From The American Sleep Apnea Association.com
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Do I have sleep apnea?
Never heard of sleep apnea? It's time you did! Sleep apnea is a debilitating and life-shortening ailment that's estimated to affect 22 million Americans. Most don't know it. Untreated, it can lead to depression, heart disease, diabetes, and fatal car crashes. Take care of your sleep Healthy sleep is largely shaped by your own behavior. Here are some tips for improving it. Four tests to take now |
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Test Yourself
If you think you may suffer from obstructive sleep apnea or some other sleep breathing disorder, there are several simple tests you can take that may suggest you should discuss the possibility with your health care provider. Remember, though, that one of the best tests may be a complaint by your bed partner that you snore loudly or that you stop breathing repeatedly while you're asleep.
Four tests that you can take right now are the American Sleep Apnea Association's own Snore Score, the Epworth Sleepiness Scale, and the Berlin Sleep Questionnaire. STOP-BANG asks for you to enter your body-mass index. If you don't know what your BMI is, the National Heart Lung and Blood Institute will help you calculate it.
If you think you may suffer from obstructive sleep apnea or some other sleep breathing disorder, there are several simple tests you can take that may suggest you should discuss the possibility with your health care provider. Remember, though, that one of the best tests may be a complaint by your bed partner that you snore loudly or that you stop breathing repeatedly while you're asleep.
Four tests that you can take right now are the American Sleep Apnea Association's own Snore Score, the Epworth Sleepiness Scale, and the Berlin Sleep Questionnaire. STOP-BANG asks for you to enter your body-mass index. If you don't know what your BMI is, the National Heart Lung and Blood Institute will help you calculate it.
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Getting a Diagnosis
If you suspect that you have sleep apnea, the usual first step is to discuss your suspicions with your primary care physician. If you don't have a primary care physician, you can go directly to a clinician who is a sleep specialist. But check your health care insurance coverage first. Some policies require you to see a primary care physician first, and some policies limit the sleep centers and testing facilities whose services they will pay for. Unfortunately, you may discover that your policy offers limited or no coverage for the diagnosis and treatment of sleep apnea, in which case you may wish to switch insurers if and when you can. |
Whichever kind of physician you consult initially, it can be helpful for you to prepare in advance a detailed account of your medical history as it may be relevant to sleep apnea. The ASAA is collaborating with Arbor Medicus to offer you a free interactive online History Taker that will help you do just that.
Sleep specialists come from a variety of medical backgrounds. They may be pulmonologists (lung specialists), otolaryngologists (ears, nose, and throat), neurologists (brain and nerves), psychiatrists (mental health), or primary care physicians--internists and family practitioners. Some dentists also have special training in the treatment of sleep disordered breathing, which includes sleep apnea. You can check the credentials of specialists at the web sites of the American Board of Internal Medicine and the American Board of Sleep Medicine. You should feel free to ask any doctor you see about his or her credentials and the diagnostic procedures to be followed.
A definitive diagnosis of sleep apnea can be made only with a sleep study conducted during a visit to a sleep lab, usually overnight, or a home study performed with special equipment. Some sleep centers are accredited by the American Academy of Sleep Medicine and you can find them listed here. Others that are just as qualified, however, may choose not to pay the cost of accreditation or may be in the process of obtaining it.
A sleep study generates several records of activity during several hours of sleep, usually about six. Generally, these records include an electroencephalogram, or EEG, measuring brain waves; an electroculogram, or EOG, measuring eye and chin movements that signal the different stages of sleep; an electrocardiogram, EKG, measuring heart rate and rhythm; chest bands that measure respiration; and additional monitors that sense oxygen and carbon dioxide levels in the blood and record leg movement. None of the devices is painful and there are no needles involved. The testing procedure as a whole is known formally as "polysomnography," and the technician who supervises it is usually a "registered polysomnographic technologist," or RPT. Usually the bedroom where the test is conducted is more like a comfortable hotel room than a hospital room.
Your doctor might prescribe a "split-night study," in which the first hours are devoted to diagnosis. If obstructive sleep apnea is found, the patient is awakened and fitted with a positive airway pressure device. The remainder of the patient's slumber is then devoted to determining how well he or she responds to PAP therapy.
A substantial amount of data is generated by a sleep study, but the most crucial is the apnea-hypopnea index, or AHI. An apnea is a complete cessation of breathing for 10 seconds or longer. A hypopnea is a constricted breath (more than one-fourth, less than three-fourths) that lasts 10 seconds or longer. The index number is the number of apneas and hypopneas the sleeper experiences each hour. An AHI of 5 to15 is classified as mild obstructive sleep apnea; 15 to 30 is moderate OSA; 30 or more is severe OSA. Here is more information about understanding the results of your sleep study. If you are diagnosed with OSA, its severity is one of the factors you and your sleep specialist will weigh as you explore your treatment options.
While polysomnography in a fully equipped sleep lab is regarded as the "gold standard" for sleep apnea diagnostics, your sleep specialist may decide that given your circumstances and your symptoms the findings produced in a home study will be sufficient to make an accurate diagnosis. A home study, especially if it is self-administered (as most are), is definitely cheaper, and some patients are unable to conform to the sleep lab's procedures. Home studies are coming into steadily wider use.
The cost of diagnosing and treating sleep apnea is significant, generally well over $1,000, and if PAP therapy is prescribed, charges will be ongoing. If you are uninsured or underinsured, you may be tempted to delay action. Be aware, though, that the consequences of untreated sleep apnea, described elsewhere on this web site, could lay a heavy cost on you as well. Diagnosis and, if necessary, treatment may be well worth the price.
Sleep specialists come from a variety of medical backgrounds. They may be pulmonologists (lung specialists), otolaryngologists (ears, nose, and throat), neurologists (brain and nerves), psychiatrists (mental health), or primary care physicians--internists and family practitioners. Some dentists also have special training in the treatment of sleep disordered breathing, which includes sleep apnea. You can check the credentials of specialists at the web sites of the American Board of Internal Medicine and the American Board of Sleep Medicine. You should feel free to ask any doctor you see about his or her credentials and the diagnostic procedures to be followed.
A definitive diagnosis of sleep apnea can be made only with a sleep study conducted during a visit to a sleep lab, usually overnight, or a home study performed with special equipment. Some sleep centers are accredited by the American Academy of Sleep Medicine and you can find them listed here. Others that are just as qualified, however, may choose not to pay the cost of accreditation or may be in the process of obtaining it.
A sleep study generates several records of activity during several hours of sleep, usually about six. Generally, these records include an electroencephalogram, or EEG, measuring brain waves; an electroculogram, or EOG, measuring eye and chin movements that signal the different stages of sleep; an electrocardiogram, EKG, measuring heart rate and rhythm; chest bands that measure respiration; and additional monitors that sense oxygen and carbon dioxide levels in the blood and record leg movement. None of the devices is painful and there are no needles involved. The testing procedure as a whole is known formally as "polysomnography," and the technician who supervises it is usually a "registered polysomnographic technologist," or RPT. Usually the bedroom where the test is conducted is more like a comfortable hotel room than a hospital room.
Your doctor might prescribe a "split-night study," in which the first hours are devoted to diagnosis. If obstructive sleep apnea is found, the patient is awakened and fitted with a positive airway pressure device. The remainder of the patient's slumber is then devoted to determining how well he or she responds to PAP therapy.
A substantial amount of data is generated by a sleep study, but the most crucial is the apnea-hypopnea index, or AHI. An apnea is a complete cessation of breathing for 10 seconds or longer. A hypopnea is a constricted breath (more than one-fourth, less than three-fourths) that lasts 10 seconds or longer. The index number is the number of apneas and hypopneas the sleeper experiences each hour. An AHI of 5 to15 is classified as mild obstructive sleep apnea; 15 to 30 is moderate OSA; 30 or more is severe OSA. Here is more information about understanding the results of your sleep study. If you are diagnosed with OSA, its severity is one of the factors you and your sleep specialist will weigh as you explore your treatment options.
While polysomnography in a fully equipped sleep lab is regarded as the "gold standard" for sleep apnea diagnostics, your sleep specialist may decide that given your circumstances and your symptoms the findings produced in a home study will be sufficient to make an accurate diagnosis. A home study, especially if it is self-administered (as most are), is definitely cheaper, and some patients are unable to conform to the sleep lab's procedures. Home studies are coming into steadily wider use.
The cost of diagnosing and treating sleep apnea is significant, generally well over $1,000, and if PAP therapy is prescribed, charges will be ongoing. If you are uninsured or underinsured, you may be tempted to delay action. Be aware, though, that the consequences of untreated sleep apnea, described elsewhere on this web site, could lay a heavy cost on you as well. Diagnosis and, if necessary, treatment may be well worth the price.
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Many of the articles below were written by Tracy, from her patient perspective, on subject matter she believes will be helpful in assisting you in reaching the successful therapy you deserve. We hope you find the information below useful but when challenges arise, always consult your medical team.
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Attitudes and Expectations
Yes, CPAP therapy is challenging. The challenge is to find the best combination of the 3 components which are CPAP device, CPAP heated humidifier and CPAP mask. Approximately 50% of all patients diagnosed with sleep apnea and prescribed CPAP therapy will abandon treatment or fail on CPAP.
Attitude and Expectations
Tracy R. Nasca
Approximately 50% of all patients diagnosed with sleep apnea and prescribed CPAP therapy will abandon treatment or fail on CPAP. Why then, if CPAP therapy is the gold standard, does this happen? It’s an intriguing question that begs for answers.
Yes, CPAP therapy is challenging. The challenge is to find the best combination of the 3 components which are CPAP device, CPAP heated humidifier and CPAP mask. All 3 must be tweaked on an individual basis through trial and error. The device itself has optional features that need be customized for each patient. The addition of heated humidifier assures comfort but sometimes challenging to find the best temperature setting. Mask choice is the most challenging and without proper assistance from your CPAP supplier, may take more trial and error attempts than your patience might allow. Ultimately, the most important factor in achieving CPAP success is the patient himself and the fortitude they encompass. So, beyond the equipment involved, this article tackles the psychological elements of making CPAP work.
“Whether you think you can, or think you can’t, you’re probably right” – Henry Ford
What have you brought to the table upon your diagnosis of sleep apnea? Do you come with a positive attitude or a negative one? Will you persevere or will you give up?
Fear Factors
You have family or friends who have failed on CPAP
You’ve heard their horror stories about how bad it is
Your first experience in the sleep lab using CPAP and mask was uncomfortable
You’ve seen the CPAP and mask and don’t want any part of it
You are claustrophobic and think you cannot wear a mask….period
You are worried that your bed partner will be turned off by how you look strapped to a medical device
You are so sleepy and depressed, a pity party is easier than a fight
Realistic Expectations
Start with a clean slate. Throw away all of your fears, negative thoughts and preconceived notions based on what you think you know, or whom you have talked to. Once you understand that CPAP therapy is challenging and you accept that challenge, success is only brief steps away. Attitude is everything.
You might be thinking that success is all about the medical devices you are faced with using and you would be partially correct. But realistically, success is determinant on you, your attitude, your expectations and your fortitude.
Be Positive and Proactive
Be proactive as you start therapy by learning the operation of your machine comfort settings and mask choice. After your CPAP supplier sets up your equipment, trial and error begin. They cannot help you unless you tell them what’s working and what’s not. While they should be holding your hand through the adjustment period, don’t sit back and wait for them. It’s your life we are talking about and no one cares more about you than you. With persistence, you can fly through the trial and error adjustment period as quickly as YOU choose. Most, who fail on CPAP, were not proactive. They did not take the time to learn about their equipment comfort setting features or mask choice and fit techniques to tweak and resolve. They gave up before they really started.
How can you psyche yourself up and have a “can do” attitude? Choose your goals from the list below and know that all that stands between success and failure is you.
Motivation
Factors Reduce risk of heart attack or stroke
Reduce risk of congestive heart failure
Lower your blood pressure
Eliminate or reduce frequent night time bathroom trips
Eliminate or reduce heartburn or GERD
Increase libido
Increase memory and concentration
End daytime sleepiness
Eliminate snoring
Eliminate headaches caused from low oxygen levels
Eliminate depression and moodiness caused by sleep deprivation
Spend more quality time with your loved ones
Be more productive at work, home, or school
Reduce the noise pollution in your bedroom ( snoring) to allow return of your bed partner
Increase energy level to allow diet and exercise to help you lose weight
Repair damaged relationships due to your lack of energy, moodiness, depression
Increase your overall health and well being
Get your life back
If it still seems overwhelming and you need assistance, consider cognitive behavioral therapy (CBT). If it wasn’t highly effective, this subsection of specially trained sleep professionals and services would not be so prevalent. Covered by insurance, ask your sleep doctor for a referral to CBT. There is no need to feel alone nor give up. Help is out there, just ask for it.
Yes, CPAP therapy is challenging. The challenge is to find the best combination of the 3 components which are CPAP device, CPAP heated humidifier and CPAP mask. Approximately 50% of all patients diagnosed with sleep apnea and prescribed CPAP therapy will abandon treatment or fail on CPAP.
Attitude and Expectations
Tracy R. Nasca
Approximately 50% of all patients diagnosed with sleep apnea and prescribed CPAP therapy will abandon treatment or fail on CPAP. Why then, if CPAP therapy is the gold standard, does this happen? It’s an intriguing question that begs for answers.
Yes, CPAP therapy is challenging. The challenge is to find the best combination of the 3 components which are CPAP device, CPAP heated humidifier and CPAP mask. All 3 must be tweaked on an individual basis through trial and error. The device itself has optional features that need be customized for each patient. The addition of heated humidifier assures comfort but sometimes challenging to find the best temperature setting. Mask choice is the most challenging and without proper assistance from your CPAP supplier, may take more trial and error attempts than your patience might allow. Ultimately, the most important factor in achieving CPAP success is the patient himself and the fortitude they encompass. So, beyond the equipment involved, this article tackles the psychological elements of making CPAP work.
“Whether you think you can, or think you can’t, you’re probably right” – Henry Ford
What have you brought to the table upon your diagnosis of sleep apnea? Do you come with a positive attitude or a negative one? Will you persevere or will you give up?
Fear Factors
You have family or friends who have failed on CPAP
You’ve heard their horror stories about how bad it is
Your first experience in the sleep lab using CPAP and mask was uncomfortable
You’ve seen the CPAP and mask and don’t want any part of it
You are claustrophobic and think you cannot wear a mask….period
You are worried that your bed partner will be turned off by how you look strapped to a medical device
You are so sleepy and depressed, a pity party is easier than a fight
Realistic Expectations
Start with a clean slate. Throw away all of your fears, negative thoughts and preconceived notions based on what you think you know, or whom you have talked to. Once you understand that CPAP therapy is challenging and you accept that challenge, success is only brief steps away. Attitude is everything.
You might be thinking that success is all about the medical devices you are faced with using and you would be partially correct. But realistically, success is determinant on you, your attitude, your expectations and your fortitude.
Be Positive and Proactive
Be proactive as you start therapy by learning the operation of your machine comfort settings and mask choice. After your CPAP supplier sets up your equipment, trial and error begin. They cannot help you unless you tell them what’s working and what’s not. While they should be holding your hand through the adjustment period, don’t sit back and wait for them. It’s your life we are talking about and no one cares more about you than you. With persistence, you can fly through the trial and error adjustment period as quickly as YOU choose. Most, who fail on CPAP, were not proactive. They did not take the time to learn about their equipment comfort setting features or mask choice and fit techniques to tweak and resolve. They gave up before they really started.
How can you psyche yourself up and have a “can do” attitude? Choose your goals from the list below and know that all that stands between success and failure is you.
Motivation
Factors Reduce risk of heart attack or stroke
Reduce risk of congestive heart failure
Lower your blood pressure
Eliminate or reduce frequent night time bathroom trips
Eliminate or reduce heartburn or GERD
Increase libido
Increase memory and concentration
End daytime sleepiness
Eliminate snoring
Eliminate headaches caused from low oxygen levels
Eliminate depression and moodiness caused by sleep deprivation
Spend more quality time with your loved ones
Be more productive at work, home, or school
Reduce the noise pollution in your bedroom ( snoring) to allow return of your bed partner
Increase energy level to allow diet and exercise to help you lose weight
Repair damaged relationships due to your lack of energy, moodiness, depression
Increase your overall health and well being
Get your life back
If it still seems overwhelming and you need assistance, consider cognitive behavioral therapy (CBT). If it wasn’t highly effective, this subsection of specially trained sleep professionals and services would not be so prevalent. Covered by insurance, ask your sleep doctor for a referral to CBT. There is no need to feel alone nor give up. Help is out there, just ask for it.
After the Sleep Apnea Diagnosis
You have been diagnosed with sleep apnea. For most patients, sleep apnea is for life and this is the time to be proactive in your prescribed treatment therapy. This is a critical time as you begin CPAP therapy and the information you will be receiving is important yet may seem overwhelming; your brain may be on overload. This is all new to you and so how will you know what questions to ask?
After the Sleep Apnea Diagnosis
Tracy R. Nasca
Check list of things to ask your sleep doctor and CPAP provider
You have been diagnosed with sleep apnea. For most patients, sleep apnea is for life and this is the time to be proactive in your prescribed treatment therapy. You are most likely in a sleepy fog when you visit the sleep doctor for your follow up visit. You will be given the results of your overnight sleep study, have a follow up visit with the sleep doctor; then be referred to a CPAP provider and not necessarily in that order. This is a critical time as you begin CPAP therapy and the information you will be receiving is important yet may seem overwhelming; your brain may be on overload. This is all new to you and so how will you know what questions to ask?
The following is a checklist of important information you should receive and questions you should ask your healthcare providers.
-Sleep Doctor
What is my specific diagnosis and what is sleep apnea?
Obstructive sleep apnea, Central Sleep Apnea or Mixed Sleep Apnea (both obstructive and central)
What is the difference between the diagnoses?
If you are diagnosed with central sleep apnea, ask for a thorough explanation of what it is, why you have it and how it may be treated differently in your case.
WHY do I have sleep apnea?
Ask the doctor what your physical/anatomical reasons are for having sleep apnea and discuss your treatment options. CPAP is typically first line treatment, but familiarize yourself with other options such as oral appliance therapy, that are appropriate for your condition. Treatment options are dependent on WHY YOU have sleep apnea in the first place.
Please provide me with my sleep study summary report
Your overnight sleep study summary report should be considered your diagnosis and baseline. It contains a summary of the data collected in your overnight stay. It is very likely that you will have subsequent visits to the sleep lab in the future to monitor your CPAP pressure requirements. It is important that you have and maintain a folder with all of the paperwork you will receive at diagnosis and afterwards. It is prudent for you to keep copies of your records rather than relying on requesting copies in the future as often doctors move, close their doors or send your records to their archives which make it more difficult for you to obtain them.
Please explain the relevance and details noted on my summary report
On your sleep study summary report, you will see AHI – apnea hypopnea index – it applies to the severity of your apnea condition, ask for details. You will also see information about your oxygen levels, limb movements and other notable details. Ask your doctor to go over each category of details so that you fully understand them.
Please provide me with a physical copy of my prescription for CPAP and equipment
In most cases, the doctor will fax this to your CPAP provider, but you should have a physical copy to keep with you. Should you move or wish to buy equipment from any other source, you will need the prescription. Should you be traveling outside your home area and need equipment, you will need the prescription. Should you decide to change CPAP providers, you will need the prescription. It is your right to have the prescription, ask for it.
What is your protocol for after care?
