New CPAP user Instruction Manual help.

[kevincoop]

Hi,
I just posted another topic about what a DME company can do to give better customer service, etc. I also wanted to get CPAPtalk users input on the initial patient instructions that I have typed up. I give out the manufacturers instruction books at every setup, but I want all the basic info that the customer may need in one place (if possible). Take a look at what I have typed up and let me know if there is anything I can add or need to take out.

This post doesnt look as pretty because it doesnt have all of the pictures and the bold font etc, but let me know if the information is ok.


CPAP/BiPAP Patient Instructions


Purpose of CPAP/BiPAP Therapy

The purpose of Continuous Positive Airway Pressure (CPAP) therapy is to provide your airway with supporting pressure so they do not collapse. The airways relax during sleep and this can cause them to collapse, which can cause you to stop breathing and wake up. When this happens repeatedly, your time spent in restful sleep is decreased. Having your sleep continually interrupted can cause daytime sleepiness and puts additional stress on your heart and other major organs. By keeping your airways open with the air pressure, you can breathe without being awakened, which means you can get more restful sleep.

Because CPAP machines provide positive pressure to your airways, they require a prescription from your physician. Your CPAP machine and its supplies are being supplied to you in conjunction with the prescription obtained from your physician.

Always read and abide by all manufacturers’ operating instructions.

Types of CPAP/BiPAP Therapy

CPAP machines come in two basic types: preset and auto adjusting. Preset or standard CPAP machines have one preset airway pressure that remains constant during treatment. Auto adjusting CPAP machines adjust the airway pressure based on individual response to the treatment. Most CPAP machines have a ramping feature that starts the pressure out at a lower level when treatment is started and slowly builds the pressure up to the prescribed level. This ramping feature can help some people gradually adjust to the pressure.

BiPAP machines also come in two basic types: preset and auto adjusting. Preset or standard BiPAP machines have two preset airway pressures that remain constant during therapy. You will have a higher pressure when you inhale (inspiratory pressure or IPAP) and a lower pressure when you exhale (expiratory pressure or EPAP). Auto adjusting BiPAP machines adjust the airway pressures based on your individual response to the treatment.

CPAP and BiPAP machines are electrical devices that take air from the room, pass the air through a filter, and then provide it back in the form of pressurized air. This pressurized air travels through a breathing tube and is applied to your airways by a mask, nasal pillows, or oral device. This pressure is expressed in centimeters of water pressure or (cmH2O).

In most cases a humidifier will be added to your CPAP/BiPAP machine in order to put extra moisture in the air. Humidifiers are provided because the air pressure tends to dry the mucous membranes of the nose and mouth.

All CPAP/BiPAP machines are supplies as part of a treatment plan from your physician. Your physician’s treatment plan includes the following prescription which was obtained from the sleep study you participated in to diagnose sleep apnea:

CPAP Pressure:____________________cmH2O
or
BiPAP Pressure: _______________ inspiratory (IPAP) _______________ expiratory (EPAP)
Ramp Pressure:____________________
Ramp Time:_______________________
CPAP/BiPAP Unit and Model Number:___________________________________________
Mask Type:________________________
Mask Size:_________________________



CPAP/BiPAP Accessories

In order to apply the pressure generated by your CPAP/BiPAP machine, you must wear an oral appliance, nasal pillows, or a mask over the nose or over the nose and mouth. The choice of device is based upon which method best fits your facial features, which provides the most comfortable fit, and whether or not you are a mouth breather.

There are many different types of masks, nasal pillows, and oral devices to choose from to facilitate a good seal and maintain comfort. If a headgear is used to secure the mask or nasal pillows, it should be snug enough for a good fit in all sleeping positions. A chin strap may be needed to help keep your mouth closed during use.

If you would like to see what types of masks are available, simply come by any of our HiTech Healthcare locations or you may look at the manufacturers’ websites.

