I can’t breathe out against the fixed CPAP pressure!


CPAP is important in order to relieve any apneas (pauses in breathing) during sleep. The “C” in CPAP stands for continuous, which basically means that you get one constant pressure throughout the whole night.  Some people really have trouble with CPAP for this reason.  Early on, learning to make this adjustment of breathing out against a fixed pressure may prove to be difficult.  Fortunately there are a couple of tips to make your transition easier.

Try this now…..Take a deep breath……now, naturally exhale.

If we pay close attention we realize that inhaling is an active effort.  We use our chest muscles and diaphragm to expand our chest and fill our lungs with air.  When we exhale, its more of a passive action. We relax our muscles and naturally release the air.  When we are on CPAP, this basically flips.  When you take a breath, the pressure of CPAP aids air delivery to the lungs so less effort is used.  When we exhale on CPAP, we have to use more force to blow the air out. For some people this is just not comfortable.  There are, fortunately, some small and helpful adjustments that can be made.


If the issue is with trouble during sleep initiation then we can use something called a ramp.  A ramp is basically a slow linear increase in the pressures, starting at a lower level, ultimately reaching goal pressure. For example if your pressure is set at 13 cmH20, you can set the ramp to start at 5 cmH2O for 45 minutes.  This way, the pressure will slowly increase and allow you to initiate sleep.  This change is usually done by your doctor or DME company.


These two terms are quite specialized in regards to sleep medicine.  The difference between CFLEX and EPR is basically the same as saying Coke vs Pepsi.  Respironics machine use CFLEX and EPR is owned by ResMed.  EPR/CFELX are unique comfort features which basically decrease the patient’s CPAP pressure during exhalation on a breath-by-breath basis.  This way it is easier to exhale.  This again can only be changed by your doctor.


OK, your tried everything else and still can’t breath.  Well in some circumstances, you would need to transition to bi-level therapy.  Bi-level therapy also call BiPAP or BPAP alternates between an inhalation and exhalation pressure which better mimics breathing. In order to qualify for a BPAP you would have to have failed CPAP before your insurance company will accepted the switch.


If you can’t breath out against the pressure there are easy changes that may help.  Ramp is a slow increase in pressure that helps patients initiate sleep.  CFLEX/EPR temporarily decrease pressure on exhalation.  If all else fails, BPAP is recommended for people who cannot tolerate CPAP.  It provides two pressure instead of one that makes breathing out easier.