Understanding How To Use a CPAP Machine
We are excited to provide you with a sample CPAP in-service and instruction for people new to CPAP therapy. Understanding CPAP is very important to therapy adherence and we strive to bring you the best information possible to assist you in your therapy. We do advise that you speak with your physician regarding the information below prior to application so that you are both informed about the steps you are taking to improve your therapy.
Instructor: What lead you to have a sleep study or sleep consultation?
Patient: I feel tired during the day and my wife says I quit breathing during my sleep.
Instructor: That’s very common to hear. It should also be noted that other chief complaints that lead many people to have a sleep study are loud snoring, short term memory loss, frequent morning headaches, moodiness or irritability and falling asleep in situations where you should be awake, like driving a car. Sometime during your routine physical, your family doctor may suggest the study based on hypertension, type II diabetes, weight issues, or restricted airway.
Patient: I agree, sometimes I suffer from some of those other symptoms.
CPAP Instructor: Have you had one sleep study or two?
Patient: I had just one sleep study.
Instructor: Did they come in the middle of the study and ask you to sleep with the CPAP mask?
Patient: Yes, they called it a split night sleep study.
Instructor: Great, how did the pressure feel and did you sleep well with the mask?
Patient: I had the best sleep I have had in a long time. They used a mask that covered my nose and mouth.
Instructor: Great, I have brought a selection of different masks. One that covers the nose only, triangle shaped that allows the user to breath in and out through the nose only. One that covers the nose and mouth, this allows the user to breathe through the nose and mouth. This is a great mask for people with deviated septums, or people that are prescribed a higher CPAP pressure. Typically at higher CPAP pressures, the force will blow the mouth open; which is not good because all of the pressurized air that is intended to keep the airway open will escape through the mouth. The loss of the pressurized CPAP air makes CPAP ineffective and will cause dry mouth or sore throat.
I have also brought one that is called a nasal pillow CPAP mask. This mask is the most non invasive of the CPAP mask and is very light weight. The mask simply seals around the nostril and is slightly larger than an oxygen cannula. More and more CPAP patients are trying these masks.
Patient: I breathe through my mouth a lot during sleep so I would like to use the Full face mask.
Instructor: I understand. Most people have a built in self defense mechanism of breathing through their mouth and/or sleeping on their side as a way for them to get more air when apneas are present.
Patient: I do both of those things.
Instructor: How much do you know about the results of your sleep study?
Patient: They told me I quit breathing 27 times per hour and my lowest oxygen level was 79%.
Instructor: They are referring to your AHI (Apnea Hypopnea Index); simply put the number of times per hour on average that you quit breathing or partially quit breathing. An AHI of 5 times to 15 times per hour is classified as a mild case of sleep apnea, 15-30 is moderate and any number over 30 is considered severe. In your case of 27 times per hour, that is nearly once every 2 minutes, your airway is collapsing and this cutting off the air to the lungs.
Our bodies convert the air in our lungs into oxygen that is pumped throughout the blood stream and to the brain. When our oxygen levels dip below a certain level, our brain will arouse, or briefly wake up, telling our body its needs more oxygen and to breathe. These awakenings, or fragmented sleep, disturb our sleep, not allowing us to get a more restful night’s sleep by limiting how much deep sleep we get. This airway closure also slows our heart rate down and drops our blood pressure when we are not breathing and then when we do start breathing, our heart races to catch up and pump more blood oxygen throughout the body.
Instructor: Do you know what CPAP is or do you know anyone on CPAP?
Patient: Yes, a person I work with uses one but doesn't use it very much.
Instructor: CPAP is an acronym for Continuous Positive Airway Pressure. It is not an oxygen machine and it is not breathing for you. It is simply pulling room air, filtering that air, passing it over humidity and pressurizing it to provide a pneumatic splint in your airway. This pressurized air keeps your airway stable, allowing you to pass air back and forth into the lungs with an ultimate goal decreasing your sleep apnea below 5 events per hour, keeping your oxygen levels above 90%, allowing you to achieve the deeper, more restful stages of sleep and eliminate any residual snoring.