Respironics: http://masks.respironics.com/
Resmed: http://www.resmed.com/us/products/masks ... c=patients
Fisher and Paykel: http://www.fphcare.com/product-overview.html

For Information and Help from other CPAP users, please try going to: http://www.cpaptalk.com

Your supplies which include your mask, tubing, humidifier, and filter have a useful life that varies depending upon use and will need to be replaced periodically. We will contact you occasionally regarding your supply needs.

Humidifier

A humidifier can be added to a CPAP/BiPAP machine if a user has continued dryness of the nose, mouth, or throat. CPAP humidifiers are medical devices and require a prescription. A water based lubricant can be used inside the nose to help with irritation; do NOT use petroleum based products like Vaseline.

There are two basic types of CPAP/BiPAP humidifiers: passover and heated.
Passover humidifiers direct the airflow of the CPAP machine over the top of water in the chamber. This allows the air to pick up some moisture as it is directed through the tubing to your airways. This type of humidifier does not require heat or additional electricity.
Heated humidifiers require an electrical connection, either directly to the wall or through the CPAP/BiPAP machine, to heat the water. By heating the water, the amount of humidity available to the user is increased. Most heated humidifiers offer a temperature control function so the user can raise or lower the heat setting to in turn raise or lower the moisture level.

ALWAYS use distilled water to fill your humidifier. There will be markings to show how much water is required to fill the humidifier. Do not overfill the chamber because there is a chance the water can flow into the machine causing damage. Never place anything in your humidifier except distilled water.


Use of your CPAP/BiPAP

The most important part of using your CPAP/BiPAP is to understand your prescription and use the machine every night as prescribed by your physician. CPAP and BiPAP machines and their accessories must be used and applied in a very specific manner. Your CPAP/BiPAP has been preset to comply with your prescription. Do not make any changes to these settings. If you have concerns or questions about your settings, feel free to call us.

Your CPAP/BiPAP machine needs to be plugged into a grounded outlet and placed on a flat sturdy surface that does not obstruct the air filter. Make sure that the machine is placed so that the filter is at least 6 inches away from any wall, drapery, furniture, or other objects. The surface that the machine is placed on should not be higher than your head while you are laying down. This will keep any water from the humidifier from draining into your mask and also prevent the machine from falling if you get wrapped up in the tubing.

Attach your tubing and mask as shown by your HiTech representative and the manufacturers instructions. Press the power button to turn your pressure on. Before putting your mask on, wash your face to remove excess facial oils and/or makup. Secure the mask with just enough pressure to ensure a comfortable, yet secure fit. It will help to adjust the mask while laying in your normal sleeping positions. You do not want to have any air pressure leaking at the bridge of your nose. A small amount leaking at your cheeks, below your nose, or chin is acceptable as long as it is not bothering you and the machine does not display a high leak.

You may press the ramp button to slow the pressure down for a more comfortable feeling. This will allow the pressure to build up slowly and give you a chance to get to sleep at a lower pressure. After a set amount of time, the pressure will build back up slowly to your prescribed pressure. If the pressure builds up before you are asleep, or if you wake up and the pressure is blowing too hard, simply enable the ramp feature again.

If you have any problems with setting up your CPAP/BiPAP or supplies, please refer to the manufacturers instructions or call us at:


CPAP/BiPAP Cleaning Instructions

Please note that this paper is an overview on how to clean all of your CPAP/BiPAP equipment. Most manufacturers have their own suggested cleaning process. Be sure to read all of your manufacturer instructions for their recommendations.


Equipment that should be cleaned daily:

CPAP Mask or Nasal Pillows: You should clean your mask or nasal pillows every day with mild soap and
warm water. The soap that you use should not contain perfumes, dyes, or moisturizers or ALCOHOL.
If you have any allergy problems while using your equipment, try switching to another cleaning product. Recommended cleaning products are clear dishwashing liquids, baby shampoo, the shampoo you currently use, or Neutrogena soap. Clean the mask or pillows with the mild soap where it touches your face or nose to clean the facial oils off of the seal. Rinse with warm water and sit on a paper towel or hang to let air dry. You may also hook the mask back up to the CPAP and turn on to let the air pressure dry out the mask. If dishwashing liquids bother your sinuses, simply switch to baby shampoo. If your skin becomes irritated try switching to Neutrogena.

