OET Nursing Speaking: Sleep Apnoea and CPAP Concerns

“Just keep trying” is rarely enough when a patient finds CPAP difficult. First find out what is difficult: the mask, the airflow, a physical symptom or the idea of needing treatment. This OET nursing lesson explains obstructive sleep apnoea and shows how to encourage a useful next step without dismissing the patient’s experience.

1. Original nurse and patient role-play cards

Nurse role-play card

Setting: A sleep-service review appointment.

Situation: You are speaking with Casey Brown, an adult with obstructive sleep apnoea confirmed by the sleep team. CPAP has been recommended and supplied. Casey reports daytime tiredness and difficulty tolerating the mask, saying, “I don’t think I can keep doing this.” The card gives no severity score, pressure setting, weight, medicine list or driving assessment.

1. Acknowledge the difficulty and ask what happens when Casey uses the mask, including the main concern about continuing.
2. Explain obstructive sleep apnoea in plain English and connect interrupted sleep with possible daytime effects.
3. Explain how CPAP works and discuss appropriate help with mask tolerance, without promising a quick result or changing device settings.
4. Explore relevant sleep habits and daytime safety, including sleepiness while driving; give clear conditional advice and identify questions for the sleep team.
5. Agree a manageable next step, explain how to seek help with continuing problems and check Casey’s understanding.

Patient role-play card

Setting: The same sleep-service review.

Situation: You are Casey Brown. You understand that you have sleep apnoea, but you are not clear what happens during sleep. You have been given CPAP. The mask makes you feel closed in, and you are worried that staff will think you are not trying. You are tired during the day. No driving incident or equipment fault is supplied.

1. Say that you do not think you can continue. If asked about the difficulty, describe feeling closed in with the mask.
2. Ask why you can spend a long time in bed and still feel tired.
3. Ask what the machine does and whether difficulty using it means you have failed treatment.
4. Ask whether habits or another treatment could help; when asked about safety, discuss the questions you need clarified without inventing driving clearance.
5. Consider help with the mask, choose a next step you are willing to discuss and summarise the advice and remaining concern.

The cards and responses are original teaching examples. The learner should explore the patient’s problem rather than assuming every CPAP user has the same barrier.

2. Understand obstructive sleep apnoea before speaking

What happens during sleep?

In obstructive sleep apnoea, the upper airway repeatedly narrows or closes during sleep. Air does not move normally, and breathing may pause or become reduced. The person’s sleep is disturbed as breathing resumes. They may not remember these interruptions. Time spent in bed therefore does not necessarily equal refreshing sleep.

Possible features include loud snoring, witnessed pauses in breathing, gasping, daytime sleepiness and concentration difficulties. Snoring alone does not establish the diagnosis. Casey’s diagnosis has already been confirmed by the sleep team; the nurse is explaining it. Do not invent an oxygen reading or a number of breathing interruptions.

The NHS sleep apnoea overview explains symptoms, sleep testing and treatment. Risk factors can include airway anatomy, weight and alcohol, but none gives you permission to assume Casey’s weight, drinking habits or cause. Ask before advising.

What CPAP does

CPAP stands for continuous positive airway pressure. A machine supplies air through a mask to help keep the airway open during sleep. A useful simple explanation is “air pressure helps prevent the breathing passage from closing”. It is not an instruction to breathe harder, and ordinary CPAP is not the same as prescribing oxygen.

Treatment can improve sleep-related breathing and may reduce sleepiness. The individual response and comfort need review. Avoid promising that Casey will feel normal by a particular date or that CPAP removes every future health risk. It is generally used during sleep as directed by the treating team; difficulty using it should prompt support rather than an invented alternative schedule.

Why the actual barrier matters

“I can’t manage the mask” can describe several problems. Feeling enclosed, air leaking towards the eyes, a dry mouth and skin soreness are not interchangeable. Ask what happens, when it happens and what the patient has already tried. Explain why you are asking: identifying the problem helps the team choose appropriate support.

The Bristol sleep service’s guidance on difficulties with CPAP describes help with mask discomfort, claustrophobic feelings, leaks and dryness. Different mask designs may be worth discussing. That is an option for assessment, not a guarantee that a smaller mask will suit everyone.

University Hospitals Sussex’s CPAP information also directs patients with leaks to the sleep-service team. For this role-play, propose a check of the equipment, fit and comfort rather than telling the patient to tighten everything, block an opening or alter the prescribed pressure. Follow the instructions for the actual device and service.

Habits can support care, but should not replace a prescribed plan

Relevant advice may include a regular sleep routine, limiting alcohol especially near bedtime, avoiding smoking and weight-management support if appropriate. Sleeping position can help some people. A nurse should check what is relevant and realistic instead of assuming a long list applies. Sleeping tablets may worsen sleep apnoea; discuss them with the prescriber rather than telling the patient to stop a medicine abruptly.