How often will I have a follow up with you, my doctor? You may have been referred to the sleep doctor by your primary care physician and never see the sleep doctor again outside of the initial follow up visit. Your follow up may be with your primary care doctor who will now manage your condition. Ask what the plan is and be comfortable with it.
How often do you recommend future titrations?
Titrations may be routine annual visits to the sleep lab to confirm or change CPAP pressures if needed. Find out what your doctors philosophy is on this important subject.
-CPAP Provider
Will I be allowed to choose my own CPAP machine, mask and humidifier, or has my doctor chosen specific brands?
Ask to be informed about the difference between CPAP, Auto CPAP and BiLevel machines. Generally, CPAP is prescribed first and then if patient is not successful, more expensive Auto or BiLevel is tried. Inform yourself about these different machines and how they work so that you will be able to suggest upgrading if CPAP is not affective. Depending on your insurance coverage, upgrade to AutoCPAP or BiLevel may only be covered if the patient fails on CPAP, so YOU must keep THEM informed of your progress or challenges. Learn what your insurance provides for. What are the features of the machine I have been given? Some features are preset and controlled by physician or home healthcare provider only. There are other patient controlled comfort features like ramp, expiratory pressure relief, auto on/auto off, altitude adjustment. Some features must be enabled before patient use. Find out if your machine features have been enabled for your use and learn how to use and change settings if needed. Don’t throw away the instruction booklets that come with your equipment!
Do you have a 30 day mask exchange program, if so, how does it work?
Most CPAP providers have a 30 day mask exchange program that allows you to choose a mask, try it at home for up to 30 days and if it does not work, exchange it for another mask of the same manufacturer’s brand.
How should we communicate during the adjustment period as I am starting CPAP therapy and beyond?
Beginning CPAP therapy can definitely be challenging and you should not feel alone in the process. Find out how often they will contact you to check on your progress or if they expect YOU to contact them with any difficulties you face. Each CPAP provider has their own follow up program, some better than others. This is where you need to be proactive and make sure to keep your healthcare team in the loop. Your CPAP provider is charged with the responsibility of assisting you, so don’t be shy in keeping them informed and asking for their help; this is part of what they are paid to do!
How often should I replace my CPAP mask cushion, CPAP Tubing, machine filters?
Equipment supply replacement will depend on your insurance coverage. Some CPAP providers may offer you an automatic replacement program where they will simply send you replacement items as often as your insurance allows. You may choose to only replace as needed. Masks for instance may be covered by your insurance to replace every 2-3 months, yet most patients can use the same mask for 6 months or more with good care and cleaning.
How should I care for and clean my equipment?
Regardless of whether or not you have insurance, CPAP equipment and supplies are expensive and you want to clean regularly to get the longest life out of your machine and other supplies.
You have been diagnosed with sleep apnea. For most patients, sleep apnea is for life and this is the time to be proactive in your prescribed treatment therapy. This is a critical time as you begin CPAP therapy and the information you will be receiving is important yet may seem overwhelming; your brain may be on overload. This is all new to you and so how will you know what questions to ask?
After the Sleep Apnea Diagnosis
Tracy R. Nasca
Check list of things to ask your sleep doctor and CPAP provider
You have been diagnosed with sleep apnea. For most patients, sleep apnea is for life and this is the time to be proactive in your prescribed treatment therapy. You are most likely in a sleepy fog when you visit the sleep doctor for your follow up visit. You will be given the results of your overnight sleep study, have a follow up visit with the sleep doctor; then be referred to a CPAP provider and not necessarily in that order. This is a critical time as you begin CPAP therapy and the information you will be receiving is important yet may seem overwhelming; your brain may be on overload. This is all new to you and so how will you know what questions to ask?
The following is a checklist of important information you should receive and questions you should ask your healthcare providers.
-Sleep Doctor
What is my specific diagnosis and what is sleep apnea?
Obstructive sleep apnea, Central Sleep Apnea or Mixed Sleep Apnea (both obstructive and central)
What is the difference between the diagnoses?
If you are diagnosed with central sleep apnea, ask for a thorough explanation of what it is, why you have it and how it may be treated differently in your case.
WHY do I have sleep apnea?
Ask the doctor what your physical/anatomical reasons are for having sleep apnea and discuss your treatment options. CPAP is typically first line treatment, but familiarize yourself with other options such as oral appliance therapy, that are appropriate for your condition. Treatment options are dependent on WHY YOU have sleep apnea in the first place.
Please provide me with my sleep study summary report
Your overnight sleep study summary report should be considered your diagnosis and baseline. It contains a summary of the data collected in your overnight stay. It is very likely that you will have subsequent visits to the sleep lab in the future to monitor your CPAP pressure requirements. It is important that you have and maintain a folder with all of the paperwork you will receive at diagnosis and afterwards. It is prudent for you to keep copies of your records rather than relying on requesting copies in the future as often doctors move, close their doors or send your records to their archives which make it more difficult for you to obtain them.
Please explain the relevance and details noted on my summary report
On your sleep study summary report, you will see AHI – apnea hypopnea index – it applies to the severity of your apnea condition, ask for details. You will also see information about your oxygen levels, limb movements and other notable details. Ask your doctor to go over each category of details so that you fully understand them.
Please provide me with a physical copy of my prescription for CPAP and equipment
In most cases, the doctor will fax this to your CPAP provider, but you should have a physical copy to keep with you. Should you move or wish to buy equipment from any other source, you will need the prescription. Should you be traveling outside your home area and need equipment, you will need the prescription. Should you decide to change CPAP providers, you will need the prescription. It is your right to have the prescription, ask for it.
What is your protocol for after care?
How often will I have a follow up with you, my doctor? You may have been referred to the sleep doctor by your primary care physician and never see the sleep doctor again outside of the initial follow up visit. Your follow up may be with your primary care doctor who will now manage your condition. Ask what the plan is and be comfortable with it.
How often do you recommend future titrations?
Titrations may be routine annual visits to the sleep lab to confirm or change CPAP pressures if needed. Find out what your doctors philosophy is on this important subject.
-CPAP Provider
Will I be allowed to choose my own CPAP machine, mask and humidifier, or has my doctor chosen specific brands?
Ask to be informed about the difference between CPAP, Auto CPAP and BiLevel machines. Generally, CPAP is prescribed first and then if patient is not successful, more expensive Auto or BiLevel is tried. Inform yourself about these different machines and how they work so that you will be able to suggest upgrading if CPAP is not affective. Depending on your insurance coverage, upgrade to AutoCPAP or BiLevel may only be covered if the patient fails on CPAP, so YOU must keep THEM informed of your progress or challenges. Learn what your insurance provides for. What are the features of the machine I have been given? Some features are preset and controlled by physician or home healthcare provider only. There are other patient controlled comfort features like ramp, expiratory pressure relief, auto on/auto off, altitude adjustment. Some features must be enabled before patient use. Find out if your machine features have been enabled for your use and learn how to use and change settings if needed. Don’t throw away the instruction booklets that come with your equipment!
Do you have a 30 day mask exchange program, if so, how does it work?
Most CPAP providers have a 30 day mask exchange program that allows you to choose a mask, try it at home for up to 30 days and if it does not work, exchange it for another mask of the same manufacturer’s brand.
How should we communicate during the adjustment period as I am starting CPAP therapy and beyond?
Beginning CPAP therapy can definitely be challenging and you should not feel alone in the process. Find out how often they will contact you to check on your progress or if they expect YOU to contact them with any difficulties you face. Each CPAP provider has their own follow up program, some better than others. This is where you need to be proactive and make sure to keep your healthcare team in the loop. Your CPAP provider is charged with the responsibility of assisting you, so don’t be shy in keeping them informed and asking for their help; this is part of what they are paid to do!
How often should I replace my CPAP mask cushion, CPAP Tubing, machine filters?
Equipment supply replacement will depend on your insurance coverage. Some CPAP providers may offer you an automatic replacement program where they will simply send you replacement items as often as your insurance allows. You may choose to only replace as needed. Masks for instance may be covered by your insurance to replace every 2-3 months, yet most patients can use the same mask for 6 months or more with good care and cleaning.
How should I care for and clean my equipment?
Regardless of whether or not you have insurance, CPAP equipment and supplies are expensive and you want to clean regularly to get the longest life out of your machine and other supplies.
The Difference between CPAP, AutoCPAP and BiLevel
Have you ever wondered what the difference is between CPAP, AutoCPAP and BiLevel devices? How do you know which one is the best for your treatment? Great questions and although the answers can be complex, it’s a good place to start your patient education after the sleep apnea diagnosis. All 3 are referred to as flow generators and are FDA controlled medical devices, which requires dispensing by prescription.
The Difference between CPAP, AutoCPAP and BiLevel
Tracy R. Nasca
Have you ever wondered what the difference is between CPAP, AutoCPAP and BiLevel devices? How do you know which one is the best for your treatment? Great questions and although the answers can be complex, it’s a good place to start your patient education after the sleep apnea diagnosis. All 3 are referred to as flow generators and are FDA controlled medical devices, which requires dispensing by prescription.
CPAP
This is the most basic flow generator and the device most often prescribed first. In many cases, our insurance coverage dictates CPAP first, because it costs less and most patients do well with it. If challenges arise, then AutoCPAP or BiLevel are then prescribed.
CPAP stands for Continuous Positive Airway Pressure and is just that; a constant and continuous flow of air that the patient must inhale and then exhale over. One of the biggest challenges adjusting to CPAP is the overwhelming feeling of that continuous flow of air pressure upon exhalation. Most manufactures offer a resolution to this challenge by sensing and / or reducing the machine pressure upon exhalation. Depending on the manufacturer, this feature has different names. The Philips Respironics features are known as it CFLEX, AFLEX or BiFLEX. ResMed refers to it as EPR (expiratory pressure relief) and Fisher & Paykel Healthcare offers the uniquely different SensAwake™. These comfort features have the ability to reduce or self adjust the machine pressure up to 3 cm H2o.
Example: Your CPAP pressure is 10. You have no problem inhaling that delivery of air, but when you begin to exhale while the air is still being delivered, you may feel overwhelmed, claustrophobic or even experience a choking sensation. So if your machine is set with EPR at 3, you would receive 10 at inhalation and then the machine reduces to 7 to make it easier for you to exhale.
AutoCPAP - Automatic titrating (measuring and adjusting) continuous positive airway pressure
This machine is also known as APAP. Unlike CPAP which is set to deliver one continuous pressure, APAP is set within a high and low pressure range for the purpose of varying inhalation needs. The range is predetermined by your prescribing physician. APAP has a sensitive algorithm technology that allows the machine to detect how much inhalation pressure you need with each breath.
The theory of providing a range is that one’s pressure needs may vary during any given night or hour of sleep. One example is sleeping position; most of us have more apnea episodes and of longer duration when we sleep on our backs vs. side or stomach sleeping. Think “gravity” as when we lay flat on our back, the jaw and tongue naturally relax and fall back, thus blocking the airway and causing apnea episodes. Some of us may have nasal conditions or seasonal allergies that require higher pressures during part of the night or seasonally. Even a slightly stuffy nose may cause worsening apnea episodes. We may need higher pressures on occasions when we are under the influence of alcohol too close to bed time (yes, with your doctors approval it is ok to have a glass of wine or alcoholic beverage). Some of us require sedative medication for pain causing deeper sleep and thus more apnea events. Even over the counter cold and flu medications can have a sedative effect. On those nights, APAP should provide the proper inhalation pressure we need on a breath by breath basis.
In theory, an AutoCPAP should work set at the lowest pressure of 4 and the highest of 20, however some experts believe APAP is more effective if the range is tightened a bit closer to the average known cpap pressure needed by each patient. If APAP is challenging for you, bring this to the attention of your prescribing physician.
BiLevel - indicates a flow generator that delivers 2 distinct pressures, one for inhalation and the second for exhalation.
The most complex device, it is also the most expensive and typically reserved for special needs. Most Bilevel devices offer a high setting range of 25 cm H2O vs CPAP and APAP which typically top out at 20. Since exhaling over a constant pressure is one of the most challenging aspects of adjustment for the patient, BiLevel best serves those who require mid to high range inhalation pressure needs. Since high inhalation pressures are extremely difficult to exhale over, this device is set at 2 distinct and constant pressures, one for inhalation and one for exhalation. Remember that CFLEX, EPR only have the ability to reduce pressure 3 points lower, so when a patient requires an inhalation pressure of 20 for example, lowering to 17 is still extremely challenging, so BiLevel can be set at any pressure from its minimum of 4 cm H2O. AutoBilevel are now available and have similar features as the APAP regarding the inhalation and exhalation pressure variables.
Since BiLevel works similarly to a ventilator, it is commonly used for patients with other disorders such as ALS, Parkinson’s or other diseases with patients who need assistance with breathing. It is also frequently prescribed for patients who have central sleep apnea, although many with central apnea do quite well with CPAP or APAP.
Having three options for treating your sleep apnea is useful knowledge. If you have tried and failed on CPAP, discuss APAP or BiLevel or AutoBilevel with your prescribing physician. Each flow generator has different features and benefits, so finding the one that best suits your needs is very important to your successful therapy.
Which Mask is Best for Me?
With dozens of CPAP masks available, which one is right for me? All of the mask types are explained in this article and I give you tips on choosing the best option for you.
Which CPAP Mask is Best for Me?
Tracy R. Nasca
With dozens of different mask choices, how can we determine which mask to choose?
Mask Types
Traditional Nasal Masks
Nasal masks are the most common interfaces used by patients and are typically triangular in shape and cover the nose. Most have additional forehead braces with pads that lay above the eyebrow area to add stability. This mask works best for patients who sleep with their mouths closed and are able to inhale and exhale well through their nostrils only.
Components include a hard plastic like frame which holds a softer inner cushion that lies against the face. Head gear consists of the straps and sometimes a forehead brace.
Nasal Pillow Masks
Nasal pillow masks have gained great popularity in past years. They work best for patients who sleep with their mouths closed and are able to inhale and exhale well through their nostrils only. They are a better choice for patients who have a narrow nose bridge or short face and have difficulty with Nasal Mask fit and leak in to the eye area. Since nothing lays above the nostrils, nasal pillow masks work well for patients who may otherwise be intimidated by the size of traditional nasal masks or have claustrophobia issues.
Components include a frame which holds the soft nasal pillow cushions which attach to strapped head gear.
Full Face Masks
Full face masks cover both the nose and the mouth. They are prescribed for patients who are mouth breathers.
Components include a hard plastic like frame which holds a softer inner cushion that lies against the face. Head gear consists of the straps and sometimes a forehead brace.
About Mask Sizing
There is no industry standard for mask sizing and so brand to brand and even within manufacturers, sizing can greatly vary. It is vital that we try on masks to know what size we need. Sizing choices can be found to include petite, extra small, small, medium, large and extra large. Many masks today come with a variety of mask cushion sizes within the packaging which takes the guess work out of the decision making process. Most masks include the strapped headgear which comes in “one size fits most” however smaller and sometimes larger sizes are available upon request or special order to accommodate those patients with a small or large head circumference.
Size Up Your Face
Most manufacturers offer sizing gauges for each of their mask products. These are useful as a starting point in determining mask size but not always completely accurate due to other variables with each of our individual facial features.
Facial features to consider when choosing a mask are: length of the nose from nose bridge to base, width of nose base, width of nose bridge; surface area of upper lip (the skin between the base of your nose and your top lip), distance between eyes and overall circumference of the head.
Consider that nasal masks and nasal pillow masks rest on the upper lip so pay particular attention to this area of the face when trying on masks. The base of the frame should not touch the top lip.
Mask Fit and Adjustment
After you have chosen the best mask size and style for your face, you must adjust it properly before sleep. Sit on your bed, turn machine on, and place mask on your face with straps loose. Lay down in your sleeping position with your head on your pillow as you would normally sleep. Slowly pull the straps JUST UNTIL you get a good seal.
Seating a Dual Cushion Mask
If your mask has a dual cushion, it will need to be “seated”. After you have fitted and adjusted your mask using the steps above, to “seat” gently pull the mask straight out and away from your face to allow the dual cushions to inflate properly. Lay the mask gently back on your face.
Don’t Expect Perfection
If you shop wisely, and try on a variety of masks, you should be able to find the best possible mask choice for your face. Know that all masks can and do leak, but usually, this occurs when we change positions during sleep and that just cannot be helped. We have little control over what we do in our sleep! Your CPAP and mask provider can help you in your search for the best mask choice, but you need to take responsibility to keep them informed as to what works and what does not. Ask your supplier about 30 day mask exchange programs that allow the patient to try a mask at home for up to 30 days with the option to exchange for another mask in the event it does not work well.
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Mask Seating Patients complain of leak and pressure point soreness on their face. They have spent a small fortune trying a variety of masks and frankly are just frustrated and ready to give up. When asked which masks they have tried and what their specific complaints are about each of them, they tick off a list of dual wall cushion masks. |
CPAP Mask Seating - No One Ever Told Me That
Tracy R. Nasca
Many of the masks offered for CPAP users now have dual cushions. ResMed comes to mind with their Mirage line which includes Quattro, Activa LT, Micro and even their Swift and FX nasal pillow systems. EasyLife, ComfortFull and ComfortGel are just a few of Respironics dual cushion interfaces.
What’s the big deal about Dual wall cushions, why is it so important?
Dual wall cushions have gained popularity because they are more comfortable and they seal better. They are the latest and greatest in engineering innovation offered to us patients. I thank the manufacturers for their continuing efforts to develop and bring us creative and quality mask choices.
Maybe you own one of these masks provided to you by your local home health care dealer or maybe you heard the great patient feedback and purchased from the internet. Is your dual wall cushion mask working for you or are you one of those patients who spent a lot of money and is wondering what all the hype was about because it’s not working for you? Maybe you have a dual wall cushion mask but are not even aware of it.
Patients complain of leak and pressure point soreness on their face. They have spent a small fortune trying a variety of masks and frankly are just frustrated and ready to give up. When asked which masks they have tried and what their specific complaints are about each of them, they tick off a list of dual wall cushion masks. When asked if they were shown how to “seat” the mask. “No”, they say, “what does that mean?”
It’s another “NO ONE EVER TOLD ME THAT” conversation. It saddens me to know so many people have great masks that would work if they knew the proper fit, adjustment and seating techniques.
Here is what you should know:
Smile, fall asleep and wake up refreshed several hours later!
It is also important to know that no mask is perfect or leak free. But taking the time to fit your mask to your face and seat it properly is important and a good start. When you change sleeping positions during the night, gravity takes over and you may experience mask leak. If you originally adjusted it for side sleeping and then you roll on your back, you’ll probably experience leak. It will have to be readjusted to eliminate that leak.
I wish I could tell you that there is a mask out there for you that will fit perfectly, never leak or hurt and that sleeping position doesn’t matter. Wouldn’t that be great? It’s just not so. But, knowing how to properly fit and adjust your mask can be one of the most important lessons you learn to help you become successful with your CPAP therapy! Wishing you great, restorative sleep!
Tracy R. Nasca
Many of the masks offered for CPAP users now have dual cushions. ResMed comes to mind with their Mirage line which includes Quattro, Activa LT, Micro and even their Swift and FX nasal pillow systems. EasyLife, ComfortFull and ComfortGel are just a few of Respironics dual cushion interfaces.
What’s the big deal about Dual wall cushions, why is it so important?
Dual wall cushions have gained popularity because they are more comfortable and they seal better. They are the latest and greatest in engineering innovation offered to us patients. I thank the manufacturers for their continuing efforts to develop and bring us creative and quality mask choices.