Humidifier Chamber: You should clean the water chamber of the humidifier daily to prevent bacteria
growth. Let the humidifier cool for about 15 minutes before cleaning. Use the same mild soap that you use to clean the mask. Squirt a little into the chamber along with warm water, cover the holes and shake. Rinse with warm water and let air dry or let your machine blow air through to dry. Make sure you refill the distilled water on a daily basis.

Tubing: We recommend you clean your tubing daily especially if using a heated humidifier and there is water
in your tubing. If there is no water in the tubing you can wait and clean once weekly. If water is in the tubing, clean with the same type of soap that is used to clean the mask and humidifier. Clean the ends off with the soap and run soapy water through the tubing. Rinse with warm water and hang to air dry. You can also hook this up to your machine and run the air through to dry. You may opt to clean the tubing in the shower and simply hang it over the shower rod to dry.


Equipment that should be cleaned weekly:

Mask and Nasal Pillows: You should clean all parts of the mask or nasal pillows once a week with mild soap
or soak in a vinegar and water solution (see instructions on next page). Make sure you take the headgear off before soaking in vinegar and water.

Headgear/Chinstrap: The headgear that attaches to the mask and chinstrap should be cleaned at least once a
week with mild soap. If you sweat excessively during sleep, you may want to clean more often. Hang to let air dry. Refer to your instructions that came with your mask before machine washing or drying. Do not dry with heat turned on You may want to leave the headgear attached to the mask when cleaning daily so you do not have to resize the velcro tabs. Do not soak your headgear in the vinegar solution.

Humidifier: You should clean your humidifier thoroughly with mild soap or soak in a vinegar and water
solution (see instructions on next page). Rinse and let air dry or hook it up to your CPAP and let air
pressure dry. Note that some brands of humidifiers may be placed in the dishwasher. Please refer to
your instruction manual before cleaning in the dishwasher.

Tubing: If you do not clean the tubing daily, make sure to clean it once weekly with mild soap and warm
water or soak in the vinegar and water solution. Hang to let air dry or hook up to your CPAP to dry.

Filters: Respironics CPAP Machines - Your machine has a gray and an optional white filter. Rinse the gray
filter with warm water to rinse the dust out of it. The white filter should be checked weekly, and when they become discolored simply discard and replace.

Resmed and Fisher and Paykel CPAP Machines – These machines only has a white filter. Check
once weekly for discoloration, air blockage, or holes. Discard and replace if needed.

Vinegar and Water Solution: To make the vinegar and water solution, simply mix 3 parts water with
1 part distilled white vinegar (or you can fill your kitchen sink halfway with warm water and add 2
cups of vinegar). Soak your equipment in this solution for 30 minutes to kill the accumulated bacteria. After your equipment soaks for 30 minutes, rinse and let air dry. You may also want to wash or soak your equipment with dishwashing liquid to get the vinegar scent off of them.

CPAP Instructions

Do these steps before going to bed:

1. If you do not use a humidifier, go to step 2. Your humidifier water chamber should be empty from cleaning the morning before. Take the chamber
off of the heater base and fill the chamber to the fill line with distilled water. Put the chamber back on the base of the humidifier. For Resmed
CPAPs - You may then press the warmup button or heat button on the CPAP machine to preheat the water if desired.
2. Connect the tubing from the machine or humidifier to your mask.
3. Press the power button to start the pressure. If you are using a Resmed CPAP machine, you may need to adjust the ramp time if necessary.
Starting the pressure before putting the mask on will ensure a good fit and ensure you are not breathing in exhaled air.
4. Put your mask on and adjust the straps if needed.
5. Respironics CPAPs - You can press the ramp button to decrease the pressure while you are going to sleep if needed. ResMed CPAPs - The pressure
should start out low and adjust up over the time that is specified.
6. Lay down and adjust your mask if needed.

