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Tips for successful CPAP therapy

Some physicians prescribe CPAP as part of the treatment for certain sleep disorders. Nevertheless, it might be difficult for patients to instantly follow this treatment without having some concerns and facing some challenges.

“First described by Sullivan in 1981, PAP (Positive Airway Pressure) provides pneumatic splinting of the upper airway and is effective in reducing the AHI. PAP may be delivered in continuous (CPAP), bilevel (BPAP), or auto titrating (APAP) modes. Partial pressure reduction during expiration (pressure relief) can also be added to these modes. PAP applied through a nasal, oral, or oronasal interface during sleep is the preferred treatment for OSA. CPAP (Continuous Positive Airway Pressure) is indicated for the treatment of moderate to severe OSA and mild OSA. CPAP is also indicated for improving self-reported sleepiness, improving quality of life, and as an adjunctive therapy to lower blood pressure in hypertensive patients with OSA.”1

Although it is extremely beneficial for improving one’s health condition while sleeping, CPAP is not the most comfortable device to accommodate in one’s life. However, depending on a person’s behaviors and actions, getting used to this device might happen sooner than expected, with light to moderate difficulties. In fact, some people are able to accept it as part of their daily routine in only a matter of few weeks.

“Treatment with PAP (Positive Airway Pressure) should ideally be approached on a case management basis utilizing a multidisciplinary care team that can include a sleep specialist, the referring physician, nursing personnel, respiratory therapist, and sleep technologist. Patients should be educated about the function, care, and maintenance of their equipment, the benefits of PAP therapy, and potential problems. Patients, in conjunction with their care team, should work together to select the most appropriate PAP interface. The nasal airway is the preferred delivery route, however, alternatives may be tried to accommodate for comfort or difficulties. The addition of heated humidification and a systematic educational program is indicated to improve CPAP (Continuous Positive Airway Pressure) utilization. CPAP usage should be objectively monitored with time meters to help assure utilization. CPAP and BPAP  (Bilevel Positive Airway Pressure) therapy are safe; side effects and adverse events are mainly minor and reversible.”2

The following are some recommendations which will help new CPAP users to welcome this device into their lives.

Selecting a Device that Appropriately Meets the Person’s Needs

There are different manufacturers of CPAP equipment, therefore picking one that is best suited for an individual requires time and brand comparison. On certain occasions, a physician will be able to recommend a variety of manufacturers. Here thoughtful consideration comes into play. It is important to not rule out or choose any manufacturer without first consulting with the company. Therefore, when looking for this device, the decision to purchase should not be made on the spot.

The device not only comes with a CPAP machine, but also a mouthpiece. A CPAP mouthpiece is crucial for improving the condition; therefore, an ideal fit is necessary. The buyers can also check the company’s return policy to see if they will be able to give the device back if any inconvenience arises.

“The selection of a comfortable mask, which provides an effective seal against the face to minimize air leaks, is a critically important aspect of CPAP therapy in OSAS. This aspect should be addressed at the initiation of CPAP, and has a major impact on the ongoing success of therapy. Mask fitting is a highly skilled process, and is best performed by a trained and experienced technologist or nurse practitioner. The technology of nasal masks has evolved greatly over the years, and there are now a large variety of masks available. Adequate time is essential for proper fitting and patient education and careful attention to this aspect of therapy will have a significant knock-on benefit in terms of treatment efficacy, side effects, and compliance.”3

Not all masks will fit perfectly since they are designed with different requirements and structures in mind. The selected mask should allow the person to inhale and exhale without posing great difficulty, while physically adapting to the area’s bone structure.

Although the less bulky mouthpiece is often advised, there are other factors which might contribute to the selection of the appliance, including:

  • Facial hair- A mouthpiece on men who have a beard or mustache might fit differently if they are shaved.
  • Underlying health conditions – Disorders that have an impact on the position of the nose come into play.
  • Form of breathing – Whether a person uses the nasal airway or mouth to take in and expel air plays a role.
  • Using the Device at its Fullest
  • Breathing with this device should be conducted slowly and deeply. Taking in air with CPAP equipment is an easy task, since the device allows a person to inhale until the lungs are at their full capacity. However, expelling air is not to be taken lightly and will probably take some time to get used to. This occurs because it requires the user to engage in extra effort.

There are some signs which can help a person make sure the device is being operated correctly. When there is a sound or sensation of air going through the opening in which gas is supposed to be released, it means that air is being exhaled properly.

To enjoy the advantages of this equipment, the user should pay attention to the following:

  • If the mouthpiece covers the nasal area partially or entirely, the mouth should be kept closed at all times.
  • If the mouthpiece covers only the mouth area, the user should be able to inhale and exhale as he/she pleases.
  • It is important to note that diverting attention from the device to something else might allow the user to continue with the therapy even longer than prescribed, therefore helping to improve his/her medical state. Psychologically, making use of this equipment while doing something enjoyable or something that stimulates the intellect can condition a person to link the use of a CPAP device with positive emotions.