Maybe you own one of these masks provided to you by your local home health care dealer or maybe you heard the great patient feedback and purchased from the internet. Is your dual wall cushion mask working for you or are you one of those patients who spent a lot of money and is wondering what all the hype was about because it’s not working for you? Maybe you have a dual wall cushion mask but are not even aware of it.
Patients complain of leak and pressure point soreness on their face. They have spent a small fortune trying a variety of masks and frankly are just frustrated and ready to give up. When asked which masks they have tried and what their specific complaints are about each of them, they tick off a list of dual wall cushion masks. When asked if they were shown how to “seat” the mask. “No”, they say, “what does that mean?”
It’s another “NO ONE EVER TOLD ME THAT” conversation. It saddens me to know so many people have great masks that would work if they knew the proper fit, adjustment and seating techniques.
Here is what you should know:
- Dual wall cushions need to be inflated to seal properly to the face.
- Put your mask on your face with straps loose.
- Turn on your machine to full pressure.
- Lay down in your bed with your head on your pillow in your normal sleeping position.
- Then and only then, gently tighten the straps JUST UNTIL you get a good seal. With dual cushion masks, there should be no reason to over tighten the straps. In fact, one of the best features of dual wall cushion masks is that they seal well even when worn loose!
Smile, fall asleep and wake up refreshed several hours later!
It is also important to know that no mask is perfect or leak free. But taking the time to fit your mask to your face and seat it properly is important and a good start. When you change sleeping positions during the night, gravity takes over and you may experience mask leak. If you originally adjusted it for side sleeping and then you roll on your back, you’ll probably experience leak. It will have to be readjusted to eliminate that leak.
I wish I could tell you that there is a mask out there for you that will fit perfectly, never leak or hurt and that sleeping position doesn’t matter. Wouldn’t that be great? It’s just not so. But, knowing how to properly fit and adjust your mask can be one of the most important lessons you learn to help you become successful with your CPAP therapy! Wishing you great, restorative sleep!
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The Importance of CPAP Humidification So what’s the big deal about using a CPAP humidifier? Why would you want to add another piece of equipment beyond the CPAP machine and mask? It’s just something else you have to buy, fill each night with water, clean, or add to your CPAP bag when you travel….why bother? |
The Importance of CPAP Humidification
Tracy R. Nasca
So what’s the big deal about using a CPAP humidifier? Why would you want to add another piece of equipment beyond the CPAP machine and mask? It’s just something else you have to buy, fill each night with water, clean, or add to your CPAP bag when you travel….why bother?
Here is a list of common complaints from CPAP users, do any of these sound familiar?
CPAP makes me sneeze
CPAP makes my mouth dry
CPAP makes my nasal passage burn and it disrupts my sleep
CPAP makes my nose runny
CPAP makes my nose stuffy so I can’t breathe I wake up with mucous in my mouth and throat Water drips into my mask at night
My humidifier water chamber is empty long before it’s time to wake up
The water chamber collects a residue that looks like mold and it’s hard to clean
My humidifier makes gurgling noises and spits water at me
Did you know?
The list of common complaints can all be resolved with proper use of a heated CPAP humidifier! Here is what you need to know:
For simplicity sake, think of your CPAP as a fan in a box. When you turn it on, it pulls in the air from your sleeping environment. The fan ramps up that air, and delivers it back to you via the tubing attached to your mask, forcing a highly pressurized blast (your CPAP pressure setting) directly into the nostrils, and mouth if you wear a full face mask. Remember that the temperature of your bedroom is the same temperature of that delivered air. Most of us prefer sleeping in a cool bedroom and sleep experts all say we should. As an example, in the winter, I set my household thermostat on 60 which means the hurricane force wind striking my nasal passages is really cold and dry! Most of us know that when we turn on our furnace during the winter it causes a drying affect. Room humidifiers help, but really have little impact on our CPAP use. In summer months, my bedroom is kept cool with air conditioning and use of a ceiling fan, so my nostrils are still blasted with cold air. No matter what the season, for CPAP comfort, I require the addition of heated humidification every night.
CPAP does not work well if we cannot breathe through our nose, or mouth if you use a full face mask. The nasal passage is highly vascular and lined with turbinates. When you have a cold or an allergy, the turbinates swell and this is what causes nasal congestion…the dreaded stuffy nose. When the nasal lining is dry, it may trigger a sneeze which is the body’s way of returning moisture. Dry mouth or airway can trigger the natural production of secretions, such as mucous. This explains why some of us awaken with mucous in the mouth and throat. It also explains why some of us experience a runny nose from CPAP use despite not having a common cold or allergy issue. When we keep the nose and mouth adequately humidified, everything works nicely together to accomplish comfort in CPAP success.
CPAP humidifiers vary brand to brand so make sure you know how yours works. Be proactive if you have doubts or questions; call or visit your CPAP provider to learn the specifics of your unit. Remember that it’s warm moisture we really need, not necessarily high heat. My best suggestion to find your optimal heat setting is to start at the lowest temperature level and turn it up only as needed to accommodate for your bedroom temperature on any given night. Your heat setting will change from season to season.
The higher our CPAP pressure and the higher our humidifier temperature is set, the more water is used. This explains why some of us run out of water before morning wake up time. If you require high CPAP pressures and run out of water too early, consider lowering the heat setting. Ask your CPAP supplier about availability of chambers which offer a larger water capacity. When we turn the heat setting too high, it can cause excess condensation in the tubing that can drip back in to our masks. It can also cause “rain out” which explains the wet mist on our face around the mask area. If this is happening to you, turn down the heat a notch or two. Use a CPAP tubing cover to help insulate the hose and reduce excess condensation. Be careful not to overfill the water chamber, it will cause a gurgling noise and spit water; think of it like a pot boiling over on the stove.
Why is distilled water is suggested by all manufacturers? It has to do with water quality. It’s ok to use tap water occasionally; it won’t harm you or your equipment. But for longevity of your water chamber, use distilled water. It is also recommended that we empty any leftover water in the chamber each morning. This helps assure that no bacteria is left to grow which might appear as a white or pink residue. Empty and rinse the chamber each morning and leave to air dry. Clean the chamber with a sudsy mix of water with a mild soap such as Ivory dishwashing liquid. At least once each week, clean chamber with a vinegar water solution soak, then rinse with clear water and air dry. This routine will remove any residue and disinfect the water chamber. Never use bleach, antibacterial soaps or other harsh chemicals in the water chamber. Please do not risk ingesting anything harmful in to your lungs.
More humidity means more comfort. Nightly heated humidification is one of the most effective tools to complete your therapy and make the CPAP experience successful.
Tracy R. Nasca
So what’s the big deal about using a CPAP humidifier? Why would you want to add another piece of equipment beyond the CPAP machine and mask? It’s just something else you have to buy, fill each night with water, clean, or add to your CPAP bag when you travel….why bother?
Here is a list of common complaints from CPAP users, do any of these sound familiar?
CPAP makes me sneeze
CPAP makes my mouth dry
CPAP makes my nasal passage burn and it disrupts my sleep
CPAP makes my nose runny
CPAP makes my nose stuffy so I can’t breathe I wake up with mucous in my mouth and throat Water drips into my mask at night
My humidifier water chamber is empty long before it’s time to wake up
The water chamber collects a residue that looks like mold and it’s hard to clean
My humidifier makes gurgling noises and spits water at me
Did you know?
- Patients over 60 are 5 TIMES more likely to require heated humidification
- CPAP users taking 2 or more medications are 6 TIMES more likely to require heated humidification
- CPAP users with chronic mucosal disease or have had UPPP surgery are 4 TIMES more likely to require heated humidification
- Patients who prefer to sleep in a cold room are most likely to experience condensation (This information was provided by Fisher & Paykel Healthcare, a leader in CPAP humidifier technology)
The list of common complaints can all be resolved with proper use of a heated CPAP humidifier! Here is what you need to know:
For simplicity sake, think of your CPAP as a fan in a box. When you turn it on, it pulls in the air from your sleeping environment. The fan ramps up that air, and delivers it back to you via the tubing attached to your mask, forcing a highly pressurized blast (your CPAP pressure setting) directly into the nostrils, and mouth if you wear a full face mask. Remember that the temperature of your bedroom is the same temperature of that delivered air. Most of us prefer sleeping in a cool bedroom and sleep experts all say we should. As an example, in the winter, I set my household thermostat on 60 which means the hurricane force wind striking my nasal passages is really cold and dry! Most of us know that when we turn on our furnace during the winter it causes a drying affect. Room humidifiers help, but really have little impact on our CPAP use. In summer months, my bedroom is kept cool with air conditioning and use of a ceiling fan, so my nostrils are still blasted with cold air. No matter what the season, for CPAP comfort, I require the addition of heated humidification every night.
CPAP does not work well if we cannot breathe through our nose, or mouth if you use a full face mask. The nasal passage is highly vascular and lined with turbinates. When you have a cold or an allergy, the turbinates swell and this is what causes nasal congestion…the dreaded stuffy nose. When the nasal lining is dry, it may trigger a sneeze which is the body’s way of returning moisture. Dry mouth or airway can trigger the natural production of secretions, such as mucous. This explains why some of us awaken with mucous in the mouth and throat. It also explains why some of us experience a runny nose from CPAP use despite not having a common cold or allergy issue. When we keep the nose and mouth adequately humidified, everything works nicely together to accomplish comfort in CPAP success.
CPAP humidifiers vary brand to brand so make sure you know how yours works. Be proactive if you have doubts or questions; call or visit your CPAP provider to learn the specifics of your unit. Remember that it’s warm moisture we really need, not necessarily high heat. My best suggestion to find your optimal heat setting is to start at the lowest temperature level and turn it up only as needed to accommodate for your bedroom temperature on any given night. Your heat setting will change from season to season.
The higher our CPAP pressure and the higher our humidifier temperature is set, the more water is used. This explains why some of us run out of water before morning wake up time. If you require high CPAP pressures and run out of water too early, consider lowering the heat setting. Ask your CPAP supplier about availability of chambers which offer a larger water capacity. When we turn the heat setting too high, it can cause excess condensation in the tubing that can drip back in to our masks. It can also cause “rain out” which explains the wet mist on our face around the mask area. If this is happening to you, turn down the heat a notch or two. Use a CPAP tubing cover to help insulate the hose and reduce excess condensation. Be careful not to overfill the water chamber, it will cause a gurgling noise and spit water; think of it like a pot boiling over on the stove.
Why is distilled water is suggested by all manufacturers? It has to do with water quality. It’s ok to use tap water occasionally; it won’t harm you or your equipment. But for longevity of your water chamber, use distilled water. It is also recommended that we empty any leftover water in the chamber each morning. This helps assure that no bacteria is left to grow which might appear as a white or pink residue. Empty and rinse the chamber each morning and leave to air dry. Clean the chamber with a sudsy mix of water with a mild soap such as Ivory dishwashing liquid. At least once each week, clean chamber with a vinegar water solution soak, then rinse with clear water and air dry. This routine will remove any residue and disinfect the water chamber. Never use bleach, antibacterial soaps or other harsh chemicals in the water chamber. Please do not risk ingesting anything harmful in to your lungs.
More humidity means more comfort. Nightly heated humidification is one of the most effective tools to complete your therapy and make the CPAP experience successful.
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More Information you Should Know about CPAP Humidification I think it is important for sleep apnea patients who use CPAP therapy to have a thorough understanding of how and why it is necessary to use humidification. Thanks to Fisher & Paykel who generously shared this information for me to pass on to you. |
What You Should Know About CPAP Humidification
Tracy R. Nasca
I have learned a lot about CPAP humidification from my friends at Fisher and Paykel Healthcare. They introduced the first heated humidifier for use in-line with a CPAP device in 1992. I think it is important for sleep apnea patients who use CPAP therapy to have a thorough understanding of how and why it is necessary to use humidification. Thanks to Fisher & Paykel who generously shared this information for me to pass on to you.
Humidifiers are used to moisten the air brought in through your CPAP. There are two basic types: passive (cold water) or heated. Pressurized air, exiting from the CPAP, is passed through a humidification chamber containing distilled water and then routed through tubing to your mask, thereby delivering air with additional moisture. Most patients prefer the heated versions, as they can also be used cold if needed.
If typical room air is at 20 degrees Celsius containing about 10mg H2O per liter of gas, and the body supplies the remaining heat and moisture required for efficient gas exchanges, what happens during CPAP therapy? Read on to find out!
The nasal airway is unable to maintain sufficient warmth and humidity for the increased gas flow of CPAP therapy. As a result, the patient's airways lose moisture and will eventually exhibit symptoms consistent with upper airy dryness and inflammation such as dry nose, dry throat, headache, chest discomfort, bleeding nose, dry cracked lips, breakdown of the soft tissue around the nares (nostril) and infections of the nose, throat and sinuses may also occur.
When the patient falls asleep using CPAP, mouth leak may occur. Because incoming air is able to travel directly out through the mouth without first going to the lungs, unidirectional airflow occurs.
The increased flow of cold dry air through the nasal passages causes mucosal drying and rebound congestion. Swelling occurs in rebound congestion and results in a decrease in nasal airway diameter and as a result increased nasal airway resistance occurs (NAR).
Increase in nasal airway resistance (NAR) leads to an increase in mouth leak as the patient begins to mouth breathe and the vicious cycle continues. Research (Am. Thoracic Society) revealed that heated CPAP humidification reduces NAR by supplying the required humidity to the air that the nose is unable to supply.
Research also noted that cold passover humidification caused little change in patient response, but that heated humidification minimized the increase in NAR.
If you live in a humid environment you probably have air conditioning and dehumidifiers operating, so the air which passes through your CPAP is cold and dry. This causes an increase in the occurrence of nasal symptoms and may result in discomfort. CPAP humidification helps! Even in humid environments, the nasal airways are unable to provide sufficient humidity to humidify the increased airflow of CPAP therapy. Thisresults in the nasal mucosa being stripped of the moisture required to humidify the air.
The nasal airway is highly vascular, enabling it to be easily dried out by cold dry air.
Cleaning instructions, according to Fisher & Paykel, include a daily 10 minute soak in warm soapy water. Disinfect weekly in vinegar and water solution of 3 parts water, 1 part vinegar.
Is it possible for a patient to catch an infection from a humidifier? Research says, "no". In fact the environment in the heated humidifier chamber under most operating conditions is such that the majority of pathogens are rapidly killed.
Studies show that even if pathogens were able to exist in the humidification chamber, they would not be able to be transported to the patient. The humidity from the chamber is in vapor form, which is too small for a bacteria or virus to travel in!
Passover humidification (both cool and heated) is molecular humidity in that what exits either a cold or heated unit is water vapor or water molecules that are in the .0001 micron size.
Bacteria (.2 to 10 microns) and virus (.017 to .3 microns) are much larger. Therefore it would be physically impossible for water molecules to transport either bacteria or virus even if the chamber was full of GUNK! In other words, there is NO means of transport.
Heated humidification adds the additional safety net in that it will kill off 90% of the pathogens within 10 minutes of achieving full temperature.
Distilled water is cleaner and lengthens the life of the humidifier; there is no medium for growth of anything in distilled water. All manufacturers recommend it. Depending on the quality, tap water is not necessarily harmful for use in humidifiers, but well water can be harmful to the chamber if there are a lot of deposits in it.
Tracy R. Nasca
I have learned a lot about CPAP humidification from my friends at Fisher and Paykel Healthcare. They introduced the first heated humidifier for use in-line with a CPAP device in 1992. I think it is important for sleep apnea patients who use CPAP therapy to have a thorough understanding of how and why it is necessary to use humidification. Thanks to Fisher & Paykel who generously shared this information for me to pass on to you.
Humidifiers are used to moisten the air brought in through your CPAP. There are two basic types: passive (cold water) or heated. Pressurized air, exiting from the CPAP, is passed through a humidification chamber containing distilled water and then routed through tubing to your mask, thereby delivering air with additional moisture. Most patients prefer the heated versions, as they can also be used cold if needed.
If typical room air is at 20 degrees Celsius containing about 10mg H2O per liter of gas, and the body supplies the remaining heat and moisture required for efficient gas exchanges, what happens during CPAP therapy? Read on to find out!
The nasal airway is unable to maintain sufficient warmth and humidity for the increased gas flow of CPAP therapy. As a result, the patient's airways lose moisture and will eventually exhibit symptoms consistent with upper airy dryness and inflammation such as dry nose, dry throat, headache, chest discomfort, bleeding nose, dry cracked lips, breakdown of the soft tissue around the nares (nostril) and infections of the nose, throat and sinuses may also occur.
When the patient falls asleep using CPAP, mouth leak may occur. Because incoming air is able to travel directly out through the mouth without first going to the lungs, unidirectional airflow occurs.
The increased flow of cold dry air through the nasal passages causes mucosal drying and rebound congestion. Swelling occurs in rebound congestion and results in a decrease in nasal airway diameter and as a result increased nasal airway resistance occurs (NAR).
Increase in nasal airway resistance (NAR) leads to an increase in mouth leak as the patient begins to mouth breathe and the vicious cycle continues. Research (Am. Thoracic Society) revealed that heated CPAP humidification reduces NAR by supplying the required humidity to the air that the nose is unable to supply.
Research also noted that cold passover humidification caused little change in patient response, but that heated humidification minimized the increase in NAR.
If you live in a humid environment you probably have air conditioning and dehumidifiers operating, so the air which passes through your CPAP is cold and dry. This causes an increase in the occurrence of nasal symptoms and may result in discomfort. CPAP humidification helps! Even in humid environments, the nasal airways are unable to provide sufficient humidity to humidify the increased airflow of CPAP therapy. Thisresults in the nasal mucosa being stripped of the moisture required to humidify the air.
The nasal airway is highly vascular, enabling it to be easily dried out by cold dry air.
Cleaning instructions, according to Fisher & Paykel, include a daily 10 minute soak in warm soapy water. Disinfect weekly in vinegar and water solution of 3 parts water, 1 part vinegar.
Is it possible for a patient to catch an infection from a humidifier? Research says, "no". In fact the environment in the heated humidifier chamber under most operating conditions is such that the majority of pathogens are rapidly killed.
Studies show that even if pathogens were able to exist in the humidification chamber, they would not be able to be transported to the patient. The humidity from the chamber is in vapor form, which is too small for a bacteria or virus to travel in!
Passover humidification (both cool and heated) is molecular humidity in that what exits either a cold or heated unit is water vapor or water molecules that are in the .0001 micron size.
Bacteria (.2 to 10 microns) and virus (.017 to .3 microns) are much larger. Therefore it would be physically impossible for water molecules to transport either bacteria or virus even if the chamber was full of GUNK! In other words, there is NO means of transport.
Heated humidification adds the additional safety net in that it will kill off 90% of the pathogens within 10 minutes of achieving full temperature.
Distilled water is cleaner and lengthens the life of the humidifier; there is no medium for growth of anything in distilled water. All manufacturers recommend it. Depending on the quality, tap water is not necessarily harmful for use in humidifiers, but well water can be harmful to the chamber if there are a lot of deposits in it.
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Troubleshooting Guide for CPAP Use Problems
Get tips, tricks and find answers to common CPAP compliance issues such as mask leaks, pressure point soreness, PAP gas and more. Learn from an experience CPAP user. |
Troubleshooting Guide for CPAP Problems
Tracy R. Nasca
I am having trouble falling asleep on CPAP
If your CPAP pressure feels overwhelming at the beginning of the night, your machine may have a feature called ramp which can be set to start your pressure at a lower setting and “ramp up” over a period of time. Call your cpap supplier to ask if your machine has this feature and if it is enabled for use.
