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Six Tips to CPAP Success

Six Tips to CPAP Success

Trouble getting comfortable with your CPAP machine? Here are some tricks and tips to being successful with your CPAP therapy at home!

PAP therapy – such as CPAP, BiPAP, ASV, etc. – can be challenging to use at first, but with the following tricks and tips, for CPAP success you’ll have yourself saying “Hello!” to sleep again before you know it.

  • Rid yourself of preconceived notions regarding the CPAP machine!

    • Most people know a family member or friend who is using a PAP machine, and he or she might love it, or hate it. Everyone goes through a very unique experience with his or her therapy, so keep your mind as open as possible, and do not let someone else’s experience influence your own.
  • Breathe naturally

    • When you first wear a PAP machine, you may be inclined to try to regulate your breathing and put in a conscious effort at inhaling and exhaling. But don’t! This can induce panic and may make you want to take the mask and machine off. Breathe naturally, and with time, typically the positive pressure becomes more comfortable.
  • Consistency of usage is key

    • “Practice makes perfect” applies to PAP therapy! The more you use the machine, the easier it becomes. On nights when you feel like you have had enough with your machine, try your best to push through. If you do need to take a brief break and step away from the therapy for a moment, do so, but plan to put the mask and machine back on before you fall back asleep for the rest of the night.
  • The mask can make or break the treatment

    • Work closely with our DME technicians to ensure that you have the best mask style and size suited for your mode of PAP therapy, your pressure settings, your facial structure, and your preferred body positioning during sleep, among other defining elements. A mask that does not fit well makes for a poor night’s rest with the machine, as the airflow can “leak” out, causing disruptive noise and discomfort.
    • Practice “mask desensitization” if you are having a hard time keeping your mask on, all night long. This involves wearing the mask and headgear for at least 45 minutes prior to bedtime, in an effort to “normalize” the apparatus and get your brain and body acquainted with the equipment before you attempt to sleep.
  • Take advantage of comfort features on your machine

    • Don’t forget about the features below for optimal comfort, and contact our DME team if you need additional assistance or further instructions on how to utilize or adjust the following:
      1. Humidifier settings – can help with dry mouth and dry mucosa
        1. Increase the level for more moisture
          1. If your tubing is “gurgling” due to water condensing in the tubing or mask when you increase the setting, ask a DME technician about a heated tube.
        2. Decrease the level for less moisture
      2. RAMP – can help you fall asleep with PAP therapy by lowering the pressure
        1. Hitting the RAMP button will drop the pressure to a lower setting (i.e. 4 cm H2O) and allow the pressure to gradually build up to your final prescribed pressure over a period of time (i.e. 30 minutes)
  • Flex – can provide extra relief when you inhale, exhale, or both, depending on your mode of PAP therapy and machine manufacturer
  • Keep your sleep medicine team involved

    • If you are having a problem using and/or tolerating your PAP therapy, let us know so we can help!

 The more you use your machine, the more you will get used to it. Give yourself time to adjust. So, stick with it and soon enough you’ll start to realize just how much treating your sleep apnea improves your sleep and your quality of life! And you can Say Hello to Sleep Again!

CPAP and COVID-19

10 Things You Need to Know CPAP and COVID-19

We are receiving a lot of questions about CPAP use during the COVID-19 Pandemic. Comprehensive Sleep Care Center is here to help you with this, and all your sleep care needs. That includes the use of CPAP (Continuous Positive Airway Pressure) as well as BiPAP and ASV Therapy during the COVID-19 Coronavirus Pandemic.

First and foremost, the most important thing we can tell you is DO NOT STOP USING YOUR CPAP without first speaking to your doctor! You were prescribed a CPAP for a medical reason and stopping can put your health at risk.

The information below is for educational use only. If you need specific medical advice, please call the office to speak to the physician or DME-Durable Medical Equipment representative.

Do I have a higher risk of getting coronavirus because I have sleep apnea?

  • There is no evidence linking sleep apnea with coronavirus risk.

