CpapWiki - User contributions [en]

Sinus congestion

2009-12-31T21:11:15Z

Katherinefulmer:

=Try=

[[Image:Sneeze.jpg|200px]]

'''1. Wait and See'''
 by rjjayrt 
There's a trend among new users of CPAP that they tend to have nasal congestion for a few days after starting cpap. Most believe that this an airway reaction due to the use of pressure. It tends to last 2 to 3 days then gos away. If after 3 days you still suffer from nasal congestion then start at the bottom and work up. Start with saline nose spray.

'''2. Visiting the ear/nose/throat doctor'''
 by Dejaboo and dkdc 
If you have a deviated septum, nasal spray or inhalers will not help.

'''3. Vicks inhaler'''
 by YawnGirl 
Looks like chapstick, rub under your nose.

'''4. Vicks steam inhaler'''

You put hot water in it and add a Vicks tiny pad, put your face over it and inhale. (You're not suppose to put it in the microwave, but I did, it's like $8, I thought I could risk it)

'''5.Vicks shower tablets'''

You put them in your shower and the hot water makes a steamy vapor and opens your sinuses.

'''6. Flonase'''
 by bearded_two and Autopapdude 
Flonase doesn't cause rebound and it takes two or more days to start working. It is used daily.

'''7. Claritin'''
 by rooster and Falcon1 
Instead of Benadryl try generic loratadine (Claritin) or Zyrtec for the antihistamine effects. 'non-sedating antihistamines' (Claritin, Zyrtec, or Allegra) at night before bedtime, see the following CPAPtalk thread: [http://www.cpaptalk.com/viewtopic/t36483/viewtopic.php?f=1&t=36483&st=0&sk=t&sd=a&start=15 Source].

=Jury is Still Out=
'''1. Neti Pot'''
 
Debate over Neti pots is provided in the following [http://www.cpaptalk.com/viewtopic/t46566/Neti-Pot-Bad-Snot-Good.html CPAPtalk thread]. It begins with a posted article advocating against neti pots (details below), and is followed by CPAPtalk members reporting their success with neti pots.

definition: A neti pot is a small pot used for irrigating the nasal passages. Typically it has a spout attached near the bottom, sometimes with a handle on the opposite side.

'''Article posted:''' 
by Rooster 
Contrary to popular belief, irrigating the nose every day with the help of a Neti pot may actually make patients more susceptible to sinus infections, researchers said.

"I don't have anything against short-term nasal saline irrigation -- even aggressive nasal saline irrigation for three, four days or one week is totally fine," Talal M. Nsouli, MD, of Watergate Allergy & Asthma Center in Washington said. "But when we are doing it on a daily basis, we are modifying the immunological biochemistry of the nose."

That, he said, can result in a "depletion of immune elements" -- hence, recurrent sinus infections.[http://www.medpagetoday.com/MeetingCoverage/ACAAI/16870?userid=142281&impressionId=1257834288671&utm_source=mSpoke&utm_medium=email&utm_campaign=DailyHeadlines&utm_content=Group1 Source]

=Avoid=
'''1. Nasonex'''
 by Lee Lee 
CPAPtalk members who discontinue their use of Nasonex report their sinus congestion and mouth infections improving or disappearing immediately. If you use Nasonex on a regular basis and have congestion that has not gone away, try discontinuing it for one or more nights and note the differences on CPAPtalk forum to benefit others. You may also add your experience here. [http://www.cpaptalk.com/viewtopic/t46566/viewtopic.php?f=1&t=46662&p=419192&hilit=nasonex#p419192 Source]

'''2. Afrin'''
 by YawnGirl 
CPAPtalk members report having to use more each time to get your nose to clear. It can caues heart rate changes that may actually keep you from a good night's sleep.

'''3. Benadryl'''
 by rooster 
I recommend against Benadryl (diphenhydramine) because it has a strong sedating effect and tends to dry the nasal membranes. The sedating effect will help you sleep but it is believed the sleep architecture is not normal and leaves many people groggy and tired the next morning.

[[Category:Prescriptions]]

Template:FeaturedArticle

2009-12-31T21:08:31Z

Katherinefulmer:

'''Pain or Irritation on the bridge of the nose'''

edited by CPAPtalk.com members Rooster and Goose

[[Image:Painfulnosebridge.jpg|right|thumb|200px]]

Pain or Irritation on the bridge of the nose is a common problem caused by CPAP Masks. Here are solutions other users have found:

The Hybrid and Liberty are two full face masks that do not touch the nose bridge so they solve the problem. I prefer the Hybrid and it comes with three sizes of nasal pillows and mouth cushions, so fitting is easy. - Rooster

I '''alternate masks every other day'''. UMFF one day and Soyala FFM the next. -track

Read the full article [http://www.cpaptalk.com/wiki/index.php/Pain_on_the_Bridge_of_the_Nose here].

Template:FeaturedArticle

2009-12-31T21:08:00Z

Katherinefulmer:

'''Sinus Congestion'''

Built by the CPAPtalk community

When you have sinus congestion and Sleep Apnea, CPAP can be no fun! Here are ideas from CPAP users of techniques to try, things to avoid and methods we're still not too sure about...

1. Wait and See
There's a trend among new users of CPAP that they tend to have nasal congestion for a few days after starting cpap. Most believe that this an airway reaction due to the use of pressure. It tends to last 2 to 3 days then gos away. If after 3 days you still suffer from nasal congestion then start at the bottom and work up. Start with saline nose spray. Read the full article [http://www.cpaptalk.com/wiki/index.php/Sinus_congestion here].

[[Image:Sneeze.jpg|200px]]

Template:FeaturedArticle

2009-12-31T21:07:25Z

Katherinefulmer:

'''Sinus Congestion'''

Built by the CPAPtalk community

When you have sinus congestion and Sleep Apnea, CPAP can be no fun! Here are ideas from CPAP users of techniques to try, things to avoid and methods we're still not too sure about...

1. Wait and See
There's a trend among new users of CPAP that they tend to have nasal congestion for a few days after starting cpap. Most believe that this an airway reaction due to the use of pressure. It tends to last 2 to 3 days then gos away. If after 3 days you still suffer from nasal congestion then start at the bottom and work up. Start with saline nose spray.

[[Image:Sneeze.jpg|200px]]

Read the full article [http://www.cpaptalk.com/wiki/index.php/Sinus_congestion here].

Template:FeaturedArticle

2009-12-31T21:06:58Z

Katherinefulmer:

Sinus congestion

2009-12-31T21:05:48Z

Katherinefulmer:

=Try=

'''1. Wait and See'''
 by rjjayrt 
There's a trend among new users of CPAP that they tend to have nasal congestion for a few days after starting cpap. Most believe that this an airway reaction due to the use of pressure. It tends to last 2 to 3 days then gos away. If after 3 days you still suffer from nasal congestion then start at the bottom and work up. Start with saline nose spray.

'''2. Visiting the ear/nose/throat doctor'''
 by Dejaboo and dkdc 
If you have a deviated septum, nasal spray or inhalers will not help.

'''3. Vicks inhaler'''
 by YawnGirl 
Looks like chapstick, rub under your nose.

'''4. Vicks steam inhaler'''

You put hot water in it and add a Vicks tiny pad, put your face over it and inhale. (You're not suppose to put it in the microwave, but I did, it's like $8, I thought I could risk it)

'''5.Vicks shower tablets'''

You put them in your shower and the hot water makes a steamy vapor and opens your sinuses.

'''6. Flonase'''
 by bearded_two and Autopapdude 
Flonase doesn't cause rebound and it takes two or more days to start working. It is used daily.

'''7. Claritin'''
 by rooster and Falcon1 
Instead of Benadryl try generic loratadine (Claritin) or Zyrtec for the antihistamine effects. 'non-sedating antihistamines' (Claritin, Zyrtec, or Allegra) at night before bedtime, see the following CPAPtalk thread: [http://www.cpaptalk.com/viewtopic/t36483/viewtopic.php?f=1&t=36483&st=0&sk=t&sd=a&start=15 Source].

=Jury is Still Out=
'''1. Neti Pot'''
 
Debate over Neti pots is provided in the following [http://www.cpaptalk.com/viewtopic/t46566/Neti-Pot-Bad-Snot-Good.html CPAPtalk thread]. It begins with a posted article advocating against neti pots (details below), and is followed by CPAPtalk members reporting their success with neti pots.

definition: A neti pot is a small pot used for irrigating the nasal passages. Typically it has a spout attached near the bottom, sometimes with a handle on the opposite side.

'''Article posted:''' 
by Rooster 
Contrary to popular belief, irrigating the nose every day with the help of a Neti pot may actually make patients more susceptible to sinus infections, researchers said.

"I don't have anything against short-term nasal saline irrigation -- even aggressive nasal saline irrigation for three, four days or one week is totally fine," Talal M. Nsouli, MD, of Watergate Allergy & Asthma Center in Washington said. "But when we are doing it on a daily basis, we are modifying the immunological biochemistry of the nose."

That, he said, can result in a "depletion of immune elements" -- hence, recurrent sinus infections.[http://www.medpagetoday.com/MeetingCoverage/ACAAI/16870?userid=142281&impressionId=1257834288671&utm_source=mSpoke&utm_medium=email&utm_campaign=DailyHeadlines&utm_content=Group1 Source]

=Avoid=
'''1. Nasonex'''
 by Lee Lee 
CPAPtalk members who discontinue their use of Nasonex report their sinus congestion and mouth infections improving or disappearing immediately. If you use Nasonex on a regular basis and have congestion that has not gone away, try discontinuing it for one or more nights and note the differences on CPAPtalk forum to benefit others. You may also add your experience here. [http://www.cpaptalk.com/viewtopic/t46566/viewtopic.php?f=1&t=46662&p=419192&hilit=nasonex#p419192 Source]

'''2. Afrin'''
 by YawnGirl 
CPAPtalk members report having to use more each time to get your nose to clear. It can caues heart rate changes that may actually keep you from a good night's sleep.

'''3. Benadryl'''
 by rooster 
I recommend against Benadryl (diphenhydramine) because it has a strong sedating effect and tends to dry the nasal membranes. The sedating effect will help you sleep but it is believed the sleep architecture is not normal and leaves many people groggy and tired the next morning.

[[Category:Prescriptions]]

Sinus congestion

2009-12-31T21:04:08Z

Katherinefulmer:

=Try=

'''1. Wait and See'''
 by rjjayrt 
There's a trend among new users of CPAP that they tend to have nasal congestion for a few days after starting cpap. Most believe that this an airway reaction due to the use of pressure. It tends to last 2 to 3 days then gos away. If after 3 days you still suffer from nasal congestion then start at the bottom and work up. Start with saline nose spray. I agree with the previous post about Afrin. I would not use it. Too many unintended side affects.

'''2. Visiting the ear/nose/throat doctor'''
 by Dejaboo and dkdc 
If you have a deviated septum, nasal spray or inhalers will not help.

'''3. Vicks inhaler'''
 by YawnGirl 
Looks like chapstick, rub under your nose.

'''4. Vicks steam inhaler'''

You put hot water in it and add a Vicks tiny pad, put your face over it and inhale. (You're not suppose to put it in the microwave, but I did, it's like $8, I thought I could risk it)

'''5.Vicks shower tablets'''

You put them in your shower and the hot water makes a steamy vapor and opens your sinuses.

'''6. Flonase'''
 by bearded_two and Autopapdude 
Flonase doesn't cause rebound and it takes two or more days to start working. It is used daily.

'''7. Claritin'''
 by rooster and Falcon1 
Instead of Benadryl try generic loratadine (Claritin) or Zyrtec for the antihistamine effects. 'non-sedating antihistamines' (Claritin, Zyrtec, or Allegra) at night before bedtime, see the following CPAPtalk thread: [http://www.cpaptalk.com/viewtopic/t36483/viewtopic.php?f=1&t=36483&st=0&sk=t&sd=a&start=15 Source].

=Jury is Still Out=
'''1. Neti Pot'''
 
Debate over Neti pots is provided in the following [http://www.cpaptalk.com/viewtopic/t46566/Neti-Pot-Bad-Snot-Good.html CPAPtalk thread]. It begins with a posted article advocating against neti pots (details below), and is followed by CPAPtalk members reporting their success with neti pots.

definition: A neti pot is a small pot used for irrigating the nasal passages. Typically it has a spout attached near the bottom, sometimes with a handle on the opposite side.

'''Article posted:''' 
by Rooster 
Contrary to popular belief, irrigating the nose every day with the help of a Neti pot may actually make patients more susceptible to sinus infections, researchers said.

"I don't have anything against short-term nasal saline irrigation -- even aggressive nasal saline irrigation for three, four days or one week is totally fine," Talal M. Nsouli, MD, of Watergate Allergy & Asthma Center in Washington said. "But when we are doing it on a daily basis, we are modifying the immunological biochemistry of the nose."

That, he said, can result in a "depletion of immune elements" -- hence, recurrent sinus infections.[http://www.medpagetoday.com/MeetingCoverage/ACAAI/16870?userid=142281&impressionId=1257834288671&utm_source=mSpoke&utm_medium=email&utm_campaign=DailyHeadlines&utm_content=Group1 Source]

=Avoid=
'''1. Nasonex'''
 by Lee Lee 
CPAPtalk members who discontinue their use of Nasonex report their sinus congestion and mouth infections improving or disappearing immediately. If you use Nasonex on a regular basis and have congestion that has not gone away, try discontinuing it for one or more nights and note the differences on CPAPtalk forum to benefit others. You may also add your experience here. [http://www.cpaptalk.com/viewtopic/t46566/viewtopic.php?f=1&t=46662&p=419192&hilit=nasonex#p419192 Source]

'''2. Afrin'''
 by YawnGirl 
CPAPtalk members report having to use more each time to get your nose to clear. It can caues heart rate changes that may actually keep you from a good night's sleep.

'''3. Benadryl'''
 by rooster 
I recommend against Benadryl (diphenhydramine) because it has a strong sedating effect and tends to dry the nasal membranes. The sedating effect will help you sleep but it is believed the sleep architecture is not normal and leaves many people groggy and tired the next morning.

[[Category:Prescriptions]]

Template:FeaturedArticle

2009-12-31T21:02:24Z

Katherinefulmer:

'''Pain or Irritation on the bridge of the nose'''

edited by CPAPtalk.com members Rooster and Goose

[[Image:Sneeze.jpg|200px]]

Pain or Irritation on the bridge of the nose is a common problem caused by CPAP Masks. Here are solutions other users have found:

The Hybrid and Liberty are two full face masks that do not touch the nose bridge so they solve the problem. I prefer the Hybrid and it comes with three sizes of nasal pillows and mouth cushions, so fitting is easy. - Rooster

I '''alternate masks every other day'''. UMFF one day and Soyala FFM the next. -track

Read the full article [http://www.cpaptalk.com/wiki/index.php/Pain_on_the_Bridge_of_the_Nose here].

Template:FeaturedArticle

2009-12-31T21:02:22Z

Katherinefulmer:

'''Pain or Irritation on the bridge of the nose'''

edited by CPAPtalk.com members Rooster and Goose

[[Image:Sneeze.jpg|500px]]

Pain or Irritation on the bridge of the nose is a common problem caused by CPAP Masks. Here are solutions other users have found:

The Hybrid and Liberty are two full face masks that do not touch the nose bridge so they solve the problem. I prefer the Hybrid and it comes with three sizes of nasal pillows and mouth cushions, so fitting is easy. - Rooster

I '''alternate masks every other day'''. UMFF one day and Soyala FFM the next. -track

Read the full article [http://www.cpaptalk.com/wiki/index.php/Pain_on_the_Bridge_of_the_Nose here].

File:Sneeze.jpg

2009-12-31T21:01:03Z

Katherinefulmer:

Template:Opentask

2009-12-31T17:24:15Z

Katherinefulmer:

Here are some '''[[CpapWiki:Community Portal/Opentask|Open Tasks]]''':
[[Image:Clipboard.jpg|50px]]
<div style="font-size: 89%; text-align:left;">

* '''Expand:''' [[Aerophagia]], [[Dental devices]], [[Visiting Your Doctor]], [[Apnea Hypopnea Index]], [[Automatic Altitude Adjustment]], [[Central Sleep Apnea]], [[Durable Medical Equipment]], [[Light Therapy]],[[Manual Altitude Adjustment]], [[Passover Humidifier]], [[Respiratory Disturbance Index]], [[Total Recording Time]], [[AutoPAP]], [[Arousal]], [[Awakening]], [[CPAP Hose]], [[Continuous Positive Airway Pressure]], [[Heated Humidifier]], [[CPAP FAQs]], [[Apnea]], [[Epworth Sleepiness Scale]], [[Sleep Diary]], [[Pressure Relief|Expiratory Pressure Relief|EPR]],[[RV Travel with CPAP]], [[Aromatherapy]], [[PAP Prescription Requirements]]

* '''Cleanup:''' [[CPAP Machine Choices]], [[Bruxism]], [[Getting Into A Sleep Specialist]], [[Insurance and CPAP questions advice]], [[Obstructive Sleep Apnea]], [[Reasons to Use APAP]], [[Sleep Study Tests]], [[Airwayease MAS]], [[Building Your CPAP Support Team]], [[CPAP Mask]]

* '''Requested:''' [[Circadian Rhythm]], [[CPAP Battery Packs]], [[CPAP Power Options]], [[Solar Power Options for CPAP]], [[Air Travel with CPAP]], [[Boat Travel with CPAP]], [[Train Travel with CPAP]], [[Truckers and CPAP]], [[Cleaning CPAP Equipment]], [[CPAP and Sleep Apnea Humor]], [[CPAP and Sleep Apnea Quotes]], [[CPAP Filters]], [[Titration]], [[Risk Factors]], [[Chinstrap]], [[Headgear]], [[Software]], [[Pillar Procedure]], [[Sleep Debt]], [[C-Flex]], [[A-Flex]], [[Easy-Breathe technology]], [[Nasal Prongs]], [[Tryptophan]], [[Compliance]], [[Mixed Sleep Apnea]]

* '''Need Images:''' [[CPAP Mask]], [[Obstructive Sleep Apnea]], [[Upper Airway Resistance Syndrome]]
</div>

Light Therapy

2009-12-31T17:23:23Z

Katherinefulmer:

{{expand}}

The short and sweet:

During winter months, especially in northern areas, the lack of light leads to [[depression]], often refered to Seasonal Affective Disorder or SADD. A big problem in Alaska and Antarctica, but also can affect certain people in areas closer to the equator - NY, New England, Maryland, Kansas, northern California, etc. Floridians may not have as much problem with this.

More light means less seasonal affective disorder.

[[Image:Lighttherapy.jpg|right|thumb|500px]]

Light boxes are made specifically for this use - very bright and safe for the eyes. Don't use incandescent bulbs, and beware of home made lights unless you read up on it first.

Particularly effective if used in early morning. Most are made to use at least 30 minutes per day, but using them longer than that at your desk at work can work even better, and lets you sit farther away which might be desirable.

See ''Winter Blues'' by [http://www.normanrosenthal.com/ Norman Rosenthal], former director of the light therapy department at NIH, for more info.

---

Now for some good editors!

[[Category: Alternative_Treatments]]

Symptoms

2009-12-31T17:23:04Z

Katherinefulmer:

{{cleanup}}
{{expand}}
== Denial and Awareness ==

[[Image:3435257717_0f7536afaf_b.jpg|right|thumb|150px|A yawn is just a silent scream for sleep. (Permission granted by Photographer Hilary Quinn)]]

The symptoms of [[Obstructive Sleep Apnea|sleep apnea]] (stopped or reduced breathing during sleep) can be very subtle and easily attributed to other factors. How can you tell what you do while you’re sleeping? It’s not unusual to be unaware of having sleep apnea, a nighttime respiratory disorder. '''You probably think you are sleeping well'''. You may be in denial of the condition and unaware of its serious health risks. Your bed partner or family may be more aware of a potential problem than you are. Fifty percent or more of people with sleep-disordered breathing (SBD) remain undiagnosed. (Carl E Hunt MD p. xi in Johnson’s Sleep Apnea – The Phantom of the Night). Other estimates are that only 5% of people with SBD have been diagnosed. Most physicians do not routinely screen for sleep apnea, and may treat resulting conditions such as high blood pressure or depression, without discovering the root cause - SBD. Most people are unaware of the symptoms and risk factors. What is needed is early detection before heart damage or falling asleep at the wheel.

Untreated sleep apnea can lead to high blood pressure, stroke, heart attack, congestive heart failure, cardiac arrhythmia, depression, glaucoma, obesity, diabetes, and a host of other medical problems. Other risks are driver fatigue, poor judgment, poor memory, and sleepiness leading to car crashes, wrongful death and injury.

== The Most Important Symptoms of Sleep Apnea ==
* loud and frequent snoring (often but not always)
* periods of not breathing (apnea) during sleep, snorting, gasping, or choking during sleep
* need to urinate during the night (nocturia) See [http://www.nocturiacures.com/]
* high blood pressure
* morning headaches
* awakening tired in the morning, daytime or evening fatigue or lethargy
* daytime or evening sleepiness when sitting or inactive, drowsy driving or falling asleep while driving
* performing actions automatically or by rote, limited attention, memory loss
* poor judgment, personality changes
* weight gain, severe leg swelling
* especially in children, hyperactive behavior.

[http://www.nlm.nih.gov/medlineplus/sleepapnea.html#cat5 National Institute of Health Sleep Apnea Links]

== Possible Risk Factors ==
* decreased size of the airways in the throat, nose, or mouth due to anatomy or allergies. Family history of sleep apnea, large adenoids or large tongue, short lower jaw which causes the tongue to position itself further back in the throat
* overweight with a body mass index (BMI) of 25 or more
* neck size for a man of 17 inches or more or for a woman of 16 inches or more
* male gender, or being a menopausal or postmenopausal woman. Both genders and all ages from infancy onward may have this condition.
* smoking and use of alcohol or sedatives
Sources: adapted from the journal Sleep, National Institutes of Health, and James C. O’Brien MD.

== More Possible Indicators of Sleep Apnea ==
* COPD (chronic obstructive pulmonary disease), asthma
* heart abnormalities, stroke
* high blood pressure that doesn’t respond to medication
* acid reflux or GERD
* diabetes
* deviated septum (cartilage separating the nostrils going off midline)
* bruxism (teeth grinding)
* insomnia
* adult bed wetting
* irritability, mood changes, anxiety, depression
* procrastination, difficulty acting on plans or finishing projects, diminished work performance
* social withdrawal, neglected relationships
* less interest in sex, sexual dysfunction
* persistent recurring dreams of struggle and failure
* the ability to fall asleep two or three hours after getting up in the morning, and/or long naps in the afternoon, and/or sleeping nine or more hours a night

== Assessment Quizzes ==
If you suspect a sleep problem, take at least the first quiz listed below. The quizzes are designed to build awareness and create dialog with your doctor, not to diagnose. Discuss the quiz results and your symptoms with your primary care physician, or a sleep doctor, pulmonologist (breathing specialist), cardiologist, ENT (Ear/Nose/Throat) doctor, or other specialist. If indicated by symptoms, the doctor may suggest a sleep study to rule out sleep apnea or other diagnostic procedures.

A very comprehensive but easy quiz looks at a wide variety of symptoms to help detect sleep apnea in the appendix of Sleep Apnea – The Phantom of the Night , a book by T. Scott Johnson MD, William A. Broughton MD, Jerry Halberstadt, a patient. Here is the quiz:

* [http://www.healthyresources.com/sleep/apnea/phantom/orders/quiz.html Quiz to identify sleep apnea syndrome].

'''Other sleep apnea quizzes'''

* [http://www.aafp.org/afp/20000315/tips/5.html Berlin Questionnaire]

* [http://www.sleepeducation.com/SleepEval.aspx Online sleep evaluation]

* [http://www.stanford.edu/~dement/epworth.html Epworth Sleepiness Scale] Widely used by sleep doctors for a before-and-after treatment comparison (looks only at sleepiness)

== The Boiled Frog Analogy ==
Maybe you’ve heard this story. If you put a healthy frog into a pot of hot water, it will quickly jump out. If you put a frog into a pot of lukewarm water, and very gradually increase the temperature, it will stay in the pot until boiled. In the hot water, the frog noticed instant discomfort and danger and took action. In the tepid water, it was lulled into complacency until unaware or unable to take action. How does this translate to sleep apnea? Have you unconsciously adapted to fatigue and eventually daytime sleepiness because its progression was so long and gradual? Have you found other reasons for fatigue, while making the best of circumstances? Are those reasons valid? You can find out by consulting a physician, taking informal sleep quizzes and, if indicated, getting a sleep study in a sleep lab. When you find the real reason for your fatigue, you can crawl out of the pot to change, improve, or reverse the condition.

Sources: Based on personal experience with obstructive sleep apnea and gleaned from the collective wisdom of cpaptalk.com contributors.

== Want more? ==
Here are some links to relevant information from member posts on the CPAPtalk.com Forum.

* [http://www.cpaptalk.com/viewtopic/t17785/I-am-not-sure-everyone-understands.html?sid=2226cb049bfe94a360773a79e7d9ac78 Is it you or sleep apnea?]

* [http://www.cpaptalk.com/viewtopic/t25205/Waking-Up-to-the-Problem-of-OSA--Improved-Recognition.html Awareness for doctors and patients]

* [http://www.cpaptalk.com/viewtopic/t22134/What-took-you-so-long.html What took you so long to seek diagnosis?]

* [http://www.cpaptalk.com/viewtopic/t23161/What-led-you-to-your-diagnosis-of-apnea.html What led to diagnosis?]

* [http://www.cpaptalk.com/viewtopic/t27149/Can-young-people-have-Sleep-Apnea.html All ages get sleep apnea]

* [http://www.sleepdisordersguide.com/sleep-apnea-symptoms.html Sleep apnea symptoms]

* [http://www.cpaptalk.com/viewtopic.php?t=16134&postdays=0&postorder=asc&start=15 More consequences] scroll down for the post from member "neversleeps"

* [http://www.cpaptalk.com/viewtopic/t13698/Any-non-snorers-with-obstructive-sleep-apnea.html Non-snorers with sleep apnea]

* [http://www.cpaptalk.com/viewtopic/t24108/I-have-severe-sleep-apnea-but-Im-not-tired-anyone-else.html Sleep apnea but not tired]

* [http://www.cpaptalk.com/viewtopic/t24642/so-what-was-you-wierd-not-listed-symptom.html Weird symptoms]

* [http://www.cpaptalk.com/viewtopic.php?t=21675&postdays=0&postorder=asc&start= How long have you had sleep apnea?]

* [http://www.cpaptalk.com/viewtopic/t26485/Well-Here-Goes.html How SA affects life and health] scroll down for the post by member "countrygent"

* [http://www.cpaptalk.com/viewtopic.php?t=15831&postdays=0&postorder=asc&start=0 Dad refuses to see doctor]

* [http://www.cpaptalk.com/viewtopic.php?t=16490&postdays=0&postorder=asc&start=0 Trucker headed to court]

* [http://www.cpaptalk.com/viewtopic/t16484/Im-SOOOOO-Lucky.html Lucky to be treated]

* See the peer coaching articles at http://smart-sleep-apnea.blogspot.com on Sleep Study Tests, Introduction to Sleep Apnea, More Sleep-Related Web Sites, and CPAP Machine Choices.

Not written by healthcare professionals. The information and opinions offered are not intended or recommended as a substitute for professional medical advice. © Mile High Sleeper, May 2006-2008. Permission to use for free educational purposes.

[[Category:Symptoms]]

Sleep Tips

2009-12-31T17:17:28Z

Katherinefulmer: /* Carolyn */

This page is for '''general''' tips and advice, that could be helpful to anyone, and that may help improve the quality of their sleep. Specific tips regarding CPAP use can be found elsewhere throughout this wiki, in the [[CPAP FAQs|CPAP FAQs]], and on the [http://www.cpaptalk.com/CPAP-Sleep-Apnea-Forum.html CPAPtalk.com Forum].

[[Image:Bed.jpg|right|thumb|500px|Create a comfortable sleep environment to promote your general sleep hygiene (Photo from Black.White.Yellow.Blogspot.com)]]

== Improve your sleep ==
Everybody needs to sleep, and sometimes we all need some friendly reminders about general sleep hygiene; good sleep habits and practices, that can help us all sleep better. There are many things that people can do to help improve the overall quality of their sleep. Here are some ideas.

===Know the Goal: Sleep Stages===

Stage 1: The lightest stage of sleep. Transitional stage from wake. top

Stage 1 shifts: The number of times the sleep stage changed to stage 1.

Stage 2: The first true stage of sleep.

Stages 3/4: The deepest, most restorative sleep.

Stage REM: The dreaming stage; Normally occurs every 60-90 minutes.

=== Daytime routine ===
Daily activities and habits can affect how you sleep at night. It is important to establish good routines during your waking moments to assist with your nightly sleep time. Here are a few areas to explore.

==== Light ====
Light is important for the body clock, or [[Circadian Rhythm|circadian rhythm]], to work properly and synchronize itself to the optimal wake and sleep cycles. Not getting enough light during the day, or not getting light early in the day, can throw the body out of sync from it's normal and optimal internal circadian sleep patterns. Light lets your body know it is time to enter the daytime active cycle. Darkness has the opposite effect. Natural sunlight also helps the body to produce vitamin D. A vitamin D deficiency may affect sleep quality.

'''Tips:'''
* Upon awakening, open the blinds or go outside for a few minutes to get some light.
* Alternatively, turn on some lights to simulate daylight.
* [[Light Therapy|Light therapy]] can also be effective for some people to keep the body clock in sync.

==== Exercise ====

Besides having many health benefits, regular exercise is very effective in helping a person fall asleep easier and achieve a better overall sleep regimen. Some people have difficulty exercising for various reasons, but even small amounts of physical activity can results in sleep dividends.
[[Image:Excerise.jpg|right|thumb|200px|Get Moving for at least 20-30 minutes a day]]
 '''Tips:'''
* Regularity is one of the keys; try to make some exercise a part of your weekly schedule

* Even 20-30 minutes of daily exercise is sufficient help get better sleep. Try a brisk walk, ride a bike, swim, or take a short jog.

