But there’s another part of your sleep setup that can make a surprising difference — your pillow.

If you sleep on your side, a traditional pillow may push against the side of your CPAP mask. This pressure can move the mask slightly away from your face, potentially causing air leaks, noise and discomfort. You might find yourself waking to readjust the mask or tightening the straps more than necessary.

Your pillow can also influence the position of your head and neck. A pillow that is too high, too low or lacks adequate support may make it harder to find a comfortable sleeping position while wearing your CPAP equipment.

Specially designed CPAP pillows often have contours or cut-outs around the edges. These create additional space for the mask and tubing when sleeping on your side, helping reduce contact between the pillow and your mask. Some also include features to help keep the CPAP hose positioned comfortably during the night.

However, you don't necessarily need a special CPAP pillow. The most important thing is finding a pillow that supports your head and neck comfortably without pushing your mask out of position.

If you're regularly waking with mask leaks, facial pressure or strap marks, don't automatically assume the mask is the problem. Take a look at your pillow and sleeping position too.

Sometimes a small change to your sleep setup can make CPAP therapy considerably more comfortable.

If you take a proton pump inhibitor (PPI) such as esomeprazole, pantoprazole, omeprazole or rabeprazole for reflux, you may wonder whether it has any effect on your CPAP therapy.

The reassuring answer is that PPIs don't directly interfere with how your CPAP machine works, and CPAP doesn't directly stop a PPI from working.

However, reflux, sleep apnoea and CPAP can interact in interesting ways.

PPIs reduce the amount of acid produced by the stomach. If night-time reflux is causing coughing, throat irritation, discomfort or repeated waking, controlling those symptoms may make sleep — and potentially CPAP use — more comfortable. Research has investigated whether treating reflux with PPIs also improves obstructive sleep apnoea itself, but the evidence isn't strong enough to conclude that PPIs significantly improve the number of apnoeas or hypopnoeas. (PubMed Central (PMC))

CPAP may actually improve night-time reflux in some people. Studies have found that people who use their CPAP consistently can experience improvements in nocturnal reflux symptoms. (PubMed)

There is one complication to watch for: aerophagia, or swallowing air during CPAP therapy. This can cause belching, bloating and abdominal discomfort, and research has found an association between CPAP-related aerophagia and reflux. Higher CPAP pressures and existing GORD may increase the likelihood of aerophagia. (PubMed)

Could successful CPAP mean I no longer need my PPI?

Possibly your reflux symptoms could improve — but don't stop your PPI on that basis without having it reviewed.

If you've been using CPAP consistently and notice that your night-time reflux has substantially improved, it's worth discussing your PPI with your pharmacist or doctor. They can determine whether you still need the same medicine and dose.

Likewise, if you've started CPAP and developed new bloating, excessive belching or worsening reflux, have your CPAP therapy reviewed rather than simply increasing your reflux medication. Sometimes the issue may be related to aerophagia and your CPAP setup or pressure. (PubMed)

The takeaway:  PPIs and CPAP don't directly interfere with each other. But because reflux, OSA and CPAP therapy are interconnected, improvement or deterioration in one area can be a good reason to review the other.

Book an appointment to discuss any medication related issues.

CPAP Quiz of the Month

💤 CPAP Adelaide Sleep Quiz

A side sleeper using CPAP has a well-fitted mask, but regularly develops leaks after turning onto their side during the night. Which pillow feature would MOST directly address this problem?

 A very firm pillow that prevents the head from moving

 A contoured pillow with side cut-outs that provides space for the CPAP mask

 A high pillow that keeps the head elevated regardless of sleeping position

 A softer traditional pillow that allows the mask to sink into the pillow