Instructor: We never sugar coat it for patients new to CPAP. It can be difficult and the first few days to weeks may take some getting used to. Most people are not used to sleeping with something on their face, let alone pressurized air blowing into it. We suggest breathing on the machine for a little while prior to going to bed so that when you do lay down to go to sleep you will not be thinking about “how to breathe” on it. If you can only sleep with it a few hours the first night, great; the next night try to get a little more and then a little more until you reach a point where you can sleep and entire night with it. Most patients will report they take mask off during the middle of night and not realize it; this is perfectly normal behavior; just put the mask back on and continue therapy.
More and more CPAP machines are equipped with comfort features that allow you to adjust to these pressures like C-Flex or EPR. These are expiratory pressure relief settings that allow you ease of breathing against the pressure (making it easier to exhale). There will still be resistance because back pressure is required to keep the airway open while exhaling. Ramp features allow the CPAP user to start at a low tolerable pressure and fall asleep while the CPAP or BiPAP machine ramp up to prescribed therapy pressure. On board displays allow you to check your therapy results the next day (available in some models of CPAP). The display settings are great encouragement tools for patients with mild to moderate sleep apnea that may not notice fatigue improvement right away but can see that their sleep apnea is improving with the use of CPAP.
Patient: This is great to know. My co worker gave up after only a couple of nights.
Instructor: Remember to use CPAP anytime you are sleeping, if you choose to use the CPAP machine sporadically, meaning skipping sessions, your symptoms will reappear and may take time to resolve.
Patient: What brands of CPAP do you carry; my friend said I should try a certain brand?
Instructor: We carry all the brands of the major manufacturers (Philips Respironics, Fisher and Paykel) and we also have access to many of the smaller companies products if you find something you would like to try. Most of the time, the equipment we dispense is based off of the recommendation of the sleep physician or sleep center that referred you to us.
Instructor: Most CPAP machine comes in 2 pieces (except the Fisher and Paykel Icon Series), the machine itself and the attachable humidifier. The humidifier connects to the CPAP and becomes one unit. Looking at the back of the machine, there are 3 main areas of focus. The filter cover, the power supply and the data card slot (located on the side of the Fisher and Paykel CPAP machines).
The filter should be replaced according to the CPAP manufacturer’s replacement schedule or when it is noticeably dusty or dirty. Some filters are cleanable, others are only disposable.
The power supply connects into the back and it is recommended that you use a surge protector.
The data card stores information that is pertinent to your therapy results and may be reviewed by your physician to assist in changes to your therapy as well as insurance reimbursement. For compliance data we are looking for at least 4 hours of use and at least 5 nights per week. However these are minimal use, we would like to see you use the machine every night or anytime that you sleep.
Instructor: Turning the machine around and starting with the humidifier. The humidifier helps alleviate any dryness you may experience from the CPAP pressure(s); it has also been shown to assist in allergy relief and nasal congestion.
The humidifier contains a water chamber and distilled water should be used in this to prevent build up of mineral deposits. The humidifier should be cleaned out daily (some are dishwasher safe) with a mild detergent. The humidifier chamber should be replaced every 3-6 months or as needed and is covered by most insurance companies. Do not leave standing water in the chamber for long periods of time and always empty the water chamber if transporting your CPAP machine. For a complete disinfection, submerge the humidifier chamber in a solution of 1 part distilled vinegar 4 parts water. Let this set for 15-20 minutes and then rinse out thoroughly.
The temperature of the humidifier is controlled through the CPAP machine. It is recommended to start in the middle setting and adjust based on need. If you wake in the morning with excessive moisture and condensation build up in the mask and tubing, the humidity may be too high and should be turned down. If you wake up in the morning with dryness and throat irritation, it could be a sign that the humidity level is too low. Seasonally, your humidity may need to be adjusted based on whether you air conditioner is on or your furnace. With the air conditioner on, more moisture is in the air and less humidity may be needed; vice versa with the furnace because the heat is a drier air and more moisture will likely be needed.
Certain manufacturers have developed special CPAP tubing that helps promote better humidity through a heated hose. With standard CPAP tubing, the heated moistures dissipates as it is traveling through the tube. If you are experiencing dryness from lack of humidity, a heated tube may be right for you.