* 60 total combined minutes of exercise a day is ideal.

* If 20-30 minutes is too long, break it up into smaller increments of activity.

* Try to exercise in the morning or afternoon, because exercising later in the day or at night can stimulate the body and raise the temperature, possibly making it harder to get to sleep.

* Exercising with a friend keeps you accountable and makes the activity fun.

* Remember starting your routine is the hardest part, once you've begun exercising each week, you won't be able to imagine life without it.

==== Napping ====
Daytime naps can hinder your nighttime slumber. Getting extra sleep during the day can upset your body clock and make it difficult to get to sleep at your normal bedtime.

* Try to limit the number of naps you take.

* If you must nap, keep it short (30-45 minutes) and take them in the early afternoon.

==== Diet ====
What you consume in your diet can play a role in how well or not you sleep. Getting proper nutrition is important to your overall health and your sleep. Taking a good multi-vitamin will assure you are not deficient of important nutrients. Some people find that by making changes to their diet, they can improve their sleep and often their overall health. Here are some basic things to know about what foods can help or hurt your sleep experience.

* Try not to eat within two hours of bedtime.
* Avoid fatty, heavy, or rich foods near bedtime.

===== Foods that can help sleep =====
Eating too much before bedtime is not healthy. Have a light snack 2 hours before sleep time the latest. This advice has simple explanation. Your organism stays awake digesting the food, so even if you fall asleep part of your body is not "sleeping" and overall you still have less effective sleep which is not restful. You will need more sleep which in turn will not let you wake up easily.

Still there are changes you can make to your diet, or inclusions to your diet that can make achieving quality sleep easier. Foods that contain the amino acid [[Tryptophan|tryptophan]] can help you get to sleep faster and sleep better. These foods should be eaten as a light snack before bed as they promote sleep. Combining tryptophan foods with carbohydrates or foods with calcium help to increase the effectiveness of the tryptophan. Milk also contains tryptophan, which is only released when heated up. Tryptophan pills may also be purchased over the counter as a natural supplement at your local pharmacy or vitamin store.

'''Good Two-hour before bedtime snacks:'''
* glass of warm milk*
* a banana*
* 1/2 of a turkey sandwich*
* 1/2 a peanut butter and jelly sandwich*
* cup of relaxing tea (chamomile tea, [http://www.celestialseasonings.com/products/detail.html/herbal-teas/sleepytime Sleepytime tea] by Celestial Seasonings, [http://www.yogitea.com/Pages/OurTeas/MindTeas/Bedtime.html Bedtime tea by Yogi Tea], or many others.

* these foods contain the sleep promoting amino-acid tryptophan

For more info about tryptophan visit this [http://www.whfoods.com/genpage.php?pfriendly=1&tname=nutrient&dbid=103#foodsources external link].

===== Foods that can hurt sleep =====
[[Image:coffee_beans.jpg|thumb|right|200px|C'mon, you know you shouldn't.]]
Avoiding certain foods before bedtime can make a difference in your sleep patterns. For example, too much of any protein rich foods before bed can keep you up. Foods high in protein contain the amino acid tyrosine, which increases brain activity, the opposite of what is needed when heading for bed. If you suspect something you are eating or drinking could be interfering with your sleep, then eliminate it from your diet for a week or two and see if your sleep improves.

'''Foods to avoid before bed:'''
* '''Sugary, fatty, heavy, or rich foods''' are often difficult to digest and may keep you up.
* '''Large meals''' before bedtime should be avoided.
* '''Spicy foods''' before bed (especially if combined with foods mentioned above) can cause heartburn or acid-reflux when laying down to sleep.
* '''Caffeine''' consumed too close to bedtime might make it difficult to fall asleep. Careful, coffee is not the only caffeine source. Sodas, tea, and chocolate usually contain caffeine.
* '''Alcohol''', while most people know it has relaxation effects, it also interferes with sleep by fragmenting it through frequent arousals, and a lack of deep restorative sleep.
* '''Too many liquids''' can cause you to get up frequently in the night to use the restroom. It is best to limit your liquid intake about an hour or two before bed.

==== Personal Habits ====
The following personal habits may create problems with sleep.

* '''Caffeine''' - The effects of caffeine in the body can last a long time and may bring about issues with someone trying to go to sleep. For some people, caffeine may last up to 10 or 12 hours after consuming the substance. It is recommended that you eliminate caffeine from your diet after lunch and see if that helps, or cut back on the amount of caffeine you consume altogether.

* '''Alcohol''' - This depressant can make a person feel quite sleeply and may even make them fall asleep faster, or pass out. However, any benefits gained by alcohol are quickly erased, once asleep, because alcohol in the system actually prevents a deep, restorative sleep, through frequent arousals or awakenings. It is best to avoid alcohol a few hours before bed. And as always, drink responsibly and in moderation.

* '''Smoking or Tobacco use''' - Nicotine, found in tobacco products, is a stimulant. Stimulants work against sleep and should be avoided. Tobacco use also has many other negative effects on health, some of which could cause sleep problems. In fact, nicotine users actually begin to experience withdrawal symptoms while they are sleeping, which disrupts the sleep cycle. If at all possible, quit smoking. In the long run, it will help your sleep and your health.

=== Sleep environment ===
Your sleep environment plays a big role in how well you sleep. Typically one should try to have a quiet, dark, and comfortably cool place to sleep. Your bed, pillows, bedding, and other factors, also play a role in creating the optimum environment for sleep. Everyone is a little different, so be sure to experiment and keep what works for you.

Make sure it's peaceful.
==== Beds and comfort ====
[[Image:Do_not_disturb_sign.jpg|right|thumb|200px|The Bedroom is for Sleeping and Sex Only]]
'''Size''' -
A comfortable bed is essential for quality sleep. The bed should be large enough for you to stretch out on and turn over in comfortably. You should not feel cramped in bed.

'''Mattress Firmness''' -
If your back or neck is sore when you wake up, this is a good sign you may need a new mattress or that you may need to adjust the firmness level of your bed. If your bed is too firm, you can add a foam topper to try and increase the softness.

'''Bedding''' -
Your bedding (sheets, covers, comforter, etc.) should be soft to the touch and preferably clean. Try soft breathable 100% cotton sheets with a higher thread count. Too much or too little bedding can be an issue, as well. Try to find the right balance.

'''Pillows''' -
There are many different pillows available. Try finding the perfect pillow by experimenting with feather, synthetic, and cotton pillows. You may also want to try some of the various specialty pillows made for stomach, back, or side sleepers, and other situations. Read more about choices on the page devoted to [[Bed Pillows]].

==== Room used for sleep ====
Experts on sleep profess that the bedroom should only be used for sleep and sex. The reasoning is that while it may be comfortable to do other things in bed (read, write, eat, surf the web, work, watch tv, etc.), associating the bedroom with other activities besides sleep can make it more difficult to unwind and fall asleep, in the end. Ideally, your bedroom should be quiet, comfortable, dark, and at your preferred temperature.

===== Light and sound =====

'''Light''' -
Keep the room dark while you sleep. Light can send your body the wrong signals and throw off your body clock. If you have light coming in from a window, it is best to use some blackout blinds, or heavy curtains, to limit the amount of light coming in through the window. Eye masks, or sleep masks, can be helpful with regards to blocking out light.

'''Noise''' -
The sound level in your bedroom should be very quiet. Some people do not like total silence and are accustomed to some kind of white noise (fan, air conditioner, etc.), which is fine. Loud conversations, TV blasting, loud music, and the like should be avoided. If there are loud sounds coming from outside the residence that cannot be controlled, such as traffic or construction, try a white noise machine, or some soft, relaxing music. Earplugs also work very well.

===== Temperature and humidity =====

Most people sleep better in a slightly cool environmental temperature with a relatively low degree of humidity. A room that is too cold, too warm, too humid, or too dry can make sleeping difficult or uncomfortable. Try adjusting the temperature in your room slightly, or use a fan to stay cool. Keep notes in a sleep diary to track if there is any improvement in your sleep. In dryer climates, or in the winter when the heater can dry out the air, try using a stand-alone room humidifier. Stagnant air is not ideal either. Use a fan to keep the air circulating, or crack a window to let in a little fresh air. Some people with night sweats have found [https://www.cpap.com/productpage/tompkins-research-bed-fan-bedfan-night-sweats-cool-sleeping-comfort.html The Bedfan] to be a helpful product.

==== Sleep preparation ====
It is true that what you do before bed and to get ready for bed, can make a difference in your sleep habits. Here are some things to consider.

==== Sleep schedule ====
[[Image: Clocks.jpg|thumb|right|250px| Wake up at the Same Time each Morning]]
Going to bed and waking up at the same time of day, each day, can improve your sleep. Even on the weekends, when it is tempting to stay up late or sleep in, try to stick to your schedule. Having the same schedule helps the body clock stay on cue and synchronized.

* Try to schedule your bedtime about the same time you normally get tired.
* Keep your schedule, even on the weekends.
* Make any changes in small increments if you need to adjust your schedule.
* Try one of the [http://www.uberreview.com/2006/03/top-ten-most-annoying-alarm-clocks.htm Ten Most Annoying Alarm Clocks].

=====Sleep Related iPhone Apps=====
1. CPAP Aide

CPAP Aide is an application to assist people that have sleep apnea manage their CPAP machines. It can track schedules for service, ordering replacement parts, cleaning or disinfecting items related to their CPAP machine and track basic information such as model, serial number and notes related to a piece of equipment. FREE

2. Sleep Tracker TYLENOL PM

Record your sleep hours and moods, view history over time, add sleep notes to create a journal & get dozens of sleep tips FREE

3. EasyWakeUp
http://www.easywakeup.net

Smart Alarm Clock. It uses a motion detector (accelerometer) in order to detect the best time to wake you up (based on research of sleep phases). $0.99 - $14.99

4. Ambience

An "environment enhancer" designed to help you create the perfect ambient atmosphere to focus or relax. Over 500 free sounds to download and choose from. $0.99

5. Relax Sound Sleep Lite

A lite version of the full version of aRelax Sound, which contain more than 50 natural sounds and noises: soft sea wave, soft wind via canyon, stream fall into river, waterfall distant, frog sing, katydid, diving, camp fire, train, ocean wave surf, rain forest, mountain hurst, wind blow tent. chimp, churchbell, clock tick, crane, thunder bolt, wild bird, wild boar, chick, lark, sea birds, seagull, sheep blat, wolf, wind chimes, bubbles noise, etc. FREE - $1.99

6. Stress Reducer

Need to unwind and let go of some stress? Stress Reducer is an application that can help you do just that. Its simple and easy.

Select a picture of a shell by touching the button on the app. Once you find a shell you like, put your iPhone to your ear (or if you have an iPod it will play through the external speaker) and hear the ocean waves through the shell (your iPhone speaker). Close your eyes, take a deep breath, and relax. You'll feel the weight of the world lift off your shoulders. FREE

==== Bedtime routine ====
Having a consistent bedtime routine and schedule helps to signal to your body that it is time to start winding down and heading for bed, making falling asleep easier. Avoid stressful situations, strenuous activities, or bright lights before bed. Try some relaxing activities before bedtime. Not only will they help your body prepare for sleep, they relieve anxiety. Here are some suggestions.

* Listen to some soft music
* Enjoy some visualization, meditation, yoga, or other relaxation technique.
* Drink a glass of sleep tea or warm milk.
* Take a warm bath

===== Television =====
Many people have a TV in their bedroom and like to watch television while in bed. However, the light, sounds, and stimulating nature of television is counterproductive to sleep. Most programming on TV is trying to get and keep your attention, and therefore is highly stimulating to the brain, the opposite of what you need when preparing for bed. The light from the TV can also interfere with your body clock and watching TV before bed, or in the bedroom, makes you associate other activities with the bed, and the bedroom. Therefore, it is recommended to remove the television from your bedroom, if you are trying to improve your sleep.

* Remove the television from your bedroom.
* Record any late night shows you enjoy for viewing earlier in the day.
* Be patient, if you were used to falling asleep with the TV on, as it takes time to adjust.
* Try some soft music or a white noise machine, instead of television.

===== Worry and anxiety =====
[[Image: Meditation.jpg|‎right|thumb|250px| Clear your head before bed]]
Worry and anxiety can make it difficult to get to sleep. Bedtime should be a time of peace, quiet, and relaxation and so things that cause worry and anxiety should be avoided, if possible. Having a good bedtime routine that is relaxing is helpful, as worry and anxiety release chemicals in the body that make you more awake and alert, making it difficult to fall, and stay, asleep. Sometimes it is difficult to quiet the mind. Try some of the following.

* Relaxation or meditation techniques are helpful.
* Make a list of what is bothering you. Sometimes just getting it out is helpful.
* Make a to do list for the next day.
* Write in a journal.
* Try something else relaxing to distract your mind.

=== Waking up in the middle of the night ===

Most people normally wake up during the night, to use the bathroom, or change positions, and then go right back to sleep without a problem. However, sometimes it can be difficult to get back to sleep. It is easy to become frustrated and then feel anxious about getting back to sleep, which only makes the problem worse.

* If you wake up and have trouble getting back to sleep, try sending signals to your brain that it is still time to sleep by keeping it dark and quiet, and engaging in some kind of relaxation or meditation technique.

* If you are awake for more than 15 minutes, it is best to get out of bed and do a quiet non-stimulating activity until you feel ready to sleep again. Keep the lights dim so as not to trigger the body clock into thinking that is time to wake up. Drinking some herbal sleep tea might be a good idea.

Other ideas: Melatonin. Blue light therapy. More time on CPAP to see if resolves. Switch to APAP machine.

=== Medications ===
There are many sleep medications or sleep aids available, either over the counter, or by prescription from your doctor. They are usually meant to be used for a short term and sometimes they can be counter productive, because of their side effects. If you have sleep problems, and want to take medications to help you sleep, it is recommended that you work closely with your healthcare professional to decide if medication is part of the solution in your particular situation. According to Donna Arand, Ph.D., clinical director of the Kettering Hospital Sleep Disorders Center in Dayton, Ohio, interviewed for a recent [http://images.google.com/imgres?imgurl=http://media.rd.com/rd/images/rdc/books/sleep-to-be-sexy-smart-and-slim/sleep-stress-and-worry-af.jpg&imgrefurl=http://www.rd.com/living-healthy/sleep-stress-and-worry--sleep-problems/article54525.html&usg=__GYtKRjTWOStyDpLj3zp8sqUM7zo=&h=340&w=492&sz=37&hl=en&start=83&sig2=JpcTnxUNuVmBie4UX8y6Kw&um=1&tbnid=IpVAgoDFLCPP8M:&tbnh=90&tbnw=130&prev=/images%3Fq%3Dworry%26ndsp%3D20%26hl%3Den%26client%3Dfirefox-a%26rls%3Dorg.mozilla:en-US:official%26sa%3DN%26start%3D80%26um%3D1&ei=Nmq6Su7RK5Gf8AaAxsGMCg Reader's Digest Article] "Sleep becomes your overriding thought in life," says Dr. Arand. You start mainlining caffeine during the day, then popping sleeping pills at night. Those strategies may give you a temporary boost in alertness, but in the long run they only exacerbate the problem.
 '''Usually behavior modifications make the biggest difference in improving the quality of your sleep.'''

[[Medication and CPAP Use]]

[[Sinus congestion]]

Other medications, either over the counter or prescription, can also have unwanted side effects that include insomnia, restlessness, and an increase in alertness. Again, read all warning labels, and work closely with your doctor, if you suspect one of the medications you are taking is interfering with your sleep.

=== External Links ===
These are links to external websites that have more sleep tips.

http://www.mayoclinic.com/health/sleep/HQ01387

http://www.spine-health.com/blog/sleep-and-insomnia/11-unconventional-sleep-tips-how-get-sleep-and-stay-asleep

http://www.huffingtonpost.com/christine-fee/10-natural-sleep-tips_b_273970.html

Sleep Tips

2009-12-31T17:17:11Z

Katherinefulmer:

This page is for '''general''' tips and advice, that could be helpful to anyone, and that may help improve the quality of their sleep. Specific tips regarding CPAP use can be found elsewhere throughout this wiki, in the [[CPAP FAQs|CPAP FAQs]], and on the [http://www.cpaptalk.com/CPAP-Sleep-Apnea-Forum.html CPAPtalk.com Forum].

[[Image:Bed.jpg|right|thumb|500px|Create a comfortable sleep environment to promote your general sleep hygiene (Photo from Black.White.Yellow.Blogspot.com)]]

== Improve your sleep ==
Everybody needs to sleep, and sometimes we all need some friendly reminders about general sleep hygiene; good sleep habits and practices, that can help us all sleep better. There are many things that people can do to help improve the overall quality of their sleep. Here are some ideas.

===Know the Goal: Sleep Stages===

Stage 1: The lightest stage of sleep. Transitional stage from wake. top

Stage 1 shifts: The number of times the sleep stage changed to stage 1.

Stage 2: The first true stage of sleep.

Stages 3/4: The deepest, most restorative sleep.

Stage REM: The dreaming stage; Normally occurs every 60-90 minutes.

=== Daytime routine ===
Daily activities and habits can affect how you sleep at night. It is important to establish good routines during your waking moments to assist with your nightly sleep time. Here are a few areas to explore.

==== Light ====
Light is important for the body clock, or [[Circadian Rhythm|circadian rhythm]], to work properly and synchronize itself to the optimal wake and sleep cycles. Not getting enough light during the day, or not getting light early in the day, can throw the body out of sync from it's normal and optimal internal circadian sleep patterns. Light lets your body know it is time to enter the daytime active cycle. Darkness has the opposite effect. Natural sunlight also helps the body to produce vitamin D. A vitamin D deficiency may affect sleep quality.

'''Tips:'''
* Upon awakening, open the blinds or go outside for a few minutes to get some light.
* Alternatively, turn on some lights to simulate daylight.
* [[Light Therapy|Light therapy]] can also be effective for some people to keep the body clock in sync.

==== Exercise ====

Besides having many health benefits, regular exercise is very effective in helping a person fall asleep easier and achieve a better overall sleep regimen. Some people have difficulty exercising for various reasons, but even small amounts of physical activity can results in sleep dividends.
[[Image:Excerise.jpg|right|thumb|200px|Get Moving for at least 20-30 minutes a day]]
 '''Tips:'''
* Regularity is one of the keys; try to make some exercise a part of your weekly schedule

* Even 20-30 minutes of daily exercise is sufficient help get better sleep. Try a brisk walk, ride a bike, swim, or take a short jog.

* 60 total combined minutes of exercise a day is ideal.

* If 20-30 minutes is too long, break it up into smaller increments of activity.

* Try to exercise in the morning or afternoon, because exercising later in the day or at night can stimulate the body and raise the temperature, possibly making it harder to get to sleep.

* Exercising with a friend keeps you accountable and makes the activity fun.

* Remember starting your routine is the hardest part, once you've begun exercising each week, you won't be able to imagine life without it.

==Carolyn==

==== Napping ====
Daytime naps can hinder your nighttime slumber. Getting extra sleep during the day can upset your body clock and make it difficult to get to sleep at your normal bedtime.

* Try to limit the number of naps you take.

* If you must nap, keep it short (30-45 minutes) and take them in the early afternoon.

==== Diet ====
What you consume in your diet can play a role in how well or not you sleep. Getting proper nutrition is important to your overall health and your sleep. Taking a good multi-vitamin will assure you are not deficient of important nutrients. Some people find that by making changes to their diet, they can improve their sleep and often their overall health. Here are some basic things to know about what foods can help or hurt your sleep experience.

* Try not to eat within two hours of bedtime.
* Avoid fatty, heavy, or rich foods near bedtime.

===== Foods that can help sleep =====
Eating too much before bedtime is not healthy. Have a light snack 2 hours before sleep time the latest. This advice has simple explanation. Your organism stays awake digesting the food, so even if you fall asleep part of your body is not "sleeping" and overall you still have less effective sleep which is not restful. You will need more sleep which in turn will not let you wake up easily.

Still there are changes you can make to your diet, or inclusions to your diet that can make achieving quality sleep easier. Foods that contain the amino acid [[Tryptophan|tryptophan]] can help you get to sleep faster and sleep better. These foods should be eaten as a light snack before bed as they promote sleep. Combining tryptophan foods with carbohydrates or foods with calcium help to increase the effectiveness of the tryptophan. Milk also contains tryptophan, which is only released when heated up. Tryptophan pills may also be purchased over the counter as a natural supplement at your local pharmacy or vitamin store.

'''Good Two-hour before bedtime snacks:'''
* glass of warm milk*
* a banana*
* 1/2 of a turkey sandwich*
* 1/2 a peanut butter and jelly sandwich*
* cup of relaxing tea (chamomile tea, [http://www.celestialseasonings.com/products/detail.html/herbal-teas/sleepytime Sleepytime tea] by Celestial Seasonings, [http://www.yogitea.com/Pages/OurTeas/MindTeas/Bedtime.html Bedtime tea by Yogi Tea], or many others.

* these foods contain the sleep promoting amino-acid tryptophan

For more info about tryptophan visit this [http://www.whfoods.com/genpage.php?pfriendly=1&tname=nutrient&dbid=103#foodsources external link].

===== Foods that can hurt sleep =====
[[Image:coffee_beans.jpg|thumb|right|200px|C'mon, you know you shouldn't.]]
Avoiding certain foods before bedtime can make a difference in your sleep patterns. For example, too much of any protein rich foods before bed can keep you up. Foods high in protein contain the amino acid tyrosine, which increases brain activity, the opposite of what is needed when heading for bed. If you suspect something you are eating or drinking could be interfering with your sleep, then eliminate it from your diet for a week or two and see if your sleep improves.

'''Foods to avoid before bed:'''
* '''Sugary, fatty, heavy, or rich foods''' are often difficult to digest and may keep you up.
* '''Large meals''' before bedtime should be avoided.
* '''Spicy foods''' before bed (especially if combined with foods mentioned above) can cause heartburn or acid-reflux when laying down to sleep.
* '''Caffeine''' consumed too close to bedtime might make it difficult to fall asleep. Careful, coffee is not the only caffeine source. Sodas, tea, and chocolate usually contain caffeine.
* '''Alcohol''', while most people know it has relaxation effects, it also interferes with sleep by fragmenting it through frequent arousals, and a lack of deep restorative sleep.
* '''Too many liquids''' can cause you to get up frequently in the night to use the restroom. It is best to limit your liquid intake about an hour or two before bed.

==== Personal Habits ====
The following personal habits may create problems with sleep.

* '''Caffeine''' - The effects of caffeine in the body can last a long time and may bring about issues with someone trying to go to sleep. For some people, caffeine may last up to 10 or 12 hours after consuming the substance. It is recommended that you eliminate caffeine from your diet after lunch and see if that helps, or cut back on the amount of caffeine you consume altogether.

* '''Alcohol''' - This depressant can make a person feel quite sleeply and may even make them fall asleep faster, or pass out. However, any benefits gained by alcohol are quickly erased, once asleep, because alcohol in the system actually prevents a deep, restorative sleep, through frequent arousals or awakenings. It is best to avoid alcohol a few hours before bed. And as always, drink responsibly and in moderation.

* '''Smoking or Tobacco use''' - Nicotine, found in tobacco products, is a stimulant. Stimulants work against sleep and should be avoided. Tobacco use also has many other negative effects on health, some of which could cause sleep problems. In fact, nicotine users actually begin to experience withdrawal symptoms while they are sleeping, which disrupts the sleep cycle. If at all possible, quit smoking. In the long run, it will help your sleep and your health.

=== Sleep environment ===
Your sleep environment plays a big role in how well you sleep. Typically one should try to have a quiet, dark, and comfortably cool place to sleep. Your bed, pillows, bedding, and other factors, also play a role in creating the optimum environment for sleep. Everyone is a little different, so be sure to experiment and keep what works for you.

Make sure it's peaceful.
==== Beds and comfort ====
[[Image:Do_not_disturb_sign.jpg|right|thumb|200px|The Bedroom is for Sleeping and Sex Only]]
'''Size''' -
A comfortable bed is essential for quality sleep. The bed should be large enough for you to stretch out on and turn over in comfortably. You should not feel cramped in bed.

'''Mattress Firmness''' -
If your back or neck is sore when you wake up, this is a good sign you may need a new mattress or that you may need to adjust the firmness level of your bed. If your bed is too firm, you can add a foam topper to try and increase the softness.

'''Bedding''' -
Your bedding (sheets, covers, comforter, etc.) should be soft to the touch and preferably clean. Try soft breathable 100% cotton sheets with a higher thread count. Too much or too little bedding can be an issue, as well. Try to find the right balance.

'''Pillows''' -
There are many different pillows available. Try finding the perfect pillow by experimenting with feather, synthetic, and cotton pillows. You may also want to try some of the various specialty pillows made for stomach, back, or side sleepers, and other situations. Read more about choices on the page devoted to [[Bed Pillows]].

==== Room used for sleep ====
Experts on sleep profess that the bedroom should only be used for sleep and sex. The reasoning is that while it may be comfortable to do other things in bed (read, write, eat, surf the web, work, watch tv, etc.), associating the bedroom with other activities besides sleep can make it more difficult to unwind and fall asleep, in the end. Ideally, your bedroom should be quiet, comfortable, dark, and at your preferred temperature.

===== Light and sound =====

'''Light''' -
Keep the room dark while you sleep. Light can send your body the wrong signals and throw off your body clock. If you have light coming in from a window, it is best to use some blackout blinds, or heavy curtains, to limit the amount of light coming in through the window. Eye masks, or sleep masks, can be helpful with regards to blocking out light.

'''Noise''' -
The sound level in your bedroom should be very quiet. Some people do not like total silence and are accustomed to some kind of white noise (fan, air conditioner, etc.), which is fine. Loud conversations, TV blasting, loud music, and the like should be avoided. If there are loud sounds coming from outside the residence that cannot be controlled, such as traffic or construction, try a white noise machine, or some soft, relaxing music. Earplugs also work very well.

===== Temperature and humidity =====

Most people sleep better in a slightly cool environmental temperature with a relatively low degree of humidity. A room that is too cold, too warm, too humid, or too dry can make sleeping difficult or uncomfortable. Try adjusting the temperature in your room slightly, or use a fan to stay cool. Keep notes in a sleep diary to track if there is any improvement in your sleep. In dryer climates, or in the winter when the heater can dry out the air, try using a stand-alone room humidifier. Stagnant air is not ideal either. Use a fan to keep the air circulating, or crack a window to let in a little fresh air. Some people with night sweats have found [https://www.cpap.com/productpage/tompkins-research-bed-fan-bedfan-night-sweats-cool-sleeping-comfort.html The Bedfan] to be a helpful product.

==== Sleep preparation ====
It is true that what you do before bed and to get ready for bed, can make a difference in your sleep habits. Here are some things to consider.

==== Sleep schedule ====
[[Image: Clocks.jpg|thumb|right|250px| Wake up at the Same Time each Morning]]
Going to bed and waking up at the same time of day, each day, can improve your sleep. Even on the weekends, when it is tempting to stay up late or sleep in, try to stick to your schedule. Having the same schedule helps the body clock stay on cue and synchronized.

* Try to schedule your bedtime about the same time you normally get tired.
* Keep your schedule, even on the weekends.
* Make any changes in small increments if you need to adjust your schedule.
* Try one of the [http://www.uberreview.com/2006/03/top-ten-most-annoying-alarm-clocks.htm Ten Most Annoying Alarm Clocks].

=====Sleep Related iPhone Apps=====
1. CPAP Aide

CPAP Aide is an application to assist people that have sleep apnea manage their CPAP machines. It can track schedules for service, ordering replacement parts, cleaning or disinfecting items related to their CPAP machine and track basic information such as model, serial number and notes related to a piece of equipment. FREE

2. Sleep Tracker TYLENOL PM

Record your sleep hours and moods, view history over time, add sleep notes to create a journal & get dozens of sleep tips FREE

3. EasyWakeUp
http://www.easywakeup.net

Smart Alarm Clock. It uses a motion detector (accelerometer) in order to detect the best time to wake you up (based on research of sleep phases). $0.99 - $14.99

4. Ambience

An "environment enhancer" designed to help you create the perfect ambient atmosphere to focus or relax. Over 500 free sounds to download and choose from. $0.99

5. Relax Sound Sleep Lite

A lite version of the full version of aRelax Sound, which contain more than 50 natural sounds and noises: soft sea wave, soft wind via canyon, stream fall into river, waterfall distant, frog sing, katydid, diving, camp fire, train, ocean wave surf, rain forest, mountain hurst, wind blow tent. chimp, churchbell, clock tick, crane, thunder bolt, wild bird, wild boar, chick, lark, sea birds, seagull, sheep blat, wolf, wind chimes, bubbles noise, etc. FREE - $1.99

6. Stress Reducer

Need to unwind and let go of some stress? Stress Reducer is an application that can help you do just that. Its simple and easy.

Select a picture of a shell by touching the button on the app. Once you find a shell you like, put your iPhone to your ear (or if you have an iPod it will play through the external speaker) and hear the ocean waves through the shell (your iPhone speaker). Close your eyes, take a deep breath, and relax. You'll feel the weight of the world lift off your shoulders. FREE

==== Bedtime routine ====
Having a consistent bedtime routine and schedule helps to signal to your body that it is time to start winding down and heading for bed, making falling asleep easier. Avoid stressful situations, strenuous activities, or bright lights before bed. Try some relaxing activities before bedtime. Not only will they help your body prepare for sleep, they relieve anxiety. Here are some suggestions.

* Listen to some soft music
* Enjoy some visualization, meditation, yoga, or other relaxation technique.
* Drink a glass of sleep tea or warm milk.
* Take a warm bath

===== Television =====
Many people have a TV in their bedroom and like to watch television while in bed. However, the light, sounds, and stimulating nature of television is counterproductive to sleep. Most programming on TV is trying to get and keep your attention, and therefore is highly stimulating to the brain, the opposite of what you need when preparing for bed. The light from the TV can also interfere with your body clock and watching TV before bed, or in the bedroom, makes you associate other activities with the bed, and the bedroom. Therefore, it is recommended to remove the television from your bedroom, if you are trying to improve your sleep.

