Overcoming CPAP Anxiety: Tips to Reduce CPAP Mask Claustrophobia

Continuous positive airway pressure (CPAP) therapy is the gold standard of treatment for obstructive sleep apnea (OSA). It involves wearing a CPAP mask connected to a machine that delivers a constant flow of air to keep the airway open during sleep.

To make matters worse, many people with OSA have difficulty getting used to wearing a CPAP mask because it can feel confining and uncomfortable to wear all night. Some CPAP users find the masks restrictive and experience severe CPAP anxiety, making it challenging to use CPAP therapy consistently.

A study of newly diagnosed adults with moderate to severe sleep apnea who underwent CPAP therapy for one night found that 63% of them experienced some form of claustrophobia.¹ This statistic highlights how CPAP claustrophobia management can improve therapy effectiveness.

In this guide, we’ll explore what causes CPAP mask claustrophobia and provide tips such as how to choose the best CPAP mask for claustrophobia, practicing positive reinforcement, and others to help you overcome this common CPAP barrier. By understanding and implementing these tips, CPAP users can embrace the full benefits of therapy and enjoy a better quality of life.

CPAP mask claustrophobia is the feeling of discomfort, anxiety, or panic that people experience when wearing a CPAP mask. This sensation is similar to claustrophobia, which is a fear of being in confined spaces.

People with claustrophobia often experience panic attacks when they are in situations where they find it difficult or impossible to escape, such as elevators, hotel rooms with sealed windows, crowded rooms, public transportation, tunnels, or locked rooms.

Symptoms of claustrophobia can vary in intensity and may include a rapid heartbeat, shortness of breath, dizziness, sweating, trembling, and chest pain. Some people with severe claustrophobia go to great lengths to avoid enclosed spaces, which can have a significant impact on their daily lives.

While claustrophobia usually occurs in enclosed spaces, it can also occur in other situations, such as wearing a CPAP mask, because the sensation of having something covering the face can make claustrophobic feelings worse. As a result, people who are prone to claustrophobia often struggle with sleep apnea treatment.

Here are some reasons for feeling claustrophobic with a CPAP mask:

• CPAP masks cover the nose and/or mouth, and some designs can feel tight, bulky, or constricting, especially for people who are new to wearing anything on their face at night.

• The noise of the CPAP machine can be unsettling for some CPAP users, adding to their anxiety.

• People with claustrophobia may find it challenging to use a CPAP mask if it does not fit properly, as the discomfort of sleeping with a mask over their face can trigger panic attacks.

• The continuous air pressure from the CPAP machine can be intense for some users, creating a sensation of suffocation or confinement.

Additionally, inadequate education and support from healthcare providers can result in improper mask fitting, which can make CPAP anxiety and mask claustrophobia worse.

Some people with claustrophobia have an oversensitive “false suffocation alarm,” which makes them feel like they are suffocating even when there is no real danger. This feeling is especially common when wearing face coverings such as a CPAP mask.

When wearing a CPAP mask, a small change in breathing can trigger the false suffocation alarm, causing someone to think they cannot breathe. This can lead to a cycle of panic and rapid breathing, which is exacerbated by the release of adrenaline. As a result, the mask user removes the mask, thinking it is the cause of their distress.

In most cases, the panic is likely triggered by a different factor, such as a crowded environment or a sudden loud noise. However, the instinctive reaction of CPAP users is usually to remove the mask, which only adds to their anxiety and further intensifies their panic. If CPAP therapy makes you feel anxious and fearful, recognizing CPAP mask claustrophobia triggers can help you manage the surge of negative emotions and improve therapy adherence.

Signs of CPAP mask claustrophobia:

• A sense of being trapped or confined, especially around the face and head region due to the mask and straps.

• Difficulty breathing, even with the CPAP machine running. 

• Having negative feelings about CPAP therapy, feeling hopeless, or thinking that you will never get used to wearing the mask.

• Sudden feelings of panic or anxiety, especially when putting on the mask or during CPAP therapy.

• Constantly adjusting the mask, pulling at it, or trying to take it off during sleep.

• Avoiding CPAP machine use or being inconsistent with therapy because you are afraid or uncomfortable wearing your mask.

• Feeling your heart rate increase rapidly when putting on the mask or during CPAP therapy.

• Excessive sweating, especially around the parts of the face covered by the mask.

• Feeling irritated, frustrated, or agitated while wearing the mask.

If you experience feelings of anxiety, panic and a fear of suffocation when wearing a CPAP mask, know that you’re not alone and that you can get used to CPAP therapy with practice. In the next section, we’ll look at helpful tips to help overcome CPAP mask claustrophobia. 

If you’re feeling claustrophobic with a CPAP mask on, here are several strategies to help you overcome this fear and make sleep apnea therapy more manageable:

Choose the Right Mask

There are different types of CPAP masks available, such as nasal masks, nasal pillow masks, and full-face masks. We suggest trying on different types of CPAP masks to find the one that feels most comfortable and least confining to you.

