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Tips for successful CPAP therapy

Some physicians prescribe CPAP as part of the treatment for certain sleep disorders. Nevertheless, patients might find difficult to instantly follow this treatment without having 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 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, accustoming could be easier with light to moderate difficulties. In fact, some people accept it as part of their daily routine in only a ew 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 Patient’s Needs

Several manufacturers of CPAP equipment offer different alternatives; therefore, selecting one suits the patient requires time and brand comparison. Occasionally, a physician will recommend certain manufacturers. Consider not to discard or select any manufacturer without first consulting with the company. When looking for this device, the do not make the final decision immediately.

“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

The device comes with a CPAP machine and a mouthpiece. A CPAP mouthpiece is crucial for improving the condition, so an ideal fit is necessary. The buyers can also check the company’s return policy to see if they accept the device back  if any inconvenience arises.

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

Although the specialists often recommend a lightweight mouthpiece, other factors might contribute to the selection of the appliance, including:

  • Facial hair- A mouthpiece on bearded men or with a mustache might fit differently if they are shaved.
  • Underlying health conditions – Disorders that impact the position of the nose.
  • Form of breathing – Whether a person uses the nasal airway or mouth to breathe.

Patients should breathe slowly and deeply with this device. Taking in air with CPAP equipment is an easy task, since the device allows the patient to inhale until the lungs are at their full capacity. However, do not take expelling air lightly, as it will probably take some time to accustom, because it requires the user to engage in extra effort.

Some signs can help ensure the device operates correctly. When there is a sound or sensation of air going through the opening that releases gas, it means that the patient is exhaling air 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 stay closed at all times.
  • If the mouthpiece covers only the mouth area, the user may inhale and exhale as he/she pleases.
  • Diverting attention from the device to something else might allow the user to continue with the therapy even longer than prescribed, helping to improve his/her medical state. Psychologically, making use of this equipment while doing something enjoyable or 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 distract from the device, the user can do the following:

  • Surf the web
  • Watch a series or film he/she enjoys
  • Read a newspaper or a literary work
  • Engage in anything that does not require too much movement
  • Developing a constructive state of mind

Although accepting the terms of incorporating a CPAP device into one’s everyday routine might be challenging, ultimately it will enhance the user’s life providing a good night’s sleep.

When feeling dissapointed by the continuous use of this equipment, remember all the advantages of 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

Accustoming to the Device

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

CPAP machines require the user to be still and confined in a space, soit presents further challenges to those who are uncomfortable being enclosed. If using 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 accustoming to the mouthpiece, switch on the device and place the mouthpiece as instructed, to avoid leakage and visual complaints.

“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 use technology that reduces the air pressure at the beginning and increases it as the treatment moves along. This facilitates breathing out against fixed pressure. If the pressure is too high to handle, then he/she can turn the device off, then on again, so that pressure sets slowly again. This system facilitates the task of falling asleep.

“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

If the user faces challenges with some type of device malfunction, inform the manufacturer or company, so that they take the appropriate procedures, depending on their policy. As soon as a problem arises with the device, the user and caregivers should perform rapid and appropriate actions without hesitation to enjoy the full advantages of a CPAP therapy.

Other methods to manage heavy sleep complications tare available, such as Bilevel Positive Airway Pressure or variable positive airway pressure.

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, are focused on surgery and its breakthroughs. Nowadays I practice my profession...read more:

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