* Remove the television from your bedroom.
* Record any late night shows you enjoy for viewing earlier in the day.
* Be patient, if you were used to falling asleep with the TV on, as it takes time to adjust.
* Try some soft music or a white noise machine, instead of television.

===== Worry and anxiety =====
[[Image: Meditation.jpg|‎right|thumb|250px| Clear your head before bed]]
Worry and anxiety can make it difficult to get to sleep. Bedtime should be a time of peace, quiet, and relaxation and so things that cause worry and anxiety should be avoided, if possible. Having a good bedtime routine that is relaxing is helpful, as worry and anxiety release chemicals in the body that make you more awake and alert, making it difficult to fall, and stay, asleep. Sometimes it is difficult to quiet the mind. Try some of the following.

* Relaxation or meditation techniques are helpful.
* Make a list of what is bothering you. Sometimes just getting it out is helpful.
* Make a to do list for the next day.
* Write in a journal.
* Try something else relaxing to distract your mind.

=== Waking up in the middle of the night ===

Most people normally wake up during the night, to use the bathroom, or change positions, and then go right back to sleep without a problem. However, sometimes it can be difficult to get back to sleep. It is easy to become frustrated and then feel anxious about getting back to sleep, which only makes the problem worse.

* If you wake up and have trouble getting back to sleep, try sending signals to your brain that it is still time to sleep by keeping it dark and quiet, and engaging in some kind of relaxation or meditation technique.

* If you are awake for more than 15 minutes, it is best to get out of bed and do a quiet non-stimulating activity until you feel ready to sleep again. Keep the lights dim so as not to trigger the body clock into thinking that is time to wake up. Drinking some herbal sleep tea might be a good idea.

Other ideas: Melatonin. Blue light therapy. More time on CPAP to see if resolves. Switch to APAP machine.

=== Medications ===
There are many sleep medications or sleep aids available, either over the counter, or by prescription from your doctor. They are usually meant to be used for a short term and sometimes they can be counter productive, because of their side effects. If you have sleep problems, and want to take medications to help you sleep, it is recommended that you work closely with your healthcare professional to decide if medication is part of the solution in your particular situation. According to Donna Arand, Ph.D., clinical director of the Kettering Hospital Sleep Disorders Center in Dayton, Ohio, interviewed for a recent [http://images.google.com/imgres?imgurl=http://media.rd.com/rd/images/rdc/books/sleep-to-be-sexy-smart-and-slim/sleep-stress-and-worry-af.jpg&imgrefurl=http://www.rd.com/living-healthy/sleep-stress-and-worry--sleep-problems/article54525.html&usg=__GYtKRjTWOStyDpLj3zp8sqUM7zo=&h=340&w=492&sz=37&hl=en&start=83&sig2=JpcTnxUNuVmBie4UX8y6Kw&um=1&tbnid=IpVAgoDFLCPP8M:&tbnh=90&tbnw=130&prev=/images%3Fq%3Dworry%26ndsp%3D20%26hl%3Den%26client%3Dfirefox-a%26rls%3Dorg.mozilla:en-US:official%26sa%3DN%26start%3D80%26um%3D1&ei=Nmq6Su7RK5Gf8AaAxsGMCg Reader's Digest Article] "Sleep becomes your overriding thought in life," says Dr. Arand. You start mainlining caffeine during the day, then popping sleeping pills at night. Those strategies may give you a temporary boost in alertness, but in the long run they only exacerbate the problem.
 '''Usually behavior modifications make the biggest difference in improving the quality of your sleep.'''

[[Medication and CPAP Use]]

[[Sinus congestion]]

Other medications, either over the counter or prescription, can also have unwanted side effects that include insomnia, restlessness, and an increase in alertness. Again, read all warning labels, and work closely with your doctor, if you suspect one of the medications you are taking is interfering with your sleep.

=== External Links ===
These are links to external websites that have more sleep tips.

http://www.mayoclinic.com/health/sleep/HQ01387

http://www.spine-health.com/blog/sleep-and-insomnia/11-unconventional-sleep-tips-how-get-sleep-and-stay-asleep

http://www.huffingtonpost.com/christine-fee/10-natural-sleep-tips_b_273970.html

Template:FeaturedArticle

2009-12-31T17:11:45Z

Katherinefulmer:

Template:FeaturedArticle

2009-12-31T17:10:37Z

Katherinefulmer:

Q: My son needs a new mask. Must be a full face mask, as he sleeps with his mouth open. He also sleeps on his stomach. In your opinion, what would be a good mask for him?

A:

1. Mirage Quattro Full Face Mask

2. UltraMirage Full Face Mask

3. Softgel Nasal Mask

4. Sleeping Position
Try the Falcon Position of Tummy Sleeping. This position avoids airway narrowing of sleeping on your back. "By sleeping on your side, or on your stomach with your head turned off to the side, this elicits the pull of gravity to cause the soft tissues of the palate and the tongue to fall somewhat forward and away from the back of the throat, preventing them from narrowing or obstructing the airway."

[[Image:sidesleeper.jpg|400px]]

Read this article [http://www.cpaptalk.com/wiki/index.php/Mask_for_a_Stomach_Sleeper%3F here]

Template:FeaturedArticle

2009-12-31T17:08:16Z

Katherinefulmer:

Q: My son needs a new mask. Must be a full face mask, as he sleeps with his mouth open. He also sleeps on his stomach. In your opinion, what would be a good mask for him?

A:

1. Mirage Quattro Full Face Mask
2. UltraMirage Full Face Mask
3. Softgel Nasal Mask

[[Image:sidesleeper.jpg|right|thumb|200px|I like sleeping on my side.]]

Read this article [http://www.cpaptalk.com/wiki/index.php/Mask_for_a_Stomach_Sleeper%3F here]

File:Sidesleeper.jpg

2009-12-31T17:07:04Z

Katherinefulmer:

Template:FeaturedArticle

2009-12-31T17:06:11Z

Katherinefulmer:

Q: My son needs a new mask. Must be a full face mask, as he sleeps with his mouth open. He also sleeps on his stomach. In your opinion, what would be a good mask for him?

A:

1. Mirage Quattro Full Face Mask
2. UltraMirage Full Face Mask
3. Softgel Nasal Mask

[[Image:sidesleeper.jpg]]

REad this article [http://www.cpaptalk.com/wiki/index.php/Mask_for_a_Stomach_Sleeper%3F here]

Mask Leaks

2009-12-31T15:39:10Z

Katherinefulmer:

=Introduction to Leak=

Air is sucked into the CPAP machine from your room. It is drawn in through a filter, and is blown out at a controlled flow rate to provide the desired pressure. Air blown out of the CPAP machine eventually leaves the machine - tubing - interface - person system and returns to your room. There are four possible routes by which air is returned to the room:

'''(1) Intentional venting'''. Virtually all commercial CPAP interface systems are designed so that air ALWAYS blows through them. This enables the moisture-laden, oxygen depleted, and carbon dioxide-rich air which you exhale into the interface to be continually "washed out" so that it is not re-inhaled. Your exhalations become part of the venting airflow. This venting is part of the interface design, with greater volumes of air being vented at higher pressures. Most manufacturers provide information as to how much leak will occur at various pressure levels. While often referred to as "leak," this normal, intentional venting should not be confused with "unintentional" leak. Intentional venting is the only DESIRABLE way for air to return to your room.

'''(2) Seal leak'''. Virtually every interface device involves some sort of contact, a "seal," between a plastic "cushion" or "pillow" and the user's skin. Air can easily leak out through these seal contact points, particularly as the user moves around during the course of the night, or as pressure increases (as with an AutoPAP). This is the first type of "unintentional leak," which should ideally be minimized.

'''(3) Mouth leak'''. This is the second type of "unintentional leak," which also should ideally be minimized. Since the mouth and the nose are connected in the pharynx, unless a "Full Face Mask" (or other special interfaces which cover both the mouth and the nose) is used, air which enters the nose may leak out of the mouth. This can occur in several different ways (or in combinations) which may more-or-less affect the effectiveness of CPAP, and which may require different strategies for dealing with the leak:

(a) "mouth breathing," in which unpressurized room air is inhaled - and exhaled - through the mouth,

(b) "open mouth flow," in which air pressurized air entering through the nose more-or-less continually escapes through an open mouth, or

(c) "mouth exhalation," in which pressurized CPAP air which is inhaled through the nose is totally or partially exhaled through the mouth.

'''(4) A defect''' in the equipment, or equipment defectively assembled. This is always bad, and should be guarded against by frequent inspection, and periodic listening and feeling for extraneous airflow.

----

=What Harm Do Leaks Cause?=

There are three mechanisms by which unintentional leak can detract from CPAP therapy. One or more of these mechanisms may be present. None are "all or nothing" phenomena; the nature, extent and freqeuncy of leak will determine the negative effect - if any - of the leak. It may accurately be stated that, "Leak is a problem only if leak is a problem."

'''(1) Disruption of Sleep'''. Leak involves the blowing of air where air "should not" be blowing. This is usually related to seal leak, but may also be applicable to mouth leak. If air is blowing across the face or into the eyes, this is likely to arouse or awaken you from sleep. Blowing air also creates sound, ranging from rushing torrents to "musical" tones when the edges of the plastic cushion vibrate. These sounds too can arouse or awaken you, interfering with sleep.

'''(2) Drying of the Airway'''. Mouth leak has the special disadvantage of the leak taking place AFTER the pressurized air is already within the body. While all leak involves additional airflow, mouth leak produces additional airflow blowing WITHIN the nose and mouth. This often results in drying of the membranes. If the nasal membranes become dried and irritated, increased resistance to breathing may ensue, with resultant congestion. Drying of the mouth may be uncomfortable, and add to sleep disruption.

'''(3) Pressure Loss'''. This problem is sometimes overemphasized and often misunderstood. To understand it properly, a bit of physics needs to be reviewed. In a small, passive, closed, pressurized system (think of a car tire, perhaps), the pressure is always everywhere the same. If a "small" leak develops in the system, the pressure drops, though it still remains the same everywhere in the system, regardless of the site of the leak. CPAP is a "small" system, and for all practical purposes the pressure everywhere - in the tubing, in the mask, in your airway - is always instantaneously the same, regardless of where the leak originates. But CPAP is not a "passive" system. The technology works by increasing or decreasing air flow in order to maintain the target pressure the machine is trying to deliver. This is important: CPAP "uses" airflow but CPAP "works" by maintaining airway pressure. Leak is the loss of airflow, but leak does not necessarily result in a loss of pressure. Modern CPAP machines are robust, and can compensate for significant loss of airflow from leaks by increasing their output airflow. In this way they maintain their desired pressure, even in the presence of substantial leak, and regardless of the location of that leak. (Thus a "mouth leak" is not necessarily any more relevant in terms of pressure than is a "seal leak.") However, if the leak is too large, it may overwhelm the machine's ability to compensate and maintain pressure. This is arguably the most severe and important consequence of leak, though its frequency may be exaggerated. It takes a LOT of leak to result in failure of the machine's ability to maintain pressure and/or the ability of the machine's sensors to accurately detect pressure and flow information. When this happens, however, the effectiveness of CPAP therapy can be markedly compromised.

Respironics documentation summarizes the above information nicely: "System leak is a combination of intentional and unintentional air leak. Intentional leak is the expected leak at the exhalation port. Some leak is required to minimize CO2 rebreathing. Unintentional leak occurs around the patient interface. If there is a large increase in the amount of leak .... the patient may need a mask refitting. Leaks that should be fixed include leaks into the eyes, leaks that bother the patient, or leaks that affect pressure stability."

----

=How Do I Know If I'm Leaking?=

Unfortunately, we're not always aware of whether or not, or of how significantly, we may be experiencing unintentional leakage. The blowing of air, or the sound created by blowing air, doesn't always awaken us. We may not be aware of, or on awakening not remember being aware of, a dry mouth caused by mouth leak (particularly if the leak is intermittent).

Fortunately, chances are that if leak is not frequent enough or large enough to cause symptoms, it's probably not significant enough to be of concern. Still, the possibility of an unrecognized large leak, which might interfere with effective therapy, cannot be discounted entirely.

Many CPAP machines provide an audible "Leak Alert" alarm function. If given a choice, and unless there is a particular reason NOT to use it, this option should generally be turned "on."

Many ResMed (S7, S8) machines offer a "Leak Alert" which can be enabled or disabled. "When enabled, leaks > 0.7 L/s for > 20s result in an audible alert and a high leak message in the LCD. Note: when Leak Alert is enabled, SmartStart/Stop is automatically disabled." We will talk more, in a subsequent section, about what these numbers mean. For the present, we might simply note that 0.7 liters per second (equal to 42 liters per minute) is a sizeable airflow. Given that a typical adult breath moves about 500 cc of air (Tidal Volume), and that we might perhaps be taking 10 breaths per minute, the amount of air moved by normal breathing is about 5 liters per minute, or 0.08 liters per second. Thus, the machinery quite reasonably becomes concerned when leakage accounts for over eight times more air movement than is produced by our breathing. Particularly for AutoPAP machines, ResMed notes that "When the leak exceeds this level, the autotitrating algorithm ceases to perform optimally."

Again, simply to keep this number in context (pending more detailed discussion below), ResMed notes that "Generally, a leak rate of more than 0.4 L/s (24 L/min) is associated with patient discomfort, disturbed sleep, and reduced efficacy of treatment."

Many Respironics machines (M-Series) also provide a "Mask Leak Alert" feature: "Mask Leak Alert – This flashing text displays on the Active Display screen if the Mask Alert setting is enabled and the device detects an excessive mask leak. .... If this feature is enabled, then the [ ] symbol flashes on the Active display screen if a significant mask leak is detected, and an audible alert sounds." Unfortunately, available Respironics documentation does not define their criteria for "excessive" or "significant" leak.

----

=What Does My Machine Tell Me About My Leak?=

More information than simply a “high leak alarm” may be available to those with “data-capable” CPAP machines (which have been configured to display such information). Such machines typically reduce to a single number, and display this number on the machine’s LCD panel, a measure of the severity and frequency of leak over a period of machine use. Discussion is complicated by the employment of different reporting paradigms by the major CPAP machine manufacturers.

'''Units''': Respironics machines generally display leak in liters per minute (lpm or L/m), while ResMed machines generally display leak in liters per second (lps or L/s). This is not a major conceptual problem; the numbers simply differ by a factor of 60.

'''Centiles vs. Averages''': ResMed machines generally display leak as the 95th centile value. These, technically, are the HIGHEST leak values which the machine encountered during the BEST 95% of the night, “best” meaning the portion of the night with the LOWEST leaks. Put another way, ResMed divides the time during which the machine is blowing into 60-second segments, computes the median leak during each 60-seconds, ranks them from lowest to highest, and reports the highest value encountered for 95% of the night.

Admittedly, not very clear. ResMed's practical goal is to encompass, in a single number on the LCD screen, the seemingly impossible task of reflecting some sense of what leak has been like for an entire night. Is the mean or median leak helpful (software generally does display these)? These measures of “central tendency” don’t reflect how severe the leak might have been, for how long. Is the maximum leak helpful (software generally does display this)? A high maximum may have lasted for only a brief period, with low leak during most of the night. What the centile value attempts to reflect (albeit imperfectly) is HOW GOOD or HOW BAD leak was for HOW LONG.

So: with a ResMed machine, if, for example, for the past seven days, your centile leak was 0.10 l/s (or 6 l/m), you know that, overall, for 95% of therapy time, your leak was NO HIGHER than these levels. Not at all shabby. And if, for the past seven nights, your centile leak was 0.40 l/s (or 24 l/m), you know that, overall, for 95% of therapy time, your leak was NO HIGHER than these levels. Well, according at least to ResMed, that’s beginning to enter into questionable territory for some significant portions of the nights. Higher values are plausibly warning signs. An imperfect system, to be sure, but not as totally irrational and unusable as might appear at first glance. (And, regretably, this discussion is a bit of an oversimplification.)

Respironics machines, on the other hand (while reporting a very similar 90th centile leak on their software) presents on its LCD screen AVERAGE leak information (for the latest 7 and 30 days). The limitations of an "average" must be remembered: an average leak of 50 lpm may have been a leak of 40 lpm for half of each night and 60 lpm for the other half of each night - not terrible. Alternatively, that same average 50 lpm may mean a leak of 40 lpm for 3/4 of each night, and an unacceptable leak of 80 lpm for 1/4 of each night: for 2 hours out of 8, leak was excessive. Software is needed to tell which of the scenarios actually occurred.

'''Granularity''': Respironics divides time during which the machine is blowing into 30-second segments, and reports its 30-second average leak data to a precision of 7 lpm (or about 0.12 lps). ResMed reports its 60-second median leak data to a precision of 0.02 lps (or about 1.2 lpm). These differences in level of detail are reflected in the leak number displayed on the LCD panels.

'''Duration''': Respironics machines display average leak values on its LCD screen as running averages for the past 7 days or the past 30 days. ResMed machines display centile leak values on its LCD screen as medians for these same time periods (as well as for six months and one year), but also for the SINGLE most recent night. Given normal night-to-night biological variability, there is some debate as to whether information for a single night is useful (though if one tracks and records the data for each night, it is hard to deny the value of such cumulative information), or whether only when looking at data compiled over multiple nights can valid information be evaluated.

'''Gross vs. Net''': Arguably the most significant difference between the two major manufacturers has been left intentionally for last. Respironics displays as “leak” what is best conceptualized as the TOTAL AIRFLOW leaving the machine. (Remember from the introduction that all air leaving the machine eventually returns to the room, either through the interface ports as intentional “venting,” or as unintentional “leak.”) ResMed, on the other hand, asks the user to identify to the machine WHAT MASK is being used, and the processor SUBTRACTS the expected venting (at the appropriate pressure), displaying as “leak” only the UNINTENTIONAL leak. (Naturally, only ResMed masks are included, so users of non-ResMed interfaces need to select the ResMed mask which is closest in pressure/flow characteristics to the mask they are using.) This distinction makes a great difference in the interpretation of leak numbers presented by the LCD panels of the two machines.

'''The bottom line''': of this long discussion (which will carry over into the topic to follow) is that data-capable machines do make available quantified information about leak. However, how best to utilize that information, and even whether that information is valuable, interpretable and actionable, is subject to much debate. In general, any information is better than no information, but that is true only if the information is capable of being understood and evaluated in a knowledgeable and valid manner.

----

=What Does Software Tell Me About My Leak?=

While the LCD screen of a data-capable machine provides one “leak number” (the average or 95th centile, for each of several available time periods), with proprietary software a great deal of additional information about leak becomes available. While Respironics and ResMed software have some major differences, the bulk of the truly significant differences revolve around the different leak “paradigms” reviewed in the previous section. Software from either manufacturer (Encore from Respironics and ResScan from ResMed) offers the following advantages over their respective LCD displays:

'''(1) Time range selections'''. The Respironics LCD screen offers average leak information for only the past 7 days and the past 30 days, and the ResMed LCD screen offers 95th centile leak information only for the past night, the past week, month, six months and year. With either manufacturer’s software, information about any group of nights between freely-selectable start and stop dates can be reviewed. This is particularly advantageous for the Respironics user, since leak information for the past night only, which is NOT displayed on the LCD screen, is available.

'''(2) Additional statistics'''. Respironics Encore software offers (on the Sleep Therapy Long Term Trend Report), in addition to the average 90th centile leak information, the average MAXIMUM leak, the AVERAGE leak, and the average LARGE LEAK, for the selected date interval. (The time interval can be specified as a single night – the same start and stop dates – so that these statistics for a single night can be viewed.) On the single-night Daily Details report, the number of minutes, and the percent of the night spent, in LARGE LEAK, are displayed, along with AVERAGE leak. On the Therapy Data Summary, the “Average Time in Large Leak per Day” is displayed for the interval. (Each report appears to use different “rounding” rules, so the numbers are not always the same.) These parameters require some explanation. MAXIMUM leak is the highest “instantaneous” leak value encountered – it is NOT the highest 30-second time window value – so this number will not correspond with graphic displays of leak. (In fact, it must be said, this maximum leak number is quite useless.) The AVERAGE leak is clearest: it is the average of the 30-second time window leak values. LARGE LEAK is not well defined in Respironics documentation: it may be what corresponds to the trigger level for their “Mask Leak Alert” feature, or it may be a somewhat lower value. In either case, it reflects what Respironics considers to be an excessively high leak; its occurrence is displayed graphically with thick, dark “warning” lines.

ResMed ResScan software offers, in addition to the median 95th centile leak information, the MAXIMUM leak, and the MEDIAN leak, for the selected date interval. As with Respironics software, information for a single night can be viewed. Unlike the Respironics software, the maximum leak for ResMed is the maximum 60-second time window value, so it does correspond with graphically-presented information.

'''(3) Summary graphics'''. Both software packages provide graphic displays enabling an overview of the night-to-night summary leak statistics. These are set up in quite different formats, and while there may be individual preferences for one or the other, they provide by-and-large the same sorts of information. The value of these graphics is in the ability to see, visually, whether leak patterns over successive nights are increasing, decreasing, or, which is frankly most common, quite erratically variable. Still, such graphs can be useful in determining whether, over time, techniques for reducing or mitigating leak (such as those reviewed in the next section) are having the desired effect.

'''(4) Individual night graphics'''. Wisely or not, to an extent far exceeding the attention given to the offerings of CPAP monitoring software just listed, the leak graphs for individual nights are by far the major attraction for most users. And with good reason. Each 30-second or 60-second time window recording of average or median leak is displayed, for the entire night. Leak changes can be correlated with pressure changes, and (if there indeed is any correlation, which is debatable) with the occurrence of respiratory events. Brief, isolated leak event spikes can be distinguished from systematic recurrences, and generally ignored. Patterns of leak, which may be amenable to remediation, can sometimes be distinguished. Periodic “hills” of increased and decreased leak may be associated with mouth exhalation which may be more frequent during cycles of deeper sleep or dreaming. But most often, it’s simply interesting, but unactionable.

It must also be remembered, as reviewed in the preceding section, that Respironics presents “leak” as total flow – normal venting plus unintentional leak – while ResMed presents an “adjusted” leak, unintentional leak only, having already subtracted out the expected normal venting for the mask which has been selected (from among its list of ResMed masks). What each of the manufacturers nightly graphs show, therefore, is in fact somewhat different, and must be carefully interpreted.

Since Respironics Encore nightly graphs display total flow, they have a built-in “baseline” of venting. And with an AutoPAP, that baseline changes as pressure varies. This makes the interpretation of Respironics nightly graphs more complex; the interpreter must know and “mentally subtract out” the venting rate of the mask in use to view the unintentional leak. Or more often, the user simply looks at the leak line and subjectively decides (hopefully) that the variability isn’t TOO wide, suggesting that the leak is relatively stable through the night, suggesting (hopefully) that it isn’t TOO large. While as "flat" as possible a leak line is certainly desirable, it is not necessarily an essential goal. Getting a firm fix on the ABSOLUTE unintentional leak, using the Respironics nightly graph, is not a simple task. Again, more often, a user will simply decide that as long as the leak is largely under, say, 65 lpm (about 40 lpm as a working average for venting, and about 24 lpm as an “acceptable” unintentional leak), everything is probably OK. Some users consider up to 75 lpm an acceptable leak. And, probably, everything is OK. Also helpful and important is the Respironics “Large Leak” graphic indicator, a thick bar telling the user (who may have otherwise been unaware of any potential problem) that the machinery is unhappy with the extent of leak. These “Large Leak” indicators need to be taken seriously, even if we don’t know precisely what criteria are used when they are displayed. The Encore software Help File simply says, “If the chart shows leakage at the “LL” level (large leak), this is an excessive leak that will compromise therapy. This could be the result of a poor mask fitting.”

On the other hand, since Resmed ResScan nightly graphs display only net unintentional leak, the baseline leak rate could be (and ideally will be) zero. A constant, higher baseline suggests a systematic leak, likely due to a mechanical defect or an incorrectly assembled mask fixture. Not having a “Large Leak” indicator, the Resmed software places a horizontal red line at 0.40 lps (= 24 lpm), suggesting that if the leak graph exceeds that level for any significant period of time, leak may be excessive and may require remedial action.

Neither software package is consistently and markedly “better” than the other in all respects. What is important is that the user learn to understand and interpret what the software being used can and cannot, does and does not, tell you, and when, and how, to respond to the information. In any case, the software VASTLY increases the amount of information regarding leak (and other important CPAP parameters) available to the user. If you have a data-capable machine, and if the additional cost of software and associated data-transfer hardware is possible, this is a highly recommended investment.

----

=What Can (And Should) I Do About Leaking?=

OK, so you have leak. Well, we all have leak. The most important thing is to keep it in perspective. Not every leak is a PROBLEM leak. Don’t allow yourself to be bullied by the pundits who proclaim, “The first thing you need to do is to get your leak under control.” This is often the first comment of those with nothing better to say, and not enough sense to keep quiet. They usually have no objective or consistent standards on which to base their rants. Still, it is possible that they are right!

ResMed provides a good perspective for thinking about leak. Some of their machines offer a “Mask Fitting Feature” (which is a good place to start if you happen to have such a machine). They clearly indicate that leak is not simply a "good vs. bad" dichotomy, but a spectrum. Some degree of leak is quite acceptable:

Star Rating Description leak l/s leak l/m

* * * * * Excellent 0.00 - 0.18 0.0 - 10.8
* * * * _ Very good 0.19 - 0.26 10.9 - 15.9
* * * _ _ Good 0.27 - 0.34 15.7 - 20.4
* * _ _ _ Adjust mask 0.35 - 0.41 20.5 - 24.6
* _ _ _ _ Adjust mask 0.42 - 0.49 24.7 - 29.9
_ _ _ _ _ Adjust mask ≥ 0.50 ≥ 30

Practical suggestions:

The place to start is with selection of a mask. There are several different types (nasal mask, nasal pillows, full-face mask, etc.) and lots of different brands. There are few up-front criteria for making a first decision. You’ll likely be pushed one way or the other by your prescriber or distributor. Not much opportunity or basis for taking control at this point. But what you can and should insist upon is a professional FITTING. Whatever the type and brand of mask, the supplier should assure that you are getting the CORRECT SIZE mask, and that the straps are properly adjusted. Ideally, the mask should be tested with the machine running, to assure a proper fit.

Adjustment of mask straps is not a one-time event. What works well while you’re sitting up is not necessarily what will work well when you’re lying down and moving around. Strap adjustment is always a compromise between minimizing leak and maximizing comfort. Additionally, over time, with use and with washing, the length and elasticity of straps change. Set-it-and-forget-it may work for a while, but periodic readjustment of the straps will likely be necessary.

Typically, the strap lengths on right and left should be symmetrical, to provide even pressure on each side. On the other hand, few of our faces are perfectly formed, and we often have sleeping positional preferences which might make an off-center strap configuration a better choice. Similarly, a fraction of an inch higher or lower may improve a mask’s leak characteristics significantly.

Different masks may require different strap-tightening techniques. Some masks (e.g. ResMed's Activa) need to be set up very loosely - "ballooning" under air pressure provides the seal. Other masks simply have to be strapped fairly firmly. Read the instructions which come with each mask! And remember that when an adjustable angle or length between the headpad and the body of the mask is provided, experimentation to find an ideal positioning to minimize leak may well be worth the time and effort. Again, read the instructions!

Sometimes, the straps supplied with a mask may simply not be adequate. Additional supportive material (ranging from elastic bandages to panty-hose) to hold the mask in place, have been recommended and found effective.

Masks can be very durable, but they aren’t designed to last forever. Periodically check your cushions for tears, or changes in texture and flexibility which can cause increased leaking. Replace them when necessary.

Similarly, check other equipment – particularly the condition of the rubber cuffs on the ends of tubing. And when you reassemble a mask after cleaning, check that all parts fit smoothly and without leak. Some masks have been reported to have “design flaws” which result in excessive leak, which can be easily corrected with such items as Teflon plumbing tape.

Facial oils can be a factor in mask seal leak. Washing the face with soap prior to applying the mask, and/or using an alcohol wipe on the facial skin areas where the mask will be in contact, may prove helpful. Similarly, oils should be gently cleaned off the cushion in the morning after use. (Note that most mask manufacturers do NOT recommend using alcohol directly on mask parts.)

Facial hair can be a challenge in obtaining a good mask seal with minimal leak. Some masks have been reported to present less leak problems than others, with mustaches and beards. Shaving before bed may also help to obtain a better seal.

Various substances have been recommended as “gaskets” to help achieve a better seal. Procedures can be found for using Macks Silicone Ear Plugs (as well as other substances) to build a more air-tight facial seal around cushions. For users of nasal pillows, a variety of commercial products have been suggested for reducing leak as well as enhancing comfort.

Some CPAP users find that “special” pillows, with unique shapes or custom filling material, prevent displacement of their masks and consequent leakage. Others find that a conventional pillow “stabilizes” a mask against their face, preventing leak.

The most effective method of dealing with mouth leak is switching to a full-face mask, which encompasses both the nose and mouth inside the mask. With no pressure differential between mouth and nose, there's no added stimulus to exhale through the mouth. Most importantly, airflow through the mouth (while it still may result in dryness) does not impact the effectiveness of CPAP therapy on sleep apnea. However, there is a price to pay. The much larger cushion needed to surround both the mouth and nose greatly increases the area of skin contact, and thus increases the potential for seal leak. And there are sometimes comfort issues: straps often need to be tighter, irritation of the nasal bridge can become a concern, the masks are often larger and heavier, and covering both the mouth and nose is psychologically uncomfortable for some people. Still, a full-face mask is the "gold standard" solution to mouth leak problems.