 If I do have the coronavirus, will CPAP help me treat it?

  • Your CPAP is used to treat one thing, your obstructive sleep apnea.
  • The question becomes, if you Do Not use your CPAP, what could happen? We know that we want to stay healthy. Well good quality sleep is needed to do that. If you’re not using your CPAP, you’re going to further weaken your immune system. And if you do have coronavirus, or you’re worried about getting coronavirus or any virus, you’re going to be more susceptible if you stop using your device.

 What’s the Difference Between CPAP Machines and Ventilators?

  • CPAP machines and ventilators are both considered mechanical ventilation. They both assist with a patient’s breathing. But there is a big difference -CPAP machines deliver a steady stream of pressurized air to keep the airways open while sleeping, thus preventing the collapse of the passageway and episodes of interrupted breathing. A ventilator is necessary for more severe respiratory conditions in which a patient is unable to breath on their own. A ventilator requires a tube being medically inserted. If you’re using a CPAP machine because you’re in respiratory distress due to COVID-19 infection, you need to call talk to your primary care or go to the emergency room.

 If I have symptoms or have tested positive for Coronavirus, should I continue using my CPAP?

  • Coronavirus doesn’t change your sleep apnea diagnosis – or your need to continue using CPAP therapy. You should continue to use your CPAP machine because a full night’s sleep benefits your overall health.
  • If you have symptoms of the coronavirus, you should isolate yourself in a separate bedroom and use a separate bathroom, if available. In this “recovery room,” you can continue to use CPAP while you sleep alone.
  • In the event of COVID-19 diagnosis, it is important to continue the cleaning guidelines provided for your unit. Please refer to our web page for step-by-step instructions on cleaning your device and mask.
  • We recommend increasing the weekly cleaning to a minimum of bi-weekly during an active infection.
  • After you are free from the coronavirus, replace your CPAP filters and disposable accessories as soon as possible.

 Can my CPAP machine spread Coronavirus to my bed partner?

  • The latest information says non-invasive ventilation (delivered by a mask with air diffusers) has a low risk of aerosolization, provided that there is a good mask fit, and you follow patient isolation (recovery room) guidelines.

Will my insurance still request compliance while in the Pandemic?

  • This is a bit tricky. Insurance companies have not provided any information to indicate that there are any changes to the compliance requirements. If there are extenuating circumstances for a patient, inform your doctor immediately so they can document the information. But it will not ensure that if compliance is requested the extenuating circumstances will override the compliance requirements.

How often should I clean and disinfect my CPAP mask and hose?

  • It’s important to clean your equipment as specified in the instructions for use that came with your equipment.  Poor or inappropriate maintenance can make your sleep therapy ineffective and damage your equipment.
  • If you’ve been sick, it’s smart to wash your mask, tubing, humidifier and filter daily until your cold, flu or virus symptoms are gone. That can help reduce the amount of time you spend feeling under the weather.
  • To be cautious in this time of COVID-19, we recommend increasing the weekly cleaning to bi-weekly cleaning.
  • Keeping it clean: CPAP hygiene
  • Replace your mask and other equipment to keep your machine clean and functioning optimally. We recommend you replace your mask/supplies every 90 days as allowed by your insurance carrier.

Distilled water is unavailable in my area. What should I use in my CPAP humidifier?

  • Optimal humidifier performance requires distilled water. That’s because most or all its minerals have been removed, preventing mineral buildup in the humidifier tub. That said, bottled (purified) water may also be used. It will not harm the device or pose a risk to patients. It will, however, require more rigorous humidifier cleaning to prevent excess mineral buildup in the tub.

 Will a CPAP cleaning machine disinfect my CPAP device and mask?

  • No, CPAP cleaning machines are not FDA-approved and especially right now, I would say, soap and water are still your best option to effectively clean your device.

 Are there any additives or chemicals that I should use to clean a CPAP machine during the coronavirus outbreak?