I don’t like using CPAP and wearing the mask to bed, what can I do?
Practice makes perfect. To help get used to wearing the mask during sleep, practice by wearing it during the day while sitting in a chair watching television or reading. This will distract your focus from the mask to a positive, familiar activity. CPAP use will become a habit and part of your routine.
Why am I still snoring?
Snoring, choking, gasping like noises should be eliminated during CPAP use. If not, it could mean that your machine pressure is not adequate. Call your cpap supplier to find a solution.
Air in tummy, painful stomach bloating and gas
The medical term for this common CPAP issue is Aerophagia. It occurs when the air delivered by your CPAP enters the esophagus and stomach rather than the lungs. It can occur when your CPAP pressure is set too low or too high. It can also occur if you are a mouth breather but not wearing a full face mask. Consult your physician if the problem is chronic and persistent.
Bed pillow problems with side or stomach sleeping
Often, side or stomach sleepers find that the head sinks in to their bed pillow which causes the blockage of mask exhalation ports and risk of dangerous CO2 (carbon dioxide) rebreathing. Others find their pillow causes unwanted mask frame movement (pushed off center) causing mask leak, pressure point soreness or bruised cheek bones. To resolve, purchase PAPillow, a specially made bed pillow designed for CPAP users and for any side or stomach sleepers.
Mask Problems
Skin irritation, sores and bruises from mask
No mask should cause pain nor discomfort if sized correctly and fitted properly. If irritation or sores are developing, chances are you are over tightening your mask. Your mask cushion may be worn out and need replacing. Mask liners called RemZzz’s might also resolve skin irritation and mask leak.
I like my mask choice, but still get occasional facial sores or leaking.
Your cpap supplier should offer products that might be helpful if you otherwise like your mask. One is the Gecko nasal pad. It is an easy to use gel pad that is placed across the nose bridge and under the mask. It helps with leak in the upper part of the mask frame and is beneficial to patients who have a narrow nose bridge or who are prone to cuts or irritation to the nose bridge. Another product patients find helpful are SoreSpot CPAP Skin Protectors. They are a unique liquid-filled bandage that minimizes friction and helps prevent skin irritation. Check out RemZzz’s full face and nasal mask liners. They are applied directly to the silicone mask cushion to help absorb facial moisture and oils, and prevent skin irritation and pressure marks as well as to reduce noisy mask leak.
I wake up without my mask on, but have no memory of removing it during sleep
This is a common occurrence, especially during the early adjustment period of CPAP use. Chances are, you removed the mask due to discomfort or leak. This would indicate that your mask choice is not the best for your face, or that it is not fitted properly.
I am claustrophobic and cannot get used to the nasal mask
Patients who experience claustrophobia usually find that the small size and simplicity of nasal pillow masks more tolerable. There is an adjustment period for most patients as they get used to sleeping with any mask on the face. While your goal is to be able to sleep all night on CPAP, using it as long as you can tolerate it each night is better than nothing. Try to increase usage over time until you reach your goal.
My eyes are swollen or irritated
No air should be directed up in to the eye area with a properly sized and fitted mask. This might indicate leak in the top area of your mask; gently tighten the top mask straps taking care not to over tighten. This leak might also indicate a worn mask cushion that needs replacing.
Some people naturally sleep with their eyes partially open which can cause dryness or irritation; they benefit from wearing a simple fabric eye mask. If swelling or irritation is chronic or persistent, consult with your sleep or primary care physician.
I use a Nasal Pillow mask and my nostrils are sore
Skin irritation can quickly occur when the nasal pillows are not inserted properly. Try rotating the barrel that holds the nasal pillow inserts to a more comfortable angled position of the pillows in to the nostrils. After best positioning, if leak occurs at the nostril opening, size up.
My mask is making a whistling noise
Most masks have exhalation ports (look for a tiny cluster of holes) that allow the escape of our CO2 (carbon dioxide). When routinely cleaning your mask parts, these tiny holes must be checked to make sure they are not soiled and clogged by body oil or bedding lint. When clogged, they can cause the mask to make a whistling noise. Use a sewing needle or toothpick to keep the holes free flowing.
My bed partner is bothered by the air flow of the exhalation ports from my mask
All masks have exhalation ports to allow the escape of CO2 (carbon dioxide). The higher the machine pressure setting, the harsher this escape flow will be. Some masks have better air diffusion features than others. Check with your Corner Team member to discuss a resolution. Some patients resolve by side sleeping with their backs turned to their bed partner to avoid a distracting air flow.
Machine Problems
My CPAP machine is not working
Make sure the electric plugs to the wall and to the machine are firmly in place. Check your electric outlet to make sure it is working. Otherwise, make an appointment to bring your machine in to be evaluated by your cpap supplier.
My CPAP machine is too noisy; it keeps me / my bed partner from sleeping.
Today’s machines are nearly silent, so unless you are hypersensitive to noise ( try ear plugs), this would indicate a problem. Check the machine filters. They should be changed monthly or when visibly discolored to help keep the machines running smoothly. There will be a slight audible noise if you are using a Bi Level machine as the pressure transitions between inhalation and exhalation settings. There will be a slight audible noise if you use an AutoCPAP as the machine changes inhalation pressure. If your machine is otherwise noisy, there may be a machine defect. Make an appointment to bring your machine in to be evaluated by your cpap supplier.
I get tangled in my CPAP tubing during the night
Try placing the tubing behind your head near the top of your pillow, or positioned behind the headboard bed post. Most cpap suppliers offer an inexpensive Tubing Lift to help with tube positioning for better sleep. Easy to use, the small frame is held in place between the box spring and mattress. The lift holds the tubing above the head allowing for better freedom of movement.
I keep pulling my CPAP machine off the night stand.
The length of standard CPAP tubing is about 6 feet. Active sleepers who toss and turn are more apt to tug on the tubing and pull their machine off the bedside table. Most cpap suppliers offer tubing in 10 foot lengths which give patients more freedom of movement especially when coupled with a Tubing Lift.
Humidifier Problems
CPAP is causing dry mouth, dry throat, runny nose, stuffy nose, sneezing
A CPAP humidifier or temperature adjustment may usually resolve all of the above issues. Start with the lowest heat setting and turn up as needed for more moisture. Biotene spray or oral rinse products may help with dry mouth. Chronic nasal lining dryness may be helped with Ocean or other simple saline spray solutions. Both are available over the counter at your pharmacy. Consult with your physician if the problem persists.
Water in CPAP tubing
Excess condensation can form in the CPAP tubing when the temperature of your bedroom is cooler than the air coming from your machine. Most cpap suppliers offer inexpensive, insulating hose covers to resolve this common problem.
White or pink film in humidifier water chamber
Bacteria can quickly develop in the water chamber. All manufacturers recommend the use of distilled water. Tap water may be used on occasion. Each morning, empty any leftover water, rinse chamber and let air dry. To remove film, fill chamber with 1/3 white distilled vinegar to 2/3 tap water solution. Let soak for one hour. Rinse with clear tap water, air dry.
Water spill
Always remove water chamber unit from machine before filling with distilled water. Spilling water in to the machine may compromise the interior circuits, damage the machine and void the warranty.
Mask Fit and Adjustment Tips
Mask leak is one of the most common challenges for patients. To assure the best fit and adjustment, when retiring to sleep, sit on your bed and place mask on the head/face with straps loose. With machine turned on and air blowing, lay down with your head on the pillow in your normal sleeping position. Slowly tighten your mask straps just until you get a good seal, being careful not to needlessly over tighten. The final step is to “seat” your mask. After straps are adjusted, pull the mask out and away from your face (about 2 inches) and gently lay back on face. This allows the dual mask cushions to inflate which will assure the best seal possible and comfortable fit. Mask fit varies with sleeping position, so if you fit for side or stomach sleeping, you will need to readjust if you roll to your back. This is why many patients train themselves to sleep solely on side or stomach (same mask fit) versus back sleeping which has a different mask fit.
Mask fit tips
Full Face - Mask users with forehead pads/brace: tighten upper strap first, then follow with lower strap positioning and fit.
Mask Headgear - Masks come with a “one size fits most” head gear. Larger and smaller strapped headgear may be available by special order.
Nasal Pillow Mask - Place mask on face and position headgear and place side straps above the ears. Gently slip nasal pillows in to the nostrils making sure to rotate the angle of the pillow barrel for a comfortable fit. The pillows are meant to lie just inside the nostril opening, not to be aggressively inserted. Proper placement should not cause the tip of the nose to be raised.
Tracy R. Nasca
I am having trouble falling asleep on CPAP
If your CPAP pressure feels overwhelming at the beginning of the night, your machine may have a feature called ramp which can be set to start your pressure at a lower setting and “ramp up” over a period of time. Call your cpap supplier to ask if your machine has this feature and if it is enabled for use.
I don’t like using CPAP and wearing the mask to bed, what can I do?
Practice makes perfect. To help get used to wearing the mask during sleep, practice by wearing it during the day while sitting in a chair watching television or reading. This will distract your focus from the mask to a positive, familiar activity. CPAP use will become a habit and part of your routine.
Why am I still snoring?
Snoring, choking, gasping like noises should be eliminated during CPAP use. If not, it could mean that your machine pressure is not adequate. Call your cpap supplier to find a solution.
Air in tummy, painful stomach bloating and gas
The medical term for this common CPAP issue is Aerophagia. It occurs when the air delivered by your CPAP enters the esophagus and stomach rather than the lungs. It can occur when your CPAP pressure is set too low or too high. It can also occur if you are a mouth breather but not wearing a full face mask. Consult your physician if the problem is chronic and persistent.
Bed pillow problems with side or stomach sleeping
Often, side or stomach sleepers find that the head sinks in to their bed pillow which causes the blockage of mask exhalation ports and risk of dangerous CO2 (carbon dioxide) rebreathing. Others find their pillow causes unwanted mask frame movement (pushed off center) causing mask leak, pressure point soreness or bruised cheek bones. To resolve, purchase PAPillow, a specially made bed pillow designed for CPAP users and for any side or stomach sleepers.
Mask Problems
Skin irritation, sores and bruises from mask
No mask should cause pain nor discomfort if sized correctly and fitted properly. If irritation or sores are developing, chances are you are over tightening your mask. Your mask cushion may be worn out and need replacing. Mask liners called RemZzz’s might also resolve skin irritation and mask leak.
I like my mask choice, but still get occasional facial sores or leaking.
Your cpap supplier should offer products that might be helpful if you otherwise like your mask. One is the Gecko nasal pad. It is an easy to use gel pad that is placed across the nose bridge and under the mask. It helps with leak in the upper part of the mask frame and is beneficial to patients who have a narrow nose bridge or who are prone to cuts or irritation to the nose bridge. Another product patients find helpful are SoreSpot CPAP Skin Protectors. They are a unique liquid-filled bandage that minimizes friction and helps prevent skin irritation. Check out RemZzz’s full face and nasal mask liners. They are applied directly to the silicone mask cushion to help absorb facial moisture and oils, and prevent skin irritation and pressure marks as well as to reduce noisy mask leak.
I wake up without my mask on, but have no memory of removing it during sleep
This is a common occurrence, especially during the early adjustment period of CPAP use. Chances are, you removed the mask due to discomfort or leak. This would indicate that your mask choice is not the best for your face, or that it is not fitted properly.
I am claustrophobic and cannot get used to the nasal mask
Patients who experience claustrophobia usually find that the small size and simplicity of nasal pillow masks more tolerable. There is an adjustment period for most patients as they get used to sleeping with any mask on the face. While your goal is to be able to sleep all night on CPAP, using it as long as you can tolerate it each night is better than nothing. Try to increase usage over time until you reach your goal.
My eyes are swollen or irritated
No air should be directed up in to the eye area with a properly sized and fitted mask. This might indicate leak in the top area of your mask; gently tighten the top mask straps taking care not to over tighten. This leak might also indicate a worn mask cushion that needs replacing.
Some people naturally sleep with their eyes partially open which can cause dryness or irritation; they benefit from wearing a simple fabric eye mask. If swelling or irritation is chronic or persistent, consult with your sleep or primary care physician.
I use a Nasal Pillow mask and my nostrils are sore
Skin irritation can quickly occur when the nasal pillows are not inserted properly. Try rotating the barrel that holds the nasal pillow inserts to a more comfortable angled position of the pillows in to the nostrils. After best positioning, if leak occurs at the nostril opening, size up.
My mask is making a whistling noise
Most masks have exhalation ports (look for a tiny cluster of holes) that allow the escape of our CO2 (carbon dioxide). When routinely cleaning your mask parts, these tiny holes must be checked to make sure they are not soiled and clogged by body oil or bedding lint. When clogged, they can cause the mask to make a whistling noise. Use a sewing needle or toothpick to keep the holes free flowing.
My bed partner is bothered by the air flow of the exhalation ports from my mask
All masks have exhalation ports to allow the escape of CO2 (carbon dioxide). The higher the machine pressure setting, the harsher this escape flow will be. Some masks have better air diffusion features than others. Check with your Corner Team member to discuss a resolution. Some patients resolve by side sleeping with their backs turned to their bed partner to avoid a distracting air flow.
Machine Problems
My CPAP machine is not working
Make sure the electric plugs to the wall and to the machine are firmly in place. Check your electric outlet to make sure it is working. Otherwise, make an appointment to bring your machine in to be evaluated by your cpap supplier.
My CPAP machine is too noisy; it keeps me / my bed partner from sleeping.
Today’s machines are nearly silent, so unless you are hypersensitive to noise ( try ear plugs), this would indicate a problem. Check the machine filters. They should be changed monthly or when visibly discolored to help keep the machines running smoothly. There will be a slight audible noise if you are using a Bi Level machine as the pressure transitions between inhalation and exhalation settings. There will be a slight audible noise if you use an AutoCPAP as the machine changes inhalation pressure. If your machine is otherwise noisy, there may be a machine defect. Make an appointment to bring your machine in to be evaluated by your cpap supplier.
I get tangled in my CPAP tubing during the night
Try placing the tubing behind your head near the top of your pillow, or positioned behind the headboard bed post. Most cpap suppliers offer an inexpensive Tubing Lift to help with tube positioning for better sleep. Easy to use, the small frame is held in place between the box spring and mattress. The lift holds the tubing above the head allowing for better freedom of movement.
I keep pulling my CPAP machine off the night stand.
The length of standard CPAP tubing is about 6 feet. Active sleepers who toss and turn are more apt to tug on the tubing and pull their machine off the bedside table. Most cpap suppliers offer tubing in 10 foot lengths which give patients more freedom of movement especially when coupled with a Tubing Lift.
Humidifier Problems
CPAP is causing dry mouth, dry throat, runny nose, stuffy nose, sneezing
A CPAP humidifier or temperature adjustment may usually resolve all of the above issues. Start with the lowest heat setting and turn up as needed for more moisture. Biotene spray or oral rinse products may help with dry mouth. Chronic nasal lining dryness may be helped with Ocean or other simple saline spray solutions. Both are available over the counter at your pharmacy. Consult with your physician if the problem persists.
Water in CPAP tubing
Excess condensation can form in the CPAP tubing when the temperature of your bedroom is cooler than the air coming from your machine. Most cpap suppliers offer inexpensive, insulating hose covers to resolve this common problem.
White or pink film in humidifier water chamber
Bacteria can quickly develop in the water chamber. All manufacturers recommend the use of distilled water. Tap water may be used on occasion. Each morning, empty any leftover water, rinse chamber and let air dry. To remove film, fill chamber with 1/3 white distilled vinegar to 2/3 tap water solution. Let soak for one hour. Rinse with clear tap water, air dry.
Water spill
Always remove water chamber unit from machine before filling with distilled water. Spilling water in to the machine may compromise the interior circuits, damage the machine and void the warranty.
Mask Fit and Adjustment Tips
Mask leak is one of the most common challenges for patients. To assure the best fit and adjustment, when retiring to sleep, sit on your bed and place mask on the head/face with straps loose. With machine turned on and air blowing, lay down with your head on the pillow in your normal sleeping position. Slowly tighten your mask straps just until you get a good seal, being careful not to needlessly over tighten. The final step is to “seat” your mask. After straps are adjusted, pull the mask out and away from your face (about 2 inches) and gently lay back on face. This allows the dual mask cushions to inflate which will assure the best seal possible and comfortable fit. Mask fit varies with sleeping position, so if you fit for side or stomach sleeping, you will need to readjust if you roll to your back. This is why many patients train themselves to sleep solely on side or stomach (same mask fit) versus back sleeping which has a different mask fit.
Mask fit tips
Full Face - Mask users with forehead pads/brace: tighten upper strap first, then follow with lower strap positioning and fit.
Mask Headgear - Masks come with a “one size fits most” head gear. Larger and smaller strapped headgear may be available by special order.
Nasal Pillow Mask - Place mask on face and position headgear and place side straps above the ears. Gently slip nasal pillows in to the nostrils making sure to rotate the angle of the pillow barrel for a comfortable fit. The pillows are meant to lie just inside the nostril opening, not to be aggressively inserted. Proper placement should not cause the tip of the nose to be raised.
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CPAP Tubing Tips
While your CPAP tubing may seem like an insignificant component of your medical equipment, it plays a vital role in comfort and accuracy of therapy delivery. Learn how to keep it functioning at its best. |
CPAP Tubing Tips
Tracy R. Nasca
While your CPAP tubing may seem like an insignificant component of your medical equipment, it plays a vital role in comfort and accuracy of therapy delivery. Most insurance companies follow the Medicare recommendation for CPAP supply replacement. Filters and tubing are both covered every 30 days. Check with your insurance company to confirm your replacement schedule.
Replacement
CPAP tubing has the appearance of being sturdy when in fact it can be damaged and compromised without you even realizing it. The thin material between the coils can be punctured and allow the escape of air. CPAP tubing is often the last thing we think of replacing. We can see when the filters are dirty, the mask cushion and headgear worn out, but there are rarely visual signs of aged tubing.
Tiny holes indiscernible by the naked eye can be detected by turning on machine and blocking the end that connects to the mask. Run your hand down the length of the tubing to see if you can feel any air escaping. Replace tubing if you detect any leaks.
How did those tiny holes get there?
Think about how active the tubing is during sleep; being pulled from machine on the night stand to various positioning during the night. If you use a tubing lift, or drape the tubing over the bed post, friction at the loop can easily cause wear and tear. Most of us handle our masks with greater care, not realizing the fragility of tubing. Be mindful when cleaning the tubing, we can easily puncture the film with our fingernails. Those with pets report that the tubing is a favorite play thing and kitty or puppy nails can easily perforate. To protect the life of your CPAP tubing, use an insulated tubing cover.
Accuracy
Standard CPAP tubing is about 6 feet long. Many patients opt for a longer tubing to give them more freedom of movement during sleep positioning changes. Your CPAP pressure was determined by your prescribing physician based on the 6 foot length. When we opt for a longer tubing length, it can compromise the accuracy of delivered pressure. Some patients are tempted to connect two 6 foot tubes, this is not recommended. Generally speaking, it should be safe to use tubing up to 9 feet long, but discuss the use of any longer tubing length with your physician.
Comfort
While 6 foot tubing may seem long enough, many patients quickly realize that it compromises movement during sleep. When I began CPAP therapy, I was obese at 297 pounds. Even with my CPAP unit sitting at the edge of my night stand and butted up against my bed, I still had to sleep at the edge of my bed if I wanted to change sleep positions by rolling over during the night. If I rolled over too quickly or tried to roll to the center of my bed, my CPAP unit was sure to fly off on to the floor. I likened it to feeling like a dog on a leash. I fought this for many years before realizing there were longer tubing lengths which helped this problem. In recent years, intuitive inventors brought us tubing lifts. These inexpensive accessories are a brilliant resolution to allowing comfort and freedom of movement during sleep. If you are obese and struggle with tubing length issues, if you get tangled in your tubing during sleep, if you have difficulty knowing where to place the excess tubing during sleep to keep it out of your way, a tubing lift is your answer.