Other methods of dealing with mouth leak are widely debated. Many commercial “chin straps” or home-made devices will reportedly help hold the jaw in place so that the mouth does not fall open. Reports of effectiveness of chin straps are mixed. Many varieties of tape, and different taping techniques, have been recommended to hold the lips closed. That lip-taping will reduce or eliminate mouth leak is clear. The absolute safety of this practice is less clear, though the theoretical dangers involved tend to be greatly overstated. There are also indications that for some individuals, lip-taping may paradoxically worsen the efficacy of CPAP therapy. “Training” for the tongue to reduce leak has been suggested, though there is precious little good published science available in this area.

Additional details about the suggestions mentioned above for dealing with leak will be easily found by suitable searches of the forum archives at cpaptalk dot com.

In conclusion, remember that leak is not a problem unless it is a problem. Otherwise, it’s just another four-letter word.

--[[User:Velbor|Velbor]] 16:24, 10 November 2009 (UTC)

--[[User:Velbor|Velbor]] 23:53, 19 November 2009 (UTC) edited by Velbor

----

= Mouth Breathing and Mouth Leaks =

'''Mouth breathing''' and '''mouth leaks''' are closely related, but not necessarily the same thing.

Mouth breathing must occur when the nasal passages are blocked, so the only way for any air to get into the lungs is through the mouth. People with blocked noses breathe through their mouth, not through their nose. The solution to mouth breathing is to use a full face mask. Some effort and time may be required to find the best full face mask, fit it, and adjust to it. Use of nasal irrigation and humidified CPAP, especially with nasal pillows, may open nasal passages that were previously chronically blocked. The person can then learn to breathe through the nose.

Mouth leaks may occur if the person is breathing through their nose, but opens their mouth during sleep. If leakage through the mouth is a persistent problem, CPAP treatment can be rendered completely ineffective. CPAP air detouring out the mouth does nothing to keep the airway open. Either mouth breathing or mouth leakage can also cause feelings of suffocation from apneas still happening and/or just the choking feeling of air rushing out the mouth unexpectedly. The safest solution to mouth leakage is to use a full face mask.

http://www.cpaptalk.com/viewtopic/t23863/Why-dont-more-people-use-a-full-face-mask.html

Other remedies including using a homemade or commercial chinstrap in hopes that the tongue will maintain an airtight seal inside the mouth if the jaw is kept up. Many people find that chinstraps don’t work to prevent mouth leakage.

Another remedy is to use the tongue to maintain an airtight seal inside the mouth. Some people train the tongue by positioning the tip of the tongue behind the upper front teeth or on the roof of the mouth, and let the tongue spread out in back to seal the throat air passage, even if the lips open. Others use a dental splint, custom made by a dentist, or a do-it-yourself mouth guard to help the tongue maintain an airtight seal.

“The safety of taping the mouth shut has not been proven and there are potential risks of regurgitation and aspiration of food and of suffocation.” TS Johnson MD et al, Sleep Apnea – The Phantom of the Night, p. 167. Mouth taping is especially dangerous for anyone who ever gets blocked nasal passages during the night. If air can’t get in through the nose, it needs to get in through the mouth. Mouth taping is also risky in case of a hose disconnect or power outage.

= Warning against mouth leakage =
Whether you use a nasal mask or nasal pillows (or any other kind of mask except a full face), if air leaks out through your mouth, the PAP therapy will not work. There are two safe options. The first is to learn to keep your mouth closed while sleeping. Since the feel of pressurized air exiting your mouth is an unpleasant sensation, PAP aids in this. Some people position the tongue behind the top teeth and let it spread out in back to cover the throat opening and make a seal so the PAP works. The second option is to use a full face mask. If you are a mouth breather, breathing in through your mouth instead of your nose, a full face mask is required. An alternative practice for mouth leaks, mouth taping or sealing, is understandable but not advisable, and is not safe if your nose gets stuffy at night, you have acid reflux, need to regurgitate; or you have a hose disconnect or lose machine power and need to breathe through your mouth.

See also [[Mask Leaks Blow onto Partner]]

----
Comment added by --[[User:Velbor|Velbor]] 21:57, 22 November 2009 (UTC) :
The above statement that "if air leaks out through your mouth, the PAP therapy will not work" is far to rigid. As described in the "Introduction to Leak" segment of this article, there are different types and severities of mouth leak. The following tracing (total time 7:09) involving use of a ResMed Activa nasal mask

[[Image:Velbor_Mouth_Exhalation.jpg]]

provides an example of an acceptable pattern of oral exhalation, sometimes referred to as "lip flutter" or "lip puffing", in which the jaw remains closed but the lips open with each exhalation as if blowing a bubble. AutoPAP is set at 10 - 20cm, with median pressure 10.8, 95% pressure 11.4, and maximum pressure 11.8. Note the periodicity of the leak and the return to zero baseline between episodes. This is presumably related to the cyclic variation in sleep stage or depth affecting orofacial musculature; note the latency after each brief arising before these patterns begin. Median leak for the night is 0.00 lps!! Seal leak is negligible. While maximum leak is 0.54 lps, above the "red line", the 95% leak is 0.38 lps, which indicates that the time spent above the 0.40 lps "alert" level is LESS THAN 5% of the night. Efficacy of treatment is excellent (particularly by ResMed standards): AHI = 5.3, AI = 0.0 and HI = 5.3 . While mouth leak is never desirable, care must be taken to avoid arbitrarily labeling it as terrible.
----

[[Category:Treatment]]

Heated hoses

2009-12-31T15:37:32Z

Katherinefulmer:

==Aussie Heated Hose==
 "Sleepzone heated cpap tube" can be found at www.sleepzone.com.au

Also carried by a U.S. online dealer:
http://www.cpapusa.com/item.php?productcode=SZ4IA-AU

Many have found a warm hose to be the best solution to prevent [[Rainout]] - condensation due to [http://www.cpaptalk.com/wiki/index.php/Heated_Humidifier heated humidifier] air cooling off during the trip through the cold plastic of the main air hose; the condensation then dripping on the face or gurgling inside a main air hose.

==Zoo Med Repti Heat Cable==
 An affordable idea from p2pjunkie:

I've been looking at the Aussie heated hose, but $139 seemed offensive. I finally found the perfect affordable solution. The Zoo Med Repti heat cable (as in reptile). The cable is a super flexible silicone, it's light weight, and it has just the right amount of warmth (15watts) the same as the Aussie.

Their shortest cable is just about perfect for CPAP. It's 11.5ft long, but only 5 ft. of it is heated (I would have preferred 6ft, but close enough). The rest is just cord to run to an outlet.

As for safety, I figure if it's safe enough for an iguana to walk on it should be safe enough for me to sleep with. Just slip it into a hose cover, a wire tie on the rubber part of the hose and your good to go. Cost $9 on eBay plus $8 for shipping (shipping fees are also offensive)

I will definitely buy another iquana cable after we get the insurance money to rebuild the house which was burned down when I left for work and failed to unplug the cable.

[[Category:Treatment]]

Depression and OSA

2009-12-31T15:24:13Z

Katherinefulmer: /* Other contributors to Depression */

'''People with depression are five times more likely to have a breathing-related sleep disorder''', according to a Standford University Study.

CPAPtalk member DSM suggests that the connection between OSA and depression is cyclical:

1.OSA/CA => 2.Decline in well being* => 3. depression => 4. sluggishness & lack of will to exercise => 5. increase in weight => 6. worse OSA/CA => go to 3.

note: *Stage 2 can be understood further as OSA related arousals occasion a release of cortisol. Chronic elevated cortisol is thought to be the main culprit that causes the brain damage (you might call it) which eventuates in mood and anxiety disorders across the board. -brain_cloud

=Other Sleep Disorders Connection to Depression=

[[Restless Leg Syndrome]] (RLS) is in some part caused by a dopamine deficiency. Dopamine is a neurotransmitter that is essential for the healthy functioning of the central nervous system; it has effects on emotion, perception and movement. A lack of dopamine can correlate to depression.

=Other contributors to Depression=
==Vitamin D Deficiency==

by KatherineFulmer

Vitamin D helps you process Calcium, or maybe it's the other way around. Either way, if you're deficient in one, you're probably deficient in the other. That means you're depressed and you have back pain!

I take Calcium daily fortified with Vitamin D. That way they work hand in hand. Also, you can treat yourself to these yummies to up your Vitamin D when the sun don't shine:

* Fish liver oils, such as cod liver oil, 1 Tbs. (15 ml) provides 1,360 IU (one IU equals 25 ng)- I recommend taking this in pill form. Take daily. To avoid fishy burps, put the jar of pills in the freezer. Don't know why, but it works like a charm.
* Fatty fish species, such as:
>o Herring, 85 g (3 ounces (oz)) provides 1383 IU
>o Catfish, 85 g (3 oz) provides 425 IU
>o Salmon, cooked, 100 g (3.5 oz]) provides 360 IU
>o Mackerel, cooked, 100 g (3.5 oz]), 345 IU
>o Sardines, canned in oil, drained, 50 g (1.75 oz), 250 IU
>o Tuna, canned in oil, 85 g (3 oz), 200 IU
>o Eel, cooked, 100 g (3.5 oz), 200 IU
* A whole egg, provides 20 IU
* Beef liver, cooked, 100 g (3.5 oz), provides 15 IU
* UV-irradiated mushrooms (Vitamin D2)[28][29]

CPAP FAQs

2009-12-28T22:59:00Z

Katherinefulmer: /* How Do I dry CPAP Hoses after cleaning? */

{{stub}}
[[Image:Question mark.jpg|right|thumb|200px|CPAP FAQs]]
In case you are looking for them, '''here are the [[Help:FAQs|Wiki FAQs]]''' which discuss how to use the CPAPtalk.com CPAP Wiki.
----
This is a list of '''CPAP FAQs'''. It is a great place to get started, especially if you are a new [[CPAP]] user. You are free to add common questions and answers here, regarding the use of an [[xPAP]] machine, or Obstructive Sleep Apnea. Answers should preferably be short in nature and link to more detailed articles in the [[CpapWiki:About|CPAPtalk.com CPAP Wiki]], if necessary.

=Selecting Equipment=
==Insurance==
=== What are the insurance billing codes for my CPAP equipment? ===

=Common CPAP Side Effects=
==Why is air leaking from my mouth?==

Air leaks from the mouth whenever the mouth is opened during CPAP therapy. This occurs for many reasons, but a very common one is due to nasal irritation from the CPAP airflow.

The correlation to a lack of humidification and mouth leaks is a topic being heavily researched. Studies are now being conducted on the hypothesis that a large amount of mouth leakage is caused by the following cycle:

1. CPAP therapy is used with ineffective or no humidification.
2. The nasal membranes are unable to adequately condition the increased airflow and after a few minutes the
airway and nasal passages become dry.
3. To remedy the dryness and obtain moisture, the body uses the mouth to breathe.
4. CPAP air follows the path of least resistance and leaks out of the open mouth.
5. The air leaking through the mouth causes more dryness.
6. Patient wakes up feeling tired with significant dryness in mouth and dry, swollen nasal passages.

The answer to this cycle is humidification. If the mouth continues to open during sleep, a chinstrap may be needed to hold the jaw up so that the mouth can close. If mouth breathing continues, a [[Full Face Mask]] that covers the nose and mouth is indicated.

[[Mask Leaks]]

===How do I stop these leaks?===
Wet your skin== '''Mask leaks''' (IPAP = 19) solved by wetting skin and mask seal just before donning; makes it seal better (Leak = 0). - rogelah

'''Mouth Leaks'''

When using nasal masks; e.g. Swift For Her, ......

Some nasal mask users need a seal over the mouth.

One form of seal is 3M Blue painter's 2" tape, or you can use (other brand tape).

Rip off a piece of tape about 3 1/2" long and place over mouth. If 3M tape is not staying stuck on skin, if tape user is waking up in the middle of the night with the tape loose and wet, it may be air puffing out between lips (blowfishing) causing warm air condensation under the tape or drooling.

To prevent this, in addition to the tape, there are numerous options; some of them are: Purse, pucker or fold lips under the tape, place Poligrip Strips between lips, or .......

To use the Poligrip Strips, bend each one so it fits the curve of the lip line, place each strip onto wet bottom lip. Then, wet the top of the strip and top lips, close lips. EASY to take off with a tissue in the a.m. There is no taste to the Poligrip Strips due to the fact that they sit on lips and do not ooze into mouth or touch tongue like polident paste would.

[[Mask Leaks]]

===Supplies===
Teflon tape

Moleskin

==Additional Problems==

[http://www.cpaptalk.com/wiki/index.php/Category:Common_Problems Bruxism, Aerophagia, Rainout Oh My!]

===Mask Fit Problems===
[[I Remove My Mask in my Sleep]]

[[Claustrophobia]]

[[Pain on the Bridge of the Nose]]

[[Mask Leaks Blow onto Partner]]

For the complete list of CPAP side effects see [https://www.cpap.com/cpap-faq/Common-CPAP-Side-Effects.html#FGID-158 CPAP.com List of CPAP Side Effects]

=Common Equipment Problems=

==Which masks work with beards?==
CPAPtalk.com Forum Members weigh in:

1. '''Full Face Masks'''

'I too have a full beard and although I normally use a [http://www.cpaptalk.com/wiki/index.php/CPAP_Mask#Nasal_pillows_masks nasal pillows mask], this past weekend I got a great seal using the Liberty. I think using a chin strap to keep the lower FF mask strap from pulling the lower jaw open helps a lot ... Try Sleep Guy's [https://www.cpap.com/productpage/pursleep-cpap-chinstrap-cotton.html PAP-Cap].' - Fuzzy Guest

'Full beard, [https://www.cpap.com/productpage/resmed-mirage-quattro-full-face-mask-headgear.html ResMed Mirage Quattro].' - Bigburd
Two fully bearded CPAP users participated in the Product Challenge 11 FullLife Full Face Mask vs. Mirage Quattro Mask. Both chose the [[ResMed Mirage Quattro]]. Their reveiws can be read here: [https://www.cpap.com/productpage/resmed-mirage-quattro-full-face-mask-headgear.html PC11]

'''Lanolin tip'''
A bit of lanolin in the beard where the seal contacts it and my leak line goes flat. It washes out easily with soap and water in the morning. - Silver Pelt

2. '''Nasal Pillow Mask'''

'When I went for my sleep study I had a full beard. The tech, who was great, started with a nasal pillow, but I hated it. We then spent hours trying to get a nasal or full mask to provide a good seal. Nada. He then said give the [https://www.cpap.com/simple-find-cpap-products/cpap-masks/cpap-masks/nasal-pillow.html nasal pillow] another chance. I did and fell asleep. I hated it during the first two weeks of use, but sometime during the third week I realized that it didn't bother me any longer. You might want to try a naal pillow and see if you can adjust to it. For me, it was that or shaving.'- norm

3. [[Nasal Aire II]]

'Contemplate the [https://www.cpap.com/productpage/innomed-nasal-aire-ii-all-size-kit.html Nasal Aire II] and a chinstrap. I've got a few friends with beards who are getting good results with it. Just had a satisfied customer leave my house in fact. Cute little beard and mustache, very happy with his NAII and PAP-CAP from http://www.pur-sleep.com.

4. '''Profile Lite'''

'I have a full, bushy beard and moustache and get a good seal using the Respironics [https://www.cpap.com/productpage/profile-lite-gel-mask-respironics.html Profile Lite] mask.' -Ladd

==Replacement==
=== How often should I replace my mask? ===
* Many masks have replaceable cushions, pillows, or other parts. Typically, a mask cushion should be replaced at least once every six to nine months. If your mask does not have a replaceable cushion, you may need to buy a whole new mask.
=== How often should I replace my headgear? ===
* It depends. Sure signs your headgear needs to be replaced are leaks, having to over tighten the headgear, elasticity is gone, etc.
=== When should I change the filters on my xPAP machine? ===
* Fine Filters should be replaced approximately every 30 days, or as necessary. If you can visibly see some dirt or dust on the fine filter then it is time to change it.

=Cleaning=
=== How do I clean my mask and hose? ===
* There are many methods available. Most manufacturers of CPAP Masks include cleaning instructions in the package with the mask. Baby shampoo or ivory bar soap is often used.
===How do I clean my humidifier?===
Use distilled water to clean your humidifier. Only use tap water if you intend to clean it daily. This avoids mineral deposits.

CPAPtalk member Bluebonnet_Gal says: Have you tried soaking it in water that has a little bleach mixed in. Bleach should kill any mold. My DME recommends cleaning my mask and hose in bleach water. I personally don't think it's a good idea to use bleach on something that I strap to my face every night, so I use vinegar to disinfect, but on a one time basis, I don't think it will do any harm. Be sure to rinse well, repeatedly, after soaking in bleach.

===How Do I dry CPAP Hoses after cleaning?===
Cleaning Tubes or Hoses requires warm soapy water.
To dry hoses, try these techniques:

1. Spin Dry 
tatooyu says: I spin the tube gently, a la Mick Dundee in Crocodile Dundee II when he was making his aboriginal "phone call" using a bullroarer. That way, the centripetal force pulls the water to the outside of the tube. Seems to work pretty well.

2. "Pipe Cleaners" 
6ptstar says: I use a nylon string with a fishing weight tied to it to drop it through the hose. Put a loop on the other end and put a couple of strips of fake camos I bought to clean my car windshield and pull it through. Gets it almost dry so in a couple of hours it finishes drying. I would thing you could use strips of a paper towel or pieces of a regular towel and it would work as well.

3. Hair Dryer 
6ptstar says: One time I did duck tape a hose connector to my wife's old hair dryer and hooked the hose up to the connector and turned the hair dryer on low. It dried it in no time. The string thing just seems easier but I don't wash it that often.

4. Let it Be 
Catnapper says: '''NEVER use paper towels'''. You want to be careful not to leave lint in the hose. You don't want lint in your lungs, right?

Unless there is lots of water, just leave it alone. You are going to send moist air through the hose anyway.

5. Rotate Hoses 
Fishhead says: bought a second hose so i could rotate them each day, doubling my drying time.

5. Place the hose in a freezer for a couple of hours. The droplets will freeze and fall off the hose surface when you flex it from the outside.
If you want to wash your hose... the best is to have a spare hose that can be used while waiting for the other to dry. In fact, having a spare hose is a good idea anyways.

== If I lose weight can I get off the CPAP? ==
Everyone is different and has a different take on this question. It is almost always true that an improved diet and level of activity is beneficial to your health.

Read Diet and excercise tips on the [Sleep Tips] page. Also explore other's experiences on relevant CPAPtalk posts here:

[http://www.cpaptalk.com/viewtopic/t37928/viewtopic.php?f=1&t=46353&p=416760&hilit=weight+CPAP#p416760 Weight Loss Surgery and CPAP]

=== Are surgeries for Obstructive Sleep Apnea effective? ===
=== Do dental devices for snoring or Sleep Apnea actually work? ===
=Miscellaneous Questions=
==Alcohol & CPAP: Bad idea?==
CPAPtalk.com member Mars says: 
Generally speaking, alcohol is a dangerous drug, and if it had just appeared in the last 20-30 years it would very likely be made illegal.

If you want to be on the safe side, I would suggest no drinking whilst you are awake, and so you will avoid all problems concerning alcohol, except those caused by others. :) :(

Otherwise, work out what a safe blood alcohol level would be for you, get an instrument for measuring blood alcohol, and keep below your safe level.

A safe level is where you metabolize the alcohol before it reaches the brain.

Alternatively, go a week with your normal drinking, and a week with no drinking, and compare the results.

Having both - an alcohol damaged brain and a sleep apnea damaged brain - I personally would tend to give what is left up there every chance of recovery.

Good luck.

PS An interesting moral/ political/ scientific arguement is currently going on in the UK

http://news.bbc.co.uk/2/hi/health/8342454.stm

Pain on the Bridge of the Nose

2009-12-28T21:24:01Z

Katherinefulmer: /* Try Using Tape or a plastic Bandage */

edited by CPAPtalk.com member Rooster and Goose

Pain or Irritation on the bridge of the nose is a common problem caused by CPAP Masks. Here are solutions other users have found:

==Get a different Mask==
The Hybrid and Liberty are two full face masks that do not touch the nose bridge so they solve the problem. I prefer the Hybrid and it comes with three sizes of nasal pillows and mouth cushions, so fitting is easy. - Rooster

Eventually I, too, switched to the hybrid-style masks. The Innomed Hybrid is my curent fave, but I seem to switch off with the Liberty on a regular basis. The Liberty leaks a bit more and is less comfortable, but gives me lower AHIs.- Link C.

I '''alternate masks every other day'''. UMFF one day and Soyala FFM the next. -track

==Get a different headgear==
PapCap II. It not only has a chin strap built in - but replaces the headgear of your mask. I have no more marks or sores on the bridge of my nose.
I have always used a resmed mirage activa - but was able to try the micro nasal mask from resmed with the PapCap II which is my favorite mask now because of the small size of it. Before using the papcap II, not only did I have sores on my nose, but it leaked like crazy.- sleepyred

==Modify your Mask==
I got SOME relief using '''moleskin''' on the upper nose seal of various FFs. I also got a [https://www.cpap.com/productpage/pad-a-cheek-cpap-mask-cover.html '''padacheek'''] "flap" made just for that purpose for my ComfortGel FF. Worked better than the moleskin with far less hassle.

I use a full face mask with a gasket made of thin knit well washed 100% cotton that I cut myself into shape.- blackspinner

I put a piece of cloth medical tape (same stuff I tape my mouth with) and it worked too. It wasn't quite as comfortable as the moleskin but I had no redness in the morning. Fold in (dog ear) the top 2 corners of the tape to make room for your eyes and to give something to grab to take it off in the morning.- nomoore

==Toughen Up==
For me, after about 2-3 weeks the bridge of my nose toughened up and it's no longer really an issue. So yeah, my personal solution? Give it time. -Mattman

==Adjust the Mask==
I started out with a ComfortFull, it promptly wore a hole in the bridge of my nose. I used a bandage to let it heal, after it healed the skin got tougher. Also I learned better how to adjust the top "T" Bar, and that I didn't have to keep it as tight too work. Jim

Getting the mask you use to sit flat on your face, and then adjust the straps evenly to hold it flat, "Not Too Tight Please"! I also after I get the mask on and the XPAP started, pull the mask forward on your face until the seal breaks then set it back down.- Goofproof

Your mask should not need to be cranked down tight to obtain a seal. Most masks will seal well with loose headgear. Use the headgear to hold the mask in place, but let the silicone membrane do what it's designed to do but it needs the space to inflate so it will seal against your face.- goose

==Sleep Comfort Care Pad==
This is a mask accessory that is placed between the mask and the bridge of the nose for protection from irritation. Description and image of the accessory can be found at https://www.cpap.com/productpage/sequal-technologies-sleep-comfort-care-pad.html.
- Rooster

I used a large Comfort Care Pad for the first time with my Quattro last night. No problems.

When I took my mask off for a bathroom break in the middle of the night the device stayed in place and I did not have to reposition it.

The lite mineral smell is certainly not offensive or bothersome, and no, you can't wash it out. If you think you can't handle a lite mineral smell, don't buy it.

The product is simple to clean with the alcohol prep-pads that I use to clean my mask.

Second night:

Same larger mask. Comfort Pad covering same spot on bridge.

No redness
.
No soreness.

Product works as advertised

Thumbs up.

- Banned

----

== Try Using Tape or a plastic Bandage ==

I've used plastic bandages for temporary relief or for healing a sore, but for the last couple of months I've been using [http://www.3m.com/Product/information/Transpore-Surgical-Tape.html 3M Transpore] surgical tape on my nose bridge . A web search for "3M Transpore tape" will show you lots of links some with pictures so you an see what it looks like. I found it in a local pharmacy in the bandages area. It is a dimpled tape with pores, it has a soft rough surface and is opaque (would be clear if not for the dimple pores) and it's very comfortable to wear. I've even forgotten about it on occassion. It can be purchased on a tear off applicator at a premium price, or just by the plain roll for a lot less and as it tears so easily, no applicator appliance is needed, nor are scissors and yet it's very tough otherwise.

My full face mask has no problem sealing on the tape. This seems to keep the pressure off my nose and so no soreness or redness from the mask. It is very inexpensive, it has a great adhesive, a small piece can be used for several nights before it becomes a bit too gummy on both sides and a new piece is needed. I've never had a piece come off due to moisture from within the mask or from skin sweating.

I use it every night now to not only relieve the mask pressure a bit more for a tighter seal when needed but if there is any redness it is very mild for me and goes away quite quickly. No more putting on make up over the red patch in the morning.

----

Pain on the Bridge of the Nose

2009-12-28T21:23:49Z

Katherinefulmer: /* Try Using Tape or a plastic Bandage */

edited by CPAPtalk.com member Rooster and Goose

Pain or Irritation on the bridge of the nose is a common problem caused by CPAP Masks. Here are solutions other users have found:

==Get a different Mask==
The Hybrid and Liberty are two full face masks that do not touch the nose bridge so they solve the problem. I prefer the Hybrid and it comes with three sizes of nasal pillows and mouth cushions, so fitting is easy. - Rooster

Eventually I, too, switched to the hybrid-style masks. The Innomed Hybrid is my curent fave, but I seem to switch off with the Liberty on a regular basis. The Liberty leaks a bit more and is less comfortable, but gives me lower AHIs.- Link C.

I '''alternate masks every other day'''. UMFF one day and Soyala FFM the next. -track

==Get a different headgear==
PapCap II. It not only has a chin strap built in - but replaces the headgear of your mask. I have no more marks or sores on the bridge of my nose.
I have always used a resmed mirage activa - but was able to try the micro nasal mask from resmed with the PapCap II which is my favorite mask now because of the small size of it. Before using the papcap II, not only did I have sores on my nose, but it leaked like crazy.- sleepyred

==Modify your Mask==
I got SOME relief using '''moleskin''' on the upper nose seal of various FFs. I also got a [https://www.cpap.com/productpage/pad-a-cheek-cpap-mask-cover.html '''padacheek'''] "flap" made just for that purpose for my ComfortGel FF. Worked better than the moleskin with far less hassle.

I use a full face mask with a gasket made of thin knit well washed 100% cotton that I cut myself into shape.- blackspinner

I put a piece of cloth medical tape (same stuff I tape my mouth with) and it worked too. It wasn't quite as comfortable as the moleskin but I had no redness in the morning. Fold in (dog ear) the top 2 corners of the tape to make room for your eyes and to give something to grab to take it off in the morning.- nomoore

==Toughen Up==
For me, after about 2-3 weeks the bridge of my nose toughened up and it's no longer really an issue. So yeah, my personal solution? Give it time. -Mattman

==Adjust the Mask==
I started out with a ComfortFull, it promptly wore a hole in the bridge of my nose. I used a bandage to let it heal, after it healed the skin got tougher. Also I learned better how to adjust the top "T" Bar, and that I didn't have to keep it as tight too work. Jim

Getting the mask you use to sit flat on your face, and then adjust the straps evenly to hold it flat, "Not Too Tight Please"! I also after I get the mask on and the XPAP started, pull the mask forward on your face until the seal breaks then set it back down.- Goofproof

Your mask should not need to be cranked down tight to obtain a seal. Most masks will seal well with loose headgear. Use the headgear to hold the mask in place, but let the silicone membrane do what it's designed to do but it needs the space to inflate so it will seal against your face.- goose

==Sleep Comfort Care Pad==
This is a mask accessory that is placed between the mask and the bridge of the nose for protection from irritation. Description and image of the accessory can be found at https://www.cpap.com/productpage/sequal-technologies-sleep-comfort-care-pad.html.
- Rooster

I used a large Comfort Care Pad for the first time with my Quattro last night. No problems.

When I took my mask off for a bathroom break in the middle of the night the device stayed in place and I did not have to reposition it.

The lite mineral smell is certainly not offensive or bothersome, and no, you can't wash it out. If you think you can't handle a lite mineral smell, don't buy it.

The product is simple to clean with the alcohol prep-pads that I use to clean my mask.

Second night:

Same larger mask. Comfort Pad covering same spot on bridge.

No redness
.
No soreness.

Product works as advertised

Thumbs up.

- Banned

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== Try Using Tape or a plastic Bandage ==

I've used plastic bandages for temporary relief or for healing a sore, but for the last couple of months I've been using [[http://www.3m.com/Product/information/Transpore-Surgical-Tape.html 3M Transpore] surgical tape on my nose bridge . A web search for "3M Transpore tape" will show you lots of links some with pictures so you an see what it looks like. I found it in a local pharmacy in the bandages area. It is a dimpled tape with pores, it has a soft rough surface and is opaque (would be clear if not for the dimple pores) and it's very comfortable to wear. I've even forgotten about it on occassion. It can be purchased on a tear off applicator at a premium price, or just by the plain roll for a lot less and as it tears so easily, no applicator appliance is needed, nor are scissors and yet it's very tough otherwise.

My full face mask has no problem sealing on the tape. This seems to keep the pressure off my nose and so no soreness or redness from the mask. It is very inexpensive, it has a great adhesive, a small piece can be used for several nights before it becomes a bit too gummy on both sides and a new piece is needed. I've never had a piece come off due to moisture from within the mask or from skin sweating.

I use it every night now to not only relieve the mask pressure a bit more for a tighter seal when needed but if there is any redness it is very mild for me and goes away quite quickly. No more putting on make up over the red patch in the morning.

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Partners and CPAP

2009-12-28T17:46:30Z

Katherinefulmer: /* CPAPtalk links */

==Single CPAP users and Partners==
[[Image:Sleeping_together.jpg‎|right|thumb|200px|Approach Treatment Together]]
[http://www.cpaptalk.com/viewtopic.php?f=1&t=16860&st=0&sk=t&sd=a Why tell your partner about CPAP treatment?]

==Partnered CPAP Users==
===What will CPAP do to our Sex Life?===
by CPAPtalk member Froro

I'm going to answer this as a 40 year old who still feels like she is in her 20's and her old self again since starting CPAP.

When I got diagnosed this last year it was like I was hit in the stomach. My foggy brain could not wrap my head around it. I didn't sleep much but when I did sleep, I felt it was reasonably restful. (I have severe OSA) Regardless of this, I was in denial and I was angry. I searched for a "surgical cure", hellbent that I would not live my life attached to a hose and a machine.

