In clinical practice, CPAP pressure settings often receive the most attention when managing obstructive sleep apnoea (OSA). However, growing evidence and real-world adherence data suggest that comfort-related factors play a greater role in long-term CPAP success than pressure optimisation alone.
The Role of Comfort in CPAP Adherence
Studies consistently show that patients are more likely to discontinue CPAP therapy due to discomfort rather than inadequate pressure. Common issues include mask leaks, skin irritation, dryness, noise, and pressure intolerance, factors that can disrupt sleep continuity even when apnoea–hypopnoea indices are well controlled.
Key Comfort Factors That Influence Outcomes
- Mask fit and type: Poorly fitting masks increase leak, reduce effective pressure delivery, and contribute to patient frustration. Individualised mask selection (nasal, nasal pillows, or full-face) is critical.
- Humidification: Heated humidifiers reduce nasal dryness, congestion, and mucosal irritation, particularly important in patients with pre-existing rhinitis or sinus disease.
- Pressure delivery mode: Features such as expiratory pressure relief (EPR) or auto-adjusting CPAP can improve tolerance during sleep onset and REM-related pressure changes.
While pressure titration is essential, optimising comfort is often the key determinant of sustained CPAP adherence. Addressing mask fit, humidification, and usability early can significantly improve both compliance and therapeutic outcomes.