Many of these experiences are temporary and improve with small comfort adjustments, patience, and better awareness of what to expect during therapy. Knowing that these difficulties are normal — and that most people work through them — can make the first week feel far less discouraging.
Feeling Uncomfortable Wearing the Mask
For most new users, the mask is the first and most noticeable challenge. Wearing something strapped to the face during sleep is simply unfamiliar, and the sensation of pressurised air flowing continuously can feel strange at first — particularly in those first few minutes before sleep.
Some users describe a feeling of mild claustrophobia, especially with full-face masks. Others find the pressure around the nose or cheeks distracting. These reactions are entirely normal and do not mean the mask is wrong for the individual — they reflect the brain's response to an unfamiliar experience.
Helpful tip: Rather than putting the mask on only at bedtime, try wearing it for 10 to 15 minutes while awake — reading, watching television, or simply relaxing. This allows the brain to associate the mask with a calm, comfortable state rather than the pressure of trying to fall asleep with it on for the first time.
Dry Mouth or Nasal Dryness
Dryness is one of the most commonly reported first-week experiences. The CPAP machine delivers a continuous stream of air through the mask, and without adequate humidification, this airflow can dry out the mouth, nasal passages, and throat — sometimes causing mild soreness on waking.
Patients who breathe through their mouth during sleep — whether habitually or because of nasal congestion — tend to experience this more noticeably, as the dry air passes more directly over the throat and oral tissues.
Comfort tips:
- Use the humidifier. Most CPAP machines include an integrated humidifier. Filling it with distilled water and setting it at a moderate to high humidity level is one of the quickest fixes for dryness. If dryness persists, increasing the humidity setting gradually usually helps.
- Stay hydrated. Good fluid intake through the day supports the body's natural moisture balance overnight.
- Check the mask seal. A leaking mask can cause mouth breathing even in patients who normally breathe through their nose. Addressing a leak often resolves the dryness alongside it.
Air Leaks During Sleep
Air leaks — where pressurised air escapes from around the edges of the mask — are a frequent first-week frustration. They reduce the therapy's effectiveness, create distracting sounds, and when directed toward the eyes, can cause irritation that wakes the patient.
Most leaks in new users come down to either an incorrect mask size or straps that have not been properly adjusted. Many people assume tightening the straps will solve a leak, but over-tightening actually distorts the mask cushion and can make leaking worse.
Helpful tip: Adjust straps while the machine is running so you can feel the airflow and identify exactly where the leak is occurring. If leaks continue despite careful adjustment, the mask size may need to be reconsidered. A mask that fits correctly should hold its seal without needing to be strapped tightly against the face.
Pillow positioning also plays a role — pressing the mask directly into a firm pillow while side sleeping can displace the seal. A pillow with a cutout designed for CPAP masks can help significantly.
Difficulty Falling Asleep
Even users who are committed to the therapy often find sleep elusive in the first few nights. The sound of the machine — though relatively quiet — is new. The sensation of breathing against a continuous airflow feels different from natural breathing. The physical presence of the mask is a constant reminder that something has changed.
This combination of unfamiliar sensations can keep the mind alert at a time when it should be winding down, making the normal transition to sleep harder to achieve.
Helpful tips:
- Use the ramp feature if available. Many CPAP machines offer a ramp function that begins at a lower, gentler pressure and gradually increases to the prescribed level over 20 to 30 minutes. Starting at lower pressure makes it easier to relax and drift off before the full therapy pressure engages.
- Create a calming environment. Keeping the room cool, dark, and free of screen light in the final hour before bed supports the natural sleep process and reduces the mental alertness that makes adapting harder.
- Be consistent. Using the machine every night — even if sleep feels lighter initially — is more effective than skipping nights when discomfort peaks. The adjustment comes from repeated exposure, and each night tends to be slightly easier than the last.
Skin Irritation or Pressure Marks
Waking up with red marks, soreness, or mild skin irritation around the nose, cheeks, or forehead is a common early experience. The mask sits against the skin for several hours, and if the straps are too tight or the cushion material is not well-suited to the individual's skin, some irritation is likely.
This issue tends to improve naturally as the user becomes more skilled at fitting the mask correctly, but a few targeted steps can speed that process considerably.
Helpful tips:
- Clean the mask after each use. Skin oils and moisture that build up on the cushion increase friction and irritation. A quick wipe with a damp cloth takes only moments and makes a noticeable difference over time.
- Consider soft mask liners. These thin fabric inserts sit between the cushion and the skin, reducing direct contact pressure. Many users find them significantly more comfortable, especially in the early weeks.
- Avoid over-tightening. The straps only need to be snug enough to prevent air leaks — not pressed firmly against the face. If there are deep marks in the morning, the straps are likely too tight.
Feeling Frustrated During the Adjustment Period
Perhaps the most underappreciated challenge of the first week is the emotional one. Many new CPAP users expect to feel better almost immediately — better sleep, more energy, less snoring. When the first few nights feel worse rather than better, frustration and doubt can set in quickly.
It is worth being honest about this: the first week of CPAP therapy is rarely the best week. Sleep may feel lighter, the mask may feel intrusive, and energy levels may not improve yet. This does not mean the therapy is failing.
The adjustment period is a recognised and expected part of beginning CPAP therapy. Most users report that comfort improves meaningfully by weeks two and three, and that the benefits of therapy — better rest, reduced breathing interruptions, improved daytime energy — begin to emerge once the body has adapted to sleeping with the device.
The patients who push through the first week with consistency are the ones most likely to experience the full benefit of therapy. Those who give up during the adjustment period often miss the point at which things genuinely start to improve.
Conclusion
The first week of CPAP therapy may feel challenging for some users, but most early difficulties — mask discomfort, dryness, air leaks, and disrupted sleep — improve with time, routine adjustments, and consistent use. Understanding that the adjustment period is normal, and that the experience genuinely gets easier with each passing night, is often the most useful thing a new user can know.
Small changes in mask fitting, cleaning habits, humidifier use, and sleep environment can make the transition noticeably more comfortable. The first week is the hardest — and it is worth getting through.