CPAP home.

Bringing Your CPAP Home

It can be exciting to bring your CPAP home: it may represent an opportunity to sleep better and wake feeling refreshed, an experience that you may have been missing out on for months, or even years. To get started, you will need to take a few minutes to put things in place.

Select a spot in your bedroom for your CPAP to reside. You will want to ensure that it is close enough to your bed so that the tubing can reach from the device to wherever you may move in bed. Most people put it on a nightstand, or just at or under the edge of the bed on the floor. Keep in mind that you will need to plug it into a power source. Once you have picked a place for it, you should fill the humidifier tank with water. (The manufacturers recommend using distilled water, but many people with safe water sources use tap water.) You will then be ready to use your CPAP for the first time.

Using CPAP for the First Time

Since you already had your mask fitted at the DME office, you should be able to put it on with relative ease. Tighten the straps of your headgear, and make certain that it fits snugly—but not too tight! You will be able to assess the fit to know for sure when you turn on your CPAP. Press the power button, and the machine should turn on. It may start at a low pressure, and newer models often have a leak check function. You can also set the temperature and humidity settings on most machines.

Once you have the mask situated, climb under the covers and make yourself comfortable. Some people are intimidated by the potential for leaks and lie on their backs, often still like a statue. You will find that as you get used to it, you will move more freely, without undue concern.

You will then begin to focus on your breathing pattern. You may find it initially uncomfortable to breathe out against the pressure of the CPAP. Keep your mouth closed with a nasal mask, or the air will escape from it. As you breathe out through your nose, there will be some resistance. As you breathe in, you'll feel like the machine is giving your breath an extra boost. If you use a full-face mask, you can breathe through your nose or mouth. Getting accustomed to this breathing pattern may take several minutes. If you struggle, you may want to practice breathing slowly with your CPAP while watching television or listening to music. This will distract you, and you will adapt to it more easily.

When you first use CPAP, you may find that it takes you a little longer to fall asleep; this will improve with time. It can be helpful to go to bed 1 hour later than usual so that you fall asleep more easily. You also may encounter a few other difficulties. You may need to adjust your mask to prevent pain or pressure sores on your face or ears. If your mouth falls open during your sleep, this may result in a dry mouth and require a chinstrap. Addressing these initial problems with compliance solutions can make a huge difference.

A Word From Verywell

By overcoming any early hurdles, you will set about on the right path that will lead you to resting and feeling better. If you do struggle, be in close contact with your DME provider and sleep healthcare provider to address your concerns. Most people can succeed with CPAP, and there are other options available to treat your sleep apnea if you do not.

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  1. Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: An American Academy of Sleep Medicine Clinical Practice GuidelineJ Clin Sleep Med. 2017;13(3):479–504. Published 2017 Mar 15. doi:10.5664/jcsm.6506