Tracy R. Nasca
While your CPAP tubing may seem like an insignificant component of your medical equipment, it plays a vital role in comfort and accuracy of therapy delivery. Most insurance companies follow the Medicare recommendation for CPAP supply replacement. Filters and tubing are both covered every 30 days. Check with your insurance company to confirm your replacement schedule.
Replacement
CPAP tubing has the appearance of being sturdy when in fact it can be damaged and compromised without you even realizing it. The thin material between the coils can be punctured and allow the escape of air. CPAP tubing is often the last thing we think of replacing. We can see when the filters are dirty, the mask cushion and headgear worn out, but there are rarely visual signs of aged tubing.
Tiny holes indiscernible by the naked eye can be detected by turning on machine and blocking the end that connects to the mask. Run your hand down the length of the tubing to see if you can feel any air escaping. Replace tubing if you detect any leaks.
How did those tiny holes get there?
Think about how active the tubing is during sleep; being pulled from machine on the night stand to various positioning during the night. If you use a tubing lift, or drape the tubing over the bed post, friction at the loop can easily cause wear and tear. Most of us handle our masks with greater care, not realizing the fragility of tubing. Be mindful when cleaning the tubing, we can easily puncture the film with our fingernails. Those with pets report that the tubing is a favorite play thing and kitty or puppy nails can easily perforate. To protect the life of your CPAP tubing, use an insulated tubing cover.
Accuracy
Standard CPAP tubing is about 6 feet long. Many patients opt for a longer tubing to give them more freedom of movement during sleep positioning changes. Your CPAP pressure was determined by your prescribing physician based on the 6 foot length. When we opt for a longer tubing length, it can compromise the accuracy of delivered pressure. Some patients are tempted to connect two 6 foot tubes, this is not recommended. Generally speaking, it should be safe to use tubing up to 9 feet long, but discuss the use of any longer tubing length with your physician.
Comfort
While 6 foot tubing may seem long enough, many patients quickly realize that it compromises movement during sleep. When I began CPAP therapy, I was obese at 297 pounds. Even with my CPAP unit sitting at the edge of my night stand and butted up against my bed, I still had to sleep at the edge of my bed if I wanted to change sleep positions by rolling over during the night. If I rolled over too quickly or tried to roll to the center of my bed, my CPAP unit was sure to fly off on to the floor. I likened it to feeling like a dog on a leash. I fought this for many years before realizing there were longer tubing lengths which helped this problem. In recent years, intuitive inventors brought us tubing lifts. These inexpensive accessories are a brilliant resolution to allowing comfort and freedom of movement during sleep. If you are obese and struggle with tubing length issues, if you get tangled in your tubing during sleep, if you have difficulty knowing where to place the excess tubing during sleep to keep it out of your way, a tubing lift is your answer.
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Overcoming the Challenges of Breathing on CPAP Sleep apnea is a life threatening disorder that should be taken seriously. For most of us, sleep apnea is “for life”. CPAP treatment is the gold standard treatment and although it has its challenges, with proper follow up care, most patients can expect a resolution of restorative sleep and return to a fully energized lifestyle. |
Overcoming the Challenges of Breathing on CPAP
Tracy R. Nasca
Sleep apnea is a life threatening disorder that should be taken seriously. For most of us, sleep apnea is “for life”. CPAP treatment is the gold standard treatment and although it has its challenges, with proper follow up care, most patients can expect a resolution of restorative sleep and return to a fully energized lifestyle.
Proper follow up care is a team effort. The team is comprised of the prescribing physician and the CPAP equipment provider but the most important part of the team is you. You, the patient must take an active role to assist in the lifetime management of your sleep apnea disorder. No one cares more about your sleep health than you. It is important to take the lead and keep your team informed of your successes as well as your difficulties. Your healthcare team cannot help you if you do not keep them informed.
After the diagnosis, the first year will offer up the most challenges as you learn to use CPAP therapy each time you sleep, including daytime naps. Getting used to the continuous flow of air from CPAP (Continuous Positive Airway Pressure) is one of the challenges.
Helpful tips are as follows:
Ramp
Ask your CPAP provider to explain RAMP to consider enabling this feature for your comfort. Ramp is a feature that allows the machine to initiate pressure at a low setting over a particular period of time with the goal of the machine reaching its full pressure as you are falling asleep. As an example, if your prescribed and optimal pressure is 10, ramp may be set to start at 6 and “ramp up” or increase slowly to 10 within 30 minutes. The ramp initial pressure and time are variable. Ramp may be enabled or disabled on your machine, so discuss this with your CPAP provider.
Expiratory Pressure Relief
Your machine may have a feature called CFLEX if a Respironics brand or EPR (Expiratory Pressure Relief) if a ResMed brand. Ask your CPAP provider to explain this option to consider enabling this feature for your comfort. Both offer the ability to reduce the CPAP pressure by 1, 2 or 3 pressure points lower as the machine detects when you begin to exhale. As an example, if your machine is set at 10, and using CFLEX or EPR at 3, the machine will always deliver 10 when you inhale, and then automatically reduce to 7 as soon as you begin to exhale. This is a helpful feature to most patients, but especially those challenged with mid to high range pressures of 10 or higher. Breathing over a constant flow of air pressure is one of the most challenging aspects of using CPAP therapy.
Anxiety
It’s hard getting used to sleeping with a mask strapped to our face delivering air that may feel like a hurricane force wind. It can be intimidating and cause some patients anxiety. Many of us retire to bed, put on our mask, turn the machine on and then lay there focusing on the feel of the mask, the noise of the machine and the air blasting at us. This can cause a feeling of claustrophobia, and even cause us to unconsciously “fight against” the delivery of air which may result in a choking sensation and panic.
When you retire, slip on your mask, turn on your machine and turn your focus totally away from the machine. Your goal is to let nature take its course and fall in to a natural rhythm of breathing. The RAMP feature will be very helpful to patients who struggle with this issue. Expiratory pressure relief is also helpful. They key is to turn your focus to something relaxing and pleasant. Using visualization techniques, create a safe and utterly relaxing place of your choosing, in your mind, and go there.
If you are especially challenged with this issue, practice using the machine during the day and while awake. Sit upright in a chair with mask and CPAP on while watching TV or doing some other activity to distract you. This will help you get comfortable wearing the mask on your face, and the distraction of watching TV will allow you to focus on something else rather than the air pressure.
CPAP Humidification
The air delivered by CPAP is the same temperature as your sleeping room environment. So if you are using air-conditioning in summer or keep your bedroom chilly during fall and early winter you may experience discomfort. The blast of air entering your nostrils may very well be 65 degrees and that can be a shock to the nasal lining and cause pain. In winter months, when we fire up our furnace, the heat can cause a drying affect in our household as well as our nasal lining! Using the addition of a CPAP humidifier with heat, resolves this common problem. To determine the best temperature, start at the lowest humidifier setting and only turn up the heat as needed. Remember, it is primarily the moisture we need, not a high heat.
Tracy R. Nasca
Sleep apnea is a life threatening disorder that should be taken seriously. For most of us, sleep apnea is “for life”. CPAP treatment is the gold standard treatment and although it has its challenges, with proper follow up care, most patients can expect a resolution of restorative sleep and return to a fully energized lifestyle.
Proper follow up care is a team effort. The team is comprised of the prescribing physician and the CPAP equipment provider but the most important part of the team is you. You, the patient must take an active role to assist in the lifetime management of your sleep apnea disorder. No one cares more about your sleep health than you. It is important to take the lead and keep your team informed of your successes as well as your difficulties. Your healthcare team cannot help you if you do not keep them informed.
After the diagnosis, the first year will offer up the most challenges as you learn to use CPAP therapy each time you sleep, including daytime naps. Getting used to the continuous flow of air from CPAP (Continuous Positive Airway Pressure) is one of the challenges.
Helpful tips are as follows:
Ramp
Ask your CPAP provider to explain RAMP to consider enabling this feature for your comfort. Ramp is a feature that allows the machine to initiate pressure at a low setting over a particular period of time with the goal of the machine reaching its full pressure as you are falling asleep. As an example, if your prescribed and optimal pressure is 10, ramp may be set to start at 6 and “ramp up” or increase slowly to 10 within 30 minutes. The ramp initial pressure and time are variable. Ramp may be enabled or disabled on your machine, so discuss this with your CPAP provider.
Expiratory Pressure Relief
Your machine may have a feature called CFLEX if a Respironics brand or EPR (Expiratory Pressure Relief) if a ResMed brand. Ask your CPAP provider to explain this option to consider enabling this feature for your comfort. Both offer the ability to reduce the CPAP pressure by 1, 2 or 3 pressure points lower as the machine detects when you begin to exhale. As an example, if your machine is set at 10, and using CFLEX or EPR at 3, the machine will always deliver 10 when you inhale, and then automatically reduce to 7 as soon as you begin to exhale. This is a helpful feature to most patients, but especially those challenged with mid to high range pressures of 10 or higher. Breathing over a constant flow of air pressure is one of the most challenging aspects of using CPAP therapy.
Anxiety
It’s hard getting used to sleeping with a mask strapped to our face delivering air that may feel like a hurricane force wind. It can be intimidating and cause some patients anxiety. Many of us retire to bed, put on our mask, turn the machine on and then lay there focusing on the feel of the mask, the noise of the machine and the air blasting at us. This can cause a feeling of claustrophobia, and even cause us to unconsciously “fight against” the delivery of air which may result in a choking sensation and panic.
When you retire, slip on your mask, turn on your machine and turn your focus totally away from the machine. Your goal is to let nature take its course and fall in to a natural rhythm of breathing. The RAMP feature will be very helpful to patients who struggle with this issue. Expiratory pressure relief is also helpful. They key is to turn your focus to something relaxing and pleasant. Using visualization techniques, create a safe and utterly relaxing place of your choosing, in your mind, and go there.
If you are especially challenged with this issue, practice using the machine during the day and while awake. Sit upright in a chair with mask and CPAP on while watching TV or doing some other activity to distract you. This will help you get comfortable wearing the mask on your face, and the distraction of watching TV will allow you to focus on something else rather than the air pressure.
CPAP Humidification
The air delivered by CPAP is the same temperature as your sleeping room environment. So if you are using air-conditioning in summer or keep your bedroom chilly during fall and early winter you may experience discomfort. The blast of air entering your nostrils may very well be 65 degrees and that can be a shock to the nasal lining and cause pain. In winter months, when we fire up our furnace, the heat can cause a drying affect in our household as well as our nasal lining! Using the addition of a CPAP humidifier with heat, resolves this common problem. To determine the best temperature, start at the lowest humidifier setting and only turn up the heat as needed. Remember, it is primarily the moisture we need, not a high heat.
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Care and Replacement of CPAP Equipment You are about to experience the beginning of a new and improved period in your overall health and well being that only quality sleep without the presence of apneas can provide. CPAP therapy is the cornerstone of sleep apnea treatment and with consistent use, you will benefit greatly. |
Care and Replacement of CPAP Equipment
Tracy R. Nasca
You are about to experience the beginning of a new and improved period in your overall health and well being that only quality sleep without the presence of apneas can provide. CPAP therapy is the cornerstone of sleep apnea treatment and with consistent use, you will benefit greatly.
Your CPAP equipment is an important investment in your sleep health, take good care of it. Proper and routine care will help you prolong the life of your mask, machine and accessories.
Nearly all manufacturer defects for masks and machines will be apparent within the first days or weeks of use and well within the warranty time limit. Don't leave your equipment vulnerable and within the reach of pets and small children; your mask is not a toy. Handle with care!
CPAP, AutoCPAP and BiLevel Machine Care
The outer casing of your CPAP should not require special maintenance. If necessary, unplug machine and wipe clean with a moist cloth using a mild pure soap detergent. Dry the unit thoroughly. Never submerge your CPAP in water.
Have your machine checked yearly, with a manometer, to make sure it’s delivering the correct prescribed pressure. Local home health care providers should provide this service at no charge. Be aware of the warranty expiration date of your machine; make sure to have it checked thoroughly by your local home healthcare provider routinely and always before the warranty period ends.
Humidifier Water Chamber
Use extreme caution not to spill any liquid on or about your machine, this may damage the interior circuits and void the warranty. When filling your humidifier water chamber, always remove it from the CPAP unit and fill it away from the machine. Distilled water is recommended by most manufacturers. Do not reuse water; empty unused water each morning. Each morning, clean water chamber with a 10 minute soak in a mild pure soap, rinse well and air dry after each use.
Cleaning Products and Cleaning Tips
Choose a mild pure soap for use in cleaning mask and tubing. Never use harsh soaps, chlorine bleach, antibacterial or alcohol based solutions. Aromatic solutions and scented oils should not be used. To cut soap residue or to disinfect, use 1 part vinegar and 3 parts water solution after cleaning.
CPAP Tubing Care
Tubing should be replaced annually or more often if needed. Tiny holes can develop that are hard to see with the naked eye. These holes can compromise the proper delivery of prescribed and adequate pressure. Pets seem to love cpap tubing, especially cat claws and tiny teeth. A tubing cover will protect the hose.
Clean tubing weekly. Fill sink with a mix of warm water and mild liquid soap. Lay tubing in mix to allow water to clean the entire inside surface area. A small baby bottle brush may be gently used to clean inside tubing if necessary. However be careful not to cut through the fragile tubing material between the coils. Rinse well and allow tubing to hang and air dry.
CPAP Machine Filters
Filters are inexpensive and routine replacement will greatly add to the life of your machine. Some machines have 2 filters; the non disposable filter is usually made of foam and usually grey or black in color. This simply needs weekly hand cleaning in a mild dish washing soap mix, then a clear water rinse and air dry. These will last for up to one year. The white fine filters should be replaced as needed when visibly discolored and dirty, just as you would your home air and furnace filters. The disposable fine filters generally need replacing every month or two.
CPAP Mask Care
The mask is comprised of different components being the outer frame, inside soft cushion and the headgear. The soft mask cushion that lies against our face is fragile and most vulnerable. To help add longevity to your mask, remove make-up at night, place mask on clean skin free of oils and moisturizers. Daily, clean the soft cushion with a mild pure soap mix and air dry. Handle the delicate cushion gently to avoid tearing. Weekly, the mask frame and headgear should be hand washed in the same gentle manner. Always air dry.
Replacement
The Medicare replacement schedule is provided below. Private insurance typically allows mask and tubing replacement every 6 months, filters every 90 days and machines every 5 years. Everyone’s private insurance replacement schedule will vary. Check to see what your durable medical equipment coverage allows.
CMS (Medicare) Recommendations for CPAP Supply Replacement
Item HCPCS Code Replacement Schedule
Full Face Mask A7030 1 per 3 months
Full Face Cushion A7031 1 per 1 months
Nasal Cushion A7032 2 per 1 month
Replacement Pillow A7033 2 per 1 month
CPAP Mask A7034 1 per 3 months
CPAP Headgear A7035 1 per 6 months
CPAP Chinstrap A7036 1 per 6 months
CPAP Tubing A7037 1 per 3 months
Disposable Filter A7038 2 per 1 month
Non-disposable Filters A7039 1 per 6 months
Oral Interface A7044 1 per 3 months
Heated Humidifier E0562 5 Years
CPAP Machine E0601 5 Years
Humidifier Chamber E7046 1 per 6 months
Tracy R. Nasca
You are about to experience the beginning of a new and improved period in your overall health and well being that only quality sleep without the presence of apneas can provide. CPAP therapy is the cornerstone of sleep apnea treatment and with consistent use, you will benefit greatly.
Your CPAP equipment is an important investment in your sleep health, take good care of it. Proper and routine care will help you prolong the life of your mask, machine and accessories.
Nearly all manufacturer defects for masks and machines will be apparent within the first days or weeks of use and well within the warranty time limit. Don't leave your equipment vulnerable and within the reach of pets and small children; your mask is not a toy. Handle with care!
CPAP, AutoCPAP and BiLevel Machine Care
The outer casing of your CPAP should not require special maintenance. If necessary, unplug machine and wipe clean with a moist cloth using a mild pure soap detergent. Dry the unit thoroughly. Never submerge your CPAP in water.
Have your machine checked yearly, with a manometer, to make sure it’s delivering the correct prescribed pressure. Local home health care providers should provide this service at no charge. Be aware of the warranty expiration date of your machine; make sure to have it checked thoroughly by your local home healthcare provider routinely and always before the warranty period ends.
Humidifier Water Chamber
Use extreme caution not to spill any liquid on or about your machine, this may damage the interior circuits and void the warranty. When filling your humidifier water chamber, always remove it from the CPAP unit and fill it away from the machine. Distilled water is recommended by most manufacturers. Do not reuse water; empty unused water each morning. Each morning, clean water chamber with a 10 minute soak in a mild pure soap, rinse well and air dry after each use.
Cleaning Products and Cleaning Tips
Choose a mild pure soap for use in cleaning mask and tubing. Never use harsh soaps, chlorine bleach, antibacterial or alcohol based solutions. Aromatic solutions and scented oils should not be used. To cut soap residue or to disinfect, use 1 part vinegar and 3 parts water solution after cleaning.
CPAP Tubing Care
Tubing should be replaced annually or more often if needed. Tiny holes can develop that are hard to see with the naked eye. These holes can compromise the proper delivery of prescribed and adequate pressure. Pets seem to love cpap tubing, especially cat claws and tiny teeth. A tubing cover will protect the hose.
Clean tubing weekly. Fill sink with a mix of warm water and mild liquid soap. Lay tubing in mix to allow water to clean the entire inside surface area. A small baby bottle brush may be gently used to clean inside tubing if necessary. However be careful not to cut through the fragile tubing material between the coils. Rinse well and allow tubing to hang and air dry.
CPAP Machine Filters
Filters are inexpensive and routine replacement will greatly add to the life of your machine. Some machines have 2 filters; the non disposable filter is usually made of foam and usually grey or black in color. This simply needs weekly hand cleaning in a mild dish washing soap mix, then a clear water rinse and air dry. These will last for up to one year. The white fine filters should be replaced as needed when visibly discolored and dirty, just as you would your home air and furnace filters. The disposable fine filters generally need replacing every month or two.
CPAP Mask Care
The mask is comprised of different components being the outer frame, inside soft cushion and the headgear. The soft mask cushion that lies against our face is fragile and most vulnerable. To help add longevity to your mask, remove make-up at night, place mask on clean skin free of oils and moisturizers. Daily, clean the soft cushion with a mild pure soap mix and air dry. Handle the delicate cushion gently to avoid tearing. Weekly, the mask frame and headgear should be hand washed in the same gentle manner. Always air dry.
Replacement
The Medicare replacement schedule is provided below. Private insurance typically allows mask and tubing replacement every 6 months, filters every 90 days and machines every 5 years. Everyone’s private insurance replacement schedule will vary. Check to see what your durable medical equipment coverage allows.
