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Sleep Care

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PAP Treatment

What is CPAP? Continuous Positive Airway Pressure, or CPAP, is the treatment of choice for many people who suffer from obstructive sleep apnea (OSA). A CPAP device includes a small lightweight machine, tubing, nose mask, and headgear. Who Needs CPAP? CPAP is used to treat breathing disorders during sleep. People with central, mixed, and the more common obstructive sleep apnea may all benefit from CPAP therapy. How Does CPAP Work? During sleep, muscles in the airway relax, allowing collapse and any excessive tissue in the throat, such as tonsils, adenoids, tongue, or uvula, to block the airway. This system gently delivers machine-generated air into the airway through a nasal mask. This air is positive pressure and acts as a splint to keep the airway open, thus eliminating obstructions. This provides immediate relief to OSA sufferers by providing uninterrupted breathing and sleep. Another method of treatment is called bilevel therapy. This also involves positive pressure but at separate settings for inspiration and expiration. There is a higher pressure on inspiration, which prevents obstructions and facilitates airflow into the lung. On expiration there is a lower pressure that allows passive, easy expiration while maintaining a patent airway. What is BPAP? BPAP or bi-level therapy is similar to CPAP as it also involves positive pressure but at separate settings for inspiration and expiration. There is a higher pressure on inspiration, which prevents obstructions and facilitates airflow into the lung. On expiration there is a lower pressure that allows passive, easy expiration while maintaining a patent airway. This method of treatment is useful for those patients that cannot tolerate the pressure of the conventional CPAP therapy. In most cases a patient will need to try and fail at CPAP before BPAP will be prescribed. What are the Side Effects or Complications of CPAP? Nasal and throat dryness: Adding a humidifier to the system can prevent dryness. Nasal Congestion: A heated humidifier can relieve most congestion. Skin irritation from the mask: There are many different types of masks made from different materials to help prevent skin hypersensitivity. Changing to a different mask could solve the problem. Pressure sores from the mask: This usually indicates that the mask is adjusted too tightly. The mask should only be snug enough to prevent leaks but loose enough to allow comfort. Different types and styles of masks should be explored to meet this goal. Eye irritation: This may also result from an improper mask adjustment. Proper mask size, type and fitting may relieve this problem. Claustrophobia: CPAP education and proper mask fitting can help to relieve anxiety and fear. Some CPAP units come with a “ramp” feature that allows the pressure to start gradually over time and increase to the pressure needed to eliminate apneas. By the time the pressure has increased to the prescribed level, the person is asleep and unaware of the pressure change. This option must be discussed with a physician. Intolerance: People who are unable to adjust and acclimate to CPAP therapy may benefit from bilevel therapy, which more closely mimics respiration. This option must be discussed with a physician. What are the benefits and how long is it needed? The benefits of CPAP therapy are immediate but many times require a life-long commitment. CPAP is a treatment for apnea but not a cure. Apnea sufferers may try different treatment options, such as oral devices, medications, surgery or weight loss, but will probably not be cured by these options, either. These other treatments may decrease the severity of the breathing disorder, but CPAP has shown itself to be most effective. CPAP consistency, as with any other treatment, is the key to successful treatment of sleep apnea. It is imperative that people on CPAP use it every time they sleep. Because CPAP immediately eliminates apneas and obstructions, there is an improvement in sleep quality and oxygen levels in the blood. Once this happens, the symptoms associated with sleep apnea may subside. A person may feel rejuvenated, with an increased energy level, may feel less fatigued throughout the day, and may experience improved job/task performance. Treating sleep apnea may also decrease the risk for hypertension, heart attack and

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stroke. CPAP may also benefit sleep partners, since they won’t be bothered by snoring anymore. How Can I Get a CPAP System? An evaluation, sleep study and prescription are needed by a physician to get started on CPAP therapy. Once all of this has been completed, the physician will order the CPAP through a homecare company. The company provides the CPAP system and a nurse or respiratory therapist completes the initial set-up and education. Follow-up with the physician and the homecare company is needed to assess the progress and success of treatment. Tips to Finding the Right Fit for Your CPAP Mask CPAP masks are all different and can be made by a variety of manufactures. For this reason, it is important to read the manufacturer’s material on the specific fit and features of your CPAP mask. Since we cannot go through each mask individually, we will discuss some universal rules to mask fittings and the problems that can arise during CPAP use. The most important thing to remember when using your CPAP mask is that it should not leak when in use. All masks have a small port to vent the air; in this area it is normal to feel air escaping the mask, and you should not worry. Leaks against your skin, however, need to be addressed so that your mask can work