Things that went through my brain. (some rational, some not, but all valid as that is what I FELT at the time)

I've lasted this long without it, who needs it, really?
My husband is going to think I'm ugly
Our sex life is going to take a nose dive (not that it already hadn't because I was so tired all the time)
What about my freedom and spontaneity? What if I feel like taking off for a weekend? Travel? who wants to travel with this.
My husband is going to think I'm ugly
I'm no longer going to be attractive
My husband is going to think I'm ugly
What if my husband dies, how will I attract a new partner with this thing attached to my face at night? (I said not all my thoughts were rational)
I'm no longer going to be attractive.

Catching a theme here? Yes it is vain, yes it is selfish and childish, but they were still real feelings. So much of my self worth has been based on image and appearance that it was a natural place to go. It took me years and years to be comfortable in my appearance and be proud of how I looked. When you get to that point after spending half your life thinking your ugly, it doesn't take much to knock you back down.

Funny thing happened. The more I researched the more I realized there was no cure. I voiced my concern to my husband about feeling ugly and feeling like he would leave me because of that. While he said it would never change how he felt, I still had my doubts.

Then the machine came in. Know what happened? I slept for the first time in at least two decades. I slept for a month. I feel 20 years younger, and I'm back to me again. I have more energy to do the million things I need to do in a day, and I don't drop into bed at night.
Our sex life not only did not suffer, It improved significantly. No planning for intimacy. It just happens, whether I'm masked up or not. We talk more than we ever have. I usually am awake longer than he is so when the conversation dies down and he is drifting, I put on the mask then. I've learned how to talk with the mask on (a little bit, it's weird but I can do it).

All those irrational fears I had and all the silliness in my own head around being attractive/ugly, etc was put to rest.

Reality is. If your partner loves you (for all the right reasons and not just the exterior shell), nothing is going to change the way they feel.

While I'm still not enamoured with the thought of living the rest of my life with this thing attached to my face at night, it's no biggie if I am. The real me is back, and stronger than ever. That person my husband fell in love with nearly 20 years ago is back. Not grumpy, not tired. Looking back I'm shocked he has put up with me the last few years I've been so miserable.

==Quiet Equipment==

'''IntelliPAP Auto Adjust CPAP Machine''' wins [http://intellipap-aflex-auto.cpaptalk.com/ Product Challenge 8] against the M Series Auto with AFLEX due to its quietness. The result of the Product Challenge proves the noise level of the machine makes a tremendous difference in the effectiveness of CPAP treatment. Product Challenge participants had this to say about the [https://www.cpap.com/cpap-machine/devilbiss-intellipap-auto-adjust-cpap-machine.html IntelliPAP Auto Adjust]:

"By far the quietest of any machine I've ever used, the intellipap is barely audible. This is a great machine for anyone whose sleeping companion complains about the sound the machine makes. My partner didnt even know the machine was on the first night." - Marc K.

"VERY quiet operation. Surprising how much of a difference this makes for a comfortable sleeping environment." - Philip B.

"This is an extremely quiet machine. You definitely wouldn't be keeping someone awake." - Margaret W.

==CPAPtalk links==
[http://www.cpaptalk.com/viewtopic/t47694/trouble-with-sleeping-with-partner.html Trouble Sleeping with Partner]

[http://www.cpaptalk.com/viewtopic.php?f=1&t=46805&st=0&sk=t&sd=a#p420900 Husband is not supportive of CPAP Use]

[http://www.cpaptalk.com/viewtopic/t47783/My-gf-and-I-need-help-using-my-cpap-device.html My girlfriend and I need help using my CPAP device]

Pain on the Bridge of the Nose

2009-12-28T17:23:28Z

Katherinefulmer:

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2009-12-28T17:20:57Z

Katherinefulmer:

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2009-12-28T17:20:18Z

Katherinefulmer:

'''Pain or Irritation on the bridge of the nose'''

edited by CPAPtalk.com members Rooster and Goose

[[Image:Painfulnosebridge.jpg|right|thumb|200px]]

Pain or Irritation on the bridge of the nose is a common problem caused by CPAP Masks. Here are solutions other users have found:

The Hybrid and Liberty are two full face masks that do not touch the nose bridge so they solve the problem. I prefer the Hybrid and it comes with three sizes of nasal pillows and mouth cushions, so fitting is easy. - Rooster

Eventually I, too, switched to the hybrid-style masks. The Innomed Hybrid is my curent fave, but I seem to switch off with the Liberty on a regular basis. The Liberty leaks a bit more and is less comfortable, but gives me lower AHIs.- Link C.

Read the full article [http://www.cpaptalk.com/wiki/index.php/Pain_on_the_Bridge_of_the_Nose here].

Template:FeaturedArticle

2009-12-28T17:19:55Z

Katherinefulmer:

Template:FeaturedArticle

2009-12-28T17:19:32Z

Katherinefulmer:

'''Pain or Irritation on the bridge of the nose'''

edited by CPAPtalk.com members Rooster and Goose

[[Image:Painfulnosebridge.jpg|right|thumb|200px]]

Pain or Irritation on the bridge of the nose is a common problem caused by CPAP Masks. Here are solutions other users have found:

The Hybrid and Liberty are two full face masks that do not touch the nose bridge so they solve the problem. I prefer the Hybrid and it comes with three sizes of nasal pillows and mouth cushions, so fitting is easy. - Rooster

Eventually I, too, switched to the hybrid-style masks. The Innomed Hybrid is my curent fave, but I seem to switch off with the Liberty on a regular basis. The Liberty leaks a bit more and is less comfortable, but gives me lower AHIs.- Link C.

I '''alternate masks every other day'''. UMFF one day and Soyala FFM the next. -track

Read the full article [http://www.cpaptalk.com/wiki/index.php/Pain_on_the_Bridge_of_the_Nose here].

Template:FeaturedArticle

2009-12-28T17:19:08Z

Katherinefulmer:

'''Pain or Irritation on the bridge of the nose'''

edited by CPAPtalk.com members Rooster and Goose

Pain or Irritation on the bridge of the nose is a common problem caused by CPAP Masks. Here are solutions other users have found:

The Hybrid and Liberty are two full face masks that do not touch the nose bridge so they solve the problem. I prefer the Hybrid and it comes with three sizes of nasal pillows and mouth cushions, so fitting is easy. - Rooster

Eventually I, too, switched to the hybrid-style masks. The Innomed Hybrid is my curent fave, but I seem to switch off with the Liberty on a regular basis. The Liberty leaks a bit more and is less comfortable, but gives me lower AHIs.- Link C.

I '''alternate masks every other day'''. UMFF one day and Soyala FFM the next. -track

Read the full article [http://www.cpaptalk.com/wiki/index.php/Pain_on_the_Bridge_of_the_Nose here].

[[Image:Painfulnosebridge.jpg|right|thumb|200px]]

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2009-12-28T17:18:22Z

Katherinefulmer:

File:Painfulnosebridge.jpg

2009-12-28T17:17:57Z

Katherinefulmer:

Template:FeaturedArticle

2009-12-28T17:15:40Z

Katherinefulmer:

Template:FeaturedArticle

2009-12-28T17:14:57Z

Katherinefulmer: /* Get a different Mask */

'''Pain or Irritation on the bridge of the nose'''
edited by CPAPtalk.com members Rooster and Goose

Pain or Irritation on the bridge of the nose is a common problem caused by CPAP Masks. Here are solutions other users have found:

The Hybrid and Liberty are two full face masks that do not touch the nose bridge so they solve the problem. I prefer the Hybrid and it comes with three sizes of nasal pillows and mouth cushions, so fitting is easy. - Rooster

Eventually I, too, switched to the hybrid-style masks. The Innomed Hybrid is my curent fave, but I seem to switch off with the Liberty on a regular basis. The Liberty leaks a bit more and is less comfortable, but gives me lower AHIs.- Link C.

I '''alternate masks every other day'''. UMFF one day and Soyala FFM the next. -track

Read the full article [http://www.cpaptalk.com/wiki/index.php/Pain_on_the_Bridge_of_the_Nose here].

Template:FeaturedArticle

2009-12-28T17:05:20Z

Katherinefulmer:

'''Pain or Irritation on the bridge of the nose'''
edited by CPAPtalk.com members Rooster and Goose

Pain or Irritation on the bridge of the nose is a common problem caused by CPAP Masks. Here are solutions other users have found:

==Get a different Mask==
The Hybrid and Liberty are two full face masks that do not touch the nose bridge so they solve the problem. I prefer the Hybrid and it comes with three sizes of nasal pillows and mouth cushions, so fitting is easy. - Rooster

Eventually I, too, switched to the hybrid-style masks. The Innomed Hybrid is my curent fave, but I seem to switch off with the Liberty on a regular basis. The Liberty leaks a bit more and is less comfortable, but gives me lower AHIs.- Link C.

I '''alternate masks every other day'''. UMFF one day and Soyala FFM the next. -track

Read the full article [http://www.cpaptalk.com/wiki/index.php/Pain_on_the_Bridge_of_the_Nose here].

Intellipap

2009-12-23T22:19:42Z

Katherinefulmer:

The IntelliPAP AutoAdjust with smart code makes it possible to get a lot of data w/o software.You are quite welcome. Another important marketing feature is the online data capability, either from you, or DeVilbiss. For those of us who are Mac users ( I have a Windows partition as well on my desktop Mac), it is crucial, as none of the software packages are Mac compatible. Same goes for Linux users. So, for all of us, it is a great option so as to monitor compliance without despoiling their computers with Windows. - from CPAPtalk mamber AutoPAPDude, David.

[[Category:CPAP Machines]]

CPAP Machine Choices

2009-12-23T22:02:25Z

Katherinefulmer: /* Data Capable machines */

{{cleanup}}
[[Image:Zzz-PAP-CPAP-Machine-with-Heated-Humidifier.jpg|right|thumb|400px|There are many choices to consider when selecting a CPAP machine. Pictured: Zzz-PAP with Heated Humidifier.]]
== Terminology ==
[[CPAP]] (pronounced see-pap) is an acronym for [[Continuous Positive Airway Pressure]]. The term CPAP is used two ways. One way is literal, indicating a straight CPAP machine with a constant pressure. The other way is generic, indicating two other types of PAP machines as well, including bilevel PAP (with one pressure for inhalation and one for exhalation) and auto-adjusting PAP (APAP with self-adjusting pressure based on your body’s requirements , and auto-adjusting bilevel.) Other terms for a PAP machine are device, flow generator, or blower. The earliest treatment for [[Obstructive Sleep Apnea]] was a tracheostomy, cutting a permanent hole in the windpipe. The CPAP machine was invented in 1981 by Dr. Colin Sullivan, an Australian pulmonologist. Later the bilevel and [http://www.cpaptalk.com/wiki/index.php/APAP AutoPAP] were developed. [http://www.sleepapnea.org/resources/pubs/pioneer.html Read an interview with CPAP’s inventor].

The term PAP indicates any type of Positive Airway Pressure machine. Compared to surgery, the PAP machine is a wonderful invention, a safe, relatively noninvasive and inexpensive way to restore you to health and happiness. Machine technology is evolving quickly; here’s a comparison to illustrate. Straight CPAP is like black and white TV, APAP is like color TV, and bilevel and PAP machines not yet on the market are like flat panel, plasma, and high definition TVs. In future PAPs, patients want better sensors, patient-centered software, better auto adjusting, exhalation relief, smart displays, [[heated hoses]], integrated power supply, and smaller footprints. One difference between TVs and PAP is that a PAP is a medical device, not a consumer product. However, PAP extra features are not frivolous “bells and whistles;” they are features to make therapy more effective so patients don’t give up on it. [https://www.cpap.com/cpap-faq/Machines.html#FGID-2 See Machine Answers]

=== Contraindications for PAP ===
Your doctor will assess medical reasons which may indicate not using PAP, involving previous or recent head injury, certain respiratory conditions or lung disease, recent ear, nose, or head surgery, vomiting, stroke (inability to maintain airway), seizures, severe cardiac arrhythmias.

Possible contraindications for the variable pressure auto-adjust mode may be epilepsy, central sleep apnea, stroke, and various heart and respiratory conditions such as Cheyne-Stokes respiration. A bilevel machine prescribed by an experienced sleep doctor may be a better choice.

PAP use may be contraindicated short term with a sinus or middle ear infection, severe ear discomfort, severe nosebleed, conjunctivitis, or skin abrasions caused by the CPAP mask. Consult your physician.

==== Prescription ====
A doctor’s prescription is required by US federal law to rent or purchase a machine, whether through a Durable Medical Equipment (DME) or home medical equipment company or online, whether paid by insurance, Medicare, or bought outright by the user. Any doctor can write the prescription, your primary care physician or a sleep doctor. Get the prescription in hand so you can choose your provider, through insurance or online through insurance or online at your own expense. There are two options for prescriptions. One is to get a general prescription for a CPAP which can also be used for an APAP, since the insurance code is the same. Another option is to get a specific prescription for a certain brand and model, if you and your doctor think that will be more useful in working with your particular DME company. The DME should not refuse your doctor’s prescription for a particular brand and model in favor of a cheaper machine to increase their profit at the expense of your successful therapy. For example prescriptions see [http://www.cpaptalk.com/wiki/index.php/Sleep_Apnea#Suggested_Specific_CPAP_Equipment_Rx.2FScripts Suggested Specific CPAP Equipment Rx].
For more on prescriptions, [https://www.cpap.com/cpap-faq/Prescriptions.html#FGID-130 see Answers, Prescriptions].

CPAPtalk member Halley's mom says:

"Thanks to lots of good info I gleaned from this site, I asked my physician to specify a fully data capable CPAP machine so that I could monitor my progress. That's exactly what he wrote on the Rx, so I got the Elite II with no problem from the DME. So, you might want to check with your doctor to see if he/she will add that requirement to your prescription. Good luck!"

== Choice ==
The choice of type, brand, and model of machine is both a medical decision and a patient-preference decision, best made as a collaborative decision between you and your prescribing physician. A sleep doctor will know your medical needs and should ideally, but not necessarily, have knowledge of brands and models of machines. You are the one who needs to use the machine all night, every night, for the rest of your life, so your agreement, cooperation, and comfort are essential. You can research machines at [https://www.cpap.com CPAP.com] and manufacturers’ web sites, and perhaps through local, unbiased sources such as a hospital sleep lab. As you learn about equipment, bring that knowledge to your doctor’s appointment. You can anticipate your machine preferences and needs for adaptability and comfort.

The choice of a machine is best not left solely to a Respiratory Therapist (RT) at a Durable Medical Equipment/home care provider. The RT may know about various machines, but their inventory (and maybe knowledge) will be limited by the brands of machine carried by their company. For example, it’s said that Apria favors Respironics machines and Lincare favors ResMed machines because of their business contracts with those manufacturers. Your patient needs are not necessarily the same as the DME’s business deal or need to move inventory. (The same is true for masks.) The DME may be able to get other brands, but not initially suggest them unless you request it. In the end, your research and trial and error are the methods for finding the best machine for you, since each person is unique. For more, [https://www.cpap.com/cpap-faq/CPAP-Brands.html#FGID-107 see Answers, CPAP Brands].

The top three PAP machine manufacturers are [[Respironics]], [[ResMed]], and [[Puritan Bennett]].

[http://www.cpaptalk.com/viewtopic/t4092/What-about-the-other-manufacturers.html Discussion thread on machine brands] beyond the big three.

===Data Capable machines===
These machines can report AHI, leak rate, etc. to help you track and improve your therapy:
Which machines can record data?

CPAP machines which record full data (like AHI and leak info):

* Respironics REMstar Pro M series
* ResMed S8 Elite and Elite II
* Puritan Bennett GoodKnight 420S and 420SP
* Covidien/Puritan Bennett Sandman Info (not to be confused with the model named "Intro.")

AUTOPAP ("autotitrating cpap" or "APAP") machines which record full data:

* Respironics REMstar Auto M series -- with or without "A-Flex."
* ResMed S8 Autoset Vantage and Autoset II
* Puritan Bennett GoodKnight 420E
* Covidien/Puritan Bennett Sandman Auto
* DeVilbiss [http://www.cpaptalk.com/wiki/index.php/Intellipap IntelliPAP] Autoadjust

The older pre-M Respironics REMstar Auto (with or without C-Flex) and ResMed S7 AutoSet autopaps record full data. Note: The pre-M Respironics machines (autopap and cpap) are often referred to on this message board as the "tank" or "legacy" or "pre-M" models.

BILEVEL ("bipap") machines which record full data:

* Respironics BiPAP Auto with Bi-Flex M series
* ResMed S8 VPAP

The older pre-M Respironics BiPAP Pro 2 with Bi-Flex and ResMed S7 VPAP III record full data.

== Failure hazard of any PAP treatment ==
Most people on PAP therapy use straight CPAP machines, and about half of PAP users fail at continuing the therapy. Those who give up on PAP have increased risk for stroke, heart failure, obesity, diabetes, and other serious health conditions, as well as a diminished quality of life overall, including greater risk of car crashes. If further medical treatment is necessary because of the consequences of abandoning PAP treatment, this is extra cost for both the patient and insurance company.

Three main reasons for the high failure rate of PAP compliance may be 1) poor mask selection and mask fitting resulting in leaks, 2) lack of quality information for the patient about PAP equipment and therapy, and lack of support in adjusting to the therapy, and 3) lack of patient involvement in therapy equipment decisions and management of therapy. Other equipment problems are wrong pressure settings, discomfort from equipment problems (humidification, rainout/condensation in the hose, hose management, aerophagia/swallowing air, bed pillows).

Comfort in using the machine and good results from it are essential for continued use. With any PAP machine, if the machine is not preventing your apnea/hypopnea events (AHI) because your pressure settings are wrong or your mask leaks too much, or if it’s hard to exhale, or if the machine is incompatible with your breathing pattern, or if it’s so noisy it keeps you awake, or if it’s too bulky to take with you when you travel, you are risking successful therapy and a happier, longer life. This is where high quality equipment as well as good patient information can help you. Software can involve you in the therapy and give you information on correcting mask leaks and AHI related to pressure. An APAP machine and software can allow you and your doctor to fine-tune the pressure. People who take control of their therapy are those who succeed.

== Selection Criteria ==
Selection criteria in order of importance for many people. What are your priorities?

1. Type of machine - CPAP, APAP (auto CPAP) or bilevel, with full data capability(software that measures more than just compliance or usage). The choice is based on both your medical needs and patient needs, since you will be sleeping with it all night, every night, for the rest of your life, and your life depends on it. An APAP machine provides two-in-one, since it can be used in either the APAP or CPAP mode. All APAP and bilevel machines are data capable. Only a few CPAP machines are data capable.

2. Software showing AHI (Apnea-Hypopnea Index of events per hour, AHI related to pressure, mask leaks, etc.). Not paid by insurance. Gives you and your doctor essential information to monitor and adjust your therapy, promoting success.

3. Heated humidifier with several temperature levels and passive (unheated) humidification; integrated (built-in) or stand-alone which can be used with another PAP if you get one. Keeps nose, mouth, throat healthier, reduces nosebleeds, required for a full face mask. Humidification is more comfortable for most, but not all, people.

4. [http://www.cpaptalk.com/wiki/index.php/CPAP_Machine_Choices#Exhalation_relief Exhalation relief] (called A-flex and C-flex in Respironics machines and EPR in ResMed machines). Briefly reduces air pressure on exhalation, making it easier to exhale, a comfort factor making it easier to sleep. Comfort is not a frill; it leads to adapting to and continuing the therapy. Those who have a higher prescribed pressure or who need more exhalation relief may require a bilevel machine. Some, especially those with low pressures, don’t need or want any exhalation relief.

5. Price, factoring in private insurance coverage, co-pays and deductibles, or Medicare, and pricing of equipment sold online

6. Size – weight, dimensions, portability

7. Features – smart LCD display, mask off alert, automatic (or manual) altitude adjustment, ramp or settling (gradual startup), AC/DC/DC power cord, international voltage, battery option, etc.

8. Ergonomics, ease of use – how to change various settings, LCD display size and readability, buttons, lights not too bright or too dim

9. Noise. Not usually a problem with current machines unless you are especially sensitive to noise. Noise level in decibels is listed in the user manual specifications. Normal conversation is 60 dB. A whisper is 15 dB. Most PAP machines are around 30 dB, much quieter than snoring. Noise is related to the individual machine; some are quieter, some more whiny. You could consider a quiet PAP machine as relaxing, soothing white noise, soft waves lulling you to sleep.

== Trying a Machine ==
Trying a machine, rental, purchase. Even if you and your doctor are convinced that a certain machine will be right for you, and even if at your first visit to the DME company they offer to let you buy it on the spot through your insurance company (after you pay a deductible), avoid buying a machine at the very start of treatment before you try it. (There’s a possibility that an unscrupulous DME is taking advantage of your being an exhausted and uninformed PAP novice by selling you a low-end or outdated CPAP machine which costs them less than $300, while billing your insurance company top dollar, the same amount they would bill insurance for a high-end APAP machine which costs them less than $600. They make twice the profit by providing you with a cheap CPAP machine.) You need time to try it out the machine to be certain it will work for you. With experience, you may change your mind about which machine is best for you.

If a machine doesn’t seem to fit your breathing patterns or is noisy or doesn’t fit your needs, work with your doctor and try out different machines through rental at your DME, at another DME on your insurance plan, or at a sleep center. If your insurance and DME are already providing a machine but you want to find a better one through a one-month trial rental, it will be at your own expense. That’s less expensive than buying a machine and then finding out it doesn’t work. Find a good local DME company by asking a hospital sleep lab for recommendations. Then inquire about a monthly rental from them, with prescription in hand.

Most insurance companies require at least a two or three month wait before they will purchase a machine for you, to make sure you are “compliant” (adapt to using the machine at least four hours nightly). When you are certain the machine is the best for your needs, then is the time to buy rather than rent. A typical approach is to let the DME rent you what seems to be the best machine from your research and your doctor’s input. If it works well, let your insurance plan buy it for you in two or three months. It’s reassuring to own the machine that you depend on. You will probably need to phone the DME to initiate the purchase, if they have been making more money by renting it than selling it. First do the math to see if purchase is more cost effective for you than continual rental. Compare the local DME price with online prices and see what your insurance company will reimburse. With purchase, you are responsible for repairs, but most machines are fairly reliable, under a two-year warranty with an anticipated life of five years or more.

Discussion threads on rental from DMEs and buying:
* [http://www.cpaptalk.com/viewtopic.php?t=14487&postdays=0&postorder=asc&start=0 CPAPtalk Thread 1]
* [http://www.cpaptalk.com/viewtopic.php?t=15970&postdays=0&postorder=asc&start=0 CPAPtalk Thread 2]
* [http://www.cpaptalk.com/viewtopic/t28179/Is-a-basic-machine-best-or-merely-adequate.html CPAPtalk Thread 3]

There are many places to buy a machine. Find out which ones are covered by your insurance. Then compare your insurance costs (deductibles, co-pays) with buying on your own, online, to find which is less expensive. Places to buy a PAP machine:

* Local branch of a large, national DME company, or small local DME company
* Sleep lab or doctor acting as a DME
* Online DME billing insurance
* Online DME billing Medicare
* Online DME for people paying at their own expense, which may or may not be reimbursable on their insurance, such as [https://www.cpap.com/ CPAP.com]

More Info
* [http://www.cpaptalk.com/viewtopic/t26648/My-CPAP-Journey.html CPAPtalk Thread] on pricing
* [http://www.cpaptalk.com/viewtopic/t24046/I-have-Medicare-should-I-use-it.html CPAPtalk Thread] on Medicare

== Medicare guidelines ==
Medicare guidelines, which most insurance companies follow, allow for machine replacement every five years. That’s a relatively long time in a market that quickly develops better new technology, so you probably want an up-to-date machine that works the best for you from the start. For more [https://www.cpap.com/cpap-faq/Machines.html#FGID-2 see Answers, CPAP and Sleep Apnea Basics, Machines].

=== Software ===
It helps enormously to have software so you can responsibly self-manage your therapy, with your doctor’s support, and monitor mask leaks and machine performance and track results. Using a PAP machine without software is like driving a car without a windshield and without an instrument panel. You may think you are on the road and getting there, but you’re really not sure; you just know you haven’t crashed yet. You may think you’re not speeding and have enough gas, but you’re not really sure. With a PAP machine with little or no feedback information, you may feel better or not feel better, but you have no other information.

If you’re not doing as well on PAP as you think you should be doing, and have no software, you and your doctor have very little information on what or how to improve. Does your mask leak? How much, acceptably or too much? Are you still having apneas (stopped breathing), hypopneas (partial breathing), and flow limitations or UARS (like small hypopneas in the nose and mouth) How many? Are you still in the severe, moderate, or mild range of the AHI (apnea-hypopnea index), or are you now in the normal range? Where in the normal range? At what pressure do you have the most and least apneas and hypopneas? When you make a mask change or adjustment, does it help or hinder? If your doctor makes a pressure change, does it help? Some doctors may be disdainful of PAP sensors and software, since they aren’t as sophisticated as sleep lab equipment. However, the smart PAP and software provide adequate night-to-night information to monitor and adjust therapy, when a full-blown sleep study isn’t needed or possible.

With a data capable machine and software, you have data on your Apnea Hypopnea Index, AHI related to pressure, flow limitation, volume of mask leaks, snores, etc. If you are computer literate, most PAP software is easy to use, even for those who aren’t computer experts. If your machine has data capability and a smart card, you can take the card to a cooperative DME for a printout sent to your doctor, and don’t need to buy software.

Warnings: 1) Not all machines are fully data-capable, so select one that is. 2) Some software records only compliance (usage) for the DME and insurance company’s benefit only, so make sure the software also records AHI, leaks, and pressure. Insurance won’t pay for software or a smart card reader, but you may be able to deduct them as a medical expense on your income tax. You don’t need a prescription for software. Software and readers can be purchased online often for less than $200 for both. [https://www.cpap.com/simple-find-cpap-products/software Find Software.]

'''Discussion threads on software:'''
* [http://www.cpaptalk.com/viewtopic/t25965/Doc-debunked-CPAP-AHI-data.html CPAPtalk.com Software Thread 1]
* [http://www.cpaptalk.com/viewtopic/t26806/Is-there-success-without-having-a-Datacapable-machine.html CPAPtalk.com Software Thread 2]
* [http://www.cpaptalk.com/viewtopic/t25720/Re-controversy-over-changing-pressure.html CPAPtalk.com Software Thread 3]

==== Heated humidifier ====
In normal breathing, your nose warms and moisturizes incoming air. With the large volume of air forced into your nose (or mouth) by a PAP machine, your nose can’t keep up. Use of PAP leads to congested nasal passages in many people who weren’t previously congested. The addition of a heated humidifier makes PAP healthier and more comfortable, which makes it easier for you to adapt or be compliant. It helps you avoid nosebleeds and dry nasal passages and mouth and maybe even helps ward off colds. A heated humidifier is required for a full face mask for mouth-breathers or people who are temporarily using a full face mask because of a cold or allergies. For many people, a heated humidifier is more natural, comfortable, and effective than unheated. Some people prefer passive or passover unheated humidification, so they don’t turn on the heating element. Most humidifiers are machine model-specific and fit into the machine (integrated). You might consider a stand-alone humidifier, which works with any machine, if you anticipate having more than one machine over time. Sometimes a certain model of humidifier is known for leaking or being difficult to fill. Check with other users on [http://cpaptalk.com CPAPtalk.com] for their product opinions. Do you have a deviated septum, nasal polyps, allergies, nosebleeds, or chronic [[sinus congestion]] that may make a heated humidifier medically necessary? Discuss use of a heated humidifier with your prescribing physician to see if it should be prescribed. A humidifier prescription is not required by law, but is required for insurance reimbursement. For more [https://www.cpap.com/cpap-faq/Humidifiers.html#FGID-61 see Answers, Humidifiers].

==== Exhalation relief ====
Some people find exhalation relief makes therapy more comfortable because it matches their natural breathing patterns and they don’t have to fight incoming air pressure to exhale. It increases their compliance. Others don’t need pressure relief. Some Respironics models (both CPAP and APAP) have A-Flex or C-Flex with three settings. The machine senses exhalation and lets the pressure drop slightly and briefly, making it easier to exhale. The Flex feature has various levels and can be easily turned off. See Respironics flex technology http://flexfamily.respironics.com/

Flex discussion threads:
http://www.cpaptalk.com/viewtopic/t20772/AFlex-a-good-thing-Or-a-sales-pitch.html
http://www.cpaptalk.com/viewtopic/t26438/Aflex-Trying-to-Self-Breathe.html
http://www.cpaptalk.com/viewtopic/t20453/Why-not-always-use-max-CFlex-setting.html

RedMed has EPR (expiratory pressure relief) available only in its straight CPAP machine. See http://www.resmed.com/en-us/clinicians/compliance_and_efficacy/epr-expiratory-pressure-relief.html?menu=clinicians

People who need a lot of exhalation relief may need a bilevel machine.

Hoses (tubing) PAP machines are dispensed with a hose to connect mask to machine. Hoses are a standard diameter to fit any machine and mask. The standard hose is 6 feet in length. Hoses also come in 10 feet and 18 inch extensions. A few machines or masks require a nonstandard hose, see [url]https://www.cpap.com/cpap-faq/Tubing-(CPAP-Hose).html#170[/url] People who experience rainout (condensation in the hose) or who want to maintain PAP heat and humidity levels in a cool bedroom buy the Australian SleepZone heated hose, http://www.sleepzone.com.au/ . There are hose-to-hose connectors and right-angle hose connectors.

Ramp or settling allows the user to start treatment at a lower pressure and as they fall asleep, the pressure slowly rises. This is a comfort setting and can be from 0 to 45 minutes on most PAP machines. Ramp is more appreciated by beginners. Sometimes the lower ramp pressure setting is too low to clear exhaled carbon dioxide from the mask, so it’s not comfortable unless it’s adjusted upward. Many experienced PAP users find ramp unnecessary.