CMS (Medicare) Recommendations for CPAP Supply Replacement
Item HCPCS Code Replacement Schedule
Full Face Mask A7030 1 per 3 months
Full Face Cushion A7031 1 per 1 months
Nasal Cushion A7032 2 per 1 month
Replacement Pillow A7033 2 per 1 month
CPAP Mask A7034 1 per 3 months
CPAP Headgear A7035 1 per 6 months
CPAP Chinstrap A7036 1 per 6 months
CPAP Tubing A7037 1 per 3 months
Disposable Filter A7038 2 per 1 month
Non-disposable Filters A7039 1 per 6 months
Oral Interface A7044 1 per 3 months
Heated Humidifier E0562 5 Years
CPAP Machine E0601 5 Years
Humidifier Chamber E7046 1 per 6 months
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CPAP Titration When sleep apnea is diagnosed during the overnight sleep study, a titration is then performed to determine the optimal CPAP pressure setting required to resolve apnea episodes. Sometimes the titration is performed during the second half of the overnight sleep study; this would be called a split night study. |
What is a CPAP Titration and how often should you have one?
Tracy R. Nasca
When sleep apnea is diagnosed during the overnight sleep study, a titration is then performed to determine the optimal CPAP pressure setting required to resolve apnea episodes. Sometimes the titration is performed during the second half of the overnight sleep study; this would be called a split night study. Your doctor may prefer a 2 night sleep study with the first night reserved for the thorough monitoring and collection of sleep architecture and data, followed by another full night for CPAP titration.
During the titration, the patient wears a mask and CPAP pressures are trialed up and down during sleep to find a single best pressure delivery and setting to control apnea events. Apneas can occur with different levels of severity during the varying sleep stages, body and sleeping position and other factors. This is why you are asked to sleep on your back, sides and stomach during the titration. The titration should include enough time to allow you to cycle through the sleep stages. Once a patient has been diagnosed and begins CPAP therapy, follow up and aftercare should include routine titrations. It is common for patients to need pressure changes during their years of CPAP therapy.
Each treating physician may have his own protocol and require a titration every year or two. Annual or frequent titrations most often occur when the patient has co morbidities such as hypertension or has previously suffered a heart attack or stroke and when closer monitoring is needed.
How will you know when it’s time for another titration? Successful CPAP therapy keeps the airway open and should cause you to awaken feeling refreshed. It should eliminate all snoring, gasping or choking sounds and sensations. When sleep apnea symptoms reappear, this would indicate that you probably need a pressure change. Old symptoms vary from patient to patient and you will remember what yours were, but they might include:
Just as you would want to keep track of your heart health, you need to monitor your apnea condition. Sleep apnea, if left improperly treated, can lead to heart attack or stroke. Think of your initial overnight sleep study and titration as your baseline. Get organized and keep a copy of your sleep study report and all subsequent titrations as a method to track your treatment and progress over your lifetime of CPAP therapy.
Don’t assume your sleep doctor or CPAP supplier will contact you to suggest a titration. If your CPAP therapy seems to be working well and you are waking each morning feeling fully refreshed, then a titration might be needed every two years. Ask your sleep doctor what he recommends. But when you notice old symptoms reappearing, contact your doctor immediately to schedule a titration. A simple machine pressure change may be all that stands between healthy and restorative sleep versus an unrefreshed, restless sleep and even a heart attack or stroke. Don’t take chances!
Tracy R. Nasca
When sleep apnea is diagnosed during the overnight sleep study, a titration is then performed to determine the optimal CPAP pressure setting required to resolve apnea episodes. Sometimes the titration is performed during the second half of the overnight sleep study; this would be called a split night study. Your doctor may prefer a 2 night sleep study with the first night reserved for the thorough monitoring and collection of sleep architecture and data, followed by another full night for CPAP titration.
During the titration, the patient wears a mask and CPAP pressures are trialed up and down during sleep to find a single best pressure delivery and setting to control apnea events. Apneas can occur with different levels of severity during the varying sleep stages, body and sleeping position and other factors. This is why you are asked to sleep on your back, sides and stomach during the titration. The titration should include enough time to allow you to cycle through the sleep stages. Once a patient has been diagnosed and begins CPAP therapy, follow up and aftercare should include routine titrations. It is common for patients to need pressure changes during their years of CPAP therapy.
Each treating physician may have his own protocol and require a titration every year or two. Annual or frequent titrations most often occur when the patient has co morbidities such as hypertension or has previously suffered a heart attack or stroke and when closer monitoring is needed.
How will you know when it’s time for another titration? Successful CPAP therapy keeps the airway open and should cause you to awaken feeling refreshed. It should eliminate all snoring, gasping or choking sounds and sensations. When sleep apnea symptoms reappear, this would indicate that you probably need a pressure change. Old symptoms vary from patient to patient and you will remember what yours were, but they might include:
- Snoring – CPAP treatment should totally eliminate snoring when sleeping wearing the mask and using the machine.
- The return of frequent nighttime awakenings; gasping or choking on CPAP might indicate insufficient CPAP pressure
- The return of headaches and especially morning headaches – this might indicate low oxygen levels and insufficient CPAP pressure
- The return of excessive daytime sleepiness and fatigue which might indicates sleep deprivation
- The return of a decreased ability to focus and concentrate which might indicate sleep deprivation
- The return of memory loss which might indicate sleep deprivation
- The return of moodiness or depression which might indicate sleep deprivation
Just as you would want to keep track of your heart health, you need to monitor your apnea condition. Sleep apnea, if left improperly treated, can lead to heart attack or stroke. Think of your initial overnight sleep study and titration as your baseline. Get organized and keep a copy of your sleep study report and all subsequent titrations as a method to track your treatment and progress over your lifetime of CPAP therapy.
Don’t assume your sleep doctor or CPAP supplier will contact you to suggest a titration. If your CPAP therapy seems to be working well and you are waking each morning feeling fully refreshed, then a titration might be needed every two years. Ask your sleep doctor what he recommends. But when you notice old symptoms reappearing, contact your doctor immediately to schedule a titration. A simple machine pressure change may be all that stands between healthy and restorative sleep versus an unrefreshed, restless sleep and even a heart attack or stroke. Don’t take chances!
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Mouth Breathing
Some people always have been and always will be mouth breathers due to their anatomical make up. Some of us lack muscle tone causing the jaw to drop. Others have chronic nasal congestion from allergies or other nasal anomalies and if one cannot breathe well through the nose, it may unconsciously forces us to mouth breathe. |
Mouth Breathing on CPAP
Tracy R. Nasca
Were you born a mouth breather, or did you develop mouth breathing as a result of having untreated sleep apnea?
Some people always have been and always will be mouth breathers due to their anatomical make up. Some of us lack muscle tone causing the jaw to drop. Others have chronic nasal congestion from allergies or other nasal anomalies and if one cannot breathe well through the nose, it may unconsciously forces us to mouth breathe.
There is a large population of people who became mouth breathers with the onset of sleep apnea. When an apnea episode occurs, we stop breathing. As our oxygen levels dip, it sends the brain in to a panic to breathe resulting in the loud snore, and sudden gasp to gulp in air as quickly as possible. When apnea events occur fast and furious all during the night, we often develop the habit of sleeping with our mouths open to accommodate the need for oxygen.
Mouth breathing in newly diagnosed sleep apnea patients is so prevalent that many sleep doctors start all of their patients on CPAP therapy with a full face mask. Most patients that weren’t born mouth breathers quickly relearn how to sleep with their mouths closed within a few weeks or months of CPAP treatment. They can then exchange a full face mask for a traditional nasal mask or nasal pillow mask if they so choose.
Full face masks can be more challenging due to their sheer size. A larger mask frame and cushion creates the greater possibility of leak simply because there is more surface area for potential leak. A mouth breather on CPAP has 2 choices, a full face mask or a traditional nasal mask/nasal pillow mask with the addition of a chin strap.
To help reduce mask leak – remember to do your final fit and adjustment while laying in bed in your normal sleeping position. So, when it’s bedtime, sit on your bed and place mask on your face with straps loose. Turn on machine so the air is blowing and then lay down with your head on the pillow the way you would naturally sleep. This is when you slowly tighten the straps just until you get a good seal. With a full face mask, leak is often more prevalent in the top portion of the mask and allows air to be blown in the eye area. Tighten the top straps to resolve this leak. If your leak problem is around the mouth or chin area, focus the adjustment on the bottom strap.
Remember that over tightening may seem like the best way to stop leak, but in truth it will only cause pressure point soreness or cuts on the nose bridge. If you find that you must tighten to the point of pain, you may very well have the wrong size or style for your face. No mask should ever cause pain! Your local home health supplier will be happy to help you select the best mask for your face. There are dozens of full face masks to choose from and one will be perfect for you!
Tracy R. Nasca
Were you born a mouth breather, or did you develop mouth breathing as a result of having untreated sleep apnea?
Some people always have been and always will be mouth breathers due to their anatomical make up. Some of us lack muscle tone causing the jaw to drop. Others have chronic nasal congestion from allergies or other nasal anomalies and if one cannot breathe well through the nose, it may unconsciously forces us to mouth breathe.
There is a large population of people who became mouth breathers with the onset of sleep apnea. When an apnea episode occurs, we stop breathing. As our oxygen levels dip, it sends the brain in to a panic to breathe resulting in the loud snore, and sudden gasp to gulp in air as quickly as possible. When apnea events occur fast and furious all during the night, we often develop the habit of sleeping with our mouths open to accommodate the need for oxygen.
Mouth breathing in newly diagnosed sleep apnea patients is so prevalent that many sleep doctors start all of their patients on CPAP therapy with a full face mask. Most patients that weren’t born mouth breathers quickly relearn how to sleep with their mouths closed within a few weeks or months of CPAP treatment. They can then exchange a full face mask for a traditional nasal mask or nasal pillow mask if they so choose.
Full face masks can be more challenging due to their sheer size. A larger mask frame and cushion creates the greater possibility of leak simply because there is more surface area for potential leak. A mouth breather on CPAP has 2 choices, a full face mask or a traditional nasal mask/nasal pillow mask with the addition of a chin strap.
To help reduce mask leak – remember to do your final fit and adjustment while laying in bed in your normal sleeping position. So, when it’s bedtime, sit on your bed and place mask on your face with straps loose. Turn on machine so the air is blowing and then lay down with your head on the pillow the way you would naturally sleep. This is when you slowly tighten the straps just until you get a good seal. With a full face mask, leak is often more prevalent in the top portion of the mask and allows air to be blown in the eye area. Tighten the top straps to resolve this leak. If your leak problem is around the mouth or chin area, focus the adjustment on the bottom strap.
Remember that over tightening may seem like the best way to stop leak, but in truth it will only cause pressure point soreness or cuts on the nose bridge. If you find that you must tighten to the point of pain, you may very well have the wrong size or style for your face. No mask should ever cause pain! Your local home health supplier will be happy to help you select the best mask for your face. There are dozens of full face masks to choose from and one will be perfect for you!
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Aerophagia Causes and Resolutions
CPAP users who experience excessive belching, stomach bloating, stomach distension and agonizing gas pains may be suffering from aerophagia. It’s the medical term for the phenomenon when air enters the esophagus, goes into the belly and causes bloating. |
Aerophagia Causes and Resolutions
Tracy R. Nasca
CPAP users who experience excessive belching, stomach bloating, stomach distension and agonizing gas pains may be suffering from aerophagia. It’s the medical term for the phenomenon when air enters the esophagus, goes into the belly and causes bloating. Aerophagia can be caused by eating, drinking or even talking too fast. It can occur with hyperventilation from anxiety, from chewing gum, smoking cigarettes and even during strenuous exercising.
For the CPAP patient, aerophagia and stomach bloating is much more prevalent than you might think. It’s not a subject many feel comfortable talking about, but this side effect of CPAP use is an important issue to discuss and with proper changes to therapy, it can be resolved.
Aerophagia occurs when air from a CPAP enters the esophagus and goes into the belly, rather than the airway and into the lungs. This can cause gas pains and distension of the stomach. It is common and can happen to anyone who uses CPAP. But when it becomes chronic, it’s a red flag, a symptom that can be overcome when the cause is properly determined.
There are many possible causes; the following are provided:
1. Your CPAP pressure may be higher than you require. The extra air has nowhere else to go – thus, it is directed in to the esophagus and on to the belly.
2. Your pressure may be too low and inadequate to resolve your apnea event. In your effort to get more air into your lungs, you gulp air in quickly and it is forced into the esophagus instead.
3. You may have nasal congestion from a cold, flu or allergies. When your nose is stuffy, you may not be able to receive the CPAP air pressure you need, so you gulp air by mouth and down into the esophagus it goes.
4. You may be a mouth breather, who is wearing a traditional nasal mask. As your mouth falls open during sleep, the air that is delivered by CPAP and intended to enter the lungs may instead, escape via your mouth. Your apnea events are not being resolved and in your unconscious panic to breathe, you may suddenly have a choking sensation and gulp air in quickly, forcing it into the esophagus.
5. You may be having difficulty learning and adjusting to exhale over the constant pressure of the air delivered by CPAP. This is especially difficult for those patients on mid- to high-CPAP pressures. Inhalation of high pressures may be easy, but exhaling may cause anxiety, panic and a feeling of suffocation or choking. When this occurs, the patient may fall out of the natural rhythm of breathing and hyperventilation may occur. This can result in a quick sucking in or gulping of air, and that air may be forced into the esophagus rather than the lungs.
Here are a few suggestions:
1. If you suspect your CPAP machine air pressure might be inadequate for reasons mentioned above (too high or too low), discuss a pressure change with your doctor.
2. Confirm with your CPAP provider that your machine was indeed set correctly as prescribed by your doctor. On occasion, mistakes happen and CPAP may be set incorrectly.
3. Expiratory pressure relief features are available on most CPAP machines today. Depending on machine brand, it may be called CFLEX, AFLEX OR BIFLEX on Philips Respironics brands and EPR (expiratory pressure relief) on ResMed brands. This feature automatically reduces air pressure upon exhalation and can help reduce or eliminate aerophagia. Contact your CPAP provider and inquire if this feature is enabled and set on your machine. This is commonly a patient controlled feature, so ask to be shown how to use it.
4. Consider if the mask you are using is the best choice. You may be a mouth breather yet using a nasal mask. Your mask may not be the best size or style suited for your face. If you experience frequent mask leak, or pressure point soreness from over tightening straps to eliminate leak, consider choosing a different mask.
5. Make sure you know how to properly fit and adjust your mask for best seal. After you have chosen the best mask size and style for your face, you must adjust it properly before sleep. Sit on your bed, turn the machine on, and place mask on your face with straps loose. Lay down in your sleeping position with your head on your pillow as you would normally sleep. Slowly pull the straps JUST UNTIL you get a good seal. If your mask has a dual cushion, it will need to be “seated.” After you have fitted and adjusted your mask using the steps above, to “seat,” gently pull the mask straight out and away from your face to allow the dual cushions to inflate properly. Lay the mask gently back onto your face . You should know, by feel, that a good comfortable seal is achieved.
6. If you suspect your aerophagia is the result of hyperventilation caused from anxiety, consider utilizing Cognitive Behavioral Therapy provided by a sleep specialist. Ask your sleep doctor for a referral.
Learning the cause of aerophagia is key to resolving it. As always, discuss this issue with your sleep doctor and CPAP provider to help determine your causes and resolutions.
Tracy R. Nasca
CPAP users who experience excessive belching, stomach bloating, stomach distension and agonizing gas pains may be suffering from aerophagia. It’s the medical term for the phenomenon when air enters the esophagus, goes into the belly and causes bloating. Aerophagia can be caused by eating, drinking or even talking too fast. It can occur with hyperventilation from anxiety, from chewing gum, smoking cigarettes and even during strenuous exercising.
For the CPAP patient, aerophagia and stomach bloating is much more prevalent than you might think. It’s not a subject many feel comfortable talking about, but this side effect of CPAP use is an important issue to discuss and with proper changes to therapy, it can be resolved.
Aerophagia occurs when air from a CPAP enters the esophagus and goes into the belly, rather than the airway and into the lungs. This can cause gas pains and distension of the stomach. It is common and can happen to anyone who uses CPAP. But when it becomes chronic, it’s a red flag, a symptom that can be overcome when the cause is properly determined.
There are many possible causes; the following are provided:
1. Your CPAP pressure may be higher than you require. The extra air has nowhere else to go – thus, it is directed in to the esophagus and on to the belly.
2. Your pressure may be too low and inadequate to resolve your apnea event. In your effort to get more air into your lungs, you gulp air in quickly and it is forced into the esophagus instead.
3. You may have nasal congestion from a cold, flu or allergies. When your nose is stuffy, you may not be able to receive the CPAP air pressure you need, so you gulp air by mouth and down into the esophagus it goes.
4. You may be a mouth breather, who is wearing a traditional nasal mask. As your mouth falls open during sleep, the air that is delivered by CPAP and intended to enter the lungs may instead, escape via your mouth. Your apnea events are not being resolved and in your unconscious panic to breathe, you may suddenly have a choking sensation and gulp air in quickly, forcing it into the esophagus.
5. You may be having difficulty learning and adjusting to exhale over the constant pressure of the air delivered by CPAP. This is especially difficult for those patients on mid- to high-CPAP pressures. Inhalation of high pressures may be easy, but exhaling may cause anxiety, panic and a feeling of suffocation or choking. When this occurs, the patient may fall out of the natural rhythm of breathing and hyperventilation may occur. This can result in a quick sucking in or gulping of air, and that air may be forced into the esophagus rather than the lungs.
Here are a few suggestions:
1. If you suspect your CPAP machine air pressure might be inadequate for reasons mentioned above (too high or too low), discuss a pressure change with your doctor.
2. Confirm with your CPAP provider that your machine was indeed set correctly as prescribed by your doctor. On occasion, mistakes happen and CPAP may be set incorrectly.
3. Expiratory pressure relief features are available on most CPAP machines today. Depending on machine brand, it may be called CFLEX, AFLEX OR BIFLEX on Philips Respironics brands and EPR (expiratory pressure relief) on ResMed brands. This feature automatically reduces air pressure upon exhalation and can help reduce or eliminate aerophagia. Contact your CPAP provider and inquire if this feature is enabled and set on your machine. This is commonly a patient controlled feature, so ask to be shown how to use it.
4. Consider if the mask you are using is the best choice. You may be a mouth breather yet using a nasal mask. Your mask may not be the best size or style suited for your face. If you experience frequent mask leak, or pressure point soreness from over tightening straps to eliminate leak, consider choosing a different mask.
5. Make sure you know how to properly fit and adjust your mask for best seal. After you have chosen the best mask size and style for your face, you must adjust it properly before sleep. Sit on your bed, turn the machine on, and place mask on your face with straps loose. Lay down in your sleeping position with your head on your pillow as you would normally sleep. Slowly pull the straps JUST UNTIL you get a good seal. If your mask has a dual cushion, it will need to be “seated.” After you have fitted and adjusted your mask using the steps above, to “seat,” gently pull the mask straight out and away from your face to allow the dual cushions to inflate properly. Lay the mask gently back onto your face . You should know, by feel, that a good comfortable seal is achieved.
6. If you suspect your aerophagia is the result of hyperventilation caused from anxiety, consider utilizing Cognitive Behavioral Therapy provided by a sleep specialist. Ask your sleep doctor for a referral.
Learning the cause of aerophagia is key to resolving it. As always, discuss this issue with your sleep doctor and CPAP provider to help determine your causes and resolutions.
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Nighttime Urination and Sleep Apnea
Nocturia (nighttime urination) is so prevalent in sleep apnea patients it has become a screening tool as significant as snoring. A research study showed that over 84% of patients with sleep apnea reported frequent nighttime urination while 82% acknowledged snoring. |
Nighttime Urination and Sleep Apnea
Tracy R. Nasca
Nocturia (nighttime urination) is so prevalent in sleep apnea patients it has become a screening tool as significant as snoring. A research study showed that over 84% of patients with sleep apnea reported frequent nighttime urination while 82% acknowledged snoring.
