The secrets of successful CPAP/APAP use

[ResmedUser]

My OSA therapy was going pretty well until a little more than a month ago, when my original APAP broke on me. That is beyond my control. But up until that, I had developed a routine and learned a lot of things that worked well for me. I had a successful OSA therapy going on, very successful. I thought I would write it down for newbies and even experienced people. I have found the keys to OSA success are not complicated. Here it is:

1) the number one secret to OSA recovery is 100% compliance with your CPAP or APAP. I use my equipment even when I have a severe cold or flu. The only time I would not use it would be if my doctor ordered me not to use it if I developed some severe respiratory infection (pneumonia, perhaps?). The more you use your equipment, the more you sleep with it on, the more you will recover. More time on gear equals better.

2) eliminate all leaks as much as possible. Get your leak level down as low as possible. I do best when mine is under 10. The DMEs wont get excited unless its "legally" high as in .40 leak rate or so. I get a leak rate that high and I feel about like I am not using my gear. I dont go by the Resmed company literature/DME/RT spiel about leak rates. High leak rates will wake you up, decrease the efficacy of your therapy and in general, screw things up.

3) use heated humidification. I crank mine up to the max in the dry winter months and turn it down during the humid summer months. I have found for me, heated humidification is absolutely essential and I cannot use CPAP without it. I do not do well breathing dried out high pressure air. The best humidifier I personally have used is a Fisher and Pykel humidifer, however I found it did not integrate well with my Resmed APAP blower. I actually like a fogged up mask, makes breathing easier. I dont like gimmicks like heated hoses.

4) dont use a hose longer than two meters, especially if you use APAP. The longer the hose, the more the pressure decreases. I know the companies claim the machines are supposed to detect pressure decreases and adjust, but I have found in the real world, the machines dont do that all that well. Two meter hoses or shorter, such as six foot hoses give me the best pressures

5) A proper mask is CRITICAL. I personally like full face masks. And it is not only important to use the proper mask, its critical you use the right SIZE mask. In my case, I use a medium Quattro. I have tried a large quattro and even a small quattro. With the large Quattro I have found I lose efficacy.

6) keep your mask clean, especially the cushion. It increases the seal and decreases leaks and skin irritation

7) wash your face with plain ivory soap, dont use soaps with oils and stuff in them. Use plain Ivory, it dries the skin out the best.

Losing weight helps my OSA, the more I lose the better my OSA seems to get and the more effective my CPAP seems to be

9) I dont use a ramp function at all. I used it when I first started and I think ramp function is necessary for newbies. But otherwise, I just put it on and go full pressure immediately.

10) I am not claustrophobic so FFMasks are not an issue for me

11) Use a cover on your hose, it prevents rainout which prevents you from waking up in the night

12) Use nasal steroid sprays to deal with sinus issues from CPAP use, I use Nasacort AQ spray regularly

14) limit booze and benzo use if you can, both destroy slow wave sleep. Unfortunately I had become physically addicted to the benzo klonopin before I went on CPAP, so getting off benzos has been impossible for me. But I have been able to decease my dosage at times. When I do decrease the benzos, my sleep is "deeper feeling." Same thing goes for anti-histamines, they screw around with sleep architecture and I avoid them as much as possible. I dont drink anymore either.

15) Use a sleep medicine doctor whose original training is pulmonary specialist. I have used one sleep doctor whose original training was psychiatry and he was not good. I would not use a sleep medicine doctor whose original training was psychiatry. I would only use a Neurology sleep doctor if I had RLS or PLMD or perhaps centrals from a nervous system illness. I have found the pulmonary guys the best for OSA. OSA is a breathing issue, first and foremost.

16) If you use a brick and mortar DME, try and find one who are pulmonary focused if possible. Rather than using one of these general DMEs who supply everything for home living stuff. My first DME was pure pulmonary oriented and they were the only DME I have used that has been worth anything. The rest have been crap.

17) See # 1

18) See # 1

19) See # 8

20) See # 8

21) Turn your room temperature down to about 68 to 70 at bedtime. This helps raise the humidity in your bedroom a little during sleep and I have found helps prevent your nose from drying out from CPAP some. This is especially important in the dry air winter months.

22) Replace your mask cushion regular, every three months max. Two months if you can afford it.

21) Replace your machine filter more frequently than the recommended every three months. I replace mine monthly

22) Get yourself checked for vitamin D deficiency, particularly if you are experiencing skin irritations or pressure sores from the mask or straps. I have found prescription strength vitamin D (drisdol and the generic version) pretty much gets rid of any red marks on my face and even goes a long way to getting rid of pressure sores.