  • The answer is NO!
  • During a time like this, people may be tempted to try different things like bleach or other chemicals in their CPAP machine. But remember these chemicals can get in your lungs and cause damage. Please, just stick to what’s recommended. Don’t add anything else.

CPAP Cleaning Instructions

 Daily Cleaning

**Do not use moisturizing soaps, bleach, scented oils, chlorine, or alcohol-based solutions to clean your supplies. These solutions may cause irritation to your skin and lungs and may reduce the life of your products.

**If you’ve been sick, it’s smart to wash your mask, tubing, humidifier and filter daily until your cold, flu or virus symptoms are gone. That can help reduce the amount of time you spend under the weather.

  • Before using your mask -wash your face daily with soap and water to remove excess facial oils.
  • Wipe down your mask (including areas that come in contact with your skin) using a damp towel with soap and warm water. This will remove any oils, dead skin cells, and sweat on the mask that can affect the quality of the seal. Gently rinse with a clean towel and let the mask air-dry out of direct sunlight.
  • **You can also use unscented baby wipes or pre-moistened towels designed specifically for cleaning CPAP masks, which are available on-line. DO NOT USE CLOROX OR DISINFECTING WIPES.
  • If your unit has a humidifier, empty any leftover water instead of letting in sit in the unit all day. Refill the humidifier with clean, distilled water right before bedtime for optimal use

Weekly (more more frequent) Cleaning

  • Your mask and tubing need a full bath at once a week to keep it free of dust, bacteria, and germs. (During COVID-19 or any other virus we recommend more frequent cleaning)
  • Clean the CPAP tubing, nasal mask, and headgear in a bathroom sink filled with warm water and a few drops of ammonia-free, mild dish detergent. Avoid using stronger cleaning products, including dish detergents, as they may damage the mask or leave harmful residue. Swirl all parts around for about five minutes, rinse well and let air dry during the day. Hang the tubing over the shower rod, on a towel rack or in the laundry room to ensure all the water drips out.
  • The mask and headgear can be air-dried on a towel or hung on a hook or hanger.
  • You should also wipe down your CPAP machine with a damp cloth. Ensure the unit is unplugged. The towel shouldn’t be too damp or wet, as water could get into the machine.
  • Clean the filter by removing it and rinsing it in warm tap water. Run it under the water and squeeze to make sure there is no dust. Then blot down the filter with a towel.
  • Do not wash your machine’s white filter, if one is present—those are disposable and should be replaced every two weeks. If you are recovering from being sick, we recommend changing the filter sooner.
  • If your CPAP has a humidifier, that also needs to be cleaned weekly.
  • Empty any remaining water and then wash the water chamber in the sink with warm soapy water. Rinse well and drain out as much of the water as possible. Let the chamber air-dry before placing it back into the CPAP unit.
  • Every other week you should disinfect the humidifier. Do that by soaking it in a solution of one-part vinegar to five parts water for 30 minutes, thoroughly rinsing and then placing in your dishwasher’s top rack for washing. And keep it clean by using only distilled water to prevent mineral deposits that can build up and cause damage to your machine.

**The following are examples of soap that may be used: Johnson & Johnson baby soap, Ivory soap (plain).

With a little upkeep, your CPAP can continue to help you breathe better for a long time. Just a few minutes a day can help keep your CPAP running efficiently for years to come.

Stay Healthy and Stay Strong!

 

 

CPAP vs APAP

CPAP vs APAP

WHAT IS THE DIFFERENCE?

CPAP = CONTINUOUS POSITIVE AIRWAY PRESSURE

AUTOPAP, AUTOCPAP, OR APAP = AUTOMATIC POSITIVE AIRWAY PRESSURE

CPAPA vs APAP? We get a lot of questions on this and there is a lot of confusing information out there. When patients are diagnosed with Obstructive Sleep Apnea (OSA), the long-standing gold standard of treatment is Continuous Positive Airway Pressure (CPAP).  For patients who cannot tolerate CPAP, the sleep medicine physician may try an Automatic Positive Airway Pressure or APAP.

