| CPAP: TREATMENT FOR OBSTRUCTIVE SLEEP APNEA |
| Use your mask right and feel better! |
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| Your doctor has recently diagnosed you with obstructive sleep apnea. Continuous positive airway pressure (CPAP) is the most commonly used and consistently effective treatment for sleep apnea. When used correctly your sleep problems will be improved greatly. |
| Who do we treat with a CPAP mask? |
| Sleep apnea patients that are tired and sleepy are usually treated with CPAP. As part your first sleep test the sleep laboratory will an “apnea hypopnea index” or AHI, which is the number of times per hour you struggle to breath. CPAP is generally given to patients that have ten or more events per hour. |
| What is CPAP? |
| CPAP consists of a mask, tubing and a fan. As most patients breath through their noses and keep their mouths closed while sleeping, CPAP is able to act as a pressure splint to push the airway open. (Figure 1) CPAP will not cure sleep apnea and you will have to wear the mask whenever you are sleeping or taking naps. The CPAP trial night in the sleep center determined how much pressure will be needed to keep your throat open and alleviate snoring. Pressures may vary between 3 and 20 centimeters of water pressure, with most patients needing between 6 and 12 centimeters of pressure to control their apnea. In general, heavier patients with short, thick necks and severe apnea will need higher pressures. Some sleep physicians have observed that the most symptomatic and severely apneic patients tolerate CPAP pressure better than a thinner patient with milder disease. |
| CPAP mask and flow of air (arrows) pushing the tongue forward and opening the throat reducing snoring and apnea |
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| Compliance with CPAP |
| Initially, many patients are not able to wear the mask every night, all night. Scientific studies have shown use of CPAP equipment up to 90% of the time however, when patients are able to closely follow up with their sleep center staff. If you are having problems related to mask fit and leakage, skin irritations, headgear, or equipment mal-function, call your home care company. Problems with nasal dryness or obstruction, claustrophobia, and inability to close your mouth when using the mask may best be solved by contacting your sleep center technical staff. The following are some of the common CPAP complaints and solutions. |
| Scientific studies have shown that regular use of CPAP reduces fatigue and sleepiness and improves mood |
| COMMON CPAP COMPLAINTS AND SOLUTIONS |
| Mask is uncomfortable |
| Everyone has a different facial size and contours so don’t be afraid to try several masks. The technicians at your sleep center are well versed in the various types of masks and sizes. |
| Nose is blocked |
| Some apnea sufferers have significant nasal disease such as chronic inflammation, polyps or a deviated nasal septum. Ask your doctor if you have a nasal problem that can be treated with steroid or other nasal sprays. You may need to see an ears nose and throat specialist for evaluation and possible surgery. |
| Often the removal of polyps or straightening out the nasal septum will allow the mask to work better. Some patients are primarily mouth breathers resulting in poor tolerance to nasal CPAP. A larger mask covering both the nose and mouth is available. This full-face mask is able to give positive pressure through both the nose and mouth and can be very effective for those who do not mind a larger mask on their face |
| Full face mask covers both the nose and mouth |
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| Mask irritates skin and nose |
| Because the mask must fit firmly over the nose and cheeks in order to avoid air leaks you may develop irritated skin from the pressure. Perhaps a different size or type of mask may help. Some patients benefit from using nasal pillows (Figure 3), which are soft tubular devices that fit into the nostrils and relieve pressure on bridge of the nose. We sometimes recommend that patients alternate the mask and nasal pillows nightly in order to avoid facial discomfort. |
| Nasal pillows. Inset shows soft plastic that inserts into each nostril (arrows) |
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| The mask is leaking |
| A chin strap stops mouth leaks by keeping the lower jaw closed. |
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| Don’t like the pressure |
| If mask pressure interferes with your ability to fall asleep ask your sleep center about a CPAP machine with a “ramp” feature; these units have the ability to start with a very low pressure as you are trying to fall asleep while increasing pressure automatically when you fall asleep. |
| Some patients are unable to tolerate the CPAP air pressure, especially when trying to breath out. Bi-level positive airway pressure machines reduce the pressure when you exhale which is more appealing to some patients. The same mask is worn with either CPAP or bi-level positive airway pressure units. |
| Claustrophobic, do not wear mask every day; take the mask off during the night Stay cool! Most patients are not able to wear the mask full time, every day from the start. The important thing is to keep trying, even if you can only use the machine for an hour a night. Once you solve the comfort problem, it is only a matter of time before you will be able to increase your wearing time. It is important to wear the mask in the early morning hours when you have REM or dream sleep because this is the time for the most significant apneic events in most patients. |
| Talk to your doctor about throat or jaw surgery. Occasionally a patient may be able to benefit from an oral appliance. For those patients who are suffering from the medical consequences of being very over weight, Bariatric (stomach) surgery may help significantly |
| TIPS TO HELP CPAP WORK BETTER |
| Avoid alcohol and sedating drugs. Alcohol and sedating drugs relax the tongue and airway and increase sleep apnea. The mask pressure that your doctor ordered may not work as well if you are drinking or taking tranquilizers or painkillers. |
| Avoid tobacco; smoking may cause irritation of the posterior airway and has the potential to increase snoring and apnea. |
| Get enough sleep; most people need 7 to 8 hours a night. If you don’t get enough sleep you will continue to feel tired even if you wear the mask. |
| Lose weight; a small reduction in weight may reduce apnea significantly or allow your apnea to be treated with a lower CPAP pressure. Modest reductions in weight of only 20 or 30 pounds may reverse sleep apnea in some individuals. |
| Raise the head of the bed and sleep on your side. This will reduce the tendency of the tongue to push back against the airway. |
| Copy write 2003 by L. D. Victor, MD |