A note about pressure sores...I am not diabetic. If you are diabetic obviously you have to be careful and avoid getting them to begin with. My advice is for non diabetic CPAP users.

23) Other things that can help redness from skin irritation are: suntanning and swimming in either salt water or chlorinated pool water. Both dry the skin out like crazy.

24) For jaw drop with the subsequent mouth leak and loss of therapy, the best full face mask I have found is the Resmed Mirage Quattro FFM.

25) See # 1

25) See # 8

Mikey

[Rodney_D]

Thanks for all of the great advice!

I have found that Visine-A Eye Allergy Relief eye drops (yes, EYE) makes a great nasal spray. It clears up congestion quickly but doesn't have the side effects commonly associated with non-saline nasal spray use.

[SleepingUgly]

Mikey, you're posting a lot. So why don't you have a membership here?

[SnoozyQ]

While it's great that these things have worked well for you, these things may not equate success for everyone. Calling these steps the secret to CPAP success is a bit loaded.

[Pugsy]

While it's great that these things have worked well for you, these things may not equate success for everyone. Calling these steps the secret to CPAP success is a bit loaded.

I agree. Might give the newbies the wrong ideas. I would think simply adding "MY" to the topic would have been nice.
"The secrets to MY succesful....."

Newbies tend to take most of what we say as the "gospel". I know I did way back when I started. Made me think I needed to have a FF mask or I would die a miserable death in the throes of an upper respiratory infection and stopped up nose. I didn't die with the first cold I got. I was able to use my nasal pillow mask just fine. Slept as well as can be expected with a cold and cough. Some people can, some people can't use a FF mask. Each person has to evaluate their own personal preferences.

There are many ways to skin the CPAP treatment cat. Each of us has to find the way that works best for us as individuals.

[Hawthorne]

I agree Pugsy!! Everyone is different. What works well for one, may not work at all for another. There is no way to know without trying various things.

It is a risk for new cpap users to come here and take everything that is said as being what THEY should do. While it may be something they should TRY, it may not work for them after all.

Very good example Pugsy! I discovered the same thing about FF masks and ME - and that's the only one I can speak for!

[jbn3boys]

In response to #8, which seems to be a favorite, since it is also #19, # 20, AND # 25, Roby sue said it so much better than I can. I'm just going to copy her recent post here:

According to my sleep doctor's PA some 40% of sleep apnea patients are NORMAL weight or UNDERWEIGHT. I'm one of them.

And of the 60% of apnea patients who are overweight, the vast majority of them will NOT be able cure their apnea even if they did lose ALL their excess weight. Why? Most OSA is caused by structural problems in the throat. In many (not all, but many) of the overweight apnea patients the connection between the apnea and the weight is far more subtle than your statement implies: For many overweight patients with OSA, the OSA lead to metabolic changes which lead to weight gain in the first place or which made it all but impossible to lose the weight until and unless the OSA is properly treated by CPAP (or an oral device---if the apnea is mild). The additional weight clearly stresses an already compromised upper airway system and may increase the severity of the apnea. But it seldom actually is the sole cause of OSA.

A lucky few overweight OSA patients are able to lose weight while NOT treating their apnea by CPAP and eliminate the apnea by weight loss alone. But they are very few and very far between.

A few more lucky overweight OSA patients are able to lose weight while ON CPAP and subsequently manage to demonstrate through a PSG that they no longer need CPAP therapy. But these people are also few and far between.

The vast majority of overweight OSA patients who manage to lose all their excess weight do NOT manage to free themselves of apnea. And they continue to need CPAP to properly treat their apnea. In many cases, the pressure needed to keep the airway does go down with weight loss, but even here it is an individual thing: Some folks find they need a pressure INCREASE after losing weight in order to keep the apnea under control.

SO: Please do NOT promulgate the myth that weight loss is a gold standard treatment for OSA. It most certainly is not. The ONLY gold standard treatment at present is xPAP therapy.

And please do NOT promulgate the myth that MOST OSA patients could cure ---or even substantially improve--- their sleep apnea by losing weight. First of all that completely ignores the 40% of us who do NOT need to lose weight. And second of all, it sends a message that the other 60% are somehow responsible for creating their problem by being overweight. And nothing could be farther from the truth.

From this post:
viewtopic.php?f=1&t=59947&p=562806#p562806

[jbn3boys]

Mikey, you're posting a lot. So why don't you have a membership here?

I've been wondering the exact same thing. What's up, Mikey?