Other treatments are considered for selected patients. Asking about alternatives is reasonable. It does not establish that Casey can safely replace CPAP with a mouthpiece or a change in sleeping position. Bring that question to the sleep team, which can consider the sleep-study findings and the person’s circumstances.

Daytime sleepiness is a safety issue

Ask whether “tired” means low energy, difficulty staying awake or unintended sleep. Explore driving and safety-critical activities rather than assuming Casey is safe because no accident has occurred. If excessive sleepiness affects driving, safety takes priority over the routine mask discussion.

In Great Britain, DVLA guidance on excessive sleepiness says not to drive until excessive sleepiness is absent or symptoms are controlled with any necessary treatment followed. Notification requirements depend on the condition and circumstances. The clinician should help clarify what applies. Do not give driving clearance from this role card or imply that owning a CPAP machine proves effective treatment.

3. Task-by-task guidance for the nurse

Task 1: Acknowledge and investigate

Use the patient’s own experience: “You have been trying, but the mask feels difficult to tolerate.” Then ask, “What happens when you put it on?” Let the answer identify the barrier. “Why won’t you use it?” implies refusal and may make a worried patient less willing to explain.

Task 2: Connect the condition with the question

Start with what Casey knows. Explain the narrowing airway and disrupted sleep in one short passage. Connect it to spending a long time in bed but waking unrefreshed. Ask what needs clarifying before describing the machine. Avoid an extended anatomy lecture or a list of severe complications.

Task 3: Offer relevant support, not pressure

After explaining the purpose of CPAP, ask permission to discuss the mask concern. If Casey feels closed in, explore which part causes that feeling and suggest discussing fit or design with the team. Avoid “Everyone gets used to it” or “You only need willpower”. Encouragement is more convincing when it contains a specific route to help.

Task 4: Ask about everyday life and safety

Use neutral questions about sleep routine, alcohol, medicines and alertness. Explain the reason for safety questions: “I ask because sleepiness can affect activities such as driving.” If a risk is disclosed, address it clearly. Do not leave important safety advice until after a lengthy lifestyle discussion.

Task 5: Agree one next step and check it

A possible next step is asking the sleep team to review mask tolerance and explain options. Check whether that addresses the patient’s main difficulty. Ask Casey to describe what CPAP is for and how they will seek help if the problem continues. Do not promise a replacement mask, same-day appointment or immediate improvement.

4. A substantial nurse-viewpoint model response

This teaching model gives the nurse’s viewpoint. It includes space for answers and choices. In practice, use the sections that match the patient’s responses; do not deliver the entire passage uninterrupted.

“Hello, Casey. I’m the nurse reviewing how you are getting on with treatment. You said you do not think you can keep doing this. Could you talk me through what happens when you try to use the mask?”

[Pause. Do not guess whether the problem is emotional discomfort, leakage or pain.]

“The closed-in feeling is the difficult part for you. Thank you for explaining that. It does not mean you have not been trying. Which part feels most uncomfortable: having something over your face, the sensation of airflow, or something else?”

[Listen. Reflect the answer briefly. Do not diagnose an anxiety disorder from this description.]

“Before we look at what might help, could I check what you have understood about sleep apnoea and why CPAP was recommended?”

[Pause for the patient’s explanation.]

“With obstructive sleep apnoea, the breathing passage can narrow or close while you are asleep. This interrupts breathing and disturbs your sleep, even when you do not remember waking. That can help explain why being in bed for a long time does not always leave you feeling rested. What would you like me to explain more clearly?”

“The CPAP machine sends air through the mask to help keep that passage open. The aim is to improve your breathing during sleep. It is important that the treatment is workable for you, so the difficulty you are describing needs attention.”

[Pause. Let Casey ask about the equipment or treatment before moving on.]

“Would you be willing to discuss the mask with the sleep team so they can check the fit and talk through suitable options? There are different designs, although the right choice depends on your needs. I cannot promise which one would work best without that assessment.”

“We can also ask about support for getting comfortable with the equipment. You do not need to hide the problem or pretend you are managing. What would make that discussion feel useful to you?”

[Listen. If Casey is reluctant, explore the reason rather than repeating the recommendation more firmly.]

“You asked about other treatments. That is a fair question for the sleep team. The choice depends on your assessment, so I would not advise replacing CPAP with something else without discussing it with them. Would you like that question included alongside the mask concern?”

“You also mentioned daytime tiredness. When you say tired, do you mean feeling low in energy, struggling to stay awake, or actually falling asleep when you do not intend to?”