Nasal Pillow Mask

Many CPAP users find nasal pillow masks and nasal masks less claustrophobic because they cover less of the face. Considered by many new to CPAP therapy as the best CPAP mask for claustrophobia, nasal pillow masks are lightweight and provide minimal contact with the face.

Nasal pillows rest underneath the nose, with their tips sitting inside the nostrils. This design delivers airflow directly into the nose and leaves the mouth uncovered, which helps minimize feelings of suffocation. Nasal pillow masks also provide an open field of vision, which can help reduce feelings of claustrophobia. The downside to nasal pillow masks is that they may not be comfortable for people who need high CPAP pressures. 

Nasal Mask

A nasal mask is also one of the best CPAP masks for people with claustrophobia. A traditional nasal mask with a triangle-shaped cushion covers the entire nose, while a nasal cushion mask sits below the nose, directing air into the nostrils.

Like nasal pillow masks, nasal masks are less likely to trigger claustrophobia because they leave the mouth uncovered. Nasal masks come in different styles and sizes to ensure a comfortable fit, and they can be used with higher CPAP pressures than nasal pillow masks.

Full Face Mask

If you tend to breathe through your mouth, you’ll need a mask that covers both your mouth and nose to prevent air from escaping out of your open mouth. Sounds uncomfortable? Unfortunately, full face CPAP masks tend to be bulkier and heavier than nasal and nasal pillow masks.

However, choosing one with a low-profile design and an under-the-nose cushion can go a long way towards reducing those feelings of suffocation. We recommend the ResMed AirFit F40 Full Face Mask, which checks both those boxes.

Practice Wearing Your CPAP Mask

Make Sure Your Mask Fits Properly

Adjust the headgear straps and mask cushion to ensure a comfortable fit and make sure to choose the right CPAP mask size. A mask that fits well is less likely to induce discomfort and agitation, which can intensify any feelings of claustrophobia.

Practice Positive Reinforcement and Relaxation Techniques

Once you can wear your CPAP mask without feeling anxious or panicky, reward yourself with something simple like positive affirmations or small rewards. Rewarding yourself will help you associate a positive experience with wearing the mask.

You can also practice relaxation techniques, such as deep breathing or meditation, to calm your mind and reduce anxiety. This can also help your body adjust to the feeling of wearing the mask.

Adjust Your CPAP Machine Comfort Features

Some CPAP machines, such as the ResMed AirMini and the Transcend Micro Auto Travel CPAP, have comfort features like ramp and pressure relief, which are designed to make your overall CPAP experience more pleasant. However, when these settings aren’t optimized, they can actually contribute to feelings of claustrophobia.

If your ramp setting is too low, you may feel like you are not getting enough air from the machine, which makes many users immediately take off their masks. This can be easily fixed by increasing your ramp pressure or changing your ramp setting to Auto, if your machine has this upgraded ramp feature. Learn more about how ramp works and why it can help you sleep better.

Create a Comfortable Sleep Environment 

Make your bedroom a comfortable and relaxing space. Use calming colors, soft lighting, and soothing sounds to create a peaceful atmosphere. A comfortable sleep environment can reduce overall anxiety, making it easier to wear the CPAP mask without feeling claustrophobic.

Seek Support

Talk to your healthcare provider about your feelings of claustrophobia, as they can offer support, guidance, and potential solutions. You can also join support groups or online forums where you can connect with others who have overcome similar issues and may have valuable insights and encouragement to share.

Overcoming CPAP mask claustrophobia is a major step in managing sleep apnea and getting restful sleep. While claustrophobia can be a challenging obstacle, with the right tips and a positive mindset, you can successfully adjust to CPAP therapy. 

The most important step is getting used to your CPAP mask. Start with short, comfortable sessions and gradually increase the amount of time you wear the mask to reduce feelings of anxiety on CPAP. Relaxation techniques, such as deep breathing and mindfulness, can also help reduce anxiety. 

Choosing a CPAP mask type with a clear field of vision, such as a nasal or nasal pillow mask, and adjusting your mask correctly will all help make therapy more comfortable. Adjusting CPAP machine comfort settings to eliminate feelings of air hunger can also go a long way towards reducing CPAP mask claustrophobia. 

The journey to overcoming CPAP mask claustrophobia is very personal and different for everyone. It requires patience, resilience, and self-compassion. By employing the tips we discussed in this article and remaining open to trying different techniques, you can find a way to comfortably adjust to CPAP therapy.

If you have any questions about CPAP therapy or want some professional help choosing a CPAP mask, feel free to contact the RespShop medical team. Use one of the three methods below to get in touch and instantly get access to our respiratory therapists and sleep technicians.

We’re here to help you sleep better!

1. Edmonds, J. C., Yang, H., King, T. S., Sawyer, D. A., Rizzo, A., & Sawyer, A. M. (2015). Claustrophobic tendencies and continuous positive airway pressure therapy non-adherence in adults with obstructive sleep apnea. Heart & lung : the journal of critical care, 44(2), 100–106. https://doi.org/10.1016/j.hrtlng.2015.01.002