Your standard CPAP tubing or heated tubing will connect to the nozzle/port on the humidifier. Since the CPAP tubing end is made out of a material that keeps a strong hold onto the nozzle/port, it is always easier to apply the tubing at an angle (as well when you are taking it off). The CPAP tubing/hose should be cleaned as often as possible as to not to promote bacteria growth. It should be cleaned by hand with a mild detergent and left to air dry. CPAP hoses and tubing should be replaced at least once every 3-6 months or if noticeable wear and tear has caused it to develop leakage (also a covered replacement item by most insurance companies). For most standard tubing, either end can connect to the mask and to the machine. Standard CPAP hoses and tubing are compatible with all manufacturers CPAP machines and masks because they all come in one standard diameter size. CPAP tubing length can vary to give you more room and are available in lengths of 6ft, 8ft, and 10 ft.
Instructor: Focusing our attention on the CPAP machines itself, you will notice on board controls that perform many functions.
The start/stop button: This button or dial activates the CPAP machine to turn on (though some manufacturers have auto on mode that starts the CPAP when you begin to breathe on it). When turning on the Fisher and Paykel and Philips Respironics CPAP machines, the pressure will immediately begin at therapy pressure unless you activate the ramp button. With the ResMed CPAP machines, the CPAP pressure will begin at the ramp pressure (as long as you have set a ramp time frame). If the ramp time is not set on the ResMed CPAP machine, it will begin at therapy pressure.
Information and data compliance: Certain models contain compliance data that is accessible to the CPAP user. This is either accessed through the info button or icon located on the on board display. This information can tell you the amount of time you have used it for a given period, whether or not you had a mask leak, and what your AHI (apnea hypopnea index) is.
Humidity: the temperature of your humidifier is typically controlled through the CPAP and is done by accessing the icon (either water vapor icon, water drop icon or thermometer icon). Referring back to what we had discussed earlier, you should increase humidity if you notice mouth dryness or throat irritation that isn’t a result of mouth breathing (remember you can check your machine to see if your mask was leaking too much). If you notice excessive moisture or condensation built up in the mask and tubing, decrease the temperature of your humidifier or check out CPAP tubing wraps that prevent rain out. I typically advise people to keep the CPAP machine below bed levels so that the moisture runs back down into the humidifier through gravity instead of collecting in the tubing. If you hear a gurgling, or popping sound in the tubing, it typically means that moisture is trapped through the loop that was formed and the air passing over it is making that sound.
Instructor: Now to the CPAP masks that we previously discussed.
The Full Face CPAP mask style is meant to cover the nose and mouth, allowing the user to breathe through either. Because this is a larger mask and it’s covering a greater surface area, it is important to keep the mask clean from facial oils and/or make up and cleaning should be done daily.
Nasal masks only cover the nose and are usually a triangle shape. For effectiveness, you should only breathe in and out through your nose, keeping your mouth closed. If air is escaping through your mouth or you are a mouth breather, the required pressure is not making its way to your airway to provide that splint that keeps it open. These masks follow the same cleaning and maintenance schedule as the full face CPAP masks.
Nasal Pillow Masks are the least invasive of the CPAP mask and seal around the nostril area. These types of mask are great for people that suffer from claustrophobia or like a clear field of vision to read or watch television as they fall asleep. The cleaning schedule should be as followed with the nasal and full face CPAP masks.
For all types of CPAP masks, please note the following: Most insurance companies will cover a replacement mask and headgear every 3-6 months and a replacement cushion every month. Never use a cleaning product that contains alcohol and stay away from detergents that have fragrances. Typically a mild baby shampoo will promote a longer life of the mask without breaking down the silicone cushion. CPAP masks are latex free.
For people new to CPAP, it is recommended to apply the mask in a mirror prior to use so that you can insure a proper fit, for your benefit we have included the CPAP mask instruction and fitting guide. All CPAP masks have CO2 exhalation ports (full face masks also include anti-asphyxiation valves) that will constantly blow off your CO2 so that you do not retain it. This CO2 exhalation port is usually located on the front of the mask and you will hear/feel air coming from it.
It is important to note that you should not over tighten the CPAP mask headgear; this will only cause additional mask leak and irritation to you. If your CPAP mask had a good fit but as time has passed, you notice that you need to tighten it down more and more, this could be an indicator that you need a new CPAP mask system or at the very least you need to replace the mask headgear or cushion. Only keep the CPAP mask straps on tight enough to prevent leaks but not so tight that it keeps you from falling asleep.
