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.

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. 

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.

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. 

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.    

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.