If you’re still figuring out the basics of sleep apnea, here are some basic links to catch you up on this underdiagnosed, yet eminently treatable, health condition.
- A is for Apnea (very basic definitions)
- Sleep Breathing Disorder Basics
- How to find out if you have a sleep breathing disorder
CPAP, incidentally, stands for Continuous Positive Airway Pressure (meaning the airway pressure delivery is one metered dosage), whereas BiPAP stands for Bilevel Positive Airway Pressure (meaning the airway pressure deliver is one measurement for inhale and a separate measurement for exhale) and APAP or AutoPAP stands for Automatic Positive Airway Pressure (meaning the airway pressure has preset customized settings based on your established range of pressure needs).
There are other PAP delivery systems as well, ASV being the most common. ASV stands for Adaptive Servoventilation, a kind of “smart” PAP delivery system based on algorithms which anticipate breathing patterns. VAPS technologies (Volume Assured Pressure Support) correct respiratory patterns literally breath by breath. These latest technologies are generally reserved for complex sleep disordered patients who may have more than one, often severe, respiratory issue.
|Masks range from nasal (as seen
here) to oral-nasal (also known as
full face masks) or nasal pillows.
You will meet with a specialist who handles PAP machines, masks and other devices. They will supply you with the devices you need and teach you how to use them (how to assemble the machine, hosing and mask; how to turn on the machine; how to fill the humidifier; how to assemble the mask; how to position the mask on your face and use its various features to adjust it) as well as how to clean and maintain all the parts. Then you basically go home and use your PAP.
|Here is a typical setup: PAP machine
with humidifier basin, tubing, and
PAP mask with headgear
Generally, the systems today also include a chip (called an SD card, smart card or memory card) that records data from your machine for your physician to review. This is often, if not always, required by insurance companies to show proof you are “adhering to” or “complying with” treatment. Some labs ask you to bring your chip in while others use equipment that remotely downloads it from your machine to their clinic for review. Insurance companies will not reimburse for PAP therapy over time if the patient fails to use it.
Insurance companies generally require at least 4 hours of use per night, at least 5 nights a week. You may have a bad week, followed by two good weeks, and still be more or less compliant. But the goal, ultimately, is to use it every night for every hour that you sleep. That way you guarantee your therapy will do what it’s meant to do: keep your airway open so you can get the necessary oxygen your body needs to perform its many functions (all the way to the cellular level) as you rest.
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One way to eliminate this is to allow yourself opportunities throughout the day to wear the mask without the machine (such as while watching TV or knitting or reading in a chair or while lying down). The more you practice wearing it, the more “normal” it will come to feel. It is okay to slowly work your way into nightly use of your PAP therapy if claustrophobia is an issue. Aim for a couple of hours a night and add a little more each night if you can.
Insurance companies do honor an adjustment period (each company is different, but 30 to 90 consecutive days seems to be the norm). You need to achieve minimum compliance by the time established by the insurance company if you are to be reimbursed for your equipment.
If you still feel claustrophobic after a week, ask your sleep specialist for advice. If you find it intolerable from Day One,call them ASAP. You may have an opportunity to try on other masks to determine which might be more comfortable and create less anxiety for you.
Struggle to keep the mask on; either you pull it off at night or it comes off
|Soft headgear wraps like this one
can help to eliminate pressure marks
Have problems with skin irritation
|This is a chin support
you can easily attach to
your mask headgear
to cut down on oral
breathing at night.
|The full face or oral-nasal mask
covers both nose and mouth to allow
for uninterrupted breathing for those
who have deviated septum or struggle
to breathe well through their noses.
You can also check your pressure settings to make sure they are correct, or ask your sleep specialist for help with this. Too much pressure can lead to air swallowing, too.
If your mask makes funny burping or whistling sounds, it’s a sign that it’s not positioned correctly or it could be over- or under-tightened. Play around with the fit until it goes silent again. If this doesn’t happen, get advice from your sleep specialist about fitting or potentially trying out a new mask.
Masks these days are getting lighter and smarter, with less parts and a closer, easier fit. You may simply need to update yours.
Have a bed partner who does not appreciate the value of your therapy
|Editor’s note: Hmm. Not sure what they
mean when they say CPAP isn’t sexy.
I’m pretty sure this is designer
Zac Posen’s doppelganger rocking
a nasal PAP mask.
Without PAP therapy, you put your entire body at risk for many other chronic problems; if you already have heart disease, diabetes or respiratory problems like COPD, PAP therapy may indeed save your life.
If your bed partner tends to complain about your therapy, have them attend your visit to your sleep specialist so they can be versed on the critical value of maintaining compliant PAP therapy for their continued health. Adequate breathing and oxygen during sleep is not an optional, cosmetic problem; it is a function of optimal health and, without it, has been proven to lead to lower mortality by all the major chronic diseases that plague our society.
If it’s the appearance of the mask, or the presence of the tubing, they need to understand how and why the therapy works and that for the vast majority of the night, they will be asleep and won’t even see the mask or notice the hosing. The mask is only used during sleep and not for any other romantic bedtime activities, after all.
Despite all this advice, many patients become frustrated and decide that PAP doesn’t matter. They give up and never go back to their sleep specialist. This could be you or a family member or other loved one in your life. You always have the choice to refuse treatment, but at what peril? Learn what happens if you don’t treat sleep apnea.
Or, you may be all for treating your sleep apnea, but the PAP setup, after a very concerted effort, just does not seem to be working for you.
Though PAP is the gold standard for treating sleep apnea, there are other therapies for sleep apnea that don’t involve a mask.
Often, trying a new therapy is a good alternative; or, these alternatives may leave you wanting to return to PAP.
In either case, you are better informed on all your options with any medical treatment so that you can make the decision that is best for you.