CPAP MACHINES(constant pressure)

== Advantages of straight CPAP ==

1. A straight, constant pressure setting delivers the best results for many people. (However, the versatile APAP is two machines in one and can be set to a straight CPAP mode.)

2. Except for some of the features noted below and in the www.cpap.com comparison charts, all CPAPs have a standard operation and give similar results. There are few performance variables, which makes it easier for your doctor to prescribe a machine and predict the machine’s performance. Your experience with it is another matter. Since CPAPs have been around the longest of the three types of machines, more research has been done on them and some doctors are more familiar with them than the advanced technology APAPs or bilevels, so may tend to prescribe CPAPs more frequently.

3. Some Respironics, ResMed, and Puritan Bennett machines have software to track your results (not just compliance). Other brands do not.

4. Some Respironics and one ResMed straight CPAP model have pressure relief for exhalation. Other brands do not.

5. CPAPs are the least expensive of the three main types of PAP machines. Prices start about $220 to $500, without a heated humidifier. The top end overlaps with the price of some APAPs. Depending on your insurance deductibles and co-pays for the machine and need for subsequent sleep studies because you don’t have an APAP with software, getting a less expensive CPAP machine may be to your financial advantage or not.

6. For backup when electric power fails, or for travel, camping, or armchair naps, there are choices of small and light CPAP machines with or without integrated rechargeable batteries and a DC port for DC power supply from batteries. (APAPs and bilevels also can run on DC power.)

7. If you already have a low-end or high-end CPAP machine and it’s continuing to work well for you, you feel good all day, and your blood oxygen saturation rates are good (measured with an overnight recording pulse oximeter), then you may already have the best machine for you.

== Disadvantages of straight CPAP ==

1. You may need a different pressure to lower your AHI.
A) Your titrated pressure may be wrong or have changed. The sleep study titration (finding a pressure setting) was probably only a few hours of one night, in an unnatural setting which some people describe as the worst night of their life. See Reasons why your titrated pressure may be wrong.
B) If your weight goes up you may need a higher pressure setting; if it goes down, a lower setting. If you have CPAP and software and work with your doctor, you can work to improve your pressure setting, but not nearly as easily as if you had an APAP machine with software, which can also be used in the straight CPAP mode.
C) You may need a different pressure during the night when sleeping on your back or side, when in REM sleep, after using alcohol or sedatives, or with nasal congestion. A straight CPAP machine cannot automatically adjust to the need for pressure changes while you are sleeping. If your pressure is not correct, you will not be getting the full benefits of therapy and won’t feel as good as you would with the proper pressure setting, and you may be tempted to give up. Only an APAP machine or auto-adjust bilevel machine can match your changing pressure needs throughout the night.

2. Because most straight CPAPs don’t provide optional software data, they don’t encourage the user involvement that a smart APAP machine does. Patient involvement is essential for buy-in and commitment leading to successful continued use.

3. If your doctor is informed about CPAP but not about the newer technology and advantages of APAP and bilevel, and is not tuned in to your individual user needs and preferences, the straight CPAP they prescribe may not be the best match for you.

4. Although the initial price may be somewhat lower, if a CPAP is your sole machine, depending on your insurance and budget, price may not be the most important factor. If your insurance deductible is the same for a basic or advanced machine, and your health depends on its successful use, you may be far better off with an advanced machine. If, by having a less expensive CPAP without software, you require additional sleep studies, that may add to your overall insurance deductible cost.

== CPAP comparison chart ==
CPAP comparison chart of various brands and models
https://www.cpap.com/cpap-compare-chart/all-CPAP

See the best selling CPAP machines at this online DME for self-paying customers at https://www.cpap.com/cpap-user-preference.php How many of these people already have an APAP machine at home and are buying a small CPAP as a backup or for travel?

APAP MACHINES (Auto-adjusting CPAPs also known as auto-titrating, self-adjusting, or auto CPAPs)

APAPs (pronounced A-paps) are the new generation of the original CPAP machines. They are smart machines which use sensors to automatically adjust pressure throughout the night if your body needs more or less pressure. In addition, when set in APAP mode with smart capability, the machine does a mini-sleep study on you every night, in the comfort of your own bed, helping you and your doctor adjust your therapy. Many APAP users find that the newer, adjustable technology of APAP provides better nightly therapy than straight CPAP. (If they find they do better on straight CPAP, they then switch their machine to the straight CPAP mode.)

For information on APAP and BIPAP Machines view:

[http://www.cpaptalk.com/wiki/index.php/APAP APAP]

[http://www.cpaptalk.com/wiki/index.php/BiPAP BiPAP]

The Categories[[http://www.cpaptalk.com/wiki/index.php/Category:APAP_Machines]]

[[Category:CPAP_Machines]]
[[Category:Treatment]]

CPAP Machine Choices

2009-12-23T22:02:17Z

Katherinefulmer: /* Data Capable machines */

{{cleanup}}
[[Image:Zzz-PAP-CPAP-Machine-with-Heated-Humidifier.jpg|right|thumb|400px|There are many choices to consider when selecting a CPAP machine. Pictured: Zzz-PAP with Heated Humidifier.]]
== Terminology ==
[[CPAP]] (pronounced see-pap) is an acronym for [[Continuous Positive Airway Pressure]]. The term CPAP is used two ways. One way is literal, indicating a straight CPAP machine with a constant pressure. The other way is generic, indicating two other types of PAP machines as well, including bilevel PAP (with one pressure for inhalation and one for exhalation) and auto-adjusting PAP (APAP with self-adjusting pressure based on your body’s requirements , and auto-adjusting bilevel.) Other terms for a PAP machine are device, flow generator, or blower. The earliest treatment for [[Obstructive Sleep Apnea]] was a tracheostomy, cutting a permanent hole in the windpipe. The CPAP machine was invented in 1981 by Dr. Colin Sullivan, an Australian pulmonologist. Later the bilevel and [http://www.cpaptalk.com/wiki/index.php/APAP AutoPAP] were developed. [http://www.sleepapnea.org/resources/pubs/pioneer.html Read an interview with CPAP’s inventor].

The term PAP indicates any type of Positive Airway Pressure machine. Compared to surgery, the PAP machine is a wonderful invention, a safe, relatively noninvasive and inexpensive way to restore you to health and happiness. Machine technology is evolving quickly; here’s a comparison to illustrate. Straight CPAP is like black and white TV, APAP is like color TV, and bilevel and PAP machines not yet on the market are like flat panel, plasma, and high definition TVs. In future PAPs, patients want better sensors, patient-centered software, better auto adjusting, exhalation relief, smart displays, [[heated hoses]], integrated power supply, and smaller footprints. One difference between TVs and PAP is that a PAP is a medical device, not a consumer product. However, PAP extra features are not frivolous “bells and whistles;” they are features to make therapy more effective so patients don’t give up on it. [https://www.cpap.com/cpap-faq/Machines.html#FGID-2 See Machine Answers]

=== Contraindications for PAP ===
Your doctor will assess medical reasons which may indicate not using PAP, involving previous or recent head injury, certain respiratory conditions or lung disease, recent ear, nose, or head surgery, vomiting, stroke (inability to maintain airway), seizures, severe cardiac arrhythmias.

Possible contraindications for the variable pressure auto-adjust mode may be epilepsy, central sleep apnea, stroke, and various heart and respiratory conditions such as Cheyne-Stokes respiration. A bilevel machine prescribed by an experienced sleep doctor may be a better choice.

PAP use may be contraindicated short term with a sinus or middle ear infection, severe ear discomfort, severe nosebleed, conjunctivitis, or skin abrasions caused by the CPAP mask. Consult your physician.

==== Prescription ====
A doctor’s prescription is required by US federal law to rent or purchase a machine, whether through a Durable Medical Equipment (DME) or home medical equipment company or online, whether paid by insurance, Medicare, or bought outright by the user. Any doctor can write the prescription, your primary care physician or a sleep doctor. Get the prescription in hand so you can choose your provider, through insurance or online through insurance or online at your own expense. There are two options for prescriptions. One is to get a general prescription for a CPAP which can also be used for an APAP, since the insurance code is the same. Another option is to get a specific prescription for a certain brand and model, if you and your doctor think that will be more useful in working with your particular DME company. The DME should not refuse your doctor’s prescription for a particular brand and model in favor of a cheaper machine to increase their profit at the expense of your successful therapy. For example prescriptions see [http://www.cpaptalk.com/wiki/index.php/Sleep_Apnea#Suggested_Specific_CPAP_Equipment_Rx.2FScripts Suggested Specific CPAP Equipment Rx].
For more on prescriptions, [https://www.cpap.com/cpap-faq/Prescriptions.html#FGID-130 see Answers, Prescriptions].

CPAPtalk member Halley's mom says:

"Thanks to lots of good info I gleaned from this site, I asked my physician to specify a fully data capable CPAP machine so that I could monitor my progress. That's exactly what he wrote on the Rx, so I got the Elite II with no problem from the DME. So, you might want to check with your doctor to see if he/she will add that requirement to your prescription. Good luck!"

== Choice ==
The choice of type, brand, and model of machine is both a medical decision and a patient-preference decision, best made as a collaborative decision between you and your prescribing physician. A sleep doctor will know your medical needs and should ideally, but not necessarily, have knowledge of brands and models of machines. You are the one who needs to use the machine all night, every night, for the rest of your life, so your agreement, cooperation, and comfort are essential. You can research machines at [https://www.cpap.com CPAP.com] and manufacturers’ web sites, and perhaps through local, unbiased sources such as a hospital sleep lab. As you learn about equipment, bring that knowledge to your doctor’s appointment. You can anticipate your machine preferences and needs for adaptability and comfort.

The choice of a machine is best not left solely to a Respiratory Therapist (RT) at a Durable Medical Equipment/home care provider. The RT may know about various machines, but their inventory (and maybe knowledge) will be limited by the brands of machine carried by their company. For example, it’s said that Apria favors Respironics machines and Lincare favors ResMed machines because of their business contracts with those manufacturers. Your patient needs are not necessarily the same as the DME’s business deal or need to move inventory. (The same is true for masks.) The DME may be able to get other brands, but not initially suggest them unless you request it. In the end, your research and trial and error are the methods for finding the best machine for you, since each person is unique. For more, [https://www.cpap.com/cpap-faq/CPAP-Brands.html#FGID-107 see Answers, CPAP Brands].

The top three PAP machine manufacturers are [[Respironics]], [[ResMed]], and [[Puritan Bennett]].

[http://www.cpaptalk.com/viewtopic/t4092/What-about-the-other-manufacturers.html Discussion thread on machine brands] beyond the big three.

===Data Capable machines===
These machines can report AHI, leak rate, etc. to help you track and improve your therapy:
Which machines can record data?

CPAP machines which record full data (like AHI and leak info):

* Respironics REMstar Pro M series
* ResMed S8 Elite and Elite II
* Puritan Bennett GoodKnight 420S and 420SP
* Covidien/Puritan Bennett Sandman Info (not to be confused with the model named "Intro.")

AUTOPAP ("autotitrating cpap" or "APAP") machines which record full data:

* Respironics REMstar Auto M series -- with or without "A-Flex."
* ResMed S8 Autoset Vantage and Autoset II
* Puritan Bennett GoodKnight 420E
* Covidien/Puritan Bennett Sandman Auto
* DeVilbiss[http://www.cpaptalk.com/wiki/index.php/Intellipap IntelliPAP] Autoadjust

The older pre-M Respironics REMstar Auto (with or without C-Flex) and ResMed S7 AutoSet autopaps record full data. Note: The pre-M Respironics machines (autopap and cpap) are often referred to on this message board as the "tank" or "legacy" or "pre-M" models.

BILEVEL ("bipap") machines which record full data:

* Respironics BiPAP Auto with Bi-Flex M series
* ResMed S8 VPAP

The older pre-M Respironics BiPAP Pro 2 with Bi-Flex and ResMed S7 VPAP III record full data.

== Failure hazard of any PAP treatment ==
Most people on PAP therapy use straight CPAP machines, and about half of PAP users fail at continuing the therapy. Those who give up on PAP have increased risk for stroke, heart failure, obesity, diabetes, and other serious health conditions, as well as a diminished quality of life overall, including greater risk of car crashes. If further medical treatment is necessary because of the consequences of abandoning PAP treatment, this is extra cost for both the patient and insurance company.

Three main reasons for the high failure rate of PAP compliance may be 1) poor mask selection and mask fitting resulting in leaks, 2) lack of quality information for the patient about PAP equipment and therapy, and lack of support in adjusting to the therapy, and 3) lack of patient involvement in therapy equipment decisions and management of therapy. Other equipment problems are wrong pressure settings, discomfort from equipment problems (humidification, rainout/condensation in the hose, hose management, aerophagia/swallowing air, bed pillows).

Comfort in using the machine and good results from it are essential for continued use. With any PAP machine, if the machine is not preventing your apnea/hypopnea events (AHI) because your pressure settings are wrong or your mask leaks too much, or if it’s hard to exhale, or if the machine is incompatible with your breathing pattern, or if it’s so noisy it keeps you awake, or if it’s too bulky to take with you when you travel, you are risking successful therapy and a happier, longer life. This is where high quality equipment as well as good patient information can help you. Software can involve you in the therapy and give you information on correcting mask leaks and AHI related to pressure. An APAP machine and software can allow you and your doctor to fine-tune the pressure. People who take control of their therapy are those who succeed.

== Selection Criteria ==
Selection criteria in order of importance for many people. What are your priorities?

1. Type of machine - CPAP, APAP (auto CPAP) or bilevel, with full data capability(software that measures more than just compliance or usage). The choice is based on both your medical needs and patient needs, since you will be sleeping with it all night, every night, for the rest of your life, and your life depends on it. An APAP machine provides two-in-one, since it can be used in either the APAP or CPAP mode. All APAP and bilevel machines are data capable. Only a few CPAP machines are data capable.

2. Software showing AHI (Apnea-Hypopnea Index of events per hour, AHI related to pressure, mask leaks, etc.). Not paid by insurance. Gives you and your doctor essential information to monitor and adjust your therapy, promoting success.

3. Heated humidifier with several temperature levels and passive (unheated) humidification; integrated (built-in) or stand-alone which can be used with another PAP if you get one. Keeps nose, mouth, throat healthier, reduces nosebleeds, required for a full face mask. Humidification is more comfortable for most, but not all, people.

4. [http://www.cpaptalk.com/wiki/index.php/CPAP_Machine_Choices#Exhalation_relief Exhalation relief] (called A-flex and C-flex in Respironics machines and EPR in ResMed machines). Briefly reduces air pressure on exhalation, making it easier to exhale, a comfort factor making it easier to sleep. Comfort is not a frill; it leads to adapting to and continuing the therapy. Those who have a higher prescribed pressure or who need more exhalation relief may require a bilevel machine. Some, especially those with low pressures, don’t need or want any exhalation relief.

5. Price, factoring in private insurance coverage, co-pays and deductibles, or Medicare, and pricing of equipment sold online

6. Size – weight, dimensions, portability

7. Features – smart LCD display, mask off alert, automatic (or manual) altitude adjustment, ramp or settling (gradual startup), AC/DC/DC power cord, international voltage, battery option, etc.

8. Ergonomics, ease of use – how to change various settings, LCD display size and readability, buttons, lights not too bright or too dim

9. Noise. Not usually a problem with current machines unless you are especially sensitive to noise. Noise level in decibels is listed in the user manual specifications. Normal conversation is 60 dB. A whisper is 15 dB. Most PAP machines are around 30 dB, much quieter than snoring. Noise is related to the individual machine; some are quieter, some more whiny. You could consider a quiet PAP machine as relaxing, soothing white noise, soft waves lulling you to sleep.

== Trying a Machine ==
Trying a machine, rental, purchase. Even if you and your doctor are convinced that a certain machine will be right for you, and even if at your first visit to the DME company they offer to let you buy it on the spot through your insurance company (after you pay a deductible), avoid buying a machine at the very start of treatment before you try it. (There’s a possibility that an unscrupulous DME is taking advantage of your being an exhausted and uninformed PAP novice by selling you a low-end or outdated CPAP machine which costs them less than $300, while billing your insurance company top dollar, the same amount they would bill insurance for a high-end APAP machine which costs them less than $600. They make twice the profit by providing you with a cheap CPAP machine.) You need time to try it out the machine to be certain it will work for you. With experience, you may change your mind about which machine is best for you.

If a machine doesn’t seem to fit your breathing patterns or is noisy or doesn’t fit your needs, work with your doctor and try out different machines through rental at your DME, at another DME on your insurance plan, or at a sleep center. If your insurance and DME are already providing a machine but you want to find a better one through a one-month trial rental, it will be at your own expense. That’s less expensive than buying a machine and then finding out it doesn’t work. Find a good local DME company by asking a hospital sleep lab for recommendations. Then inquire about a monthly rental from them, with prescription in hand.

Most insurance companies require at least a two or three month wait before they will purchase a machine for you, to make sure you are “compliant” (adapt to using the machine at least four hours nightly). When you are certain the machine is the best for your needs, then is the time to buy rather than rent. A typical approach is to let the DME rent you what seems to be the best machine from your research and your doctor’s input. If it works well, let your insurance plan buy it for you in two or three months. It’s reassuring to own the machine that you depend on. You will probably need to phone the DME to initiate the purchase, if they have been making more money by renting it than selling it. First do the math to see if purchase is more cost effective for you than continual rental. Compare the local DME price with online prices and see what your insurance company will reimburse. With purchase, you are responsible for repairs, but most machines are fairly reliable, under a two-year warranty with an anticipated life of five years or more.

Discussion threads on rental from DMEs and buying:
* [http://www.cpaptalk.com/viewtopic.php?t=14487&postdays=0&postorder=asc&start=0 CPAPtalk Thread 1]
* [http://www.cpaptalk.com/viewtopic.php?t=15970&postdays=0&postorder=asc&start=0 CPAPtalk Thread 2]
* [http://www.cpaptalk.com/viewtopic/t28179/Is-a-basic-machine-best-or-merely-adequate.html CPAPtalk Thread 3]

There are many places to buy a machine. Find out which ones are covered by your insurance. Then compare your insurance costs (deductibles, co-pays) with buying on your own, online, to find which is less expensive. Places to buy a PAP machine:

* Local branch of a large, national DME company, or small local DME company
* Sleep lab or doctor acting as a DME
* Online DME billing insurance
* Online DME billing Medicare
* Online DME for people paying at their own expense, which may or may not be reimbursable on their insurance, such as [https://www.cpap.com/ CPAP.com]

More Info
* [http://www.cpaptalk.com/viewtopic/t26648/My-CPAP-Journey.html CPAPtalk Thread] on pricing
* [http://www.cpaptalk.com/viewtopic/t24046/I-have-Medicare-should-I-use-it.html CPAPtalk Thread] on Medicare

== Medicare guidelines ==
Medicare guidelines, which most insurance companies follow, allow for machine replacement every five years. That’s a relatively long time in a market that quickly develops better new technology, so you probably want an up-to-date machine that works the best for you from the start. For more [https://www.cpap.com/cpap-faq/Machines.html#FGID-2 see Answers, CPAP and Sleep Apnea Basics, Machines].

=== Software ===
It helps enormously to have software so you can responsibly self-manage your therapy, with your doctor’s support, and monitor mask leaks and machine performance and track results. Using a PAP machine without software is like driving a car without a windshield and without an instrument panel. You may think you are on the road and getting there, but you’re really not sure; you just know you haven’t crashed yet. You may think you’re not speeding and have enough gas, but you’re not really sure. With a PAP machine with little or no feedback information, you may feel better or not feel better, but you have no other information.

If you’re not doing as well on PAP as you think you should be doing, and have no software, you and your doctor have very little information on what or how to improve. Does your mask leak? How much, acceptably or too much? Are you still having apneas (stopped breathing), hypopneas (partial breathing), and flow limitations or UARS (like small hypopneas in the nose and mouth) How many? Are you still in the severe, moderate, or mild range of the AHI (apnea-hypopnea index), or are you now in the normal range? Where in the normal range? At what pressure do you have the most and least apneas and hypopneas? When you make a mask change or adjustment, does it help or hinder? If your doctor makes a pressure change, does it help? Some doctors may be disdainful of PAP sensors and software, since they aren’t as sophisticated as sleep lab equipment. However, the smart PAP and software provide adequate night-to-night information to monitor and adjust therapy, when a full-blown sleep study isn’t needed or possible.

With a data capable machine and software, you have data on your Apnea Hypopnea Index, AHI related to pressure, flow limitation, volume of mask leaks, snores, etc. If you are computer literate, most PAP software is easy to use, even for those who aren’t computer experts. If your machine has data capability and a smart card, you can take the card to a cooperative DME for a printout sent to your doctor, and don’t need to buy software.

Warnings: 1) Not all machines are fully data-capable, so select one that is. 2) Some software records only compliance (usage) for the DME and insurance company’s benefit only, so make sure the software also records AHI, leaks, and pressure. Insurance won’t pay for software or a smart card reader, but you may be able to deduct them as a medical expense on your income tax. You don’t need a prescription for software. Software and readers can be purchased online often for less than $200 for both. [https://www.cpap.com/simple-find-cpap-products/software Find Software.]

'''Discussion threads on software:'''
* [http://www.cpaptalk.com/viewtopic/t25965/Doc-debunked-CPAP-AHI-data.html CPAPtalk.com Software Thread 1]
* [http://www.cpaptalk.com/viewtopic/t26806/Is-there-success-without-having-a-Datacapable-machine.html CPAPtalk.com Software Thread 2]
* [http://www.cpaptalk.com/viewtopic/t25720/Re-controversy-over-changing-pressure.html CPAPtalk.com Software Thread 3]

==== Heated humidifier ====
In normal breathing, your nose warms and moisturizes incoming air. With the large volume of air forced into your nose (or mouth) by a PAP machine, your nose can’t keep up. Use of PAP leads to congested nasal passages in many people who weren’t previously congested. The addition of a heated humidifier makes PAP healthier and more comfortable, which makes it easier for you to adapt or be compliant. It helps you avoid nosebleeds and dry nasal passages and mouth and maybe even helps ward off colds. A heated humidifier is required for a full face mask for mouth-breathers or people who are temporarily using a full face mask because of a cold or allergies. For many people, a heated humidifier is more natural, comfortable, and effective than unheated. Some people prefer passive or passover unheated humidification, so they don’t turn on the heating element. Most humidifiers are machine model-specific and fit into the machine (integrated). You might consider a stand-alone humidifier, which works with any machine, if you anticipate having more than one machine over time. Sometimes a certain model of humidifier is known for leaking or being difficult to fill. Check with other users on [http://cpaptalk.com CPAPtalk.com] for their product opinions. Do you have a deviated septum, nasal polyps, allergies, nosebleeds, or chronic [[sinus congestion]] that may make a heated humidifier medically necessary? Discuss use of a heated humidifier with your prescribing physician to see if it should be prescribed. A humidifier prescription is not required by law, but is required for insurance reimbursement. For more [https://www.cpap.com/cpap-faq/Humidifiers.html#FGID-61 see Answers, Humidifiers].

==== Exhalation relief ====
Some people find exhalation relief makes therapy more comfortable because it matches their natural breathing patterns and they don’t have to fight incoming air pressure to exhale. It increases their compliance. Others don’t need pressure relief. Some Respironics models (both CPAP and APAP) have A-Flex or C-Flex with three settings. The machine senses exhalation and lets the pressure drop slightly and briefly, making it easier to exhale. The Flex feature has various levels and can be easily turned off. See Respironics flex technology http://flexfamily.respironics.com/

Flex discussion threads:
http://www.cpaptalk.com/viewtopic/t20772/AFlex-a-good-thing-Or-a-sales-pitch.html
http://www.cpaptalk.com/viewtopic/t26438/Aflex-Trying-to-Self-Breathe.html
http://www.cpaptalk.com/viewtopic/t20453/Why-not-always-use-max-CFlex-setting.html

RedMed has EPR (expiratory pressure relief) available only in its straight CPAP machine. See http://www.resmed.com/en-us/clinicians/compliance_and_efficacy/epr-expiratory-pressure-relief.html?menu=clinicians

People who need a lot of exhalation relief may need a bilevel machine.

Hoses (tubing) PAP machines are dispensed with a hose to connect mask to machine. Hoses are a standard diameter to fit any machine and mask. The standard hose is 6 feet in length. Hoses also come in 10 feet and 18 inch extensions. A few machines or masks require a nonstandard hose, see [url]https://www.cpap.com/cpap-faq/Tubing-(CPAP-Hose).html#170[/url] People who experience rainout (condensation in the hose) or who want to maintain PAP heat and humidity levels in a cool bedroom buy the Australian SleepZone heated hose, http://www.sleepzone.com.au/ . There are hose-to-hose connectors and right-angle hose connectors.

Ramp or settling allows the user to start treatment at a lower pressure and as they fall asleep, the pressure slowly rises. This is a comfort setting and can be from 0 to 45 minutes on most PAP machines. Ramp is more appreciated by beginners. Sometimes the lower ramp pressure setting is too low to clear exhaled carbon dioxide from the mask, so it’s not comfortable unless it’s adjusted upward. Many experienced PAP users find ramp unnecessary.

CPAP MACHINES(constant pressure)

== Advantages of straight CPAP ==

1. A straight, constant pressure setting delivers the best results for many people. (However, the versatile APAP is two machines in one and can be set to a straight CPAP mode.)

2. Except for some of the features noted below and in the www.cpap.com comparison charts, all CPAPs have a standard operation and give similar results. There are few performance variables, which makes it easier for your doctor to prescribe a machine and predict the machine’s performance. Your experience with it is another matter. Since CPAPs have been around the longest of the three types of machines, more research has been done on them and some doctors are more familiar with them than the advanced technology APAPs or bilevels, so may tend to prescribe CPAPs more frequently.

3. Some Respironics, ResMed, and Puritan Bennett machines have software to track your results (not just compliance). Other brands do not.

4. Some Respironics and one ResMed straight CPAP model have pressure relief for exhalation. Other brands do not.

5. CPAPs are the least expensive of the three main types of PAP machines. Prices start about $220 to $500, without a heated humidifier. The top end overlaps with the price of some APAPs. Depending on your insurance deductibles and co-pays for the machine and need for subsequent sleep studies because you don’t have an APAP with software, getting a less expensive CPAP machine may be to your financial advantage or not.

6. For backup when electric power fails, or for travel, camping, or armchair naps, there are choices of small and light CPAP machines with or without integrated rechargeable batteries and a DC port for DC power supply from batteries. (APAPs and bilevels also can run on DC power.)

7. If you already have a low-end or high-end CPAP machine and it’s continuing to work well for you, you feel good all day, and your blood oxygen saturation rates are good (measured with an overnight recording pulse oximeter), then you may already have the best machine for you.

== Disadvantages of straight CPAP ==

1. You may need a different pressure to lower your AHI.
A) Your titrated pressure may be wrong or have changed. The sleep study titration (finding a pressure setting) was probably only a few hours of one night, in an unnatural setting which some people describe as the worst night of their life. See Reasons why your titrated pressure may be wrong.
B) If your weight goes up you may need a higher pressure setting; if it goes down, a lower setting. If you have CPAP and software and work with your doctor, you can work to improve your pressure setting, but not nearly as easily as if you had an APAP machine with software, which can also be used in the straight CPAP mode.
C) You may need a different pressure during the night when sleeping on your back or side, when in REM sleep, after using alcohol or sedatives, or with nasal congestion. A straight CPAP machine cannot automatically adjust to the need for pressure changes while you are sleeping. If your pressure is not correct, you will not be getting the full benefits of therapy and won’t feel as good as you would with the proper pressure setting, and you may be tempted to give up. Only an APAP machine or auto-adjust bilevel machine can match your changing pressure needs throughout the night.

2. Because most straight CPAPs don’t provide optional software data, they don’t encourage the user involvement that a smart APAP machine does. Patient involvement is essential for buy-in and commitment leading to successful continued use.

3. If your doctor is informed about CPAP but not about the newer technology and advantages of APAP and bilevel, and is not tuned in to your individual user needs and preferences, the straight CPAP they prescribe may not be the best match for you.

4. Although the initial price may be somewhat lower, if a CPAP is your sole machine, depending on your insurance and budget, price may not be the most important factor. If your insurance deductible is the same for a basic or advanced machine, and your health depends on its successful use, you may be far better off with an advanced machine. If, by having a less expensive CPAP without software, you require additional sleep studies, that may add to your overall insurance deductible cost.

== CPAP comparison chart ==
CPAP comparison chart of various brands and models
https://www.cpap.com/cpap-compare-chart/all-CPAP

See the best selling CPAP machines at this online DME for self-paying customers at https://www.cpap.com/cpap-user-preference.php How many of these people already have an APAP machine at home and are buying a small CPAP as a backup or for travel?

APAP MACHINES (Auto-adjusting CPAPs also known as auto-titrating, self-adjusting, or auto CPAPs)

APAPs (pronounced A-paps) are the new generation of the original CPAP machines. They are smart machines which use sensors to automatically adjust pressure throughout the night if your body needs more or less pressure. In addition, when set in APAP mode with smart capability, the machine does a mini-sleep study on you every night, in the comfort of your own bed, helping you and your doctor adjust your therapy. Many APAP users find that the newer, adjustable technology of APAP provides better nightly therapy than straight CPAP. (If they find they do better on straight CPAP, they then switch their machine to the straight CPAP mode.)

For information on APAP and BIPAP Machines view:

[http://www.cpaptalk.com/wiki/index.php/APAP APAP]

[http://www.cpaptalk.com/wiki/index.php/BiPAP BiPAP]

The Categories[[http://www.cpaptalk.com/wiki/index.php/Category:APAP_Machines]]

[[Category:CPAP_Machines]]
[[Category:Treatment]]

Partners and CPAP

2009-12-23T21:52:44Z

Katherinefulmer:

Working with Physicians.2C Insurance and DMEs

2009-12-23T21:46:03Z

Katherinefulmer:

=Physician Help=
==Getting into a Sleep Specialist/Sleep Lab Quickly==
author unknown

This might seem like a no-brainer, but I'm going to mention this anyway just in case someone out there needs this info.

