It is always a challenge when we have met a person for the first time and we ask a few questions and than we have to help them choose a mask that will work for him or her. This is a very interactive experience that can take a short period of time, or what usually happens is that it takes quite a bit of time making the decision. There are basically five ways to make this experience easier and more successful

  1. You need to come in with your mind open. Many people go into the experience thinking they know what want in a mask. This may be because a friend has a CPAP and is successful with a mask they chose and so you figure it will work for you. It could also be because you went researching on the internet and thought the newest mask on their looked like something you want. The truth is that there are so many masks on the market because there are that many different needs for different people.

  2. Claustrophobia does not mean that a smaller mask is a better mask. The fact is that nasal pillows and can sometimes feel stronger and make you feel more claustrophobic. A mask that allows you to breathe through your mouth may be more comfortable. There are masks on the market that do not block your line of vision and will make you feel more comfortable.

  3. If you take steroids or blood thinners your skin will react differently to masks. Your skin will be more fragile. The person working with you needs to be aware of this so they can choose a mask that puts less pressure on the bridge of your nose. There are extra cushions if needed but the ideal is to find the right mask that does not put pressure on your face.

  4. Do not be afraid to ask to try a different mask. You will be using this mask for a long period of time and you have the right to try as many masks as you want. You are not annoying the technologist. We would rather have someone tell us that there is a problem with the mask during the night than to find it out after the test when they cannot do anything about it.

  5. If you think you will need time to get used to the mask and the therapy see if you can come in before the night of your study. In many labs they will have you come in for a PAP NAP during the day. They will allow you to trial masks and get used to the pressure during the day. It is a great opportunity to take your time and not feel the pressure of having to go to sleep on the machine right away.

CPAP therapy can help you to improve your health and allow you to feel more energetic. Being successful using the therapy requires that you find just the right mask whether it is a full face mask, nasal mask or nasal pillows. The goal is for you to find a mask that will allow you to sleep comfortably and breathe easily.

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More people are being diagnosed with obstructive sleep apnea every day.  With this increase it is important to develop new ways of treating this disorder.  PAP, positive airway pressure, devices are considered the gold standard of treating sleep apnea.  The problem is that there are patients who are unable to tolerate this therapy.  One of the options for people who are unable to tolerate PAP is an oral appliance or dental device. 

These devices work best for those who have mild to moderate sleep apnea.  Mild sleep apnea is defined as 5-15 respiratory events per hour.  Moderate sleep apnea is defined as 15-30 respiratory events an hour.  Anyone who has more than 30 respiratory events per hour is considered to have severe sleep apnea and although they can use an oral appliance it is not as successful in treating this disorder.

There are two different types of oral appliances, mandibular advancement devices and tongue retention devices.  The MRA devices work by advancing the mandible or lower jaw forward 6-11mm to help open the back of the airway.  TRA devices work by pulling the tongue forward and that helps to keep the airway open. 

MRA devices are generally fitted and adjusted by a dentist.  Ideally you should go to a dentist that specializes in sleep dentistry.  You can get a list of registered dentists at http://www.aadsm.org/FindaDentist.aspx.  These dentists are board certified in this specialty and have the ability to fit you with the correct device and to do any follow up testing you may need.  The dentist will take an impression of your teeth and create an oral appliance that will fit you and cause the least amount of side effects while opening your airway sufficiently to correct your sleep apnea. 

The TRA devices are also fitted by a dentist however there are several styles that are available to buy directly and to then self-fit by the boil and bite method.  These particular devices work best for patients who have an oversized tongue. 

Some of the side effects of these devices are drooling, your teeth shifting, tooth pain and sometimes jaw pain.  According to current research it does not appear that the devices contribute to TMJ.

Patient with severe sleep apnea may consider using an oral appliance in conjunction with the CPAP because you might be able to decrease the pressure of the PAP device. 