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properly. If your mask does leak and you are not able to fix the problem, contact your home health provider and ask for assistance. The second most important thing to keep in mind is that tightening your mask is not always the solution to fixing a leak. It is possible to over-tighten a mask and make your problems worse. The masks are designed to be comfortable when worn, not to be painful. When fitting your mask, you want to make sure that the mask does fit snuggly to the face without being uncomfortable. The mask should not be so loose that it can slide around, but it should also not be so tight that it causes discomfort. If the mask has to be uncomfortably tight in order for any leaking to stop, contact your provider and discuss other mask options. Quick guides for all mask types: Nasal Pillows: A nasal pillow is a small nasal mask that should sit right on the tip of your nose and seal around your nostrils. These masks are designed to be as small as possible while still delivering the pressurized air from the CPAP. It is important that the pillow portion of the mask correctly fits in your nose. Nasal prongs that are too big or too small can cause leaking and discomfort. The angle of the mask and its tightness are often the biggest obstacles to a comfortable fit. It is important to adjust all the straps of the mask individually so that an optimal fit can be achieved. These masks should not leak air onto your face or into your eyes. If they do, adjust them again to see if the leaking can be stopped. Nasal Masks: A nasal mask is a small triangle-shaped mask that fits snuggly around the nose. These masks usually fit from the bridge of the nose down to the top of the upper lip. These masks may also have a small stabilizing bar that rests on the forehead. When fitting this mask, you want to make sure that the cushion (the softer gelatinous or plastic part) fits close to the actual size of your nose. You do not want your mask to be too large, leaving portions of your cheek s covered by the mask, noor do you want it to be too small, with the mask actually lying on the

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nose. It should fit into a nice triangle right along the outside of the nose. These masks tend to be easier to fit properly, and leaks are frequently taken care of with either a little adjustment to the mask angle or a small tightening of the headgear. If you have facial hair, however, this can interfere with mask fit. A mustache often will hinder the mask from fitting properly along the upper lip. Usually shaving or trimming the hair can help this problem. Full-face Masks: A full-face mask is a mask that fits from the middle of the chin area to the bridge of the nose, often with a stabilizing bar that sits on the forehead. As with all masks, sizing is very important. Your masks should not be too large or too long (falling off the end of your chin or lying too high on the bridge of your nose), nor should they be too small (hindering you from slightly opening your mouth). These masks often have an exhalation port on them where you will find a small leak so that the air can circulate in the mask. These masks should not leak onto the skin. If you do have leaks into the eyes or along your cheeks, or if you hear any noise coming from the mask, you should refit the mask again. Full-face masks should fit tightly on the face, but not too tightly. Small adjustments should be made to the straps to see if the leaking can be stopped. If the mask becomes painful or too tight, you should go to your provider and ask to be fitted again. Facial hair can cause a lot of leaking with these masks. Men with beards and mustaches may have difficulty getting these masks to fit with any leakage. If you do have facial hair, a good idea may be to shave some of it or to trim it to try to lessen the leak. As always, if you are having trouble with your mask or are getting discouraged about the fit, contact your home healthcare provider and seek assistance. Quick Tips: Sores or redness on the face: Soak the mask in warm water to make sure there is no build-up on the mask causing irritation. Also, check the size of the mask to make sure it is the correct size for your face. Make sure that you are not allergic to the materials in the mask. Discomfort from tightness: Loosen the mask and check that the mask is fitting properly on your face. Check that facial hair or other skin problems are not causing the mask to leak. Mask stiffness: Make sure to wash your mask often and take proper care of it. If the mask continues to be stiff or to crack, call your home health provider about ordering a new mask.  

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