Why CPAP Does Not Work For Some People

Filling your cup with water so CPAP can work analogy

Why is it that after using your CPAP machine or dental appliance religiously, it still does not work? Some days you feel great after sleeping with CPAP. But on other days, you feel like CPAP does not work at all.

I learned a very important concept that may explain this situation from Dr. David Buchholz, author of “Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Pain.

(Click here to listen to my podcast interview with Dr. Buchholz.) 

Dr. Buchholz’s “threshold” concept explains why you may get migraine headaches on some days and not on other days. There are many different reasons or risk factors for migraines. Different combinations of risk factors stack up to push you over your particular threshold level resulting in a migraine headache. This concept can be used to describe negative symptoms (such as a migraine headache), or positive symptoms (when CPAP works).

Overflow Your Water Cup To Make CPAP Work

Another way of thinking about this is to consider a cup filled halfway with water. Every negative risk factor (your genes, chocolate, red wine, low pressure, sleep deprivation, etc.) is equivalent to a different volume of water. As you keep putting in more water, at a certain point, the water will overflow and spill out of the cup and trigger your migraine. The cup’s size is your threshold. Everyone has a different cup size and different size of spoons for each risk factor. This is why eating chocolate one day may set off a migraine headache, but not on another day. On the first, day, you

didn’t sleep well, and it was about to rain (low pressure). You eat some chocolate, which leads to a headache. The next day, you slept a bit better and it’s still raining, but having some chocolate was a piece of cake!

The CPAP Success Threshold Level

Similarly, but in reverse, how well you feel after using CPAP is determined by how many checklist items you addressed. There will be a number of items on your particular checklist which will determine why CPAP does not work.

These items are the equivalent to the list of troubleshooting steps when first using CPAP. If you fill the cup with enough water, the water will overflow (good sleep). Some common examples include making sure your nasal breathing is clear, you have the right type of mask, and consider suspending the hose above your head. Other factors may include your sleep position, what and when you eat, vitamin or mineral deficiencies, toxins or irritants in your food and environment, and allergies. As illustrate in the above figure, eating late one night may tip you over the edge to make CPAP not work as well.

(For a more detailed discussion of what these troubleshooting steps are, listen to my podcast or read my book, Totally CPAP.)

Plug All the Leaks To Make CPAP Work

For some people, you can keep filling the cup with water but can never cause it to overflow. In this case, it’s possible that your cup is leaking. If your mask is literally leaking, then the leak must be addressed. However, there are two physical conditions that can prevent CPAP not to work, no matter how may checkboxes you complete (or fill the cup with water). The first one is when your epiglottis flops back into your airway when you breath in. It’s like a valve that closes suddenly as you start to inhale. The other situation is when your soft palate backs up into your nose as you breathe out, leading to air leaking out your mouth.

(More information about a floppy epiglottis and expiratory palatal obstruction can found in this blog post and podcast.)

Two or Three is Better Than One 

If you are still struggling to figure out why CPAP does not work, it’s possible that you haven’t stacked up enough positive items to push you over the threshold that’s required. The same situation applies if your results are inconsistent. Whether you’re struggling with CPAP, dental appliances, or had a failed surgical procedure, use this concept to troubleshoot.  Some people need to stack two types of treatment options for better results.

For example, nasal surgery or UPPP can help you use your CPAP or dental device work much more effectively. Palatal expansion or any dental appliance to widen your airway can work better if you have good nasal breathing, or if your epiglottis doesn’t keep blocking your breathing at night.  Oftentimes, the decision to make is not treatment A vs. treatment B, but consider both options.

Take Charge of Your CPAP and Make It Work

I’ve seen thousands of patients that are eventually successful if they don’t give up and are relentless in pursuing their goal of good sleep and better health. Be a detective and try to figure out what steps you need to stack on top of one another to get your cup to overflow with water. Involve all your healthcare practitioners, and do your research. Take charge of your quest to make CPAP work and finally get the sleep you need for the life you want. 

Please note: I reserve the right to delete comments that are offensive or off-topic.

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5 thoughts on “Why CPAP Does Not Work For Some People

  1. I am curious if you have any experience or knowledge about the Inspire Implant for the treatment of Severe Obstructive Sleep Apnea? I’ve been using a CPAP for about a year and I still hate it. I dread going to sleep and putting on that nose mask. I awaken almost every night because of the tube and then I have trouble returning to sleep. Also, the CPAP has ruined much of the nightly affection I shared with my wife for over 50 years. I’m currently researching the Inspire system and would like to know Dr. Parks’ opinion. Sincerely, Gerald F Serafino

  2. Mr. Serafino,

    There are very specific inclusion criteria for the Inspire procedure. Your BMI has to be less than 32, and you have to undergo drug induced sleep endoscopy to see if you’re a candidate. Also, your AHI must be > 15. The only way to know if you’re a candidate is to see a sleep surgeon that does Inspire. There are also other good options besides Inspire. Good luck.