Patient: What if my mask does not work for me or I want to try another one?
Instructor: We offer a 30 day free replacement or exchange on all of our masks. You can visit our website or simply call our office to speak to one of our clinical specialist.
Instructor: The CPAP or BiPAP machine and humidifier comes with a manufacturer warranty of 2 years (2.5 years for the Fisher and Paykel ICON series). If manufacturer defect is the cause of your CPAP or humidifier to stop working, please let us know and a new CPAP machine with a new warranty will be issued to you (as long as it is within its original warranty period). If the machine is outside of the warranty period, please let us know and a loaner CPAP will be issued to you while yours is sent to the manufacturer for repair estimate. Most insurance companies pay for a new CPAP machine every 3-5 years.
Patient: What about travel with my CPAP machine? Should I take it or leave it at home?
Instructor: We always encourage users to take their equipment with them when they travel. The last place you want to feel run down and tired is when you are on the road or on vacation. If traveling by air, please take your CPAP machine as a carry-on (you don’t want to run the risk of it being damaged in baggage claim). Most airlines are very familiar with these medical devices and will not count it against your carry-on items. To play it safe, it is best to obtain a letter of medical necessity from your physician.
Patient: How do I get replacement parts?
CPAP Instructor: Most replacement parts are covered by your healthcare insurance and can be replaced every 3-6 months. We have 2 ways that you can go about getting these replacements. 1.) You can sign up to have these supplies automatically shipped to you on a reoccurring schedule. 2.) You can call us when you feel like you need new supplies and we will verify your eligibility and send them directly to you.
Patient: Are there any side effects I should know about?
Instructor: CPAP has long been the gold standard for sleep apnea therapy and is the only 100% proven effective therapy. There are some minimal potential side effects of use and they may include the following:
- Bloating or excessive air/gas
- Excessive dryness of the nose and throat
- Nasal congestion
- Mask irritation/discomfort
- Chest discomfort
- Dizziness or feeling light headed
Patient: What are some things I may notice with use of CPAP?
Instructor: In the beginning weeks you may notice an increase in long vivid dreams that are sometime reported with use. A severe OSA patient typically notices results right away with each day feeling better then the day before until you plateau (Remember, if you discontinue use, the symptoms will re-appear). Some mild or moderate cases may take longer to notice these differences but be assured that your body is feeling the positive effect of the CPAP use. In the beginning, some users will take their mask off during the middle of the night or turn the machine off and not remember that they did it. This is perfectly normal and you should just put the mask back on, turn the machine on and go back to sleep if you notice it during the middle of the night. We have staff members that perform routine follow up calls to you to see if they can answer questions you may have at the time or provide advice for adjusting to therapy. Also, Please note that people that use CPAP report the following positive benefits:
- Improved Quality of Life
- Increased Energy and Motivation
- Improved Mood
- Better Productive Job Performance
- Increased Sexual Drive
- Increased Alertness and Awareness
Patient: What happens if I don’t use the CPAP machine or stop using it?
Instructor: In depth and proven research has shown that untreated sleep apnea can result in the following:
- Hypertension ( High blood pressure is up to 5x more likely)
- Congestive heart failure (CHF)
- Increased risk for motor vehicle accident
- Type II Diabetes
Patient: How does the CPAP billing work for my insurance?
Instructor: We perform a benefits and pre-authorization check to verify your eligibility. The insurance company will determine if they will outright purchase your equipment or choose a rental method until its proven that CPAP is effective for you and you are using the device. We bill your insurance first and you will receive an EOB (explanation of benefits in the mail). Our billable rate is typically higher than the fee schedule that the insurance provider pays. Your portion of responsibility is meeting your deductible (if you have one) and then once that has been met, insurance coverage is based on your plan (this means if you have an 80%-20% plan, they will cover the 80% and you are responsible for the 20%). It is hard to quote an exact dollar amount because each insurance company is different for what they pay for the device and certain plans within the insurance company cover differently. Our billing representative can discuss in further detail).
Instructor: We encourage you to call us with any questions regarding your therapy, billing, or general discussion about your CPAP device.