To accelerate the perceived passage of time and forget about the device, the user can do the following:

  • Surf the web
  • Watch a series or film he/she enjoys
  • Grab a newspaper or a literary work
  • Engage in anything that does not require too much movement
  • Developing a Constructive State of Mind

Even though it might be challenging to accept the terms of incorporating a CPAP device into one’s everyday routine, ultimately it will enhance the user’s life by providing a good night’s sleep. When feeling let down by the continuous use of this equipment, it is important to remember all the advantages provided by proper sleep, including:

  • A shift towards pleasing feelings
  • An increased level of physical and emotional stamina
  • An increased ability to concentrate
  • A comprehensive good health status
  • Getting Used to the Device

After some time, the constant use of a CPAP device will become a common and natural activity. Although a person might experience no difference in health after using the device for a couple of days, he/she should adhere to the schedule since the life enhancements CPAP provides, usually present themselves after a while. If the user does not seem to get used to it, he/she should use the device even when it is not required. This will help the body get used to this shift in the daily routine.

CPAP machines require the user to be still and confined in a space, therefore it presents further challenges to those who are not comfortable being enclosed. If the use of this device becomes unbearable, the user can first learn to adapt to the mouthpiece without turning the device on. The patient can do this for a while until he/she feels more at ease. After getting used to the mouthpiece, the device should be switched on and the mouthpiece should be positioned as instructed.

“Even with a proper fit, mask leak is a common complaint, especially during the early stages of CPAP therapy. Dry eyes, conjunctivitis, or loud noises from the mask are clues the mask is improperly sealed. If the mask does not fit properly, patients may quickly lose interest in the therapy particularly if they do not experience improvements in daytime symptoms. During the initial educational visit, the clinician must reassure the patient that excessive mask leak is not normal and can easily be resolved. Changing the size or type of mask may be necessary and the patient should contact their DME ((durable medical equipment) vendor to re-fit their mask. If a patient has significant facial hair, nasal pillows may provide a better seal. Additionally, some simple behavioral interventions can engrain sleep habits to minimize the possibility the mask will dislodge throughout the night. One example is a muscle memory exercise whereby the patient places their hand over the mask whenever they move while awake. Over time, this becomes a reflexive behavior that continues unconsciously during sleep. It is important to inform the patient that they should turn on the CPAP at full pressure (not using the ramp feature) prior to donning the mask in order to improve the seal. Masks should be replaced every 3–6 months as older masks may experience silicone breakdown and begin to leak.”4

Usually, CPAP devices have settings which accommodate the first-time user’s needs. They employ technology which reduces the air pressure at the beginning and increases it as the treatment moves along. This makes breathing out against fixed pressure more bearable and easier to get used to. If the subjects feels the pressure is too high to handle, then he/she can turn the device off, then on again, so that pressure is set slowly again. This system makes falling asleep an easier task to get over with.

If the challenge the user is faced with is related to some type of device malfunction, it is recommended to inform the manufacturer or company. This is recommended so that the manufacturing company is able to take to the appropriate procedures, depending on their policy. As soon as a problem arises with the device, rapid and appropriate actions should be taken without hesitation to enjoy the full advantages of a CPAP therapy.

It is important to be aware of other methods to manage heavy sleep complications that a medical professional might advise, such as Bilevel Positive Airway Pressure or variable positive airway pressure.

“CPAP remains a safe and very effective means to improve sleep-disordered breathing, and the rapid advances in technology have resulted in a simple-to-use, portable and unobtrusive machine. Despite advances in CPAP platforms and comfort features, CPAP remains underutilized largely because of poor patient acceptance. Adequate education and rapid troubleshooting of initiation problems is critical to maximizing CPAP use.”5

 

References

(1, 2) Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults. Epstein, L.J., Kristo, D., Strollo, P.J., Friedman, N., Malhotra, A., Patil,  S.P., Ramar, K., Rogers, R.,  Schwab, R.J., Weaver, E.M. & Weinstein, M.D. Journal of Clinical Sleep Medicine. 2009. http://jcsm.aasm.org/Articles/05_03_263_1.pdf

(3) Follow-up and outcomes of nasal CPAP therapy in patients with sleep apnea syndrome. McNicholas,  W.T. Monaldi Archives for Chest Disease. 2001. https://www.researchgate.net/profile/Walter_Mcnicholas/publication/11389727_Follow-up_and_outcomes_of_nasal_CPAP_therapy_in_patients_with_sleep_apnea_syndrome/links/55edd5dd08aef559dc437cb4/Follow-up-and-outcomes-of-nasal-CPAP-therapy-in-patients-with-sleep-apnea-syndrome.pdf

(4, 5) CPAP: enhancing its use. Williams, S.G., Lettieri, C.J. & Dombrowsky, J.W. Sleep Medicine 2012. https://link.springer.com/article/10.1007/s13665-012-0015-z

 

María Laura Márquez
13 October, 2018

Written by

María Laura Márquez, general doctor graduated from The University of Oriente in 2018, Venezuela. My interests in the world of medicine and science, is focused on surgery and its greatest advances. Nowadays I practice my...read more:

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