Do these steps every morning:

1. Press the start/stop button to turn the CPAP and Humidifier off.
2. Disconnect the tubing from the mask and humidifier or machine.
3. If you have a humidifier, empty the water and clean with mild soap and let air dry.
4. Clean your mask (where it touches your face) with mild soap and let air dry.
5. If you want to clean your tubing daily, clean with a mild soap and hang to let dry.
6. If the parts that you clean are still wet when you get ready to use your CPAP, connect all of the parts and turn the machine on to let air dry. (You
may need to disable the auto-off feature on the machine or it will cut off soon after turning the machine on.)

Do these steps once weekly:

1. Disconnect all of your equipment and clean with mild soap and warm water or in a solution of vinegar and water.
2. For Respironics CPAP: Take the cap off of the back of the machine to expose the filter. Take the gray filter out of the back and rinse with warm
water. Check the white filter for discoloration and replace if necessary.
3. For Resmed CPAP: Take the filter cover off and inspect the filter for discoloration, blockage, or holes. If any of these are present, discard the filter
and replace.


Shopping List:

Mild Soap (Ivory, Baby Shampoo, Neutrogena)
Distilled Water (if using a humidifier)
Distilled White Vinegar


Getting New Supplies:

This is the Medicare replacement schedule. Please note that your insurance may not let you replace your supplies exactly as this schedule states.

Monthly- Replacement Nasal Pillows (if applicable), Replacement Mask Seal (for nasal
or full face mask, if applicable), Pack of 2 disposable Filters (Respironics CPAP)
Every 3 Months- Mask only, (without headgear), 6’ tubing
Every 6 Months- Mask and Headgear , Heated Humidifier Water Chamber, 1 non-disposable
filter
(Note: Georgia Medicaid Programs replace Mask and Tubing every 6 months, United Healthcare patients may be required to pay a portion if they choose to upgrade to any mask other than standard masks)



Please give me your opinions. If you want me to respond, please private message me.
Thanks for your input,
Kevin Cooper

[rested gal]

Very well organized and well written, Kevin.

The people you help should really appreciate having such useful info at their fingertips.

This is a nitpick... but under the Equipment Cleaning section, you might want to add a sentence reminding them to remove the humidifier water chamber before squirting soap in, etc.

The added sentence (in red) could be placed here (your sentences in blue):

Let the humidifier cool for about 15 minutes before cleaning. Remove the water chamber. Use the same mild soap that you use to clean the mask. Squirt a little into the chamber along with warm water, cover the holes and shake.

It should be a no-brainer to remove the water chamber before squirting soap in it and shaking it, but... you know better than I do how that might go...

You're a "good'un!"

[kevincoop]

Yep, the most common CPAP error we get is a bad flow sensor. This usually happens when the person sloshes water into the machine. I should probably put something in about that.
Thanks,
Kevin

[BleepingBeauty]

Hi, Kevin. First, let me say that I applaud your efforts to educate your consumers.

Personally, I think the proposed cleaning regimen is overkill, but I'm not going to quibble with what you advocate. I think most people will come to the conclusion, eventually, that cleaning everything every day isn't necessary. The only thing that popped out at me that's questionable (from a typo-POV) is your recommendation that the mask be cleaned every day and weekly:

Equipment that should be cleaned daily:
CPAP Mask or Nasal Pillows

Equipment that should be cleaned weekly:
Mask and Nasal Pillows

The only other suggestion I have is to amend the part that speaks to using the machine every night to something like "Use the machine every time you sleep" so that new PAPers will understand that they need therapy even when taking a nap.

