New to CPAP
CPAP/BiPAP DESENSITIZATION STEPS
CPAP stands for Continuous Positive Airway Pressure. Your CPAP/BiPAP delivers prescribed amounts of pressurized air, and only a physician can determine the pressure amount needed. The air pressure is measured in centimeters of water (cm of H2O). The air acts as a splint to hold open the airway during sleep. Your CPAP/BiPAP should be used during all naps and nighttime sleep. To acclimate yourself to CPAP therapy, try the following:
- Try using your CPAP/BiPAP machine at home, while awake, for one hour each day.
- Attach the mask to one end of the tubing, attach the other end of the tubing to the CPAP/BiPAP unit, and turn it on. Practice breathing through the mask for one hour while watching television, reading, or performing a sedentary activity.
- Use the CPAP/BiPAP during scheduled 1-hour naps at home.
- Use the CPAP/BiPAP during the first 3-4 hours of nighttime sleep.
- Use the CPAP/BiPAP through an entire night of sleep.
Advance by one step after every 5 days. When you can perform a step without anxiety, move on to the next step. Therapeutic guidance should be provided during outpatient visits to the prescribing physician.
Expect to “work" with your CPAP/BiPAP unit. It is important to try to relax when beginning CPAP/BiPAP therapy. Inhalation and exhalation should occur through the nose only. If you are unable to consistently breathe this way, do not panic or lose hope. There are other types of masks which allow you to breathe through your nose and/or your mouth. Don't give up after a few attempts—some patients need 3 to 4 weeks (or sometimes longer) to become accustomed to CPAP therapy.
Contact Marras's Homecare if you experience any problems with the mask, unit, etc. Contact your sleep medicine specialist if you have a significant change in weight, since this may affect your pressure.
CPAP/BiPAP TOLERANCE RECOMMENDATIONS
Some patients may have difficulty tolerating CPAP for many different reasons which are discussed below:
- Lack of Humidification In general, CPAP tends to dry out the air, therefore, extra humidification is usually required. A pass-over humidifier and a heated humidifier are available to help add moisture or humidity to the air moving through the breathing circuit. A heated humidifier produces more moisture than the pass-over humidifier. Occasionally, too much humidification may be produced causing irritation of the nasal passages and moisture to collect in the tubing and mask. Lowering the number on the heated humidifier usually remedies this problem.
- Temperature The air coming from the CPAP/BiPAP can be cold. This can be corrected by ensuring the room temperature is warmer or by using a heated humidifier.
- Nasal Allergies Sometimes nasal allergies can be exacerbated by CPAP therapy. Any known allergens in the room should be removed. Frequent vacuuming may be required. Raise the CPAP blower to a higher level if it is located on the floor. Elimination of animals in the bedroom may be helpful. Ensure that CPAP filters are changed frequently. Use only distilled water in the humidifier and replace it daily. Try the humidifier with and without heat to determine which is best for you. An oral antihistamine may be taken before sleep if needed.
- Nasal Dryness Use a humidifier, either heated or regular pass-over. Use a nasal saline spray before sleep at night.
- Nasal Congestion Check for nasal allergies and take appropriate action to treat them (see step #3). nasal dilator during sleep at night may help, however, you should check with your doctor first.
- Nasal Irritation Use a humidifier, preferably a heated one. Use a saline spray before sleep. Consider using a small amount of a non-petroleum-based cream in your nostrils.
- Mask Pressure The mask should not be too tight on the face. If it needs to be very tight for an adequate seal, try a different type of mask—there are many types from which to choose. Consider nasal pillows to reduce mask contact with the skin.
- Skin Allergies: Make sure you have a hypoallergenic mask made of silicone. If experience a reaction to the mask cushion, consider a nasal mask with pillows to reduce mask contact with the skin.
- Mouth Opening Any of the above recommendations may be helpful for your dry mouth. To ensure CPAP pressure is optimal, you may need to get a full-face mask.
HEALTHY SLEEP TIPS FOR PATIENTS WITH OSA
An increase in your weight will make your snoring and sleep-related breathing irregularities worse, and reducing your weight is likely to improve your condition. It is important that you try to reach an ideal body weight and maintain it. Reducing your weight and being more physically active will also decrease the risk of developing cardiovascular disease.
