You’ve already beaten the odds. By completing your sleep apnea studies and successfully starting constant positive airway pressure (CPAP) therapy, you have achieved what the undiagnosed 80% of sleep apneics, and the 50% of those remaining who can’t comply with treatment, have not: you’re in the top 10% of CPAP compliance!¹
According to one sleep apnea patient, "CPAP changed my life. It immediately changed my level of awareness, and I work better and live better since starting treatment. Plus, it's just nice not to be so tired all the time. For the first time in my life, I can get out of bed without feeling like I need to crawl back in for another couple of hours of sleep."²
You know that CPAP is the best solution for your breathing issues, and have been told it will improve the quality of and maybe even extend your life, but living with CPAP over the long haul means overcoming many obstacles. And that is what today’s Circadiance blog is all about.
How DO I get from the initial steps of treatment setup to having CPAP change my life for the better? Positive Airway Pressure (PAP) therapy is the gold standard and most widely used treatment for obstructive sleep apnea (OSA). PAP therapy is recommended by the American Academy of Sleep Medicine (AASM) for the treatment of moderate to severe obstructive sleep apnea in adults, and an option for the treatment of mild sleep obstructive sleep apnea.³‐⁴
PAP is a generic term applied to all therapies that use air pressure delivered through the upper airway of patients with sleep related breathing disorders (SRBDs) with the purpose of creating a “pneumatic splint” to support the anatomical structures of the upper airway by opening and thus allowing an uninterrupted flow of air to the lungs during sleep. This mechanical intervention of opening up the airway means that CPAP has an immediate effect on the user, the very first night. As a sleep lab manager, I have interviewed hundreds of sleep technologists and they all have the same answer for, “What is the best part of being a sleep tech?” Every tech knows that the meaning in the work comes from changing people’s lives in one night. Patients who have suffered a lifetime of sleep disruption from sleep apnea and the effects that come from it are often elated that for the first time they wake up refreshed with CPAP use.
From a patient perspective, though, the first exposure to positive pressure is akin to sticking your head out the car window at speed…the sensation “takes your breath away” at first, and requires some getting used to. That’s why getting a proper interface selection, fit, and overall accommodation, on the very first go at it, is crucial for long-term success with CPAP.
The Intersection of Comfort and Compliance. Long-term adherence to CPAP means you have to be able to live with the interface and machine. This is because, because unlike an acute illness that resolves in the short term, and is characterized by abrupt or rapid onset, limited duration, and a single cause (usually), OSA is a chronic illness characterized by gradual onset of lengthy or indefinite duration. This means that for someone with sleep apnea, the disease shows up whenever sleeping and CPAP must therefore be worn, even for naps. Equate this with a teeth grinder (known as bruxism) who has to wear a mouth guard whenever sleeping to avoid tooth damage. Chronic disease means chronic treatment.
Living with CPAP during the day helps you to live with it at night. Wear the mask while watching TV or doing normal activities to become even more accustomed to the sensation.
If you find that your mask is no longer comfortable, ask for a refit from your durable medical equipment (DME) company. The refit rate is as high as 1 in 3 masks when using a typical DME (durable medical equipment company) or online CPAP supplier. But if your DME offers a remote mask selection application software, be sure to take advantage of this option—the failure rate has been observed at only around 10% when using such a product.
Nuts and bolts of living with CPAP. Of course, living with CPAP is about more than just initial setup. It means a lifetime of maintenance including cleaning, equipment replacements, retitrations, following best practices for CPAP use, and using good sleep hygiene. This can seem overwhelming, but like anything, it gets better when you break things down into small parts. Following the manufacturers’ recommendations for cleaning is your best bet for getting the most out of your equipment. Typically, soap and water are all that are needed for cleaning the mask, headgear and tubing. There is uncertainty though about the safety and effectiveness of both ozone and ultraviolet cleaning methods. In February 2020 the FDA issued a safety communication and consumer update about concerns related to CPAP cleaning devices that use ozone or ultraviolet light.