Anyone who has been into see a sleep specialist / neurologist as a new patient and then has booked a night at a sleep lab knows all too well how even in first rate medical cities (ie. Boston; Philly; Cleveland) it can easily take 1-3 months to get an appointment with a good Neurologist / Sleep Specialist. And then you're at the back of the line again to get into a sleep lab. AND THEN you're at the back of the line AGAIN to get back into see your Neurologist for the results of the sleep study. And if your results are inconclusive as they often are, add another 1-3 months for a repeat night at a sleep lab etc etc. When you're suffering from Sleep Apnea, nothing is more painfull than knowing it might take 6-8 months to finally be treated for the disorder.

So here are my tactics for getting into Sleep Specialist, Sleep Lab, and most importantly getting treatment ASAP or well within 6-12 weeks.

1. After you book your first appointment with your Neurologist / Sleep Specialist, call the scheduling desk and quickly convey that you are available on short notice if anyone else should cancel their appointment. If they say they have a long list, then pull out the "friendliness card" and make sure you're well known to the office staff.

2. After your first night at the sleep lab is booked, get on the phone to the sleep lab and do the exact same thing. Sleep Labs bill $1,000-$4,000/night so they are always eager to book empty beds, and people cancel their sleep lab nights left and right.

3. After your night in the sleep lab, you have no choice but to wait for your results to be compiled and sent to your neurologist. But once you\'re able to get into see your Neurologist for follow up, get on the phone and request that the office call you for cancelled appointments.

Hope this helps! I've been into 5 sleep studies and this always works for me.

==Suggested Specific CPAP Equipment Rx/Scripts==
by CPAPtalk member Slinky

(Editor's note: a doctor's prescription is required for a PAP machine and mask whether through a local DME or online. Online, a generic CPAP prescription will work for either a CPAP or APAP. At a local DME, a prescription specific for APAP will probably be required. See prescription advice and requirements at https://www.cpap.com/cpap-faq/Prescriptions.html#FGID-130 )

If your equipment order (Rx/script) will be for "just" a straight CPAP and not one of the more sophisticated bi-levels (Bi-PAP) or SV, etc. most doctors write a fairly genetic script and then most DMEs will take advantage and provide you with a bare-bones CPAP.

I would suggest that you ask your doctor to write a very explicit equipment order so that you get EXACTLY what you want and really need. The following are some suggested orders (not that I am recommending one machine over the other, just to give you and your doctor an idea).

'''You will notice the similarities to each suggestion.'''

1] Exact brand and model of machine

2] Scripted pressure (the autoPAPs have a pressure range rather than a set pressure)

3] Scripted amount for lower pressure at exhalation

4] Starts w/4 cms of pressure and ramps up to your set pressure after you get to sleep

5] Allows you to access your nightly data via the LCD screen

6] While the integrated humidifiers are most convenient for travel and take up less space on your nightstand,
in really dry situations sometimes they can't provide as much humidity as you might need or want. For many the integrated humidifiers are more than satisfactory.

7] This ensures that you can try several masks, including a Full Face mask (sometimes they insist on a script specifiying full face if the script just says mask, or will only provide the exact mask mentioned in the equipment order).

[[Rx Sample 1]]
 
[[Rx Sample 2]]
 
[[Rx Sample 3]]
 
[[Rx Sample 4]]
 
To the best of my knowledge the only other fully data capable CPAPs (as of January 2008) are the Puritan Bennet GoodKnight 420E autoPAP and one other Puritan Bennet GoodKnight straight CPAP. I'm not sure of the correct model. Nor do I know the specifics for those Puritan Bennet's or I would have included them. Those who have the 420E really like them so hopefully further information can be included by someone who knows the Puritan Bennet devices.

==Glossary for PSG (Sleep Study) Terms==

The [http://www.cpaptalk.com/wiki/index.php/Category:CPAP_Definitions PSG Glossary] is the first section of the CPAP Definitions page.

Get a copy of your sleep study report. You can refer to it from time to time as you learn more about your treatment. If you visit a specialist (sleep doctor, Ear/Nose/Throat doctor, pulmonologist, cardiologist, eye specialist, allergist, surgeon, dentist, etc.), give them a copy of your sleep study.

=Insurance and DME Help=

==Getting the data-capable xPAP machine you need==
by slinky (compilation of various posts)

Often beginners to CPAP end up with the low-end, non-data capable xPAP's. However, we know that the ability to monitor your own progress (AHI, leaks, etc) greatly increases compliance and allows you to make knowledgeable changes to your therapy (hopefully with the help of your sleep doctor).

'''Insurances WILL cover data capable machines. DME's WILL supply you with data capable machines, and here's how to ensure that you end up with a data-capable machine''' (or the machine and mask you want) when dealing with un-helpful Insurance, DME's, and doctors:

1] Call your insurance company.
 a] Ask them what local DME CPAP suppliers they are contracted with
 b] Ask them what your DME CPAP benefits are: copays? deductibles?

2] Since you found this forum I can guarantee you that you are NOT going to be satisfied w/anything LESS than a FULLY DATA CAPABLE CPAP.
 a] Start checking out CPAPs at cpap.com. Never mind price at this point. Just check out the features. You can choose those CPAPs that interest you and cpap.com offers the opportunity to run a comparison of features of those that interest you.
 b] Check out autoPAPs separate from "just" CPAPs. You might well get "auto fever" before you are done reading here.

3] Prepare a WRITTEN request for:
 a] The doctor's dictated results of BOTH your sleep evaluation AND your titration studies
 b] The full scored data summary report w/condensed graphs for BOTH your evaluation AND your titration studies
 c] The script (equipment order) so that you may "shop" your local DME options
 d]If you will not be seeing the sleep doctor for a consultation again FAX this above request to him and keep the proof of FAX. If you will be seeing him BEFORE you receive your equipment then you can just GIVE the request to him TO BE PUT IN YOUR RECORDS as well as discuss the results w/him.

===WRITE, don't call===
WRITE, don't call, this sleep lab/clinic and request a copy of the doctor's dictated results of both your sleep evaluation AND titration studies (about 1-2 pages each), AS WELL AS the scored report (full data summary report w/condensed graphs - about 5-7 or more pages each) from both studies AND your equipment order (script). This might also be a good time to diplomatically express your disappointment that doctor isn't interested enough in your therapy to want to monitor your data from a fully data capable CPAP.

That letter just MIGHT get you another appointment w/that doctor, your reports AND the script you want for a fully data capable CPAP. Maybe not an autoPAP, but at least a fully data capable CPAP.

It might even be a good idea to send that letter CERTIFIED MAIL, RETURN RECEIPT REQUESTED as PROOF that you HAVE requested those copies which you have a legal right to under HIPAA if you are in the USA. It also signals to the lab and doctor that you ARE serious about wanting them. Keep a copy AND all your receipts of having sent it.

With those copies you have almost all you need. The only other thing you will need is your family doctor to write the equipment order YOU WANT.

For examples of how scripts should be written see the section [http://www.cpaptalk.com/wiki/index.php/Sleep_Apnea#Suggested_Specific_CPAP_Equipment_Rx.2FScripts Suggested Specific CPAP Equipment Rx].

Don't get your heart set on an autoPAP. That can be a tough one to get, especially if you are stuck w/this same DME supplier which you might well be depending on how long you've had your current CPAP.

Also give consideration (if you already have a non-data-capable CPAP) that you will be better off getting the same brand of CPAP, just a fully data capable model, so that the humidifier doesn't have to be replaced as well. The more equipment this DME supplier has to exchange the harder they are going to fight providing it. AND your insurance is NOT going to be happy if they have to purchase another humidifier, all they know is they purchased A humidifier, not which one nor that a Respironics integrated isn't going to fit on a Resmed or vice versa. They most likely would refuse to do so and you'd end up buying the humidifier out of pocket - or going w/o.

=Working with the VA=
For insight into working with the VA as a veteran with Obstructive Sleep Apnea, visit the page dedicated to that subject written by your very own: [[Veterans and OSA]]

Working with Physicians.2C Insurance and DMEs

2009-12-23T21:45:52Z

Katherinefulmer:

=Physician Help=
==Getting into a Sleep Specialist/Sleep Lab Quickly==
author unknown

This might seem like a no-brainer, but I'm going to mention this anyway just in case someone out there needs this info.

Anyone who has been into see a sleep specialist / neurologist as a new patient and then has booked a night at a sleep lab knows all too well how even in first rate medical cities (ie. Boston; Philly; Cleveland) it can easily take 1-3 months to get an appointment with a good Neurologist / Sleep Specialist. And then you're at the back of the line again to get into a sleep lab. AND THEN you're at the back of the line AGAIN to get back into see your Neurologist for the results of the sleep study. And if your results are inconclusive as they often are, add another 1-3 months for a repeat night at a sleep lab etc etc. When you're suffering from Sleep Apnea, nothing is more painfull than knowing it might take 6-8 months to finally be treated for the disorder.

So here are my tactics for getting into Sleep Specialist, Sleep Lab, and most importantly getting treatment ASAP or well within 6-12 weeks.

1. After you book your first appointment with your Neurologist / Sleep Specialist, call the scheduling desk and quickly convey that you are available on short notice if anyone else should cancel their appointment. If they say they have a long list, then pull out the "friendliness card" and make sure you're well known to the office staff.

2. After your first night at the sleep lab is booked, get on the phone to the sleep lab and do the exact same thing. Sleep Labs bill $1,000-$4,000/night so they are always eager to book empty beds, and people cancel their sleep lab nights left and right.

3. After your night in the sleep lab, you have no choice but to wait for your results to be compiled and sent to your neurologist. But once you\'re able to get into see your Neurologist for follow up, get on the phone and request that the office call you for cancelled appointments.

Hope this helps! I've been into 5 sleep studies and this always works for me.

==Suggested Specific CPAP Equipment Rx/Scripts==
by CPAPtalk member Slinky

(Editor's note: a doctor's prescription is required for a PAP machine and mask whether through a local DME or online. Online, a generic CPAP prescription will work for either a CPAP or APAP. At a local DME, a prescription specific for APAP will probably be required. See prescription advice and requirements at https://www.cpap.com/cpap-faq/Prescriptions.html#FGID-130 )

If your equipment order (Rx/script) will be for "just" a straight CPAP and not one of the more sophisticated bi-levels (Bi-PAP) or SV, etc. most doctors write a fairly genetic script and then most DMEs will take advantage and provide you with a bare-bones CPAP.

I would suggest that you ask your doctor to write a very explicit equipment order so that you get EXACTLY what you want and really need. The following are some suggested orders (not that I am recommending one machine over the other, just to give you and your doctor an idea).

'''You will notice the similarities to each suggestion.'''

1] Exact brand and model of machine

2] Scripted pressure (the autoPAPs have a pressure range rather than a set pressure)

3] Scripted amount for lower pressure at exhalation

4] Starts w/4 cms of pressure and ramps up to your set pressure after you get to sleep

5] Allows you to access your nightly data via the LCD screen

6] While the integrated humidifiers are most convenient for travel and take up less space on your nightstand,
in really dry situations sometimes they can't provide as much humidity as you might need or want. For many the integrated humidifiers are more than satisfactory.

7] This ensures that you can try several masks, including a Full Face mask (sometimes they insist on a script specifiying full face if the script just says mask, or will only provide the exact mask mentioned in the equipment order).

[[Rx Sample 1]]
 
[[Rx Sample 2]]
 
[[Rx Sample 3]]
 
[[Rx Sample 4]]
 
To the best of my knowledge the only other fully data capable CPAPs (as of January 2008) are the Puritan Bennet GoodKnight 420E autoPAP and one other Puritan Bennet GoodKnight straight CPAP. I'm not sure of the correct model. Nor do I know the specifics for those Puritan Bennet's or I would have included them. Those who have the 420E really like them so hopefully further information can be included by someone who knows the Puritan Bennet devices.

==Glossary for PSG (Sleep Study) Terms==

The [http://www.cpaptalk.com/wiki/index.php/Category:CPAP_Definitions PSG Glossary] is the first section of the CPAP Definitions page.

Get a copy of your sleep study report. You can refer to it from time to time as you learn more about your treatment. If you visit a specialist (sleep doctor, Ear/Nose/Throat doctor, pulmonologist, cardiologist, eye specialist, allergist, surgeon, dentist, etc.), give them a copy of your sleep study.

=Insurance and DME Help=

==Getting the data-capable xPAP machine you need==
by slinky (compilation of various posts)

Often beginners to CPAP end up with the low-end, non-data capable xPAP's. However, we know that the ability to monitor your own progress (AHI, leaks, etc) greatly increases compliance and allows you to make knowledgeable changes to your therapy (hopefully with the help of your sleep doctor).

'''Insurances WILL cover data capable machines. DME's WILL supply you with data capable machines, and here's how to ensure that you end up with a data-capable machine''' (or the machine and mask you want) when dealing with un-helpful Insurance, DME's, and doctors:

1] Call your insurance company.
 a] Ask them what local DME CPAP suppliers they are contracted with
 b] Ask them what your DME CPAP benefits are: copays? deductibles?

2] Since you found this forum I can guarantee you that you are NOT going to be satisfied w/anything LESS than a FULLY DATA CAPABLE CPAP.
 a] Start checking out CPAPs at cpap.com. Never mind price at this point. Just check out the features. You can choose those CPAPs that interest you and cpap.com offers the opportunity to run a comparison of features of those that interest you.
 b] Check out autoPAPs separate from "just" CPAPs. You might well get "auto fever" before you are done reading here.

3] Prepare a WRITTEN request for:
 a] The doctor's dictated results of BOTH your sleep evaluation AND your titration studies
 b] The full scored data summary report w/condensed graphs for BOTH your evaluation AND your titration studies
 c] The script (equipment order) so that you may "shop" your local DME options
 d]If you will not be seeing the sleep doctor for a consultation again FAX this above request to him and keep the proof of FAX. If you will be seeing him BEFORE you receive your equipment then you can just GIVE the request to him TO BE PUT IN YOUR RECORDS as well as discuss the results w/him.

===WRITE, don't call===
WRITE, don't call, this sleep lab/clinic and request a copy of the doctor's dictated results of both your sleep evaluation AND titration studies (about 1-2 pages each), AS WELL AS the scored report (full data summary report w/condensed graphs - about 5-7 or more pages each) from both studies AND your equipment order (script). This might also be a good time to diplomatically express your disappointment that doctor isn't interested enough in your therapy to want to monitor your data from a fully data capable CPAP.

That letter just MIGHT get you another appointment w/that doctor, your reports AND the script you want for a fully data capable CPAP. Maybe not an autoPAP, but at least a fully data capable CPAP.

It might even be a good idea to send that letter CERTIFIED MAIL, RETURN RECEIPT REQUESTED as PROOF that you HAVE requested those copies which you have a legal right to under HIPAA if you are in the USA. It also signals to the lab and doctor that you ARE serious about wanting them. Keep a copy AND all your receipts of having sent it.

With those copies you have almost all you need. The only other thing you will need is your family doctor to write the equipment order YOU WANT.

For examples of how scripts should be written see the section [http://www.cpaptalk.com/wiki/index.php/Sleep_Apnea#Suggested_Specific_CPAP_Equipment_Rx.2FScripts Suggested Specific CPAP Equipment Rx].

Don't get your heart set on an autoPAP. That can be a tough one to get, especially if you are stuck w/this same DME supplier which you might well be depending on how long you've had your current CPAP.

Also give consideration (if you already have a non-data-capable CPAP) that you will be better off getting the same brand of CPAP, just a fully data capable model, so that the humidifier doesn't have to be replaced as well. The more equipment this DME supplier has to exchange the harder they are going to fight providing it. AND your insurance is NOT going to be happy if they have to purchase another humidifier, all they know is they purchased A humidifier, not which one nor that a Respironics integrated isn't going to fit on a Resmed or vice versa. They most likely would refuse to do so and you'd end up buying the humidifier out of pocket - or going w/o.

==Working with the VA==
For insight into working with the VA as a veteran with Obstructive Sleep Apnea, visit the page dedicated to that subject written by your very own: [[Veterans and OSA]]

Cleaning CPAP Equipment

2009-12-21T19:42:20Z

Katherinefulmer: /* Main Tubing: Humidifier to Mask */

= Introduction =

Few topics engender more diversity of approach than that of routine cleaning of CPAP equipment: humidifier chambers, tubing and masks. (I might dare also include the checking and periodic replacement of machine filters.)

Practices range from doing nothing (often accompanied by the claim that “…. and I’ve never been sick or had any problem”) to vigorous daily disassembly and thorough washing (often accompanied by the conclusion that therefore “…. I’ve never been sick or had any problem”).

Philosophies range from “people today would be a lot healthier if they ate more dirt” (which might or might not be so, but “back in the day” life expectancy surely was a lot shorter) to germophobic fatalism, to holistic health practices including homeopathy and nasal irrigation (reminds me of reading literature on the virtues of daily enemas).

The equipment manufacturers don’t help much. Almost all advise daily draining, washing, and rinsing of humidifier chambers and masks. (Perhaps because tubing isn’t often sold as a “branded” product, there is less emphasis on daily care in that realm.) They are often accused of taking that position as a litigation preventive measure; that may or may not be so. They rarely present actual research to support or explain their cleaning recommendations.

Recognizing that my complete objectivity and rationality is not infrequently called into question (even, or perhaps especially, by those who know me best), let’s take a stab at thinking through the issues. In that way, whatever decision we reach, we can pretend that it’s based on careful and deliberate thought, rather than on our own laziness or on our obsessive-compulsive inclinations.

== General Principles ==

● Microbes tend to grow in warm, moist, dark places.

● Our world, including the air we breathe, is full of microbes.

● The danger posed by commonly encountered microbes is directly proportional to the number of them that get inside us, and inversely proportional to our overall state of health. (This is true also of microbes normally found in our own bodies. Change the number or ratio of our internal microbial flora, or experience a general decline in health, and our own microbes can literally “eat us alive”.)

Based on these principles, let’s consider the equipment in our CPAP set-ups, in order from the most distant components to those closest to our bodies.

=== Air Filters ===

ResMed suggests, “Inspect the air filter every month to check if it is blocked by dirt or contains holes. With normal use of an S8 AutoSet II, the air filter needs to be replaced every six months (or more often if your device is in a dusty environment).”

Respironics states, “Under normal usage, you should clean the gray foam filter at least once every two weeks and replace it with a new one every six months. The white ultra-fine filter is disposable and should be replaced after 30 nights of use or sooner if it appears dirty. DO NOT clean the ultra-fine filter.”

Why does Respironics suggest so much more frequent checking and changing of filters? One explanation is that their filtering system is much more efficient than the open fiber filters – reminiscent of inexpensive filters used in my home HVAC system – employed by ResMed. Fine particulates appear much more likely to be blocked and kept out of the air stream – and thus much more likely to foul and block the filters – in the Respironics systems. Still, it does not necessarily follow that the presumed higher efficiency of the Respironics filtration is either necessary or helpful – do we need to breathe air that is cleaner than our room air?

Respironics nicely summarizes why filter cleaning is important:

----
'''Caution''': Operating the device with a dirty filter may keep the system from working
properly and may damage the device. …

'''Caution''': Dirty inlet filters may cause high operating temperatures that may affect
device performance. Regularly examine the inlet filters as needed for integrity
and cleanliness.
----

Ah, a reference to “cleanliness.” Comfortable, culturally correct, but still, just a bit …. vague.

=== CPAP Machine ===

No one recommends that we clean the CPAP machine (at least not beyond the careful application of a moist cloth to the exterior to remove grease, grime and dust). Isn’t that an oddly fortunate coincidence, since there’s no safe way in which we’re ABLE to clean the belly of the beast. Besides, though it may be dark inside and warm when it’s running, it’s dry, and nothing goes through it except filtered room air.

Well, that may not be quite exactly true. There are two ways in which moisture might get inside. The most serious is if there’s backflow into the machine from the humidifier. This, apparently, is most likely to happen if the set-up is moved while the machine is attached to a humidifier containing water. BIG OOPS. Not only is there danger of microbial growth wherever the water manages to ooze, but there is also danger of electrical component malfunction, corrosion, or even potential short-circuit and fire. The manufacturers are unanimous:

ResMed: “Water must be prevented from entering your flow generator. Do not transport the flow generator with the H4i attached.” …. “This Limited Warranty does not cover: …. d) any damage caused by water being spilled on or into a flow generator.”

Respironics: “If the device and humidifier fall and water gets into the device, drain all water out of the device and make sure it is completely dry before reapplying power. … If the device falls or water gets into the device upon falling, let the device dry completely and then restart it. If it does not operate correctly after falling, contact Respironics or an authorized service center.”

----

But there is a second, more subtly insidious, and perhaps more common way for moisture to enter the CPAP machine and cause any or all of the nasties described above. That is by diffusion. The physics is very simple and straightforward. Just as “nature abhors a vacuum,” nature abhors any difference in concentration of any substance.

You are using your CPAP with a heated humidifier. The CPAP blows air in one direction: away from the machine, over the water surface in the humidifier chamber, and towards you. You sleep well, with not a care in the world. In the morning, you wake up, turn everything off, and go about your business. (Or, similarly, you get up during the night for an extended period.) And diffusion goes about its business.

Water has a high “specific heat” – higher than almost any other common substance. That means that it takes more heat to raise the temperature of water, than it does to raise the temperature of an equal mass of any other substance, an equal amount. That also means that warm water stays warmer, longer than just about anything else. And THAT means that the moisture level – the absolute humidity – the concentration of water – in the air above the water in the humidifier chamber, will be greater than that in the air anywhere else in the room. That water vapor will want to get – everywhere, anywhere else.

If tubing is connected to the humidifier chamber under these conditions, that humid air will begin to diffuse into the tubing. And in both directions: since no air is flowing, it will equally seek to go into your main tubing, AND into your CPAP machine. In either direction, that warm, moist air will find cooler surfaces. And on cooler surfaces, water will precipitate out of the air. (Yes, right, just like rainout!) The amounts may be minute. Or not. Diffusion occurs on a molecular level, and the warm water vapor can find its way through the most minute cracks and crevices. Even into areas of the machine where little airflow moves – so that there may not be the “normal” opportunity for drying during normal machine use. Dangers of machine damage due to this water vapor diffusion are arguably small. Dangers of providing a habitat for microbial growth may also be arguably small.

Still, it’s simple enough, with most machine designs, to disconnect the direct connection between the humidifier and anything else. With a stand-alone humidifier, disconnect the tubes. With a ResMed Humidaire humidifier, lift the top cover to unseat the gasket and let the humid air pass harmlessly into the room. With Respironics humidifiers – sorry, I have never used an integrated Respironics humidifier, so I don’t know how best to take action. (By the way, if you use a Fisher & Paykel stand-alone humidifier with the HC-325 chamber, the blue plastic caps that come with each new chamber should be kept - they make an excellent cover for the chamber AFTER you remove the tubing. And an excellent cover for the CPAP machine blower port.)

This is a simple, proactive way to prevent even the small possibility of physical damage, and, more to the point of this article, to prevent even the small possibility of microbial growth inside the blower.
----

Aha! ResMed has already thought of this, though paradoxically they give what for all the world looks like a bogus reason for their very innovative response. In their manual for the HumidAire series of humidifiers (though generally NOT in the manuals for their CPAP machines themselves) they write:

“Note: In order to assist the heater plate in cooling, some flow generators continue to
blow air gently for up to an hour after treatment has stopped. However, you can unplug the device from the power outlet at any time and allow the heater plate to cool without airflow. ”

In fact, with water still present in the chamber, this slight blowing will have virtually no effect on the humidifier heater plate temperature. Their comment that this function can be easily aborted strongly suggests that there is no need to cool the heater plate. (The best way to cool the heater plate is to remove the reservoir chamber!) Nor is this function useful, as some have suggested, in drying the hose. To the contrary, it is still warm, moist air being gently blown INTO the hose, and rainout may result.

What this "gentle blowing" DOES accomplish is to keep warm moist air flowing AWAY from the machine, preventing diffusion of water vapor INTO the machine. Well done (though poorly explained), ResMed! But even better is to simply disconnect or remove the humidifier chamber from its connection to the blower.

=== Machine–to–Humidifier Hose ===

This component exists principally in systems which utilize a “stand-alone” rather than an integrated humidifier (though even with an integrated system, “something” connects the machine to the humidifier). Such a hose, if it exists, should be inspected periodically for physical integrity and leaks (run you hand along and around it while the machine is running to check for any airflow), and inspected visually for anything inside that should not be inside. The need for any active cleaning should be rare.

[http://www.cpaptalk.com/wiki/index.php/CPAP_FAQs#How_Do_I_dry_CPAP_Hoses_after_cleaning.3F How to dry CPAP Hoses]

=== Humidifier Chamber ===

Now the disputation begins in earnest. The “never empty or clean unless there’s an obvious reason to do so” advocates make some excellent points:
----
● even if the occasional microbe gets into the chamber, if you are using distilled water (as you probably should be), there’s nothing for them to feed and grow on.

● even if there is microbial growth in the water, there little likelihood that they can enter the airstream, and

● even if microbes did enter the airstream, there is little evidence that they could successfully navigate and survive the trip down the main tubing in sufficient number to cause illness.
----

On the other side of the table, activists may well claim:
----
● distilled water is not necessarily sterile water, and even if it were, it can no longer be considered sterile once the bottle has been opened

● even with filtration, air flowing through the system is neither microbe-free nor particulate free, and particulates (which may provide microbial nourishment) certainly have an opportunity to enter the humidifier during the filling process, and (depending on whether and how portals are covered) during the day.

● while it is true that humidifiers work by producing molecular water which “dissolves” in the overlying air, rather than water “particles” which can “carry” microbes “piggyback” down the tubing, there are other potential transport processes. Observation of the surface of CPAP humidifiers during respiration generally show “rippling” as airflow increases on inspiration. This non-laminar flow “rippling” is effectively wave generation with associated “spray” production – i.e., water particulates capable of carrying microbes. Convection within in the heated water will regularly carry microbes, if present within the water, to the surface, waiting for their “ride”.

● in addition to the presence of surface-effect “spray” water particulates as just described, “clumps” of microbes, even without water droplets as a transport vehicle, can be “lifted up” directly by the non-laminar airflow, either from the water surface, or from the humidifier chamber walls as the water level falls through the night.
----

There is little good, hard, convincing, available science upon which to base a firm preference for either of these two positions. A published study of radioisotopes placed in humidifier water was found to detect radiation as have traversed the tubing, but only at very high pressure (and correspondingly high flow-rate, due to increased venting flow at higher pressures) conditions.

In a brief departure from focusing on microbes, a mention of mineral precipitation is in order. In all but distilled water, there will be dissolved mineral ions. As molecular water is lost overnight through evaporation (whether in a heated or even in a passive pass-over system), the mineral concentration will increase. (It should be noted that periodically adding additional fresh water through the night will help to minimize this.) There may come a point when the minerals reach their saturation point, and begin to precipitate out of solution, potentially resulting in a build-up on the chamber walls and, more likely, on the heating plate. There are two principal down-sides to the deposition of mineral precipitates. First, they tend to form cavernous networks, which provide attractive housing for microbes. (So I lied; we are still talking about microbes.) Second, precipitation on the heater plate tends to decrease the efficiency of heat transfer. (That it may look unattractive is a personal problem; deal with it.) The general recommendation for removing such precipitate is rinsing in a dilute vinegar solution, with the acidic environment hopefully dissolving the minerals and allowing them to be rinsed away. (In addition it is claimed that the vinegar has mild antiseptic properties, helping to kill, yes, again, microbes.) It should also be noted that many insurance plans cover twice-yearly humidifier chamber replacement.

Thus, the range of options for humidifier chamber care and maintenance, from least interventionist to most conservative, runs something like:

● doing nothing; simply adding water each night
● draining out the leftover water and allowing to dry, each morning, or periodically
● draining, rinsing and allowing to dry, each morning, or periodically
● all the above, plus use of soap and/or vinegar, followed by thorough rinsing

A final comment on drying. If you are “drying out” the humidifier at all, the faster the drying process, the less likely that any microbes will find residual moisture and “settle in.” (The bathroom, by the way, may be the most convenient place for drying, but it is the least desirable, in view of typically higher moisture levels, typically higher levels of airborne particulates, and – yes – typically higher level of airborne microbes.) Drying can be accelerated by vigorous shaking, not only to remove excess water, but also to break up remaining water into smaller droplets. (Smaller droplets have a larger surface-area to volume ratio, and will therefore evaporate more rapidly.) Inserting a clean, thin, threadbare washcloth into the chamber prior to the shaking process will facilitate the removal of excess water. And blowing air through the chamber with a CPAP machine will greatly enhance the evaporation of any remaining water.

Where you choose to place yourself on this spectrum is largely a matter of choice, involving such factors as your overall health, your overall “tidiness”, and your overall risk tolerance preferences. It’s hard to imagine even the most “non-interventionist” CPAP user ignoring a humidifier chamber which begins to look cruddy or colorful. If a decision regarding action is based on what you see (or more precisely, on what you NOTICE), then we in fact are already operating on an analog basis – how much contamination is present – rather than on a yes/no digital basis - whether or not contamination is present. Even in our digital age, much of life remains analog.

=== Main Tubing: Humidifier to Mask ===

People often talk about cleaning their tubing, but few seem to do anything about it. I suspect that’s because the process is so cumbersome. And perhaps also because, arguably, it’s relatively unnecessary.

In the absence of rainout (precipitation of water from warm, moist air against the cooler walls of the tubing), the tubing interior typically remains dry. Mask venting and continuous airflow from the machine (and, for some masks, extension tubing) typically prevent any significant amounts of exhaled air from retrograde entry into the tubing. Under these “ideal” conditions, there’s nothing needing to be cleaned.