The main difference between CPAP and APAP is how the air pressure is administered.

CPAP machines are set at a fixed pressure that is determined through an in-lab titration sleep study. The goal of an in-lab CPAP titration is to achieve a pressure setting where the patient demonstrates high-quality sleep, reduction in respiratory events by keeping the airway “propped” open while sleeping, and a consequent improvement in their circulating oxygen. An APAP, on the other hand, is given a range of pressures, rather than a single fixed pressure, and therefore has the ability to auto-adjust to the patient’s breathing. This option can be used when a patient’s recommended in-lab titration study is denied by the insurance carrier. Specifically, some CPAP machines available today include a new technology that allows the machine to change to a 30-day APAP mode. Once the 30 days are completed, the machine automatically selects a fixed pressure that is based upon the 90th percentile pressure administered to the patient through the machine during its APAP trial period. A dedicated APAP machine, however, may be more appropriate than a fixed CPAP for certain patients.

There is a lot of misleading information on the internet about CPAP vs APAP treatment.

It is important to note that much of the information is coming from the manufacturers of APAP machines and it may not be based on scientific research. Here at Comprehensive Sleep Care Center, we follow the guidelines of the American Academy of Sleep Medicine (AASM), not equipment manufacturers and distributors.

The below practice parameters are the most recent updates from the AASM regarding the use of auto-titrating positive airway pressure (APAP) devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome.

Continuous positive airway pressure (CPAP) at an effective setting verified by attended polysomnography {in-lab sleep study} is a standard treatment for obstructive sleep apnea (OSA). APAP devices change the treatment pressure based on feedback from various patient measures such as airflow, pressure fluctuations, or measures of airway resistance. These devices may aid in the pressure titration process, address possible changes in pressure requirements throughout a given night and from night to night, aid in treatment of OSA when attended CPAP titration {in-lab sleep study} has not or cannot be accomplished {insurance denial}, or to help improve patient comfort.

A task force of the Standards of Practice Committee of the American Academy of Sleep Medicine has reviewed the literature published since the 2002 practice parameter on the use of APAP.

CURRENT PAP RECOMMENDATIONS FOLLOW:

(1) APAP devices are not recommended to diagnose OSA

(2) patients with congestive heart failure, patients with significant lung disease such as chronic obstructive pulmonary disease; patients expected to have nocturnal arterial oxyhemoglobin desaturation due to conditions other than OSA (e.g., obesity hypoventilation syndrome); patients who do not snore (either naturally or as a result of palate surgery); and patients who have central sleep apnea syndromes are not currently candidates for APAP titration {sleep study}or treatment.

(3) APAP devices are not currently recommended for split-night titration {in-lab sleep study for OSA and if present the addition of PAP device to find appropriate settings}.

(4) certain APAP devices may be used during attended titration with polysomnography {in-lab sleep study} to identify a single pressure for use with standard CPAP for treatment of moderate to severe OSA.

(5) certain APAP devices may be initiated and used in the self-adjusting mode for unattended treatment of patients {at home use} with moderate to severe OSA without significant comorbidities {the simultaneous presence of two chronic diseases or conditions in a patient} (Congestive heart failure, COPD, central sleep apnea syndromes, or hypoventilation syndromes).

(6) certain APAP devices may be used in an unattended way to determine a fixed CPAP treatment pressure for patients with moderate to severe OSA without significant comorbidities (Congestive heart failure, COPD, central sleep apnea syndromes, or hypoventilation syndromes).

(7) patients being treated with fixed CPAP {set pressure} on the basis of APAP titration or being treated with APAP must have close clinical follow-up {follow up with sleep medicine office}to determine treatment effectiveness and safety.

(8) a re-evaluation and, if necessary, a standard attended CPAP titration study {in-lab sleep study} should be performed if symptoms do not resolve or the APAP treatment otherwise appears to lack efficacy.

https://aasm.org/resources/practiceparameters/pp_autotitrating.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225554/