- Make sure you use the ramp feature (if you have one on your machine), which starts off at a low pressure and increases gradually, at the beginning of each night.
- Use heated humidification if you can to prevent dryness in the mouth, nose and throat.
- Keep your treatment going the full night. The threshold is 7 hours, but research shows that CPAP effects grow the more you use it, and that your body doesn’t need a certain threshold of hours.
- If you remove your mask at night without remembering it, wear gloves (particularly large gloves) to make it more difficult to take off your mask
- Keep a consistent bedtime, wake time and routine.
A new prescription may be needed as the factors affecting your sleep apnea change, including changes in: weight (especially weight gain, which may worsen sleep apnea); surgical history (especially oral and upper airway); alcohol (which worsens sleep apnea symptoms) or stimulant use; allergies (which can affect your nasal passages); medications (especially muscle relaxants and those that affect arousal).⁵
Your provider may change the pressure settings by trial-and-error (empirically) or schedule you for a follow up titration (retitration) to check the effects of a new pressure setting.
Stay tuned for Part 2 of Living with CPAP next week!
—Matthew Anastasi, BS RST RPSGT, Clinical Coordinator Consultant, Circadiance
REFERENCES
¹ Watson NF. Health Care Savings: The Economic Value of Diagnostic and Therapeutic Care for Obstructive Sleep Apnea. J Clin Sleep Med. 2016;12(8):1075-1077. Published 2016 Aug 15
² ‘CPAP Machine Changed My Life'. MedicineNet. https://www.medicinenet.com/script/main/art.asp?articlekey=158679. Published May 29, 2012.
³ Epstein LJ; Kristo D; Strollo PJ; Friedman N; Malhotra A; Patil SP; Ramar K; Rogers R; Schwab RJ; Weaver EM; Weinstein MD. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009;5(3):263–276
⁴ Anastasi MW. Chapter 46: Positive Airway Pressure Therapy: Basic Principles. In Lee-Chiong TD, Mattice C, Brooks R, eds., Fundamentals of Sleep Technology. 3rd ed. Wolters Kluwer Health, Inc., 2019:580-587.
⁵ Brandon Peters MD. What Side Effects to Expect From CPAP Therapy. Verywell Health. https://www.verywellhealth.com/cpap-therapy-what-are-the-side-effects-3015024.
⁶ Lewis KE et al. (2004). Early predictors of CPAP use for the treatment of sleep apnea. Sleep, 27, 134-138.
⁷ Krakow, B, et al. (2008). A daytime, abbreviated cardio-respiratory sleep study to acclimate insomnia patients with sleep disordered breathing to positive airway pressure (PAP-NAP). J Clin Sleep Med, 4,212-22.
⁸ Anastasi M, Pasquale M, Tubbs A. Comparison of PAP Interface Pressure on the Nasal Bridge: Soft Cloth vs. Traditional Masks. Abstract submitted for publication. 2020.
⁹ Perez C. Managing Multiple Masks. Sleep Review. https://www.sleepreviewmag.com/uncategorized/managing-multiple-masks/. Published August 19, 2015.
¹⁰ Young, T., Finn, L., Peppard, P. E., Szklo-Coxe, M., Austin, D., Nieto, F. J., et al. (2008). Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep, 31(8), 1071-1078.
¹¹ Miller MA, Cappuccio FP. A systematic review of COVID-19 and obstructive sleep apnoea. Sleep Medicine Reviews. https://www.sciencedirect.com/science/article/pii/S1087079220301258?via=ihub. Published September 8, 2020.
¹² Michaud L. 4 realities of life with sleep apnea and living with your CPAP Machine. https://www.alaskasleep.com/blog/4-realities-of-life-with-sleep-apnea-living-with-your-cpap-machine.
¹³ Rodriguez J. Best Online CPAP Support Groups and Resources. Advanced Sleep Medicine Services, Inc. https://www.sleepdr.com/the-sleep-blog/best-online-cpap-support-groups-and-resources/. Published December 7, 2016.