CPAP

This information was reviewed and approved by Sheila Tsai, MD (3/1/2017).

Sleep apnea is a condition characterized by brief interruptions of breathing during sleep. Most cases of sleep apnea may require CPAP (Continuous Positive Airway Pressure).

This common and effective treatment provides pressure to the person's airway through a machine that blows air. The airflow from the CPAP machine is delivered through a mask that fits on the face and covers the nostrils, the nose, or the nose and mouth. This air pressure acts as a splint to keep the airway open during sleep, allowing breathing to become more regular. Snoring stops, and restful sleep is restored. Risk factors associated with untreated sleep apnea are greatly reduced when CPAP is used as prescribed by the doctor.

Hello, my name is Anne Cartwright.

I'm a physician assistant in the sleep medicine division of National Jewish Health. In this presentation, I'll be talking about CPAP masks.

There are a lot of mask choices, and this is usually the biggest challenge for patients when starting CPAP therapy.

Some people are lucky and the first mask they pick is a good fit for them, but often patients have to try several different masks before they find one that they really like. And mask preferences can change over time.

So it's very important that you work with your medical equipment company or your sleep doctor to find the mask that's the right fit for you.

When you're thinking about which mask to use, there's a lot of things to consider.

Obviously you need to look at the size and shape of your face, your nose, your nasal bridge, and the lower jaw.

The nasal bridge is the hardest part for people when they're trying to find a mask. That's the spot that tends to cause the most pain and the most leaking.

You need to consider if you have any facial hair, like a mustache or a beard. Whether you have any skin allergies, the masks are all latex free, but they are mostly made of silicone.

So if you're allergic to silicone, we need to look at another option. You need to consider if you breathe through your nose or your mouth, or both, or if you have any sinus problems or nasal congestion.

You also want to take into consideration your sleeping position.

Do you sleep on your side, or do you sleep on your back, or do you switch back and forth?

And if you have any claustrophobia or anxiety issues that might make CPAP difficult for you.

But most important, you want to consider what is comfortable for you.

So there's three main types of masks that we'll talk about.

Full face masks, nasal masks, and nasal pillows.

Full face masks are the largest masks available.

They cover the mouth and the nose.

Full face masks are good for mouth breathers, people that have trouble with sinus congestion and allergies, or people that have nasal blockage because of a deviated nasal septum, which means they have a crooked nose.

Nasal masks are the same idea as the full face masks, except they're smaller and they just cover the nose.

Nasal masks work well for nasal breathers, but if you tend to open your mouth at night, they don't work real well because the air goes in your nose and it blows back out your mouth and you don't get the air pressure you needed down into your throat.

Sometimes patients will use a nasal mask with a chin strap to help hold the mouth closed.

Patients usually prefer the nasal masks as opposed to the full face masks because there's less stuff on their face and it's just a smaller fit compared to the full face masks, but you must have a clear and open nose in order for it to work.

The last major type is nasal pillows. Nasal pillows go up the nostrils, kind of like oxygen tubing, except the portion that goes up your nose is larger and it actually plugs up your nostril completely.

These are preferred by a lot of patients because it's the smallest mask with the least amount of stuff on your face.

There's some really good options for side sleepers if you don't want to have any straps on the side of your face.

Nasal pillows are generally preferred by people who have a lot of difficulty with claustrophobia or anxiety.

There is one oral mask on the market. Part of the mask goes in the mouth and part of it goes on the outside over the mouth.

Because of the part that goes in the mouth, for some patients it can cause tooth pain or sores on their gums, so these aren't generally well tolerated and they're rarely used, but it is an option.

There is a hybrid mask on the market. This is a combination of nasal pillows and an oral mask that goes on the outside of the nose.

This is a very helpful mask for people who tend to breathe through their mouth but have trouble with the full face masks irritating the bridge of their nose.

The last unique mask we'll talk about is what we call a complete face mask.

This mask covers the entire face, going all the way from the forehead to the chin, including covering the eyes.

This mask is rarely used because it is quite large and cumbersome, but some patients who are on extremely high CPAP pressures find this mask comfortable because it does help diffuse the pressure.

There are some gadgets that can make the CPAP mask more comfortable and easier to use.

There are CPAP pillows available on the market.

These pillows have the sides cut out to allow room for the mask when you're laying on the side so that the pillow doesn't push your mask out of place.

There's gel pads available to put on the top and the bridge of your nose, and this help prevents any soreness or irritation and can be helpful for leaking.

There are strap covers available.

Strap covers are nice, soft material that goes over the strap so that the material does not irritate your face.

There's also mask liners that you can put between your face and the mask, and this prevents the mask from touching your face.