[Pause. Follow up the answer. The role card does not establish the degree of sleepiness.]

“Do you drive or do work where becoming sleepy could put you or someone else at risk? Have you noticed difficulty staying alert during those activities? I ask because we need to make sure you are safe while the treatment is being reviewed.”

[If excessive sleepiness is reported, prioritise the safety response and clinical review. Do not continue as if this is only a mask-fitting issue.]

“If you have excessive sleepiness, you must not drive until it has resolved or is controlled and any necessary treatment is being followed. The clinician can clarify the driving and notification advice that applies to you. I would not want you to assume that simply having the machine makes driving safe.”

“Could we also briefly look at your usual sleep routine and anything you take to help you sleep? Some habits and medicines can affect sleep apnoea. We can identify what is relevant to you and what needs checking with the prescriber.”

[Ask about one area at a time. Do not assume alcohol use, smoking, excess weight or sleeping-tablet use.]

“From what you have told me, the next step we are considering is a review of the mask difficulty and your questions about treatment. Does that address what matters most to you, or is there another obstacle we should discuss first?”

“So I can check that I have explained things clearly, could you tell me what the machine is intended to do and what you would do if the mask remained difficult? What advice have you understood about daytime sleepiness and safety?”

[Listen to the patient’s summary. Correct any misunderstanding, confirm how to contact the treating service using its actual details, and invite a final question.]

5. Speaking tips, useful sentences and complete practice

Encouragement that follows the patient’s answer

• Acknowledge effort: “You have tried it, and this particular sensation is getting in the way.” Use this only when the patient has described trying.
• Explore: “What is the hardest part of using it?” Leave time for the answer.
• Explain the purpose: “The air pressure helps keep the breathing passage open.” Then check what the listener understood.
• Offer a next step: “Would a discussion about fit and suitable mask options be a useful place to start?”
• Respect a concern: “What worries you about trying that?” A refusal may contain important information.
• Be precise: “We can ask the team to review that.” This does not claim that an appointment is already booked.

Say “sleep apnoea” clearly, then use “breathing interruptions during sleep” if needed. Avoid rushing through the explanation because the term feels familiar to you. Use a firmer, calm tone for driving safety than for an optional discussion of mask preferences.

Common mistakes

Complete practice: first attempt

1. Prepare five prompts from the nurse card. Underline the unknowns: severity, settings, medicines and alertness assessment.
2. Record the role-play with a partner using the patient card. Pause after open questions and let the answer change your next sentence.
3. Check whether your condition explanation connects sleep interruption with daytime symptoms without inventing a test result.
4. Identify the proposed next step. Does it address the actual mask difficulty, and has the patient had a chance to respond?
5. Review the safety discussion and closing check. Remove any guarantee about comfort, energy or fitness to drive.

Changed answer and revision

For round two, replace the first explanation with: “I don’t feel trapped. Air keeps blowing towards my eyes, and I wake up trying to move the mask.” This new answer describes a possible leak or fit problem. It does not establish the exact cause.

Revise in three steps. First, acknowledge the correction: “So it is the airflow towards your eyes that is disturbing you.” Second, ask when it happens, how the mask is fitted and what guidance the patient has followed. Third, propose contacting the sleep team to check the fit and equipment. Avoid diagnosing the cause, tightening the straps excessively or changing pressure yourself.

A useful revised passage is: “That sounds uncomfortable. The fit and equipment need checking, rather than assuming you just need to get used to the sensation. What have you already tried, and have you been able to speak with the sleep service?” Continue with the condition explanation and safety questions as relevant; remove the long discussion of feeling enclosed.

Compare the two recordings. The patient’s answer should change the support you offer. Write down one sentence you removed, one question you added and the reason for each change. Finish by asking your partner to explain the agreed next step in their own words.

Continue with the sleep-apnoea topic and persuasion-without-pressure language in OET Speaking for Nurses — Course 20. For feedback on your speaking, explore online one-to-one OET tuition. You may propose dates and times around your shifts, subject to tutor availability.

Teaching source: Selected sections of Jobins Training’s OET Nurse Speaking Essentials: 50 Role-Plays for Strong Performance (OET NURSE 3825-3), introduction and Set 17 sleep-apnoea paired cards, condition explanation, model sentences and sample response. This scenario and model are original. Clinical and Great Britain driving guidance linked above were checked on 26 September 2026. No individual pressure setting, treatment outcome or driving clearance is supplied.

Source: OET NURSE 3825-3.epub, Jobins Training. Examples labelled original or illustrative were written for this article. Independent exam preparation; no affiliation with or endorsement by the examining body. Practice does not predict an official score.