PAP Tolerance and Side Effects

Even when PAP is beneficial and successfully lowers the patient’s AHI to targeted therapeutic levels, some patient’s will simply not tolerate the mask and straps associated with this therapy. This intolerance can result in taking a very long time to fall asleep (long sleep latency).

To overcome this, it is suggested that the patient try wearing PAP during the daytime even if awake and just reading for a half an hour, in order to become acclimated to the PAP mask. Furthermore, a hypnotic such as zolpidem or eszopiclone may be prescribed within the first month to help facilitate the process of falling asleep while wearing the mask.

There is regular home maintenance required for PAP users. At weekly intervals, the tubes and mask need to be washed and hung to dry. At monthly or bimonthly intervals the filters need to be cleaned out or replaced. There is also an ongoing cost in that replacement tubing, filters, headgear and masks will be mailed to the patient to periodically replace used parts.

Side effects of PAP include dry mouth. Humidification and a chinstrap to help keep the mouth closed assist to a degree. Naturally, in the presence of dry mouth caries risk increases. Research on the effects of PAP on plaque, calculus build-up and periodontal disease is minimal but mixed.20-22 Some studies have suggested there can be changes in facial morphology and maxillary incisal flaring with continued use.23

PAP requires a power source. Thus, there are limitations to PAP use amongst campers, deployed military personnel in austere environments, and a need for power adapters when traveling abroad.