The ability to have a choice of therapy for obstructive sleep apnea is a great advance for people.  Not everyone can tolerate CPAP or BIPAP but they still need to have some treatment for their sleep disorder. 

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The new Respironics TrueBlue mask

One of the biggest issues people have with CPAP is that if they sleep in any position other than on their back the mask slips, slides, leaks or honks.  The goal is for you to be able to use your CPAP every night and for you to get a restful night sleep.   The solution comes in several little changes and maybe one big change.
  •        Make sure you are not over tightening or under tightening your mask.  The newer masks are designed to be put on with the machine on so that the mask makes an air cushion against your face.  This will allow the mask to shift slightly when you move,
  •      Look at your pillow.  Sometimes it pays to invest in a good pillow.  There are several companies online who sell pillows designed specifically for use with your mask.  Contourliving.com has two pillows that are designed with cutouts indentations your mask will fit into when you roll over.  It also gives you support on your neck and head.  These are latex foam.  Papillow.com has created a more traditional pillow that is shaped so the neck support is wider than the rest of the pillow so the mask fits and does not shift.  They also offer a travel size pillow.
  •      A hose support might help.  Sometimes it is not the mask that causes the mask to shift.  Depending where you have your machine you might consider using something to support the hose so it does not move around quite so much.
  •    Get a leak cushion. There are several brands of gel cushions that fit over your nose and help to make a better seal.  If you have a narrow bridge to your nose this may help.  It also may help if you tend to wake up with a sore bridge to your nose. 
  •    Change your mask.  If all else fails you may not have the best mask for you.  Respironics has an interesting new mask called the True Blue nasal mask.  It is a unique design that will adjust without shifting on the face.  The Resmed Mirage FX and Swift FX have low profiles and because of the soft texture that allows it to adjust to your movements.
No matter what the most important thing you need to do is find a way to make your PAP therapy work for you.  The doctor who ordered the machine and the technicians who tested you and set up the machine are your best resources; you just have to ask the questions.
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Everyone has questions and issues as they learn about their new bedtime friend, their CPAP machine.  This first week will really set the tone for your success with your machine.  During this time it is essential for you’re to ask questions and get the help you may need so that you sleep better at night. 

These 5 steps will help you have a great first week on your CPAP and will help you move on to a successful future of restful sleep

1.       Learn what the results of your sleep study were.   You really need to understand why you need the CPAP.  Learn what your test says.  What was your Apnea/Hypopnea index, the number of times you stopped breathing and breathed so shallow your oxygen levels dropped?  Knowing how bad your sleep apnea is will allow you to understand that this machine will help you to feel better and live healthier,   Did you have other issues such a limb movements and teeth grinding, also known as Bruxism?  If you have other issues your doctor may not want to deal with them until after he has dealt with the sleep apnea.  Know that these conditions may still cause you to wake up during the night and might have to be pursued at a later time.  What pressure did they use to correct the breathing issues and what pressure did all snoring go away?  If you understand why the pressure was set at a certain level you might better understand why the machine feels the way it does.

2.       If you are having a mask problem, deal with it as soon as possible.  Most insurance companies will replace a mask during the first 30 days.  If you do not give the company enough notice you may run out of time and have to pay for a new mask.  This is especially true if you develop a pressure mark of any type.  These usually occur on the bridge of the nose.  They mean one of two things, either you have the headgear too tight or that your skin cannot tolerate the pressure of the mask.  There are many masks on the market so if the first one gives you problems there is likely a second style of mask that will work better for you. 

3.       If you cannot sleep with the machine the first night, do not fret.  Many people have this problem.  The sensation of CPAP blowing air in your nose and mouth may take a little getting used to.  Try using it while sitting in the living room watching television.  This will give your mind something to concentrate on, a comfortable place for you to learn to adjust to the air and will make it less threatening then lying in a dark room with nothing to do but stare at the ceiling.  Once you have done that for a few hours then bring it back to the bedroom and try using it at night again.  The second time you should feel more comfortable and be more successful falling asleep with your CPAP.

