Starting CPAP therapy means learning new equipment and establishing new routines. While your equipment provider will walk you through the basics, having a reference guide can help reinforce what you’ve learned and answer questions that arise. Here’s a practical walkthrough from unboxing your equipment to waking up after your first night.
Initial Setup
Positioning the Machine
Place your CPAP machine on a flat, stable surface near your bed—a nightstand works well for most people. Position it close enough that the tubing can reach you comfortably without being stretched tight, but not so close that you risk knocking it over during the night.
Keep the machine at or below pillow level. Placing it too high can cause water from the humidifier to flow down the tubing toward your mask.
Ensure easy access to a power outlet. CPAP machines require consistent power; most don’t have battery backup, so positioning near an outlet prevents accidental unplugging.
Preparing the Humidifier
Most modern CPAP machines include a heated humidifier. Before first use:
Remove the water chamber and fill it with distilled water to the indicated fill line. Using distilled water prevents mineral buildup and extends equipment life.
Reinsert the chamber into the machine, ensuring it seats properly. An improperly seated chamber may cause leaks or prevent the humidifier from functioning.
Your provider will suggest an initial humidity setting. You can adjust this based on comfort—increase it if you experience dryness, decrease it if you notice condensation in your tubing.
Connecting the Tubing
Attach one end of the tubing to the air outlet on your CPAP machine. This connection typically involves a simple push-fit or twist-lock mechanism.
Connect the other end to your mask. Most masks have a quick-release connector that makes nightly attachment and detachment simple.
Check that all connections are secure. Loose connections can cause air leaks and noise.
Fitting Your Mask
Proper mask fit is crucial for comfortable, effective therapy. Spend time getting this right.
Finding the Right Style
If you haven’t already selected a mask style with your provider, consider your breathing habits:
Nasal masks cover only the nose and work well for people who breathe through their nose during sleep. They’re less intrusive than full-face masks but require keeping your mouth closed.
Nasal pillows are the most minimal option, with small cushions resting just inside your nostrils. They’re lightweight and leave your face largely uncovered but may feel uncomfortable at higher pressures.
Full-face masks cover both nose and mouth. They’re essential for mouth breathers and can be more stable for people who move a lot during sleep.
Adjusting the Fit
Put on the mask while sitting upright. Adjust the headgear straps until the mask rests comfortably against your face without pressing too hard. The cushion should seal gently around the perimeter—a light, even contact rather than a firm press.
Lie down in your sleeping position and refine the fit. Mask fit often changes when you’re horizontal. Make small adjustments until you achieve a seal in your typical sleep positions.
The fit is right when air doesn’t leak significantly around the edges while the mask remains comfortable. You should be able to slip one or two fingers under the straps. Over-tightening rarely improves the seal and often causes discomfort and facial marks.
Operating the Machine
Turning It On
Most CPAP machines turn on when you press a single button or, on some models, when they detect you breathing into the mask. A display will illuminate showing basic information like pressure settings.
If your machine has a ramp feature, it will likely activate by default. The pressure will start low and gradually increase to your prescribed level over a period you (or your provider) can adjust, typically 15-45 minutes.
Breathing With the Machine
Once the machine is running and you’re wearing your mask, breathe normally through your nose (or nose and mouth, depending on your mask type). The pressurized air will flow in as you inhale.
Exhaling against the pressure may feel unusual at first. You’re pushing air out against a constant inward flow. This sensation typically becomes unnoticeable within a few nights. If it remains uncomfortable, talk to your provider about pressure relief features that can help.
Try to relax. Anxiety about the equipment can make the first night harder. Remind yourself that the machine is simply providing air—you remain in control of your breathing.
During the Night
Ideally, you’ll fall asleep and wake in the morning with the mask still in place. In reality, especially during early use, you may wake during the night aware of the mask or find you’ve removed it while sleeping.
If you wake up, check that your mask seal is intact and try to go back to sleep. Don’t worry if you remove the mask unconsciously during the first few nights—this is common and typically decreases as you adjust.
Your First Morning
Removing the Equipment
When you wake up, turn off the machine (many power down automatically when the mask is removed) and remove your mask. Some people experience brief dryness or a “stuffy” sensation that clears quickly.
Disconnect the tubing from the mask for easier storage. Coil the tubing loosely—don’t kink it—and place it where it won’t collect dust.
Daily Maintenance
Each morning:
Wipe down your mask cushion with a damp cloth or CPAP-specific wipe to remove facial oils.
Empty any remaining water from the humidifier chamber and leave it open to air dry.
These simple daily steps prevent odors and bacterial growth.
Troubleshooting Common First-Night Issues
Mask leaks: If you hear air escaping or feel it blowing around your eyes, adjust the mask position and headgear tension. Sometimes lying in a different position temporarily helps identify where the leak originates.
Dry mouth or throat: Increase your humidifier setting. If you use a nasal mask and breathe through your mouth, consider a chin strap or switching to a full-face mask.
Feeling like there’s too much air: Try increasing the ramp time so pressure builds more gradually. Enable pressure relief features if available. If the sensation persists, contact your provider—your pressure setting may need adjustment.
Difficulty falling asleep: Practice wearing the mask while awake before trying to sleep with it. Use the ramp feature. Consider relaxation techniques as you acclimate to the equipment.
Removing the mask during sleep: This often improves with time. Some users find wearing long sleeves or mittens prevents unconscious mask removal during the adjustment period.
Building the Habit
Successful CPAP therapy requires consistent use. Aim to use your machine every time you sleep, including naps. The benefits compound with regular use, and your body adjusts more quickly when use is consistent.
Keep your equipment clean, maintain supplies as needed, and stay in contact with your healthcare team. With patience and persistence, CPAP therapy will become as routine as any other part of your sleep hygiene—and the results will speak for themselves in how you feel each morning.