One night in the sleep lab while preparing the hook-up (sleep technician talk for applying electrodes and sensors) I witnessed something I had never seen in my 8 years as a sleep medicine professional. Before I tell you what it is I would like to give you a little bit of background on this patient. He was a 46 year old male that had been using CPAP for 3 years. He had his original polysomnograph (PSG) to diagnose sleep apnea and CPAP titration done through our company. He had been diagnosed with an AHI (apnea hypopnea index) of 47, meaning on average he quit breathing or partially quit breathing 47 times per hour with a low oxygen level of 74%. Needles to say he was dedicated to treating his OSA and promoting a longer healthier life.
So why was he back in the lab? Our doctor had prescribed him a fixed pressure machine (a device that puts out one set pressure throughout the night) and he had lost a bit of weight and felt like his current pressure setting was too high. A CPAP re-evaluation was ordered and he showed up for his appointment at the clinic. He knew the routine and we were almost set to do lights out and bio-calibrations when he pulled out a roll of duct tape and ripped of a healthy piece and proceeded to cover his mouth shut like a hostage victim. At first I was speechless but once I realized what he was attempting to do I just had to question him about this. He went on to explain that he can’t’ stand full face masks and this was his fix to mouth breathing. After we discussed what excessive or insufficient CPAP pressures can cause as well as proper humidity levels the topic turned to CPAP mask chin straps. He was unaware of them but happy to hear he had an option other than taping his mouth shut every night.
“Rainout”-Ever wake up from a dream thinking you’re barreling down a slide at your favorite water park only to realize the water splashing you in the face is coming from your CPAP mask? Effectively using your CPAP humidifier can be a tricky learning experience with a few different solutions. Try keeping your machine below bed level, the moisture build up in the hose tubing will drain back into the humidifier by the natural effect of gravity. You will want to adjust your humidifier temperature setting with the changing of the seasons, in the summer time when air-conditioners are running there is more moisture in the air versus winter when your furnace tends to dry out the air. Another solution would be to consider a heated tube that regulates the moisture which research has shown the proper humidity can lead to lower CPAP pressure needed.
Nostril Discomfort from Nasal Pillow Mask-Tightening the headgear strap may seem like the solution to prevent mask leak but it can lead to discomfort and embarrassing marks on your face. Nothing worse than getting confronted on the street by strangers that see your red cheek lines (aka The CPAP Scarlet Letter) and they point out you’re a CPAP user like Paul Revere warning the “British Are Coming”. I use the ResMed Swift FX mask and I can tell you first hand that if your headgear strap is too tight it will cause added pressure on your nose and upper lip. Loosen the mask strap to provide just enough pressure that provides a seal.
Tubing Restrictions-Many users find themselves confined to a small section of their bed because they are tethered by a 6ft CPAP hose. Did you know that these hoses also come in 8ft and 10ft options? Give yourself the freedom to move about the bed. These tubes are universal to fit all makes and models of machines.
Hose Hog Tied?-Ever wake up to find yourself wrapped up in your hose like a damsel in distress tied to railroad tracks? There is a product out there that will suspend your hose above your face and it conveniently fits between your mattress and box spring. The CPAP Hose Lift rotates with sleep movement and allows you to move freely around your bed without getting tangled up.
Allergies- Seasonal allergies can wreak havoc for sleep apnea sufferers and their therapy. Luckily most manufacturers have hypo-allergenic machine filters that provide a higher level of filtration that reduce the particulates that pass through device.
Noise-Though some people enjoy the white noise produced by therapy devices some others, or their bed partner, may find it difficult to fall asleep to or bothersome. There are CPAP bedside holders that allow you to free your machine from the nightstand and drop it below ear level and set in between the mattress and box spring. Also see previous tip that describes putting your machine on the floor. If you bedroom is carpeted you may want to consider resting the machine on a 12×12 ceramic tile that you can pick up for under $1 at your local home improvement store.
Congestion- It is recommended that you not use therapy, especially if you use a full face mask, when you have a cold or severe congestion. If you had slight congestion and still wish to use your therapy device you can consider a few options to help you get through the night such as increase your humidity, use a saline flush of your nasal passage prior to going to bed or a vapor cream just below your nostrils (speak with your physician if you have issues with blood pressure prior to trying this method).
Pressure Feel Too High- This is a tricky one that can be a result of a few different reasons. If you are new to CPAP this is a common occurrence because you are just not used to sleeping with it. Adjust your ramp setting to start at the lowest pressure that will ramp up over a period of 5-45 minutes. You can also consider starting with a full face mask that allows you to breathe through your nose and mouth instead of just your nose. Most manufacturers offer a pressure relief setting that allows you to breathe easier during your exhale, speak with your care provider to see if this is an option for you.
If you are a “seasoned” user of therapy you may want to consider a titration reevaluation or an updated prescription that allows you to use an auto adjusting CPAP machine (APAP). Physiological changes to our bodies can dictate what the appropriate amount of pressure required is and since this may be a constant changing factor (i.e. weight loss or gain), it is important that you have a machine that will react to your pressure needs.
“Plasticy” (is that a real word?) Smell-New products can often come with a new smell and not the good new car smell that everyone loves but more of a smell of silicone components. There are aromatherapy kits that offer a wide array of different scents and these kits sit behind the CPAP device filter and flow throughout the device. These soothing scents have also shown to provide an environment that encourages relaxation and sleep onset.
Leaking and Discomfort-Feel like your mask is leaking too much air and your headgear is stretched thin because you are over tightening to compensate for the leak? First things first, ask yourself how long you have had the same mask or cushion and headgear. If the answer is over a year it may be in your best interest to get a new one and start over, this time with a cleaning schedule. Secondly, what color is your mask cushion? If it isn’t close to the clear silicone color it was when you’re first got it you may want to consider a new one. If it is yellow you should replace immediately.
If you fall into the category where your mask is relatively new you should adopt a cleaning schedule that insures your mask is going to last longer (you just saved money) and you are going to get the optimal therapy (you just saved headaches). You do this by wiping down the mask cushion every night with a baby shampoo or CPAP mask wipes that do not contain harsh chemicals. This process eliminates facial oils and dirt build up that is the major cause of mask leak and cushion discoloration and hardening. If you have a narrow nose bridge it may not be the mask cushion at all but simply your facial features. If this is the case you may want to consider a nasal pillow mask or mask comfort pads such as the Gecko.