4.       Find the right humidity for you.  Humidification can help reduce stuffy nose, sinus issues and dry mouth but you have to find the balance between fixing drying problems and getting too much water in your mask and tubing during the night.  Just remember that a dry nose and mouth is much more uncomfortable then a little condensation on your nose.

5.       Talk to someone if you cannot solve a problem.  Three days after you get your new machine the company that set you up should call you to see how you are doing.  Do not hesitate to talk to them.  Tell them the truth.  They may have a solution to your problem.  If they do not have a solution, talk to your doctor.  Sometimes they are able to give you a prescription to help deal with an issue.  If you need to be reinstructed about something to do with the machine.  The company that set you up will be happy to come out and reinstruct you.  That is what they are paid for.  But they do not know what you need if you do not tell them.  Ask the question you never know what solutions will pop up. 

Once you have had your first week of sleep on your CPAP machine you will find that you will start to feel less tired during the day.  You might even find that some of your health issues that brought you to the sleep lab in the first place may be improving.  It might take a little work but in the end the time you spend learning to use your CPAP will be well worth it. 

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CPAP therapy is considered the gold standard for treating sleep apnea.  It is a machine that uses a mask of some type to deliver   a specific pressure of air to help keep the airway open.  The problem with CPAP therapy is that it does take getting used to in order to be successful in using it nightly.  There are some very specific reasons that people fail to be able to adjust to it and there a definitely ways to overcome these obstacles to be successful and feel better.

  1. There is a lack of communication.  Many patients are afraid they are disturbing someone if they call when they are having issues with their CPAP.  The truth is that if you want to be successful using your machine you need to communicate your issues with a professional.  Depending on who you are working with you should call your doctor, the company that set up the machine or the sleep lab who performed your study.  There can be many issues but if no one knows you are having problems then the problem can not be fixed.
  2. You have the wrong mask.  If you had a sleep study where they fit you with a mask you must remember that you were only there for a short time.  A mask might seem right during the study but may not fit as well at home.  You may also find that although the mask is good the first couple of night after wearing it for a week it may not be as comfortable.  In most cases insurance will pay for a change of mask during the first 2-4 weeks after your machine is delivered.  This may not be true for those who have an HMO where the insurance company may dictate which mask you are given.  In those cases it may benefit you to purchase a mask that might fit you better.  It may cost you but it will be worth it in the end.  Also those who have sensitive spots from the mask may benefit from having two masks to rotate through to change the pressure point.
  3. You do not use the humidifier.  Many patients think that the humidifier is an optional piece of equipment but it is not.  It is essential that you use the humidifier and that you set it to the appropriate setting.  In the winter you will need more humidification then during the summer due to the air being dryer.  If you do not get enough humidity you will find your mouth, nose and sinuses will get sore, swollen.  You may also find that you will develop a stuffy nose due to the welling of the nasal tissue and the increase of mucus being secreted to deal with it.
  4. The pressure is too high or too low.  The goal of the sleep lab is to find the lowest pressure needed to eliminate most of your respiratory events.  However, just because they achieved a final pressure does not mean that it is the best pressure for you.  Remember you are only in the sleep lab for one night and it is not the optimal sleep conditions.  You are wearing wires, sleeping in a strange bed and it is usually the first time you have ever tried on a CPAP mask.  The pressure achieved may be a little high or a little low.  It may be that you need a higher pressure then you can handle.  No matter what the issue there are certain procedures that must be followed before lowering the pressure.  You will probably be asked to try a different mask.  This is to see if the issue is not pressure but comfort.  You may then have to see the sleep specialist before he is willing to turn you pressure down.  This is because he is ultimately responsible for making sure your care is the best you can receive. 
  5. You did not give yourself enough time.   This is long term therapy.  That means you will be using this equipment for a long time.  So give yourself a little time to get used to it.  For the first few days if you feel uncomfortable wearing it at night.  Put it on while you are sitting in your recliner in the living room.  Wear it for about an hour.  Get used to it.  Then increase your time wearing it.  Usually be the end of the first one or two weeks you should be ready to sleep with it. 
CPAP therapy is an important part of keeping you healthy if you have sleep apnea.  Giving up before you give the therapy some time will do nothing to improve your health and in the long run can have very serious consequences.  Remember your doctor and the people who have worked with you want you to be successful.    

