Dry eyes from a CPAP mask

CPAP can leave eyes feeling dry when air escapes from the top edge of the mask and blows across your eyes while you sleep. A steady stream of air for hours dries the tear film, and your eyes are closed or nearly closed, so you don’t notice until morning. Mask fit is a question for the doctor or sleep provider who set up your machine; an eye drop’s label doesn’t cover CPAP use.

Dry eyes from a CPAP mask: why it happens

A CPAP machine pushes air through a hose into a mask at steady pressure. The air is meant to go into your nose or mouth. When the seal isn’t complete, some of it finds the easiest way out, and on many masks the easiest way out is along the bridge of the nose, right below the eyes.

That leak is a small, constant breeze aimed at the eye for as long as you sleep. The tear film has a watery layer under a thin oily layer that slows evaporation, and moving air speeds it up. Eyelids don’t always close completely during sleep, either, so some of the eye’s surface can be exposed to that airflow. The result can be eyes that feel gritty, dry or tired on waking.

Waking up with dry eyes on CPAP: signs it’s the mask

• Your eyes feel dry in the morning but improve as the day goes on.
• One eye is worse than the other, often on the side you sleep on.
• You or a partner notice air hissing or a draft near your eyes at night.
• The dryness started around when you began CPAP, changed masks or changed cushion sizes.
• Pressure lines on the bridge of your nose shift from night to night.

None of these proves the cause, but they’re worth noting down before you talk to your provider. A short log of which nights felt worse helps; keeping a simple eye drop log has a format you can borrow.

Who to ask about mask fit

The mask, its size, its cushion and the machine’s settings were chosen by the doctor who prescribed the machine and the sleep provider or equipment supplier who fitted it. They’re the right people to look at a leak. Mask style, cushion size and machine settings are part of the therapy, so changing them on your own isn’t something an eye drop guide should advise.

When you call, be specific. Say that you think air is escaping toward your eyes, describe which side and when you notice it, and mention any change in mask or equipment. Many machines record data about leaks, so your provider may be able to see it on their end.

The bedroom air still matters

Separate from the mask, the room you sleep in affects how dry your eyes feel. Furnace heat in winter or air conditioning in summer dries the air further. A humidifier in the bedroom, kept in the EPA’s recommended range of 30 to 50 percent, helps the room; does a humidifier help dry eyes? explains the details. A space heater aimed at the bed adds to the problem, so point it away.

Using eye drops when you’re on CPAP

Quell’s label doesn’t mention CPAP. Its directions are the same for everyone: Apply 1 drop 3 times per day in each eye. Its Uses section reads: For use as a protectant against further irritation or to relieve dryness of the eye. If you’re thinking about timing a drop around putting on the mask or taking it off, ask the doctor who manages your CPAP or your eye doctor how that fits with your therapy; the label doesn’t address it.

Within the label’s directions, many people place their three drops across the day, with one in the morning after they’ve taken the mask off and are up. Quell is designed to reinforce the tear film’s oil layer to help reduce moisture loss. Follow the label’s handling line every time: Do not touch tip of bottle to any surface to avoid contamination.

Keeping the bottle on your nightstand

If you keep the bottle by the bed, keep it within the label’s range, Store between 15° to 30°C (59° to 86°F), and away from the CPAP machine’s heated humidifier if yours has one, a space heater or a sunny windowsill. Put it where you won’t knock it off reaching for the mask in the dark, and out of reach of children and pets. If it looks different from usual, check the label’s Do not use line: If this product changes color.

When to see a doctor

Eyes that feel dry after a night of air blowing on them are one thing. Pain, changes in vision or discomfort that doesn’t ease during the day are another. The label is plain about it: Stop use and ask a doctor if you feel eye pain or changes in your vision, if irritation or redness continues, or if the condition worsens or persists for 72 hours. Tell your eye doctor you use CPAP; it’s useful context for them. The questions to ask your eye doctor guide can help you prepare.