How many bathroom trips do you make during the night? It’s considered normal for one to be awakened once or twice during the night to urinate, but many patients with untreated sleep apnea report as many as 6 or more nightly trips. Often, people assume this disruption of sleep and having a small bladder causes treks to the bathroom.
"Sleep researchers know that nocturia is a sign of sleep apnea," says Mary Umlauf, Ph.D., associate professor of nursing at UAB and lead investigator of the research study. "However, because the underlying mechanisms linking sleep apnea and nocturia had not been studied before, people with nocturia were more likely to report the problem to their gynecologist or urologist, not a sleep clinician. Doctors most often attribute nocturia to aging in women or to prostate problems in men."
The study states that “nocturia can be defined as awakening from sleep to voluntarily urinate. It differs from enuresis or bed-wetting, where the person does not arouse from sleep, but the bladder empties anyway. Until recently, nocturia was thought to be caused by a full bladder, but it is also a symptom of obstructive sleep apnea. What actually causes nocturia is still being investigated. Some researchers believe that one event per night is within normal limits; two or more events per night may be associated with sleep deprivation.”
How does apnea cause nocturia? Umlauf explains that during episodes of sleep apnea, the soft structures in the throat relax and close off the airway, setting into motion a chain of physiological events. "Oxygen decreases, carbon dioxide increases, the blood become more acidic, the heart rate drops and blood vessels in the lung constrict," says Umlauf. "The body is alerted that something is very wrong. The sleeper must wake enough to reopen the airway. By this time, the heart is racing and experiences a false signal of fluid overload. The heart excretes a hormone-like protein that tells the body to get rid of sodium and water, resulting in nocturia."
The good news is that many people who have nocturia due to their untreated sleep apnea find that it totally resolves once they become cpap compliant. We are aware that the ravages of sleep apnea can and do cause a higher risk of heart problems and stroke. These present serious incentives for patients to strive for successful use of cpap. Nocturia is yet another motivation to become therapy compliant to achieve apnea free, quality, restorative sleep. There are other medical reasons to experience nocturia, so if you suffer with frequent nighttime urination, please discuss with your medical team.
Tracy R. Nasca
Nocturia (nighttime urination) is so prevalent in sleep apnea patients it has become a screening tool as significant as snoring. A research study showed that over 84% of patients with sleep apnea reported frequent nighttime urination while 82% acknowledged snoring.
How many bathroom trips do you make during the night? It’s considered normal for one to be awakened once or twice during the night to urinate, but many patients with untreated sleep apnea report as many as 6 or more nightly trips. Often, people assume this disruption of sleep and having a small bladder causes treks to the bathroom.
"Sleep researchers know that nocturia is a sign of sleep apnea," says Mary Umlauf, Ph.D., associate professor of nursing at UAB and lead investigator of the research study. "However, because the underlying mechanisms linking sleep apnea and nocturia had not been studied before, people with nocturia were more likely to report the problem to their gynecologist or urologist, not a sleep clinician. Doctors most often attribute nocturia to aging in women or to prostate problems in men."
The study states that “nocturia can be defined as awakening from sleep to voluntarily urinate. It differs from enuresis or bed-wetting, where the person does not arouse from sleep, but the bladder empties anyway. Until recently, nocturia was thought to be caused by a full bladder, but it is also a symptom of obstructive sleep apnea. What actually causes nocturia is still being investigated. Some researchers believe that one event per night is within normal limits; two or more events per night may be associated with sleep deprivation.”
How does apnea cause nocturia? Umlauf explains that during episodes of sleep apnea, the soft structures in the throat relax and close off the airway, setting into motion a chain of physiological events. "Oxygen decreases, carbon dioxide increases, the blood become more acidic, the heart rate drops and blood vessels in the lung constrict," says Umlauf. "The body is alerted that something is very wrong. The sleeper must wake enough to reopen the airway. By this time, the heart is racing and experiences a false signal of fluid overload. The heart excretes a hormone-like protein that tells the body to get rid of sodium and water, resulting in nocturia."
The good news is that many people who have nocturia due to their untreated sleep apnea find that it totally resolves once they become cpap compliant. We are aware that the ravages of sleep apnea can and do cause a higher risk of heart problems and stroke. These present serious incentives for patients to strive for successful use of cpap. Nocturia is yet another motivation to become therapy compliant to achieve apnea free, quality, restorative sleep. There are other medical reasons to experience nocturia, so if you suffer with frequent nighttime urination, please discuss with your medical team.
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What you need to know about Sleep Apnea and Surgery
If you are contemplating any medical or dental procedures or surgery in the future, the following information is provided to assist you. |
What You Need to Know About Sleep Apnea and Surgery
Tracy R. Nasca
If you are contemplating any medical or dental procedures or surgery in the future, the following information is provided to assist you.
While sleep apnea has become a recognized medical condition within the medical community, one shouldn't assume that all healthcare professionals are aware of sleep apnea. It is the responsibility of any patient with a sleep disorder to make it known to their doctor, nurse, therapist, dentist and anyone involved in their medical care.
The preoperative conference with a member of the anesthesia department is an important time to get to know your anesthesiologist and to exchange the necessary information that will make the up and coming surgery a complete success. Always indicate to this member of the surgical team that you have sleep apnea and are using a CPAP device. Inform them of your prescribed device pressure. Ask the surgeon and anesthesiologist if it is appropriate or required to bring your CPAP with you to the hospital on the day of your surgery. Some surgery centers and hospitals prefer to use their own devices but they will need to know your prescribed pressure.
Following successful surgery and during your stay in the recovery room, it might be necessary to use CPAP, since your upper airway is still under the influence of sedating drugs and may be acting like you are asleep. During this transition from anesthesia to wakefulness, the use of CPAP can provide normal breathing until you are totally awake and alert.
Make sure someone on the healthcare team, or even a family member is given this specific responsibility to insure the use of CPAP in the recovery room, such that a smooth transition to wakefulness will occur.
During surgery, a variety of medications can be given to relax the patient and enable the surgery to go smoothly. Generally these medications can and do relax the throat and upper airway, which then resembles the effects encountered during a very deep sleep (REM stage). In addition, some surgical procedures that require the patient to be flat on their back, typically aren't positions that untreated patients with sleep apnea favor or breathe better in, during sleep.
Local anesthesia, by itself, will generally not affect an apnea patient's breathing. However, if a sleep apnea patient does receive a relaxant medication prior to or during the local anesthesia, then there could be an increased risk of abnormal breathing that would benefit by the use of CPAP.
General anesthesia always requires an increased vigilance in any patient with sleep apnea. The induction of sleep apnea patients with anesthesia can require a rapid intubation to maintain the upper airway during the initiation of any surgery.
So, if you are contemplating any procedures or surgeries, it’s your responsibility to inform your entire healthcare team. Don’t forget the dentist!
Tracy R. Nasca
If you are contemplating any medical or dental procedures or surgery in the future, the following information is provided to assist you.
While sleep apnea has become a recognized medical condition within the medical community, one shouldn't assume that all healthcare professionals are aware of sleep apnea. It is the responsibility of any patient with a sleep disorder to make it known to their doctor, nurse, therapist, dentist and anyone involved in their medical care.
The preoperative conference with a member of the anesthesia department is an important time to get to know your anesthesiologist and to exchange the necessary information that will make the up and coming surgery a complete success. Always indicate to this member of the surgical team that you have sleep apnea and are using a CPAP device. Inform them of your prescribed device pressure. Ask the surgeon and anesthesiologist if it is appropriate or required to bring your CPAP with you to the hospital on the day of your surgery. Some surgery centers and hospitals prefer to use their own devices but they will need to know your prescribed pressure.
Following successful surgery and during your stay in the recovery room, it might be necessary to use CPAP, since your upper airway is still under the influence of sedating drugs and may be acting like you are asleep. During this transition from anesthesia to wakefulness, the use of CPAP can provide normal breathing until you are totally awake and alert.
Make sure someone on the healthcare team, or even a family member is given this specific responsibility to insure the use of CPAP in the recovery room, such that a smooth transition to wakefulness will occur.
During surgery, a variety of medications can be given to relax the patient and enable the surgery to go smoothly. Generally these medications can and do relax the throat and upper airway, which then resembles the effects encountered during a very deep sleep (REM stage). In addition, some surgical procedures that require the patient to be flat on their back, typically aren't positions that untreated patients with sleep apnea favor or breathe better in, during sleep.
Local anesthesia, by itself, will generally not affect an apnea patient's breathing. However, if a sleep apnea patient does receive a relaxant medication prior to or during the local anesthesia, then there could be an increased risk of abnormal breathing that would benefit by the use of CPAP.
General anesthesia always requires an increased vigilance in any patient with sleep apnea. The induction of sleep apnea patients with anesthesia can require a rapid intubation to maintain the upper airway during the initiation of any surgery.
So, if you are contemplating any procedures or surgeries, it’s your responsibility to inform your entire healthcare team. Don’t forget the dentist!
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US Travel Tips for CPAP Users
Whether you are traveling for business or pleasure, it is important that you sleep well while away from the comfort and routine of your own bedroom. To assure the best chance of achieving restorative sleep, the following tips for traveling with CPAP are suggested. |
US Travel Tips for CPAP Users
Tracy R. Nasca
Whether you are traveling for business or pleasure, it is important that you sleep well while away from the comfort and routine of your own bedroom. To assure the best chance of achieving restorative sleep, the following tips for traveling with CPAP are suggested.
Documents
Ask your doctor to provide you with a prescription for CPAP, heated humidifier, mask, filters and tubing. Keep the RX in your wallet or CPAP carrying case in the event you find yourself outside of your insurance network and need to buy any equipment that might be damaged or stolen while you are away from home.
Ask your doctor to provide a letter of medical necessity on his/her letterhead. This is especially important should you require use of your CPAP machine while traveling in flight or on a train or other transportation mode. The letter should read something like:
Letter of Medical Necessity
Patient Name
Date Physician
Diagnosis
My patient has been diagnosed with obstructive sleep apnea and requires CPAP therapy with heated humidification to permit adequate compliance to their necessary therapy.
Doctor’s name Address Telephone
Doctor’s Signature
What to pack
Whether your final sleeping destination is a hotel, condo or private home, always carry a 12 foot extension cord in your CPAP carrying case. Available electrical outlets at bedside may be used by other items you need such as lamps and clocks. Additional outlets may be too far removed as to accommodate the electrical cord of your CPAP machine.
Getting through security check points
Rules change every now and again, but for the most part, CPAP is well known in the travel industry. With air travel, generally speaking, you will be asked to place your CPAP and humidifier with their electric cords in the plastic tub. While some airlines may send them through x-ray, most will pull them aside for a quick inspection that only takes a minute. Place the devices in the tub. When it gets close to the point where it goes through x-ray, simply alert security that you have a CPAP. They appreciate the heads up and it makes the process go quicker.
Keep your tubing and mask in your carrying on case. These are not inspected and you want to keep them clean, sanitary and safe from handling by others.
Hotel challenges
When the nightstand in a hotel is full with phone, lamp and clock, there is often no room to place your CPAP machine. This might be resolved by pulling out the top drawer of the night stand and placing CPAP there. If this is not an option, most hotels, upon request, can provide you with a portable stand with round tray top such as used in the delivery of food service.
If you need an extension cord, one can be provided by the hotel upon request.
Water for heated humidifiers
If you have the luxury of taking your own bottle of distilled water, do so. If you are packing light, you can buy water at your destination. Although distilled water is preferred for longevity of your equipment, using tap water for short periods of time will not be harmful to you or your water chamber.
Using CPAP on the plane, bus, train or boat
Each transportation mode and company has their own rules and regulations. Well before travel date, contact your travel carrier and ask what their requirements are. You may need a letter of medical necessity from your doctor. They may or may not be able to provide an electrical outlet so you may need to bring your own battery operated unit. Should they have electric outlets available, these seats may be in limited supply and need booking well in advance.
Comfort away from home
You want to be well rested and alert to fully enjoy your business trip or vacation. Leaving CPAP at home deprives you of this opportunity and puts your health at risk. Sleeping in strange surroundings may be challenging. You never know what kind of sleeping accommodations you will find at your destination. The bed you sleep in may be more or less comfortable than you own bed. Pillows offered at hotels are often oversized, thick and lofty but not the best choice for CPAP users. You may want to consider taking your own bed pillow, that final piece that assures the best possible quality restorative sleep. There are many CPAP bed pillows on the market that fit easily in a suitcase or CPAP carry case. If you are a stomach sleeper and require little elevation, hotel pillows may be soft and lofty which can block exhalation ports putting us at risk for rebreathing CO2.
Safe and happy travels to you. CPAP, don’t leave home without it!
Tracy R. Nasca
Whether you are traveling for business or pleasure, it is important that you sleep well while away from the comfort and routine of your own bedroom. To assure the best chance of achieving restorative sleep, the following tips for traveling with CPAP are suggested.
Documents
Ask your doctor to provide you with a prescription for CPAP, heated humidifier, mask, filters and tubing. Keep the RX in your wallet or CPAP carrying case in the event you find yourself outside of your insurance network and need to buy any equipment that might be damaged or stolen while you are away from home.
Ask your doctor to provide a letter of medical necessity on his/her letterhead. This is especially important should you require use of your CPAP machine while traveling in flight or on a train or other transportation mode. The letter should read something like:
Letter of Medical Necessity
Patient Name
Date Physician
Diagnosis
My patient has been diagnosed with obstructive sleep apnea and requires CPAP therapy with heated humidification to permit adequate compliance to their necessary therapy.
Doctor’s name Address Telephone
Doctor’s Signature
What to pack
Whether your final sleeping destination is a hotel, condo or private home, always carry a 12 foot extension cord in your CPAP carrying case. Available electrical outlets at bedside may be used by other items you need such as lamps and clocks. Additional outlets may be too far removed as to accommodate the electrical cord of your CPAP machine.
Getting through security check points
Rules change every now and again, but for the most part, CPAP is well known in the travel industry. With air travel, generally speaking, you will be asked to place your CPAP and humidifier with their electric cords in the plastic tub. While some airlines may send them through x-ray, most will pull them aside for a quick inspection that only takes a minute. Place the devices in the tub. When it gets close to the point where it goes through x-ray, simply alert security that you have a CPAP. They appreciate the heads up and it makes the process go quicker.
Keep your tubing and mask in your carrying on case. These are not inspected and you want to keep them clean, sanitary and safe from handling by others.
Hotel challenges
When the nightstand in a hotel is full with phone, lamp and clock, there is often no room to place your CPAP machine. This might be resolved by pulling out the top drawer of the night stand and placing CPAP there. If this is not an option, most hotels, upon request, can provide you with a portable stand with round tray top such as used in the delivery of food service.
If you need an extension cord, one can be provided by the hotel upon request.
Water for heated humidifiers
If you have the luxury of taking your own bottle of distilled water, do so. If you are packing light, you can buy water at your destination. Although distilled water is preferred for longevity of your equipment, using tap water for short periods of time will not be harmful to you or your water chamber.
Using CPAP on the plane, bus, train or boat
Each transportation mode and company has their own rules and regulations. Well before travel date, contact your travel carrier and ask what their requirements are. You may need a letter of medical necessity from your doctor. They may or may not be able to provide an electrical outlet so you may need to bring your own battery operated unit. Should they have electric outlets available, these seats may be in limited supply and need booking well in advance.
Comfort away from home
You want to be well rested and alert to fully enjoy your business trip or vacation. Leaving CPAP at home deprives you of this opportunity and puts your health at risk. Sleeping in strange surroundings may be challenging. You never know what kind of sleeping accommodations you will find at your destination. The bed you sleep in may be more or less comfortable than you own bed. Pillows offered at hotels are often oversized, thick and lofty but not the best choice for CPAP users. You may want to consider taking your own bed pillow, that final piece that assures the best possible quality restorative sleep. There are many CPAP bed pillows on the market that fit easily in a suitcase or CPAP carry case. If you are a stomach sleeper and require little elevation, hotel pillows may be soft and lofty which can block exhalation ports putting us at risk for rebreathing CO2.
Safe and happy travels to you. CPAP, don’t leave home without it!
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OSA Treatment OptionsPositive Airway Pressure Devices
Positive airway pressure machines, used with a variety of breathing masks, are the most widely used treatment for moderate and severe sleep apnea. They have been endorsed by the American Academy of Sleep Medicine. The mask, worn snugly over the nose, or sometimes nose and mouth, during sleep, supplies pressurized air that flows continuously or intermittently into the sleeper's throat. The increased air pressure prevents the sleeper's airway from collapsing. |
The pressurized air is supplied through a flexible tube from one of several types of machines: CPAP (continuous positive airway pressure), BiPAP (bilevel positive airway pressure), VPAP (variable positive airway pressure), and so on. Studies of the effect of PAP therapy show that OSA patients who consistently use their machines feel better and, as a result of the reduction of apnea and hypopnea episodes during sleep, encounter fewer complications of the disease. There's more information about PAP therapy here.
A variant on the PAP device is Provent. Operating on the same principal of keeping the lungs full and the upper airway open, this therapy does not require electricity to operate or the use of a humidifier.
Although PAP devices are not used to treat snoring alone, they do eliminate snoring in addition to treating obstructive sleep apnea.
Oral Appliances
Oral appliances for the treatment of sleep apnea continue to increase in popularity as awareness grows amongst the public that oral appliances are an effective first line treatment for many sleep apnea sufferers. Over 100 different oral appliances are FDA approved for the treatment of snoring and obstructive sleep apnea (OSA). These appliances are worn in the mouth, just like a sports mouth guard or an orthodontic appliance, while you sleep. Oral appliances hold the lower jaw forward just enough to keep the airway open and prevent the tongue and muscles in the upper airway from collapsing and blocking the airway.
The American Academy of Sleep Medicine (AASM) has approved Oral Appliance Therapy (OAT) as a first line treatment for patients diagnosed with mild to moderate OSA. The AASM also recommends oral appliances for patients with severe OSA, who are unable to tolerate or cannot wear Continuous Positive Airway Pressure (CPAP) devices. Another option for people with severe OSA is Combination Therapy (wearing CPAP and an oral appliance together) to help reduce the pressure on a CPAP machine, making it more comfortable to use.
Custom Made Oral Appliance vs. Boil and Bites
Although there are a few over-the-counter appliances you can purchase at drug stores or even online, remember that these oral appliances are not FDA approved for sleep apnea. When not fitted properly over-the-counter appliances can cause unwanted side effects, such as jaw problems or tooth movement or can even have the opposite effect and inadvertently worsen sleep apnea.
If you snore or believe you have sleep apnea, contact your Primary Care Physician (PCP) to help schedule a sleep study to determine if you do have OSA. If it’s determined that an oral appliance is an option for you, it should be fitted by a dentist specially trained in Dental Sleep Medicine.
Finding a Dentist
The organization Snoring Isn’t Sexy® has a network of dentists trained in sleep apnea who can assist you with treatment. Trained dental professionals will conduct a full evaluation of your teeth, mouth, and temporomandibular joint (TMJ) to ensure that your teeth and jaw structure are healthy enough to wear an oral appliance. Following the examination, you will have models of your teeth made and a follow-up appointment is scheduled to fit your custom oral appliance.