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If you wear a CPAP you might notice that this time of year you have more side effects.  The cold dry weather and the increased time indoors can cause many side effects such a drying of the mouth and nose, congestion, sinus infections, and illness.  It is important that if you are using your CPAP that you are comfortable all year  so you have to consider the time of the year and make the changes you need.

The first problem is the dry air that occurs during the winter.  This is true even if you have a humidifier in the house.  Your humidifier is the best defense for this.  Most humidifiers on CPAP machines have settings of 1 to 5 and are usually set to 1 or 2.  The reason for the low setting is due to water accumulating in the tubing and mask.  This problem can be reduced by making a sleeve for your tube.  A nice piece of flannel and some seam glue is all you need.  You want to turn it up high enough to make your airway comfortable.

One of the side effects of an overly dried airway is congestion.  This is one of the easiest ways to tell if you need to increase the humidifier setting.  If you are experiencing congestion you might also want to use a nasal saline spray before going to bed and then again when you wake up to help rehydrate your airway. 

The other issue that really causes problems during the winter is colds and flu.  Illnesses makes wearing your CPAP challenging.  This is where owning two masks can come in handy.  It helps to have a full face mask if you usually wear a nasal mask or nasal pillows.  It is essential that you keep your mask, tubing and humidifier clean.  Warm damp places are a great place for viruses and bacteria to grow.  The best way to keep your equipment clean is to wash it with soap and water and then you can disinfect it with one part white vinegar and 3 parts water.  Just soak them for 20 minutes then rinse very well so your equipment does not smell like salad dressing then allow your equipment to air dry. 

If you try some of these ideas and they do not help you then go back to your doctor, sleep lab or DME company and ask for some help.  Everyone wants you to succeed with your CPAP and they will be happy to help.

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With the increase in the ability to diagnose and treat obstructive sleep apnea a new group of issues have come into play for many people.  It is time to take the family vacation or on a business trip and you wonder do you have to bring this machine with you?  If you do what do you need to know to make traveling with it easier?   

The first question of whether or not you need to bring it with you is relatively easy to answer.  CPAP and BIPAP do not cure sleep apnea they treat it.  Just like medication, you should not stop using it without a doctor’s order.  As soon as you stop using it your symptoms will reappear.  Keep in mind that the fatigue which may have brought you to the sleep lab may not come back quickly because you are no as sleep deprived as you were before you were treated.  However, the issues of low oxygen levels and the fact that you stop breathing and your snoring will come back when you do not use your therapy.  If you are sharing a room, this can be quite troublesome for yourself or your room mates.   

When packing up your PAP machine there are a couple of things to keep in mind.  The first is that it is important that you empty the humidifier.  Many people forget this step and upon arriving at their destination they find a waterlogged machine.  If the humidifier is separate from the machine you should still take it with you.  Nasal congestion can be a problem when you travel and the humidifier will help to limit issues you might have with congestion and drying of the mouth and nose. 

 

When you are flying it is essential that your machine be a carry on.  The change in pressure in the baggage compartment is not healthy for your machine.  With most airlines, because it is medical equipment, it will not count as your one carry on luggage.  You should have no problem making it through security because they are quite familiar with CPAP machines.  Just take it out of the carry on case like you would a computer.  In some airlines if you are taking a long flight and you are traveling first class or business class there may be electrical plugs that you can plug your machine in and wear if you plan on sleeping.   