Unfortunately, conditions are sometimes less than ideal. (Descriptions on the CPAPTalk discussion forums of insects entering the tubing will be left for those interested to find on their own.)

It is a good practice to INSPECT your tubing on a regular basis. When turning the machine on at night, run your hand along the length of the tubing, feeling for leaks. In the morning, visually check the entire length of tubing. Look for evidence of water droplets or mist suggesting rainout; look for any dark or discolored areas or objects. Tubing which is transparent is obviously highly preferable to tubing which is more or less opaque in this regard. Tubing which is covered (to prevent or diminish rainout) should periodically be “undressed” so that it can be inspected.

If there has been ANY rainout, you now have a condition in your tubing which will arguably support microbial growth. (See the discussion about humidifier chambers, and the variety of opinions about whether microbes can in fact get into, and live in, the tubing. I will simply suggest that the longer you go without inspecting, drying or cleaning your tubing, the greater the possibility of microbial growth, survival, and migration down your tubing toward you face, becomes.)

If there has been rainout, it should be PROMPTLY and RAPIDLY dried. The hose should be first shaken, from the center toward each end, to remove as much water as possible. If you have sufficient room, twirling the hose, from the center toward each end, will also expel excess water. The most convenient technique for rapid drying is to run air from your CPAP blower through the tubing until all evidence of water is gone. (Some machines may automatically shut off when no resistance to flow is encountered. On some of these, it may be possible to disable and turn off that feature. It may also be possible to put a flow-limiting connector on the end of the tubing, but this will increase drying time, since maximal flow will product the most rapid evaporation.) Sucking air through the tubing (rather than blowing as with a CPAP machine) may be attempted; devising a connector to the suction of a household vacuum cleaner has been suggested. Another attractive suggestion (presented on the CPAPTalk forum) is that of connecting a weight to one end of a six-foot-plus length of fishing line, and connecting a thin, dry cloth to the other end of the fishing line. Drop the weight into one end of the tubing, let it pull the line through the tubing, and then the fishing line can be used to pull the dry cloth through the tubing. Special care may need to be taken with heated tubing, or with tubing having custom connectors on one or both ends.

All else failing, tubing can simply be left hung to dry, but passive diffusion of air through a narrow six-foot tubing is not an ideal methodology. Under such circumstances, it has been wisely recommended that one have a spare second tube to use while the first one is drying overnight. For additional ideas on how to dry the tube see the section here on [http://www.cpaptalk.com/wiki/index.php/CPAP_FAQs#How_Do_I_dry_CPAP_Hoses_after_cleaning.3F CPAP FAQs]

Actually “cleaning” the tubing may occasionally be desirable, as for example when rainout droplets have been allowed to sit in the tubing for days, or even just hours. Some people "dunk" the tubing into a basin of soapy water; possibly a bit awkward due to the tubing length. Simply rinsing the interior by holding one end against a spigot, and allowing the other end to drain into the bathtub, may be sufficient. (Some people have described taking the tubing into the shower with them for rinsing!) If it is desired to use soap (or some other safe cleaning material), the use of a male-to-male adaptor makes the task much easier. (A male-to-male adaptor is typically a small plastic connector, both of whose ends will fit inside the rubber cuffs at the ends of the tubing, and which may be used to connect two hoses together. Some masks come with parts which may be usable for this purpose – e.g. the swivel assembly on a Mirage Activa. An adapter suitable for such use is sold by CPAP dot com at:
https://www.cpap.com/productpage/hose-coupling-swivel-adapter-cpap.html .)
After partially filling the hose with water, and adding a suitable amount of soap, use the adapter to connect the two ends so that the tubing forms a continuous loop. The cleaning solution can now be easily “swished” through the tubing, and allowed to stay inside for as long as is desired. After cleaning, rinse thoroughly and dry rapidly, as already described.

=== Mask ===

While the risk of microbes reaching us through the airstream is debatable, the risk of contamination of the mask is far less controversial. All night, every night, we are exhaling warm (at body temperature) moist (100% relative humidity) air, laden with microbes (yes, our own) from our upper airway, and proteins and enzymes and sloughed cellular debris, into the mask. The thought question with regard to mask cleaning is not so much, “Do you feel lucky?” as, “Why do you brush your teeth?” The conditions which can lead to halitosis, gingivitis, dental decay, and that grubby trench-mouth feeling, is now present on and in the surfaces and crevices of our masks. Further, he grease and grime on our facial skin is transferred to the cushions.

Despite the difficulty of making a convincing case AGAINST regular mask cleaning, CPAPTalk forum postings demonstrate a wide variety of practices (and a wide spectrum of embarrassment and guilt) for our failures to care for our equipment.

Mask manufacturers routinely provide their “instructions” for cleaning, which typically take the form of daily disassembly, cleaning with soap and water, drying and reassembly. As previously noted, whether this is done simply to ward off litigation, or whether there is actual science and research underlying these recommendations, they are generally presented to users without factual explanation of their basis or origin.

One specific area of contention is that of the extent of mask disassembly required for thorough cleaning. The inconsistencies in manufacturer recommendations are telling. ResMed, for example, instructs complete disassembly of the Activa mask. This is not unreasonable; there are only 10 parts (excluding headgear), only one relatively small, fairly easily disassembled and reassembled (though I have done it improperly with resulting leaks). On the other hand, ResMed instructs only partial disassembly of the UltraMirage Full Face mask. This too is not unreasonable; there are some 13 parts (excluding headgear), six of which are relatively small, and those involved in the elbow and anti-asphyxia valve assembly require some level of dexterity and competence to handle safely and correctly. Loss of small parts down the sink is not unheard of. Obviously, there is a balance between the goals of cleanliness, and the goals of correct and non-destructive disassembly and reassembly. Some appropriate degree of balance must be found by each user. (I still have trouble properly replacing the UMFF venting system and cushion, for which ResMed does recommend daily disassembly.)

Other areas of concern involve whether the life expectancy of the delicate plastic cushion membranes are enhanced or lessened by the handling involved in disassembly and cleaning. This, too, involves personal issues of dexterity and confidence, as well as the development of good, safe practices.

The preventive measures of facial washing (possibly including the use of special cleansers or alcohol wipes to remove skin oils) before donning masks, and of course appropriate oral hygiene before bed, would seem appropriate. At the very least, daily rinsing of the fully-assembled mask appears to be reasonable. Gentle cleansing of the cushion surfaces in contact with the face, to remove grease and oils, may help in minimizing leak (though there are some who insist that either cleaning itself, or the process of disassembly and cleaning, increases the likelihood of leak). Periodic more thorough cleaning, including soaking in soapy water, with an appropriate level of disassembly, should not be neglected.

Finally, an industry has arisen which provides convenient “wipes” and “sanitizers” specifically for CPAP masks. Certainly better than doing nothing, I can’t help but wonder what research has been done, and what the use of such products actually accomplishes.

=== Headgear Straps ===

Finally, we move out of the realm of microbes, and into the personal comfort zone of dealing with our own head and hair greases and oils. Whether regular cleansing increases or reduces the lifespan of headgear is not at all clear. Washing certainly appears to vary the size and elasticity of some headgear materials, necessitating periodic readjustment of the straps (which is probably a good idea in any case). If a basin of soapy water left is over after having just given your mask a periodic cleaning, it seems wasteful not to give the headgear a dunking as well.

= Concluding Comments =

In the absence of reliable data, risk / benefit analyses devolve to decisions about what feels comfortable, and how much time and effort that comfortable feeling is worth. The wide spectrum of equipment cleaning practices frequently described on the CPAPTalk forum emphasizes that there are no simple answers which are always right for everyone.

On the other hand, if there’s visible crud anywhere on your CPAP system, be ashamed. And if you’re not regularly LOOKING for visible crud, be ashamed. Hygiene can be overdone, but that generally costs only time. Those of us with Sleep Apnea have a chronic condition which threatens our health, and failure to take appropriate care of our equipment and ourselves is at best short-sighted and risky. I’m not necessarily against risky behavior per se, but it seems as though it should be based on positive decisions rather than on laziness, and should deliver a lot more benefit (and fun).

----

--[[User:Velbor|Velbor]] 23:45, 21 November 2009 (UTC)

updated --[[User:Velbor|Velbor]] 15:25, 25 November 2009 (UTC)

released --[[User:Velbor|Velbor]] 21:56, 29 November 2009 (UTC)

Nasal Aire II Modifications

2009-12-17T17:30:33Z

Katherinefulmer:

by Babette, 07/06/07

Here are some links to how to wear the Nasal Aire II, as requested by other forum members:

http://www.mergenetsolutions.com/innomedinc/documents/na2headgear.pdf

http://www.mergenetsolutions.com/innomedinc/na2.htm

https://www.cpap.com/productpage/innomed-nasal-aire-ii.html
(Scroll down to the bottom for several helpful videos)

I decided I didn't need the headgear that came with it, and attached my NAII directly to my chinstrap:

http://s124.photobucket.com/albums/p36/BabetteLaMauvaise/CPAP/

I sleep on my side, both sides actually, and can mash my face into my pillow with no difficulties. I do not have any leaks, and the tubing is perfectly comfortable to sleep on.

Others have said the noise is worse than any other interface. I have found all interfaces noisy, and have gotten used to the noise. I like the "white noise" factor because it keeps the neighbor-noise at bay.

Your mileage may vary. I say, if you're a side sleeper, this is the best interface available. I've tried nearly all the pillows interfaces, and everytime I rolled, the pillows slid off my nose. I have NO leaks with this mask, it doesn't give me any pain or cause facial red marks, it's perfectly comfortable and doesn't pull my nose or rub my upper lip raw.

[[Category: CPAP Masks]]

Nasal Aire II Modifications

2009-12-17T17:30:17Z

Katherinefulmer:

Questions to Ask your Doctor

2009-12-17T17:20:12Z

Katherinefulmer: New page: ==Examples of Situations== 1. Let’s say your primary care physician or family doctor is very helpful and was instrumental in suggesting a sleep study which led to the diagnosis of OSA, ...

==Examples of Situations==

1. Let’s say your primary care physician or family doctor is very helpful and was instrumental in suggesting a sleep study which led to the diagnosis of OSA, but is not a specialist in subsequent CPAP therapy. You may want to find a doctor experienced in sleep therapy. This may be a sleep doctor who is board certified and experienced in sleep medicine, a pulmonologist (breathing specialist) or other specialist; or a primary care physician or family doctor with sleep therapy experience. Treatment of sleep disorders is still relatively new in the medical community and sleep doctors may be overbooked. There is a body of knowledge about ever-evolving treatment techniques not known to every physician. It’s worth searching for a doctor with experience in sleep apnea. Ask your family doctor and/or local hospital sleep lab for names of sleep doctors. Prepare a few questions about their practice. Phone their offices for answers and talk to the nurse, front desk people, the doctor, your family doctor, or to other patients or sleep lab technicians in the hospital where the doctor practices.

Discussion thread on sources of finding a sleep doctor:
http://www.cpaptalk.com/viewtopic/t14872/What-is-a-sleep-doctor.html?sid=bb563d5b160be04b2a29a62356138016
Finding a sleep doctor through the American Board of Sleep Medicine:
http://www.absm.org/diplomates/listing.htm

===Questions to ask===

• Does this practice accept your insurance? 
• Is the doctor accepting new patients? 
• How long does it take to get an appointment; how busy or accessible is the doctor? 
• What is the doctor’s experience with sleep apnea? 
• Does the doctor ever recommend alternatives to CPAP treatment (dental devices, pillar procedure, etc.)? (Depending on your condition, if the doctor immediately suggests surgery as a first step rather than CPAP, he/she may not be up-to-date on less invasive and less risky treatment options.) 
• What types of CPAP treatment does the doctor use? Does he/she categorically disapprove of auto CPAP (APAP)? (The answer may give you some indication of how up-to-date the doctor is on APAP research and newer machines. APAP may not be the best choice for you, but open-mindedness is helpful.) 
• Does the doctor support a cooperative, collaborative relationship with the patient and advocate responsible patient self-management of their therapy? Does he/she support patient responsibility and empowerment in their therapy, or are they more “old school” and paternalistic with the doctor as the authoritarian manager of the therapy and the patient as passively obedient and compliant? Which style are you as a patient? Discussion thread on doctors and Internet patient information: http://www.cpaptalk.com/viewtopic/t16401/Doctors-vs-Internet-Information.html 

If after a few visits you find that your doctor’s style and your style of handling your therapy are incompatible, find a different sleep doctor, if you can.

2. After the diagnosis of OSA, if suggested by your primary care physician or the sleep study report, you may want to visit an ENT (Ear/Nose/Throat) doctor, pulmonologist, cardiologist, or other specialist to learn more about your health conditions. Bring a copy of your sleep study report.

3. DME or home care provider. You may be assigned to a Durable Medical Equipment provider by your insurance company, or given a choice of several DMEs, depending on your insurance plan. Following your doctor’s prescription, a respiratory therapist (RT) or technician may outfit you with a machine and mask, and provide training tips for use and cleaning. DMEs are a profit center store, warehouse distributor, and delivery service (except that they don’t usually deliver CPAP equipment) with a measure of therapeutic support; a valuable service if done right.

• Is the DME company’s customer service knowledgeable, accurate and prompt in handling your prescription and equipment orders? 
• Do they return your phone calls promptly? 
• Do they give you phone numbers to contact your local office or always require you to go through regional customer service and then not follow up to help you? 
• Are there procedural conflicts and poor communication between one part of the company and another (customer service, local office, billing, regional, legal for HIPPA), so they can’t easily help you if you have problems? In other words, do you get the run-around? 
• Are they genuinely courteous and helpful or do they take a hard line against you and your needs and act dismissive under the guise of their procedures? 
• Do they offer accurate information and assistance or do they conceal information in order to push their products, or are they uninformed or misinformed? 
• How long does it take to get equipment? 
• Do they ship the right equipment? Is it easy to return incorrect equipment? 
• Do you have a short drive to the local office and short waits for an appointment or service? Under what circumstances do they deliver equipment? 
• Is the RT both knowledgeable and compassionate? 
• Does the RT provide safety information about the CPAP machine and masks? 
• Does the RT show competence and confidence in setting up (programming) your machine and set it up correctly? 
• Does the RT show you how the machine is set up and how to work the controls and mask, at a time and pace when you can absorb the information? 
• Does the RT show you a reasonable choice of masks, both types (nasal mask, nasal pillows, full face) and brands (ResMed, Respironics, AEIOMed, Fisher and Paykel, others)? The DME will probably have a contract with only a few brands or manufacturers, but you may require a different brand. Can they order that brand for you? Will getting it take an unreasonable amount of time? 
• Does the RT seem to know how to fit a mask? Is the mask trial and fitting done while you are lying down on your sides and back, with the CPAP machine turned on to check for leaks? 
• If your machine has a smart card, is the DME able to provide you with software reports on a timely basis? 
• With new HIPPA regulations, does the organization make it easy for you to get your software reports, equipment information, and billing information? 
• How well do they handle equipment replacements and repairs? Billing? 
• Does dealing with them relieve your stress as a new CPAP user or add stress? 

If the service at your DME is unsatisfactory, you can ask for a different RT in the same office, or try another office of the same DME company. If your attempts at consistently getting adequate service fail, you can go up the chain of command to the branch manager and regional manager or headquarters. You can phone your insurance to see if other DME or home care respiratory equipment providers are available on your insurance plan, in-network or out-of-network, local or online, and try them. You can try an online DME and compare pricing and service. If you have an effective local DME, you are fortunate indeed.

4. Online DME. Some people give up on hassling with the ineffective and expensive local DME office and order equipment on the Internet at a much lower price with faster delivery and good customer service and advice. At www.billmyinsurance.com you can see if your insurance plan will cover purchases through them. If you are a senior on Medicare, you can order through www.cpapforseniors . You can use an online DME such as www.cpap.com paying out-of-pocket. Because they don’t need to deal with insurance and maintain expensive local offices, drivers, and a huge inefficient infrastructure, online prices are astonishingly low for the same high quality equipment offered at much higher prices by large national DMEs with local offices. With luck and ingenuity, you can combine various options for service to get your needs met for OSA equipment. For example, first you can research machines and masks at www.cpap.com. Can you try on the specific masks that seem promising at a sleep center and buy it there? Can your local DME order the mask and let you try it? It may be easiest and most cost effective just to order the mask through the online DME.

5. The sleep center or hospital sleep lab may be a resource beyond your initial sleep study. Technicians at a hospital may be less profit motivated and more patient-focused, more informed, and not hampered by a dysfunctional organization.

• Does the center’s sleep technician offer mask trials (trying on various brands and types of masks under pressure)? 
• Does it offer mask fittings (adjustments) of your current mask, no matter where you purchased it? 
• Have you compared the center’s sleep tech’s skills at mask trials and mask fitting with the skills of the technician at your local DME? 
• Does it offer these services to people who are not former patients? Are services free to former patients or at a cost? 
• Does it sell equipment and how do the costs and services compare with your local DME or an online DME? 
• Does it have a return policy within 30 days? 
• Do other sleep centers in your region offer these services, and can you use them even if your sleep study was not
done there? 
• Does the sleep center offer expertise (or pamphlets) not readily available elsewhere? Does it sponsor support group meetings through ASAA (American Sleep Apnea Association) AWAKE groups or another organization? 

6. Online support group. A very helpful community of xPAP (CPAP, APAP, BiPAP) users is found at www.cpaptalk.com . You can ask individual questions and quickly get a variety of supportive responses from people with experience. Sponsored by www.cpap.com, this forum gives back information to the CPAP community. See http://www.cpaptalk.com/viewtopic.php?t=9385 and http://www.cpaptalk.com/viewtopic.php?t=9375 . If you regularly read this forum, you may quickly find that you know more about certain practical aspects of sleep therapy than your professional healthcare advisers. You may want to explore other online support groups as well. Remember, opinions and personal truths are offered, not necessarily facts or your truth, so be discerning.

7. Community support group. Look for ASAA AWAKE group local meeting information at http://www.sleepapnea.org/awake/index.html . If you attend a meeting, you may find that you are able to help other xPAP users with your new-found knowledge from www.cpaptalk.com. If you want to start your own support group, explore http://www.awakeinamerica.org/Groups/LaunchGroup.shtml .

8. Others with OSA, family and friends, an advocate. Personal support, both given and received, can be invaluable. Do you need reassurance? Do you need help with using technology, the machine or its software? Do you need help adjusting your masks? Do you need help with running interference with an uncooperative DME or perplexing insurance coverage? It can be quite trying to be exhausted from sleep deprivation and need to repeatedly deal with DME hassles. A friend acting as an advocate can help.

Building Your CPAP Support Team

2009-12-17T17:19:45Z

Katherinefulmer: /* Examples of Situations */

Building Your CPAP Support Team

2009-12-17T17:18:38Z

Katherinefulmer: /* Questions to ask */

{{cleanup}}
'''Building Your CPAP Support Team''' is a critical step in your treatment. There is the old saying "It Takes a Village". There is power in numbers.

[[Image:The_Thinker_Musee_Rodin.jpg|thumb|Food for Thought]]
==Why is it necessary to have a support team?==

1) Because it can be difficult to adjust to the cumbersome [[CPAP]] (CPAP, AutoPAP, BiPAP) treatment for OSA (obstructive sleep apnea). About half the people who start CPAP therapy fail, and failure increases their risk for heart attack, stroke, car accidents, and diminished quality of life.

2) Because selection of equipment, its set-up, and ongoing adjustments usually have some difficulties. There are many important details and variables. In addition, research is ongoing and equipment technology is rapidly changing.

3) Because for many people there are two missing links – good information sources and an informed person to help with frequent therapy questions. Patients are largely on their own with OSA treatment. Basic and detailed therapy information and ongoing assistance at a local [[DME]] (Durable Medical Equipment or home care provider) are not as easy to find as you might expect, or be used to from medical personnel in a hospital or medical clinic. Technicians (respiratory therapists, clinicians, or sleep technicians) even at many national chain DMEs, and even if patient-centered and kind, may be hampered in assisting you by organization constraints (business contracts and fear of litigation), misinformation, or dysfunctional organizational systems. For example, the technician is not allowed to share certain information with you such as general information about pressure settings and refers you to your doctor, who may not be an experienced sleep specialist. If you spoke to the same technician in a more neutral setting such as an AWAKE support group meeting, maybe they could share more general information from their experience. Or the DME sells equipment from only a few manufacturers, so their people only suggest those products, even though you may need better equipment from a different manufacturer. Perhaps they can get you other equipment, but they don’t volunteer that information, it may take a long time to get it, they don't have a refund policy for special orders, and they say they can't handle replacement parts for it. Your doctor, focusing on medicine, probably doesn’t have the time, nor anyone in his/her office, to assist with the many and frequent therapy issues better handled by a respiratory therapist.

Ideal team members: a doctor experienced in sleep medicine, specialist doctors, sleep center/lab, local DME, online DME, online support group, community support group, others with OSA, family and friends acting as helpers or as an advocate, OSA web sites.

==Examples of Situations==

1. Let’s say your primary care physician or family doctor is very helpful and was instrumental in suggesting a sleep study which led to the diagnosis of OSA, but is not a specialist in subsequent CPAP therapy. You may want to find a doctor experienced in sleep therapy. This may be a sleep doctor who is board certified and experienced in sleep medicine, a pulmonologist (breathing specialist) or other specialist; or a primary care physician or family doctor with sleep therapy experience. Treatment of sleep disorders is still relatively new in the medical community and sleep doctors may be overbooked. There is a body of knowledge about ever-evolving treatment techniques not known to every physician. It’s worth searching for a doctor with experience in sleep apnea. Ask your family doctor and/or local hospital sleep lab for names of sleep doctors. Prepare a few questions about their practice. Phone their offices for answers and talk to the nurse, front desk people, the doctor, your family doctor, or to other patients or sleep lab technicians in the hospital where the doctor practices.

Discussion thread on sources of finding a sleep doctor:
http://www.cpaptalk.com/viewtopic/t14872/What-is-a-sleep-doctor.html?sid=bb563d5b160be04b2a29a62356138016
Finding a sleep doctor through the American Board of Sleep Medicine:
http://www.absm.org/diplomates/listing.htm

===Questions to ask===

• Does this practice accept your insurance? 
• Is the doctor accepting new patients? 
• How long does it take to get an appointment; how busy or accessible is the doctor? 
• What is the doctor’s experience with sleep apnea? 
• Does the doctor ever recommend alternatives to CPAP treatment (dental devices, pillar procedure, etc.)? (Depending on your condition, if the doctor immediately suggests surgery as a first step rather than CPAP, he/she may not be up-to-date on less invasive and less risky treatment options.) 
• What types of CPAP treatment does the doctor use? Does he/she categorically disapprove of auto CPAP (APAP)? (The answer may give you some indication of how up-to-date the doctor is on APAP research and newer machines. APAP may not be the best choice for you, but open-mindedness is helpful.) 
• Does the doctor support a cooperative, collaborative relationship with the patient and advocate responsible patient self-management of their therapy? Does he/she support patient responsibility and empowerment in their therapy, or are they more “old school” and paternalistic with the doctor as the authoritarian manager of the therapy and the patient as passively obedient and compliant? Which style are you as a patient? Discussion thread on doctors and Internet patient information: http://www.cpaptalk.com/viewtopic/t16401/Doctors-vs-Internet-Information.html 

If after a few visits you find that your doctor’s style and your style of handling your therapy are incompatible, find a different sleep doctor, if you can.

2. After the diagnosis of OSA, if suggested by your primary care physician or the sleep study report, you may want to visit an ENT (Ear/Nose/Throat) doctor, pulmonologist, cardiologist, or other specialist to learn more about your health conditions. Bring a copy of your sleep study report.

3. DME or home care provider. You may be assigned to a Durable Medical Equipment provider by your insurance company, or given a choice of several DMEs, depending on your insurance plan. Following your doctor’s prescription, a respiratory therapist (RT) or technician may outfit you with a machine and mask, and provide training tips for use and cleaning. DMEs are a profit center store, warehouse distributor, and delivery service (except that they don’t usually deliver CPAP equipment) with a measure of therapeutic support; a valuable service if done right.

• Is the DME company’s customer service knowledgeable, accurate and prompt in handling your prescription and equipment orders? 
• Do they return your phone calls promptly? 
• Do they give you phone numbers to contact your local office or always require you to go through regional customer service and then not follow up to help you? 
• Are there procedural conflicts and poor communication between one part of the company and another (customer service, local office, billing, regional, legal for HIPPA), so they can’t easily help you if you have problems? In other words, do you get the run-around? 
• Are they genuinely courteous and helpful or do they take a hard line against you and your needs and act dismissive under the guise of their procedures? 
• Do they offer accurate information and assistance or do they conceal information in order to push their products, or are they uninformed or misinformed? 
• How long does it take to get equipment? 
• Do they ship the right equipment? Is it easy to return incorrect equipment? 
• Do you have a short drive to the local office and short waits for an appointment or service? Under what circumstances do they deliver equipment? 
• Is the RT both knowledgeable and compassionate? 
• Does the RT provide safety information about the CPAP machine and masks? 
• Does the RT show competence and confidence in setting up (programming) your machine and set it up correctly? 
• Does the RT show you how the machine is set up and how to work the controls and mask, at a time and pace when you can absorb the information? 
• Does the RT show you a reasonable choice of masks, both types (nasal mask, nasal pillows, full face) and brands (ResMed, Respironics, AEIOMed, Fisher and Paykel, others)? The DME will probably have a contract with only a few brands or manufacturers, but you may require a different brand. Can they order that brand for you? Will getting it take an unreasonable amount of time? 
• Does the RT seem to know how to fit a mask? Is the mask trial and fitting done while you are lying down on your sides and back, with the CPAP machine turned on to check for leaks? 
• If your machine has a smart card, is the DME able to provide you with software reports on a timely basis? 
• With new HIPPA regulations, does the organization make it easy for you to get your software reports, equipment information, and billing information? 
• How well do they handle equipment replacements and repairs? Billing? 
• Does dealing with them relieve your stress as a new CPAP user or add stress? 

If the service at your DME is unsatisfactory, you can ask for a different RT in the same office, or try another office of the same DME company. If your attempts at consistently getting adequate service fail, you can go up the chain of command to the branch manager and regional manager or headquarters. You can phone your insurance to see if other DME or home care respiratory equipment providers are available on your insurance plan, in-network or out-of-network, local or online, and try them. You can try an online DME and compare pricing and service. If you have an effective local DME, you are fortunate indeed.

4. Online DME. Some people give up on hassling with the ineffective and expensive local DME office and order equipment on the Internet at a much lower price with faster delivery and good customer service and advice. At www.billmyinsurance.com you can see if your insurance plan will cover purchases through them. If you are a senior on Medicare, you can order through www.cpapforseniors . You can use an online DME such as www.cpap.com paying out-of-pocket. Because they don’t need to deal with insurance and maintain expensive local offices, drivers, and a huge inefficient infrastructure, online prices are astonishingly low for the same high quality equipment offered at much higher prices by large national DMEs with local offices. With luck and ingenuity, you can combine various options for service to get your needs met for OSA equipment. For example, first you can research machines and masks at www.cpap.com. Can you try on the specific masks that seem promising at a sleep center and buy it there? Can your local DME order the mask and let you try it? It may be easiest and most cost effective just to order the mask through the online DME.

5. The sleep center or hospital sleep lab may be a resource beyond your initial sleep study. Technicians at a hospital may be less profit motivated and more patient-focused, more informed, and not hampered by a dysfunctional organization.

• Does the center’s sleep technician offer mask trials (trying on various brands and types of masks under pressure)? 
• Does it offer mask fittings (adjustments) of your current mask, no matter where you purchased it? 
• Have you compared the center’s sleep tech’s skills at mask trials and mask fitting with the skills of the technician at your local DME? 
• Does it offer these services to people who are not former patients? Are services free to former patients or at a cost? 
• Does it sell equipment and how do the costs and services compare with your local DME or an online DME? 
• Does it have a return policy within 30 days? 
• Do other sleep centers in your region offer these services, and can you use them even if your sleep study was not
done there? 
• Does the sleep center offer expertise (or pamphlets) not readily available elsewhere? Does it sponsor support group meetings through ASAA (American Sleep Apnea Association) AWAKE groups or another organization? 

6. Online support group. A very helpful community of xPAP (CPAP, APAP, BiPAP) users is found at www.cpaptalk.com . You can ask individual questions and quickly get a variety of supportive responses from people with experience. Sponsored by www.cpap.com, this forum gives back information to the CPAP community. See http://www.cpaptalk.com/viewtopic.php?t=9385 and http://www.cpaptalk.com/viewtopic.php?t=9375 . If you regularly read this forum, you may quickly find that you know more about certain practical aspects of sleep therapy than your professional healthcare advisers. You may want to explore other online support groups as well. Remember, opinions and personal truths are offered, not necessarily facts or your truth, so be discerning.

7. Community support group. Look for ASAA AWAKE group local meeting information at http://www.sleepapnea.org/awake/index.html . If you attend a meeting, you may find that you are able to help other xPAP users with your new-found knowledge from www.cpaptalk.com. If you want to start your own support group, explore http://www.awakeinamerica.org/Groups/LaunchGroup.shtml .

8. Others with OSA, family and friends, an advocate. Personal support, both given and received, can be invaluable. Do you need reassurance? Do you need help with using technology, the machine or its software? Do you need help adjusting your masks? Do you need help with running interference with an uncooperative DME or perplexing insurance coverage? It can be quite trying to be exhausted from sleep deprivation and need to repeatedly deal with DME hassles. A friend acting as an advocate can help.

==External Links==

[http://www.cpaptalk.com/viewtopic.php?t=5326 Humor: Unofficial CPAP Glossary]

==References==

[http://smart-sleep-apnea.blogspot.com Original writer's Sleep Apnea Blog] 
Source: Based on personal experience with Obstructive Sleep Apnea.

Not written by health care professionals. The information and opinions offered are not intended or recommended as a substitute for professional medical advice. © Mile High Sleeper, May 2006. Permission to use for free educational purposes.
[[Category:Treatment]]