Kudos for your efforts!

[kevincoop]

I understand completely. I say every day, my customers will do it once a week. I do try to instruct to clean quickly each day so they don't have to get up 30 minutes early and good once a week.

[BleepingBeauty]

I understand completely. I say every day, my customers will do it once a week. I do try to instruct to clean quickly each day so they don't have to get up 30 minutes early and good once a week.

You may want to suggest CPAP wipes (or baby wipes, which I use) for a daily quick-clean of the mask's seal or pillows. Cleaning everything every day is just not a reality for most people.

[BleepingBeauty]

Kevin, I just thought of something else (related to the data collection you do at your office). You might consider including a suggestion to shut the machine off during a middle-of-the-night bathroom break (to prevent large leak from being recorded and skewing the data).

FYI, when I have to get up during the night, I shut the machine off and disconnect the hose from the mask, keeping the mask on (so there's no re-fitting or fiddling needed when I get back into bed).

[SleepyInIndy]

Kevin,

Another small item. Under the shopping list you might suggest buying some Ayr-Gel type product. Make sure you emphasize to make it non-petroleum. People with nasal pillows will occasionally develop a 'sore nare', especially when first adjusting to that type of mask.

John

[rested gal]

Kevin's other excellent topic is at:

"What a DME company can do to be better!"
March 24, 2010
viewtopic.php?p=464997#p464997

[dtsm]

I would include a reference to cpaptalk.com, including the new users section "Learn", aka Collective Wisdom: our-collective-cpap-wisdom.php. Maybe even provide a hard copy, if the rules of this forum permit the same?

I would include a section re travel with cpap, including carry-on regulations, luggage tags, stuff to bring along, etc.

[kevincoop]

Thanks for all of your input.

I have actually been telling people about using baby wipes because most don't have alcohol but our company doesnt let us suggest that so I don't put it in writing. I do tell people about the Citrus wipes and spray, although, most people would probably buy baby wipes before ordering CPAP wipes. (Thats just my opinion)

I am also just learning about some of the moisturizers to use. I have always told customers to use a water based lubricant like KY and saline nasal spray, but I am learning about several new ones on this site.

I did just add a reference to CPAPtalk. I don't want to reference cpap.com or cpapman.com just because they can sell supplies for less than what we can, but I think everyone should at least look here if they are having issues. By the way, DME companies that sell to Medicare are not supposed to sell anything that they bill to medicare to anyone for less than they bill to Medicare. If we get audited by Medicare and we are selling a mask for less than Medicare's allowable, Medicare can lower our reimbursement and request refunds for every mask we have billed for the last year for the difference of what we collected from them and what we collected from a self pay patient. That is part of the reason why internet sites are so much cheaper. Also, they don't offer the support that DME companies offer (or should offer).

Thanks
Kevin

[fiberfan]

I would add something about it taking time to adjust and not expecting a great night's sleep the first night with a cpap. Reading here and in a sleep group on Ravelry is where I learned that before my titration sleep study. Having reasonable expectations has really helped me not get frustrated when it seemed like I hardly slept the first few nights and still helps on nights when things don't go smoothly.

[Janknitz]

Reading here and in a sleep group on Ravelry is where I learned that before my titration sleep study.

What group on Ravelry? I've been trying to find a sleep apnea group there, and didn't find anything particularly related to sleep apnea.

Seems like somewhere else on Ravelry I once saw something about knitting a hose cover, but I can't remember where.

[fiberfan]

What group on Ravelry? I've been trying to find a sleep apnea group there, and didn't find anything particularly related to sleep apnea.

The group isn't sleep apnea/cpap specific but much of the talk in Knitting In Our Sleep is about sleep apnea and cpap.

[Janknitz]

The group isn't sleep apnea/cpap specific but much of the talk in Knitting In Our Sleep is about sleep apnea and cpap.

Thanks! I found it and joined--same screenname if you see me there.