If you are traveling to a high altitude some of the older CPAP machines have an adjustment that you can set to deal with the change in pressure.  Other machines have internal sensors that will make this adjustment for you.   

Camping with your machine may be one of the most interesting issues that you may to deal with.  If the campground has electricity then this is not an issue.  If you are going to be somewhere a little more rural and you camp on a regular basis you might want to look at a machine that has a back up battery pack for it.   

It is always important to enjoy yourself when you are taking a vacation.  If you do not sleep well then you may miss out on the enjoyment of your trip.  With a small amount of planning using you CPAP will allow you and your family or friends to be well rested for the next day’s activities.
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You have been diagnosed wit sleep apnea for the most part you are dependent on your doctor, lab technicians, the equipment company and your insurance for which machine you will have the ability to get.  But if you know what machines are on the market and what they offer you can choose a machine that will help you while keeping your needs in mind

The first think you need to consider is cost.  What really is the issue is not so much the cost of the machine, because they all run about the same price, but what you are willing to pay for and what you are willing to accept if you have insurance.  Insurance companies have different ways of paying for durable medical equipment.  Some treat as a regular part of insurance.  So if you have a deductible of $500 and then they pay 80% for care once that deductible is reached then you know what your expense will be.  This is not all insurances.  You may have an insurance hat has a durable medical equipment rider.  In this case it will have its own deductible that you will have to meet and then it will pay a percentage after it is met.  The third type of program is an HMO program.  Usually they have a specific copay of $50-$100.  They also require the use of a specific durable medical equipment company and will limit what equipment can be used including machines, masks and if you get a home visit or if you receive the machine from a UPS box.    If you are paying cash then you will have the most say over what type of machine you will receive.  However if you have a big deductible and know it you might get a better deal paying cash and submitting the claim yourself then you would using your insurance.

Once you have determines what you are willing to spend and what your insurance will cover then next decision is to figure out what is the most important aspects of the machine for you.  If you travel a lot it might be the size of the machine.  If you like to camp it might be that you want a back up battery.  If you know you have a great deal of problems with nasal congestion in might be a machine with the best humidification system.   Whatever issues you face it is important to know them up front so when you are working with the therapist who is setting up you new machine they know what is important to you.

The other issue is something that many patients are not aware of but is vital to getting insurance to pay for the machine.  Many insurances including Medicare require documented compliance of the use of the equipment.  This is usually done one of three ways.  A person comes to your house reads the hours of use on the machine.  The second way is that the machine has a card that you either plug into your computer and download and send to the DME company or your physician.  The third, and newest way, is that your machine will have a modem that will allow the DME company and your physician to follow you use remotely.  The remote compliance also allows changes to your machine without someone having to come to your house.  

Now that you know about what factors are involved with choosing a machine let discuss what some of the machines on the market have to offer.  

As far as size on the average the newer machines weight between 2.5 and 3 pounds and are quite small.  They have built in humidification systems, although some are better then others.  The newest machines are also more aesthetically pleasing.  Resmed's new machine the S9 has a sleep look and resembles a book shape sitting on the night stand.  Most of the other machines are either shaped as a cube or shaped like and alarm clock.  They all have a hose and a mask to attach the machine to the patient. If however you plan to travel the Everest has the ability for you to purchase a rechargable battery that fits over the bottom of the machine.  This allows for a stacked cube shape that is still faily light weight.

The cost can be a big consideration for a person especially if they have a high deductible or no insurance.  Some of the basic machines like the Everest, the Tango and some of the older models do not have as many of the newer comfort measures but they do allow for good basic therapy at an affordable price.  For those with no insurance and limited income many of the DME companies work with the manufacturers to get discounts of no cost machines based on income. 

If you have trouble with drying during the night then one of the machines with a heated wire tubing system such as the Resmed S9 or the Fisher Paykel machines will pprobably be your best choice.  Fisher Paykel is the leader in this technology having initially created it to help with ventilation of neonatal patients who were being ventilated. 

