5 little known ways to optimise PAP therapy

5 [little known], bizarre facts about PAP therapy, to make it safer and more effective (2023)

Estimated reading time: 6 minutes

In the old and grainy image to the right, I’m learning about Positive Airway Pressure (PAP) therapy.

Indeed, there’s so much to learn it can feel overwhelming, and when you’ve just been prescribed a life-long therapy, it can feel like a curse and not the blessing it really is.

So, these 5 little known, bizarre and seemingly counter-intuitive facts about PAP therapy for obstructive sleep apnoea / apnea, aim to help and inform you.

Help you avoid some of the common mistakes and make PAP easier to live with, more comfortable, safer and ultimately more effective.

Quick side note: I use the ‘PAP’ acronym to encompass both CPAP and APAP

If you or someone you know uses PAP, then you need to read this…

Adrian wearing CPAP

Adrian Zacher MBA

Author, Snoring and Sleep Apnoea Care Navigator

I teach healthcare professionals how to help their patients stop snoring; sleep and breathe at the same time.

Good to know:

Snorer.com is independent. We don’t sell anti-snoring devices, chin straps or whatever! And we don’t benefit from affiliate deals.

Bizarre Fact 1:

For a Better Fit LOOSEN the Headgear 

When your PAP mask leaks, it seems completely logical to tighten the headgear straps.


Yes, I know it seems insane, and I’ve even witnessed experienced sleep professionals, over-tighten headgear straps… So, you’re in good company if you’ve done this…

How loosening PAP headgear straps improves fit

PAP masks or ‘interfaces’ are made of a soft and highly flexible material that inflates a bit like a hovercraft cushion , and in so doing, adapts to the contours of your face. 

If you over-tighten the straps, you ‘crush’ this cushion and push the hard plastic frame into your face. Ouch! This makes it leak even more…

Getting the fit of your mask right is a moving target. You should adjust the straps when you are lying down and the PAP machine is blowing air.

PAP exhaust in your partner's face

Bizarre Fact 2:

Exhaust in your partner’s face

The Truth

PAP therapy exhaust is vented from the front of the mask straight at your sleeping partner. This venting is essential to prevent CO2 building up for when you breathe in (inhale).

While this might be fine in the Tropics… in Blighty at 2am, it can be less than desirable. Perhaps, if not a rocket exhaust, it’s a flow of air into your partner’s face which makes them turn over and move away from you #nice

Other than a mask redesign, not a lot you can do about it.

This is something some sleep professionals and businesses may shy away from discussing…


Perhaps because it might discourage you from using what is already an arduous therapy.

I disagree. Education informs choice. And who are they to judge what you should know?!

Choice is what drives manufacturers to produce better products. Today, the noise created by the PAP mask exhaust is a design target.

Perhaps tomorrow directing the exhaust will be.

Bizarre Fact 3:

Adjust Your Mask Straps – Once Again

Back to those darn straps….

This one is particularly for those that are new to PAP therapy.

Once you’ve got the tension of the straps about right by LOOSENING them – Fact 1 above (I found I had to pretty much have it falling off my face before turning on the machine…) leave it a week or so, and you’ll find you need to adjust the straps once more…

This is because the headgear fabric stretches. As I said above, its a moving target.

Quite literally.

Leave it a week or so, and you’ll find you need to adjust the straps once more…

It’s a moving target

WAKE UP! Bizarre facts about PAP for sleep apnoea

Bizarre Fact 4:


This is for the sneaky, cheeky partner of a PAP user. And who knows, they may take some sort of insane ‘pleasure’ in this…

Should the partner suddenly hear an increase in air hissing from the mask while the PAP user sleeps, they have full licence to WAKE THEM UP! and get them to restore their mask ‘fit’.

This is because the pressurised air is escaping (that’s what’s making the hissing noise) and not keeping the user’s airway open.

They are not treated. Go ahead and wake ’em up!

Bizarre Fact 5:

Don’t put petroleum jelly up your nose

PAP therapy can make the inside of your nose sore. Really sore. 

The WRONG thing to do is to shove petroleum jelly up your nose in an attempt to soothe and protect the broken skin.

The RIGHT thing to do is to consult your sleep unit and discuss humidification.

Why is this?

Small particles of petroleum based products may enter your lungs as you breathe, over time this may cause chemical pneumonia (more correctly termed ‘chemical pneumonitis’).

Don't put petroleum jelly up your nose

Bonus tip

Cleanliness is next to Godliness” so pay really close attention to keeping your mask clean.

The part of the mask that is in contact with your skin is removable, so EVERY MORNING remove it and wash it with washing-up liquid and warm water.

You’re trying to remove the natural oils from your face.

If you don’t do this, the mask will not ‘stick’ to you and it may leak. Driving the mask over-tightening cycle.


PAP therapy when it’s working is awesome. But it’s a bit like riding a bike. You need to learn how to use it, you will fall off at first and you will probably get cheesed off with it.

Perseverance, help and advice will see you using PAP therapy and appreciating the benefits.

Grab our free PAP guide and if you or your loved one are struggling with PAP therapy consult your sleep unit immediately for help.

There are also fantastic support groups who offer online and even 1-2-1 phone support (read the free PAP guide – they’re listed at the end).

Don’t give up = fit some stabilisers! Just like you did as a kid!!

How to choose PAP therapy information guide

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