Alcohol is a potent sedative that can induce irregular breathing apneas in healthy people. Alcohol will not only increase the number of apneas but will make them longer and reduce the oxygen level in the blood. It is very important that alcohol is avoided within 4 to 6 hours before bedtime.
Other Sedative Medications
Sedative medications include sleeping pills, antihistamines, anti-allergy pills, some cold medications, some epilepsy drugs, and other medications for psychiatric conditions. As with alcohol, sedative medications are likely to worsen your breathing irregularities. Consult your physician before taking sedative medications. Definitely, do not use any sedative medication with alcohol as the effects will be potentiated several times.
Try to maintain a regular schedule with a full 8 hours of sleeping time. Any loss of sleep will increase your need for sleep the next night, and your breathing irregularities are likely to become more severe.
Sleeping on your back is likely to increase breathing irregularities as your tongue tends to obstruct the back of your throat resulting in a decrease in the size of the airway. Some find that sewing a waffle ball into the back of a sleeping shirt helps prevent back sleeping.
Elevate the head of the bed 4 to 6 inches to take some of the pressure off the diaphragm. This will ease breathing during sleep. You can also put wood blocks under the legs of the head of the bed so it will be on a slight incline.
Colds and Allergies
Any infection affecting your nasal passages or throat will cause swelling and tend to worsen breathing irregularities.
Large meals should be avoided at least 2 hours before bedtime. A large meal will increase the pressure on the diaphragm and worsen breathing. It may also predispose you to regurgitation of the stomach contents during sleep which will provoke irritation of the airway.
Nicotine and other substances contained in cigarettes, when inhaled, will provoke irritation of the upper airway and worsen breathing irregularities. Try to stop smoking altogether.
SLEEP HYGIENE TIPS
If have trouble getting to sleep, try getting out of bed and doing something else. Preferably move to another room and return to bed only when sleepy. Establish a routine for an hour or so each night before bedtime, such as reading, taking a warm bath, light exercise, such as stretching, or just relaxing quietly. Avoid too much mental stimulation during the hour prior to bedtime.
Almost everyone experiences an occasional night of lost or disturbed sleep. This can be caused by stress. Try the above suggestions for falling asleep.
If you are having trouble falling asleep at night, avoid naps in the early afternoon or evening.
No matter how poorly you have slept, always set your alarm to arise at the same time each morning.
Regular exercise can be an effective aid to sleep. It releases energy and eases mental tensions. Do not exercise strenuously just before bedtime.
Occasional loud noises from aircraft, streets, or highways disturb sleep even in people who do not awaken and who do not remember the noise in the morning. These sleep disturbances can reduce restful sleep. People who sleep near excessive noise should try heavy curtains in their bedrooms or ear plugs to help block the outside noise.
A light snack or warm milk seems to help some people get to sleep. Always avoid coffee, tea, and cola near bedtime. Also, void heavy meals 2 hours before bedtime.
Everyone has a unique sleeping pattern. Some adults need 10 hours of sleep a night—others need only 6. Many people function best at 8 hours of sleep per night. Your requirement for sleep is unique, and what is effective for others may not be effective for you. Find your individual sleep need, and maintain a consistent schedule for sleeping.
Symptom of Medical Problems
Sleeping problems may signal a medical condition such as anxiety, depression, or other disorder. It is important to get a proper diagnosis and treatment of the underlying cause of a chronic sleep disorder.
Excessive sleepiness the first 3 months of pregnancy is normal. Pregnant women also tend to sleep about 2 additional hours a night.
An occasional sleeping pill may be of some benefit, but chronic (nightly) use of sleeping pills may actually hinder good sleep. Sleeping medications should be used with caution, for the short-term management of a sleep complaint, and only upon the advice of a physician. Do not increase the dosage yourself. If you feel that the medication is losing its effect, report this to your doctor. Although alcohol may help to induce sleep, the chronic use of larger quantities of alcohol causes disturbed sleep and dependency.