There are quite a few causes for waking up every hour or so despite compliance with CPAP therapy.

If this is happening to you, the obvious approach is to first identify if there are any new situations that are awakening you every hour, such as (by coincidence) a new pillow that’s not as comfortable as you thought it might be; a new pet that hops up on your bed throughout the night; etc.

Another obvious approach is to see if a condition—that pre-existed your use of CPAP—is the cause of waking up so often. For example, do you have unresolved acid reflux?

Waking up Every Hour with CPAP:
Causes & Solutions

“There are many potential reasons for this, and more history is needed before a conjecture could be made,” says Joseph Krainin, MD, board certified in sleep medicine and neurology and founder of the online sleep apnea clinic Singular Sleep.

“I recommend consulting with a sleep doctor to evaluate for sleep apnea treatment efficacy related issues vs. an additional co-morbid sleep disorder.”

In other words, an issue with the CPAP therapy is more likely to be causing frequent awakenings than is, say, restless leg syndrome.

Possible Causes of Frequent Waking Up
Despite CPAP Compliance

• Too much pressure
• Swallowing air
• Change in sleep position causing body part to contact hose
• Eye or lip irritation from exhaust flow
• Sore nose from nasal pillows
• Dry nose from lack of humidity
• Wet nose from too much humidity
• Irritated or itchy nose/lip from the mask
• Mask leaks
• CPAP noise
• New sleep position to accommodate mask/hose efficacy

Psychological Cause of Frequent Wakeups
“It is fair to say that among people with no biological explanation for repeated waking, stress is a common cause,” says David D. Clarke, MD, president of the Psychophysiologic Disorders Association (stressillness.com), and Clinical Assistant Professor of Gastroenterology Emeritus, Oregon Health & Science University, Faculty Associate, Arizona State University.

Once you’re asleep, daytime worries and anxieties get temporarily pushed to the background, but eventually barge their way into the foreground and awaken you.

The anxiety may be solely related to your new status as a “hose head.” For example, how will this impact business and vacation travel?

Will you ever adjust to that thing on your face? This thought alone can be enough to waken you every hour.

“I divide stresses into two groups,” says Dr. Clarke. “Those that are obvious and can be accurately assessed when a person looks at their life and (2), those that are not as readily recognized. Among the latter are:

“Poor self-care skills (working to meet the needs of others to the neglect of oneself, often linked to lack of enough opportunities to play in childhood).

“Long-term impact of adverse childhood experiences.

“Unrecognized depression, anxiety or post-traumatic stress (quite common for these to be present but not detected by the sufferer or their doctor).”

The key, then, is to determine if your repeated awakenings, despite compliant CPAP use, were actually present prior to getting on CPAP.

Are you awakening more frequently with CPAP? Maybe it only seems you’re awakening every hour. Make a note of the times you awaken for no apparent reason.

If you’re clearly awakening more often since beginning CPAP treatment, chances are high that this is linked to a problem with the CPAP device – which includes stressing about having to use it lest you develop serious cardiovascular problems from untreated sleep apnea!