If you wish  for the newest, quietest machines with the most comfortable software so that the machines allows the pressure to work with you both the Respironics  PR series and the Resmed S series of machines have been upgrades to be the quietest on the market.  They have also created software for their machines that will work to make these machines more like natural breathing then breathing on a machine.  Both of these machines also have th eability to have a modem added for closer following of compliance and for changing of pressures without having to go visit the patient's house. 

When choosing a CPAP machine you should always listen to you physician but with a little education you might be able to avoid some of the problems that many new patients have.  Decide for yourself what issues are most important to be met and then discuss your options with a professional.  Look at these machines and try them out at your local DME company before you make a final decision. 

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  You have been diagnosed with obstructive sleep apnea or OSA and then they hit you with a bunch of words you have never heard before.  They start talking about machines and mask and humidity.  You are told this is long term therapy.  What they do not explain is what the machine does, what types of therapy are you eligible for and what will be the best type of therapy for you. 

  • CPAP stands for continuous positive airway pressure.  It is the most common therapy used for the treatment of OSA.  It is one continuous pressure that supports the airway.  This pressure was determined during the second sleep study, called the titration study.  On some occasions the titration is able to be done on the same night as the diagnostic study.  During the titration the technician will slowly increase the pressure until the breathing issues, snoring and airway resistance is eliminated or reduced to within normal levels.  In order for the insurance company to pay for the machine you must have at least 5 respiratory events an hour with some type of co-morbitity such as hypertension, or excessive daytime sleepiness.  Once the respiratory events increases to 15 events or higher a co-morbidity is no longer needed.
  • Bilevel or BIPAP therapy is similar to CPAP however, instead of one continuous pressure there are two pressures.  The lower pressure is the EPAP or expiratory pressure is increased to eliminate obstructions.  The higher pressure called IPAP or inspiratory pressure is adjusted to eliminate snoring, upper airway resistance and partial closing of the airway.  This therapy is also used to help people who can not tolerate CPAP therapy.  Patients who can not tolerate the pressure they need or who need high pressures this can allow the use of a more comfortable lower pressure.  The change in pressure also assists some people to feel more comfortable or natural.  In order for insurance to pay for this therapy the technician or the doctor must document that CPAP was used unsuccessfully and that Bilevel therapy is the best alternative.
  • APAP or AutoPAP is a self titrating therapy that is used for people who may need higher pressures part of the night such as when they are in REM, the stage of sleep where they dream or when they sleep on their back.  This allows the pressure to remain low until the higher pressure is needed.  This therapy is also used when the patient does not wish to come back for the second sleep study.  Many insurance companies do not wish to pay for Autopap because it is more expensive and it is not set to specific settings.
  • ASV, AutoSV, or BIPAP ST all of these are similar.  They have an inspiratory pressure and an expiratory pressure the difference is they have a rate as well.  This particular therapy was designed for people with central apnea.  Central apnea is when the brain does not tell the body to breathe.  The Bilevel therapy allows the machine to give a breath and the back up rate allows the machine to give the breaths when it does not sense a breath after a certain period of time.  These machines are only ordered when there are more central apneas then obstructive apnea.  Insurances pay differently for this therapy since it needs closer follow up by the doctor and the durable medical equipment company that sets it up. 
  • Oxygen can be ordered for some patients.  It can be added to the therapies described above or be given alone.  Oxygen is prescribed when the level of oxygen in the blood is lower then 89% for a minimum of 5 minutes without an associated respiratory event.  This means that there is not an obstructive apnea or hypopnea causing the decrease in oxygen.
Therapy for breathing disorders can be complicated.  It is best to talk to your doctor and your technicians.  The more information you have about the therapy and the options available the more likely that you will be successful.  It is also important to understand your insurance policy’s durable medical equipment reimbursement as this can have a high initial cost.  If you work with your team you should have a successful experience and start to feel better rested and healthier in no time.

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