Adjusting to Oral Appliance Therapy
Since custom made oral appliances are adjustable, your dentist will work with you to maintain your jaw position by continuously monitoring your progress. It is important to maintain a prescribed follow-up schedule with your dentist to ensure the device is working, fitting properly and that you see an improvement in your symptoms. It usually takes only a few days to adjust to wearing the oral appliance all night while sleeping. Your dentist will review the details with you as well as the best way to maintain your oral appliance at home.
Types of Oral Appliances
Below are just a few examples of custom made oral appliances (also known as mandibular advancement devices or MADs) that are available. You can see a detailed oral appliance list here at Snoring Isn’t Sexy®.
Sleep Review’s oral appliance comparison guide (up to date as of August 2015) compares 21 oral appliances side-by-side. It compares features such as fitting description, adjustment description, materials, and recommended cleaning for the different devices. Click the image to view the full 4-page comparison guide.
A variant on the PAP device is Provent. Operating on the same principal of keeping the lungs full and the upper airway open, this therapy does not require electricity to operate or the use of a humidifier.
Although PAP devices are not used to treat snoring alone, they do eliminate snoring in addition to treating obstructive sleep apnea.
Oral Appliances
Oral appliances for the treatment of sleep apnea continue to increase in popularity as awareness grows amongst the public that oral appliances are an effective first line treatment for many sleep apnea sufferers. Over 100 different oral appliances are FDA approved for the treatment of snoring and obstructive sleep apnea (OSA). These appliances are worn in the mouth, just like a sports mouth guard or an orthodontic appliance, while you sleep. Oral appliances hold the lower jaw forward just enough to keep the airway open and prevent the tongue and muscles in the upper airway from collapsing and blocking the airway.
The American Academy of Sleep Medicine (AASM) has approved Oral Appliance Therapy (OAT) as a first line treatment for patients diagnosed with mild to moderate OSA. The AASM also recommends oral appliances for patients with severe OSA, who are unable to tolerate or cannot wear Continuous Positive Airway Pressure (CPAP) devices. Another option for people with severe OSA is Combination Therapy (wearing CPAP and an oral appliance together) to help reduce the pressure on a CPAP machine, making it more comfortable to use.
Custom Made Oral Appliance vs. Boil and Bites
Although there are a few over-the-counter appliances you can purchase at drug stores or even online, remember that these oral appliances are not FDA approved for sleep apnea. When not fitted properly over-the-counter appliances can cause unwanted side effects, such as jaw problems or tooth movement or can even have the opposite effect and inadvertently worsen sleep apnea.
If you snore or believe you have sleep apnea, contact your Primary Care Physician (PCP) to help schedule a sleep study to determine if you do have OSA. If it’s determined that an oral appliance is an option for you, it should be fitted by a dentist specially trained in Dental Sleep Medicine.
Finding a Dentist
The organization Snoring Isn’t Sexy® has a network of dentists trained in sleep apnea who can assist you with treatment. Trained dental professionals will conduct a full evaluation of your teeth, mouth, and temporomandibular joint (TMJ) to ensure that your teeth and jaw structure are healthy enough to wear an oral appliance. Following the examination, you will have models of your teeth made and a follow-up appointment is scheduled to fit your custom oral appliance.
Adjusting to Oral Appliance Therapy
Since custom made oral appliances are adjustable, your dentist will work with you to maintain your jaw position by continuously monitoring your progress. It is important to maintain a prescribed follow-up schedule with your dentist to ensure the device is working, fitting properly and that you see an improvement in your symptoms. It usually takes only a few days to adjust to wearing the oral appliance all night while sleeping. Your dentist will review the details with you as well as the best way to maintain your oral appliance at home.
Types of Oral Appliances
Below are just a few examples of custom made oral appliances (also known as mandibular advancement devices or MADs) that are available. You can see a detailed oral appliance list here at Snoring Isn’t Sexy®.
Sleep Review’s oral appliance comparison guide (up to date as of August 2015) compares 21 oral appliances side-by-side. It compares features such as fitting description, adjustment description, materials, and recommended cleaning for the different devices. Click the image to view the full 4-page comparison guide.
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TAP
The Thornton Adjustable Positioner, or TAP, is a patented mandibular advancement device specifically engineered for keeping the airway open during sleep. The protrusive mechanism is a single midline tension device that is easily adjusted by the patient while in the mouth. With its ease of adjustability, unlimited protrusive range of motion, gradual titration, and patient involvement in their therapy, the TAP has shown in numerous independent peer-reviewed studies to be superior and more effective than any other appliance on the market. In fact, it’s the only device proven to be equivalent to CPAP. |
myTAP PAP Nasal Pillow Mask
myTAP PAP is a big leap forward in CPAP mask technology. By combining the upper tray technology of the myTAP and a traditional CPAP mask, myTAP PAP alleviates the common problems that too often lead to discontinuance of therapy. myTAP PAP’s upper tray anchors the mask in place. This stability means less movement, no leaks and no headgear required since it stays firmly in place without straps (although headgear is available for those patients who prefer it). myTAP PAP also has the lowest pressure drop among nasal pillows and is one of the quietest on the market. Learn More
Narval
Narval, by ResMed, is recognized by many as the most discrete and comfortable mandibular advancement device due to its precise, custom-fit. By decreasing bulk through the use of lighter materials and maintaining a more natural jaw position, Narval provides plenty of space for the tongue and enables freedom of vertical movement to maximize clinical effectiveness, patient comfort and compliance.
SomnoDent Fusion
The new Fusion offers patient specific calibration using 3 removable wings for 1mm of protrusion on the bottom, and fine calibration in .1mm increments with lugs on the top, allowing for a longer range of advancement (8.5mm). With device wings that are closer to the occlusal surface, patients experience more room in their mouths and less bulk.
OASYS
The OASYS Oral/Nasal Airway System is the first dental device to be reviewed by both the dental and ENT divisions of the FDA. It is approved for the treatment of OSA but it also has a nasal dilator for reduction of nasal resistance and improved nasal breathing.
TRD
The Tongue Retaining Device (TRD) does not depend on teeth for retention. Rather, the tongue is held forward by the negative pressure created in the vacuum bulb on the front of the appliance.
myTAP PAP is a big leap forward in CPAP mask technology. By combining the upper tray technology of the myTAP and a traditional CPAP mask, myTAP PAP alleviates the common problems that too often lead to discontinuance of therapy. myTAP PAP’s upper tray anchors the mask in place. This stability means less movement, no leaks and no headgear required since it stays firmly in place without straps (although headgear is available for those patients who prefer it). myTAP PAP also has the lowest pressure drop among nasal pillows and is one of the quietest on the market. Learn More
Narval
Narval, by ResMed, is recognized by many as the most discrete and comfortable mandibular advancement device due to its precise, custom-fit. By decreasing bulk through the use of lighter materials and maintaining a more natural jaw position, Narval provides plenty of space for the tongue and enables freedom of vertical movement to maximize clinical effectiveness, patient comfort and compliance.
SomnoDent Fusion
The new Fusion offers patient specific calibration using 3 removable wings for 1mm of protrusion on the bottom, and fine calibration in .1mm increments with lugs on the top, allowing for a longer range of advancement (8.5mm). With device wings that are closer to the occlusal surface, patients experience more room in their mouths and less bulk.
OASYS
The OASYS Oral/Nasal Airway System is the first dental device to be reviewed by both the dental and ENT divisions of the FDA. It is approved for the treatment of OSA but it also has a nasal dilator for reduction of nasal resistance and improved nasal breathing.
TRD
The Tongue Retaining Device (TRD) does not depend on teeth for retention. Rather, the tongue is held forward by the negative pressure created in the vacuum bulb on the front of the appliance.
Medical Insurance for Oral Appliance Therapy
Although a dentist will be placing your custom oral appliance, the great news is that oral appliances are generally covered under your health insurance plan, not your dental plan. Prior to treatment, you or your dentist may want to contact your health insurance, directly, for an estimate of insurance coverage. Due to variations in medical insurance plans, coverages do vary.
Medicare provides reimbursement for oral appliances for those 65 or older under the Durable Medical Equipment (DME) benefit. In order to help Medicare patients with a portion of the reimbursement for oral appliances, many dentists around the country have enrolled as Medicare DME Suppliers for oral appliance therapy for obstructive sleep apnea.
Upper Airway Stimulation Devices
Inspire Upper Airway Stimulation (UAS) Therapy
Some people with Obstructive Sleep Apnea, or OSA, are unable to use Continuous Positive Airway Pressure (CPAP) therapy, the most commonly prescribed OSA treatment, despite best efforts. Now there’s a new, clinically proven therapy for some people with moderate to severe OSA who are unable to use CPAP. Inspire therapy was introduced in 2014.
Inspire is a revolutionary therapy that works inside your body, and with your natural breathing process, to treat moderate to severe sleep apnea. Inspire therapy might be right for you if:
Although a dentist will be placing your custom oral appliance, the great news is that oral appliances are generally covered under your health insurance plan, not your dental plan. Prior to treatment, you or your dentist may want to contact your health insurance, directly, for an estimate of insurance coverage. Due to variations in medical insurance plans, coverages do vary.
Medicare provides reimbursement for oral appliances for those 65 or older under the Durable Medical Equipment (DME) benefit. In order to help Medicare patients with a portion of the reimbursement for oral appliances, many dentists around the country have enrolled as Medicare DME Suppliers for oral appliance therapy for obstructive sleep apnea.
Upper Airway Stimulation Devices
Inspire Upper Airway Stimulation (UAS) Therapy
Some people with Obstructive Sleep Apnea, or OSA, are unable to use Continuous Positive Airway Pressure (CPAP) therapy, the most commonly prescribed OSA treatment, despite best efforts. Now there’s a new, clinically proven therapy for some people with moderate to severe OSA who are unable to use CPAP. Inspire therapy was introduced in 2014.
Inspire is a revolutionary therapy that works inside your body, and with your natural breathing process, to treat moderate to severe sleep apnea. Inspire therapy might be right for you if:
- You have been diagnosed with Obstructive Sleep Apnea (OSA)
- You can’t use or don’t get relief from CPAP
FOR HEALTH CARE PROFESSIONALS:
Inspire therapy is a small, fully implanted system that senses breathing patterns and delivers mild stimulation to maintain multilevel airway patency during sleep. The system consists of three implanted components including a small generator, breathing sensor lead, and stimulation lead, all controlled with the small handheld Inspire sleep remote.
Inspire therapy is indicated for patients with the following characteristics: 22 years of age or older, have moderate to severe OSA (AHI range from 20-65 with <25% central apneas), unable to use CPAP, and free of complete concentric collapse at the palate. Inspire therapy has not been tested in people with BMI greater than 32.
The Inspire stimulation lead is designed to gently conform to a variety of hypoglossal (XII) nerve types. Securing the stimulation lead to the optimal location on the XII nerve facilitates stable, consistent stimulation of targeted airway muscles.
Using a proprietary algorithm, Inspire therapy continuously monitors the patient’s breathing patterns and delivers mild stimulation during inspiration, which is when the airway is most vulnerable to collapse.
For most patients, the Inspire system can be implanted during an outpatient procedure. Patients may experience some pain and swelling at incision sites but should be able to return to nonstrenuous activities after a few days. Approximately one month after implantation, patients return to their physician’s office where personalized stimulation settings are established and patients are trained to use the handheld Inspire sleep remote.
Inspire therapy is a small, fully implanted system that senses breathing patterns and delivers mild stimulation to maintain multilevel airway patency during sleep. The system consists of three implanted components including a small generator, breathing sensor lead, and stimulation lead, all controlled with the small handheld Inspire sleep remote.
Inspire therapy is indicated for patients with the following characteristics: 22 years of age or older, have moderate to severe OSA (AHI range from 20-65 with <25% central apneas), unable to use CPAP, and free of complete concentric collapse at the palate. Inspire therapy has not been tested in people with BMI greater than 32.
The Inspire stimulation lead is designed to gently conform to a variety of hypoglossal (XII) nerve types. Securing the stimulation lead to the optimal location on the XII nerve facilitates stable, consistent stimulation of targeted airway muscles.
Using a proprietary algorithm, Inspire therapy continuously monitors the patient’s breathing patterns and delivers mild stimulation during inspiration, which is when the airway is most vulnerable to collapse.
For most patients, the Inspire system can be implanted during an outpatient procedure. Patients may experience some pain and swelling at incision sites but should be able to return to nonstrenuous activities after a few days. Approximately one month after implantation, patients return to their physician’s office where personalized stimulation settings are established and patients are trained to use the handheld Inspire sleep remote.
Weight Loss
About 70 percent of people with obstructive sleep apnea are overweight or obese. Their health care professionals usually encourage them to lose weight.
Surprisingly, there have been few formal studies of how effectively weight loss leads to lesser, lighter snoring and diminished incidents of apnea and hypopnea during sleep. Despite this, anecdotally practitioners report striking improvements in both OSA and snoring among patients who lose weight.
In some situations a physician may wish to prescribe weight loss medications to an overweight or obese patient with OSA.1
Nasal Decongestant
Nasal decongestants are more likely to be effective in cases of snoring or mild sleep apnea. In some cases, surgery is an effective way to improve airflow through the nose.
Positional Therapy
Some people snore or have sleep apnea only when sleeping on their back. Such people can eliminate or reduce airway blockage simply by learning to sleep on their side.
The traditional technique to induce side-sleeping is dropping a tennis ball in a sock and then pinning the sock to the back of the pajama top. There are also a couple of companies that make a products designed to discourage supine sleeping.
Positional therapy generally works only in mild cases of OSA. In more severe cases, the airway collapses no matter what position the patient assumes.
Surgery (Adults)
Surgery is often effective in treating snoring. It is less effective in treating obstructive sleep apnea.
The challenge that confronts the surgeon is determining what part of the upper airway is causing the obstruction to airflow. There are many possible sites, and conventional sleep testing does not identify the area the surgeon should modify. If the surgeon does not treat that site in the airway, or if there are multiple sites of obstruction, it is unlikely that the sleep apnea will diminish to a degree that eliminates the need for other treatment.
Given the several sites where airway obstruction may exist, there are several types of operations currently used to treat sleep apnea. The most common is uvulopalatopharyngoplasty, or UPPP. The success rate of this operation is about 50 percent. Some surgeons have achieved very high success rates using multiple, staged operations.2 Nonetheless, most authorities recommend routine re-assessment for sleep apnea after surgery.
Surgery (Children)
Most children with snoring or sleep apnea have enlarged tonsils, or adenoids, or both. In 75 percent of those cases, surgical removal of these tissues cures sleep breathing problems.
The American Academy of Pediatrics has endorsed removal of the tonsils and adenoids as the initial treatment of choice for sleep breathing problems in children.
Other
Abstinence from alcohol before bedtime is an important part of treating sleep apnea.
In one study, several persons who received cardiac pacemakers were reported to have shown an improvement in their sleep apnea. No major organizations have endorsed this type of treatment, however. Further studies are underway.
Alternative healing methods are also in use. There is some evidence that playing thedidgeridoo or other wind instruments may help in managing OSA. In Brazil, acupuncture researchers who are physicians report positive results in treating OSA with acupuncture.
Caution
Snoring, and certain details of snoring, can be a valuable early-warning alarm that sleep apnea is present. Treating snoring can remove this warning system. Just as seeing smoke is a warning that a fire may be burning, hearing snoring is a warning that sleep apnea may be present. And just as smokeless fires may be discovered late, with unfortunate consequences, so too may snore-free sleep apnea. Thus, when surgery or oral appliances are used to treat snoring, it is important to check for sleep apnea on a regular basis afterwards.
Anesthesia and Pain Medicine
The presence of sleep apnea presents special challenges to the administration of anesthesia and pain medications that may affect respiration or relax muscles. Since most people who have sleep apnea don't know it, the anesthesiologist or pain clinician is well advised to screen the patient for OSA before proceeding. Should it be determined there is a likelihood that OSA is present, the next move is to order a sleep study to make sure or, at a minimum, to take the precautionary steps that should be taken with a patient whose sleep apnea has been diagnosed.
This summary of obstructive sleep apnea treatments is adapted from an article written by John Sotos, M.D
About 70 percent of people with obstructive sleep apnea are overweight or obese. Their health care professionals usually encourage them to lose weight.
Surprisingly, there have been few formal studies of how effectively weight loss leads to lesser, lighter snoring and diminished incidents of apnea and hypopnea during sleep. Despite this, anecdotally practitioners report striking improvements in both OSA and snoring among patients who lose weight.
In some situations a physician may wish to prescribe weight loss medications to an overweight or obese patient with OSA.1
Nasal Decongestant
Nasal decongestants are more likely to be effective in cases of snoring or mild sleep apnea. In some cases, surgery is an effective way to improve airflow through the nose.
Positional Therapy
Some people snore or have sleep apnea only when sleeping on their back. Such people can eliminate or reduce airway blockage simply by learning to sleep on their side.
The traditional technique to induce side-sleeping is dropping a tennis ball in a sock and then pinning the sock to the back of the pajama top. There are also a couple of companies that make a products designed to discourage supine sleeping.
Positional therapy generally works only in mild cases of OSA. In more severe cases, the airway collapses no matter what position the patient assumes.
Surgery (Adults)
Surgery is often effective in treating snoring. It is less effective in treating obstructive sleep apnea.
The challenge that confronts the surgeon is determining what part of the upper airway is causing the obstruction to airflow. There are many possible sites, and conventional sleep testing does not identify the area the surgeon should modify. If the surgeon does not treat that site in the airway, or if there are multiple sites of obstruction, it is unlikely that the sleep apnea will diminish to a degree that eliminates the need for other treatment.
Given the several sites where airway obstruction may exist, there are several types of operations currently used to treat sleep apnea. The most common is uvulopalatopharyngoplasty, or UPPP. The success rate of this operation is about 50 percent. Some surgeons have achieved very high success rates using multiple, staged operations.2 Nonetheless, most authorities recommend routine re-assessment for sleep apnea after surgery.
Surgery (Children)
Most children with snoring or sleep apnea have enlarged tonsils, or adenoids, or both. In 75 percent of those cases, surgical removal of these tissues cures sleep breathing problems.
The American Academy of Pediatrics has endorsed removal of the tonsils and adenoids as the initial treatment of choice for sleep breathing problems in children.
Other
Abstinence from alcohol before bedtime is an important part of treating sleep apnea.
In one study, several persons who received cardiac pacemakers were reported to have shown an improvement in their sleep apnea. No major organizations have endorsed this type of treatment, however. Further studies are underway.
Alternative healing methods are also in use. There is some evidence that playing thedidgeridoo or other wind instruments may help in managing OSA. In Brazil, acupuncture researchers who are physicians report positive results in treating OSA with acupuncture.
Caution
Snoring, and certain details of snoring, can be a valuable early-warning alarm that sleep apnea is present. Treating snoring can remove this warning system. Just as seeing smoke is a warning that a fire may be burning, hearing snoring is a warning that sleep apnea may be present. And just as smokeless fires may be discovered late, with unfortunate consequences, so too may snore-free sleep apnea. Thus, when surgery or oral appliances are used to treat snoring, it is important to check for sleep apnea on a regular basis afterwards.
Anesthesia and Pain Medicine
The presence of sleep apnea presents special challenges to the administration of anesthesia and pain medications that may affect respiration or relax muscles. Since most people who have sleep apnea don't know it, the anesthesiologist or pain clinician is well advised to screen the patient for OSA before proceeding. Should it be determined there is a likelihood that OSA is present, the next move is to order a sleep study to make sure or, at a minimum, to take the precautionary steps that should be taken with a patient whose sleep apnea has been diagnosed.
This summary of obstructive sleep apnea treatments is adapted from an article written by John Sotos, M.D