This is a good option for people who are allergic to the silicone, and in some patients it can help prevent mask leaking as well.

If you're struggling with a mask, take your time. Sleep apnea is a fairly serious medical condition, and there's many consequences, but sleep apnea usually is not an emergency situation.

People have usually had sleep apnea for many, many years before they discovered that they have it, and you've slept for most of your life without CPAP, so give yourself some time to get used to it.

You're changing decades of sleep habits, so it can take some time. The average person takes about two to four weeks to get adjusted to CPAP therapy.

Some take more and some take less, but you can go slow, take your time, and get acclimated to CPAP therapy and your mask at the pace that's right for you.

Again, some people are lucky.

They start CPAP and they say they sleep better than ever, but if you're struggling, take your time and go slow.

I tell people, don't put your CPAP on at night. When you're laying in bed in the dark, you have nothing else to do but lie there and think about the mask on your face.

So instead of using it at night, put your CPAP on during the day or in the evening while you're awake and you're in the light.

Then you can see what's happening if you need to make any adjustments to your mask so you're not fiddling with the straps in the dark, or if you start experiencing any anxiety, you can see and take your mask off quickly.

I also suggest that you wear CPAP while you're distracted. Do something like watch TV, read a book, or use the computer. That way your brain is focused on something else and it's not solely focused on the mask on your face.

Slowly increase the time you're able to wear the mask and when you feel like you're ready, then you can transition to using CPAP at night.

And a lot of patients like to use CPAP during short naps first before they try to use it for an entire night.

And using stress relief and relaxation techniques can help in this process as well.

National Jewish Health has been ranked the number one respiratory hospital in the United States and we are here to serve all of your respiratory and sleep needs.

Please visit our website or contact our sleep medicine clinic for further information.

How to Obtain a CPAP Machine

A DME (durable medical equipment) company will provide the CPAP equipment prescribed by your doctor. The insurance company involved may have an agreement with a specific company to provide this service to you. The DME provider should help you pick out a CPAP machine and mask. They should show you how to use and properly care for the equipment. They should also answer any questions you may have concerning the use of the equipment.

Getting Used to a CPAP Machine

It is important to make CPAP a part of your everyday life, as this treatment only works if it is used. It should be used at night for sleep, as well as for planned naps. The treatment only works if it is used. CPAP should be the last thing that is put on at night and the first thing that is taken off in the morning.

Getting used to the CPAP machine is different for each person. Some people may put the CPAP mask on the first night and wear it all night with great results. Others may struggle from the start. Most people fall in between these two extremes.

CPAP users normally need a period of adjustment. Remember, CPAP is something that can improve your quality of sleep and life. It does require cooperation on the user's part. It is important not to get discouraged. It can take several months for some people to get used to using CPAP all night long. Contact your DME provider concerning problems with equipment or comfort. Contact your doctor for medical problems. If you have problems, make sure to ask for help so you can get used to using your CPAP.

Side effects of CPAP use include headaches, dry or stuffy nose, sore eyes or bloating of the stomach. You can work with your health care provider to alleviate these problems. For example, you may be able to get a better-fitting mask or use a nasal spray to relieve a dry nose. If you have problems using CPAP, make sure to ask for help. Contact your DME provider concerning problems with equipment or comfort. Contact your doctor for medical problems.

About Auto-CPAP

Your doctor may order an auto-titrating CPAP, otherwise known as APAP or autoPAP. Rather than a fixed pressure with CPAP, a pressure range is provided with the autoPAP. The machine’s delivered pressure will adjust during sleep depending on the breathing pattern it senses. Your doctor may initially start with a large pressure range and narrow this range depending on the information obtained from the machine and your tolerance to the machine.

About BIPAP

Most peoplewith sleep apnea can be successfully treated with CPAP. In some cases, your doctor may prescribe BIPAP instead of CPAP for obstructive sleep apnea. BIPAP, (pronounced "BY-PAP") is short for bi-level positive airway pressure. The function of the BIPAP machine is the same as CPAP; however, it provides two different levels of pressure. There is a higher pressure provided when you are breathing in. A lower pressure is provided when you are breathing out. This mimics normal breathing and can be more comfortable for some people.

Portability of the PAP Machine

The PAP machine is portable. It will work with electricity, (either 110 or 220 current) with an adapter for a car cigarette lighter or with a 12-volt deep cycle marine battery. When flying, take CPAP as carry-on luggage only. Travel bags are available through the DME provider. CPAP can go anywhere.

Your doctor may prescribe oxygen to be used with the CPAP equipment. The oxygen is added to the system with a special adaptor. If traveling away from home, contact your DME provider. The DME provider can arrange for oxygen while you travel.

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