What is CPAP?
CPAP means Continuous Positive Airways Pressure. It is a machine that delivers air into your airways at a specific pressure set during a titration sleep study. It uses regular room air (although some people require additional oxygen) and it lets you breath yourself, it does not breathe for you like a ventilator would. The air is delivered through a mask, nasal interface or oral interface. For more information on masks visit the mask page.

The CPAP machine was invented by an Australian, Dr Colin Sullivan, in the late 1970s but didn't start becoming available for apnea sufferers until the mid 1980s. Sullivan started out using a vacuum cleaner in reverse to test his theory that positive airways pressure would reduce apnea events in sufferers. The first masks used had to be made specifically for each patient and were glued to their face each night.

Today, many great advances have been made to improve performance, patient comfort and general design. Today's CPAPs are quiet and small and there are many mask types available to suit each individual (none of them require glue!). There are now several types of CPAP available, more info on this page

Adjusting to CPAP can be difficult in the beginning for some, but most people after persevering for a while will find that they get so used to it that they can no longer sleep without it. There are many simple things that can be done to improve CPAP compliance, some of them are listed below.

CPAP Hints & Tips

• Basic CPAP Tips (submitted by Tal)
• Mask Recomendations
• CPAP Recomendations
• Humidifiers
• Suspending Your Hose
• Chin Straps
• Problems with abdominal bloating and / or wind
• OSA & Asthma or Allergy Problems
• Should I use Aromatherapy or Fragrant Oils in my CPAP?
  

Basic CPAP Tips (submitted by Tal)

The following is from an article posted to a specific few people who had been having trouble with CPAP and has not yet been adapted for this website.

If you are diagnosed with sleep apnea....let me say before anything else, it is VERY important that you get it treated, not only may you find a vast improvement in your energy levels, memory and cognition, you also won't be getting up during the night to pee and you will be saving your life. Untreated sleep apnea is now believed to be THE major cause of heart attack and stroke. The reason for this is that apnea means you stop breathing frequently when you sleep. When you stop breathing, it means your brain isn't getting oxygen and stress is placed on your heart.

For those of you who haven't tried CPAP yet, don't let the look or thought of the thing put you off, you really DO get used to sleeping with that stuff on - sometimes a lot quicker than you'd expect and before you'll know it, you'll do what I do and sometimes almost forget to take the thing off before you get out of bed! I've only been on CPAP since September, and I feel odd NOT wearing it to bed now.

Now.....as to wearing a CPAP mask, there are several things I want to mention. The first is, DON'T GIVE UP, it can take a little time to get used to it but there are several things that can help.

IF YOU'RE FEELING CLAUSTROPHOBIC or just generally uncomfortable sleeping with something on your face, sit with the mask on (not connected to the machine) for a while each day while you're doing some daily activity, like watching TV or reading a book, this gets you used to having something there and makes it easier then to sleep with it on.

GET THE RIGHT MASK. There are many different masks available, and new ones coming out all the time. The most common type is a nasal mask which fits over your nose kind of like oxygen masks in hospitals. Then there are nasal pillows, which I've heard heaps of great comments about. Instead of covering your entire nose, nasal pillows sit under your nostrils. The main benefit of this is that there is less in contact with your face. This can help those who are feeling claustrophobic and it can also mean more freedom to move around (more on moving around later). There are now a few oral devices available which actually deliver the air through your mouth, rather than your nose - this may be a good option for mouth breathers. The only report I have personally heard so far was in relation to the Fisher & Paykel Oracle mask. The user stated that it made him gag and was uncomfortable, but as with anything, different systems suit different people.

SPECIFIC MASKS
There are a few masks that seem to be highly recommended by users (not by companies or insurance or docs....but the people who use them - the people who know).

• ULTRA MIRAGE is one of the most common, people say it's comfortable and seals well.
  Ultra Mirage Mask
  

• FISHER & PAYKEL ACLAIM (I have this one myself) mask which is particularly good for a number of reasons. 1. I find it very comfortable
  2. it's a very quiet mask and doesn't cause air to blow all over you (or your partner) through the exhale port on the front of the mask (it has what's called a diffuser which prevents this) and
  3. it's very good if you move about a lot when you sleep. I noticed myself, and have since heard a number of other people say the same thing. I think it is because of the "Glider" which allows you to move without the mask unsealing from your face.
  See a picture of my own Fisher & Paykel Aclaim mask or visit the Fisher & Paykel website
  

• BREEZE NASAL PILLOWS. I've heard a lot of people prefer this to the other common nasal pillow setup which is the Adams Circuit. People almost always seem to need the LARGE size pillows.
  Breeze Nasal Pillows

FOR MOUTH BREATHERS,
If you naturally breathe through your mouth while you sleep you may find that the use of CPAP and a humidifier clears up your nasal passages. Unfortunately, for some this doesn't work and mouth breathing can still be a problem....air escaping through your mouth all night can be unpleasant to say the least. To prevent this problem there are a number of options.

You can use a nasal mask, or nasal pillows with a chin strap to keep your mouth closed......for some this is either not comfortable or not that successful but there's another option.. There are now a couple of full face masks available, they usually fit over both your nose and your mouth so that if you open your mouth to breathe you still get the required amount of pressure. There is also available a total face mask that actually covers your entire face....I don't like the sound of that personally but it's helped at least once person I've come across (quite rare to need one of those I'm sure).
Mirage Full Face Mask
Total Face Mask

YOU NEED A HEATED HUMIDIFIER
Another vitally important thing is to make sure you use a heated humidifier. Most people who have trouble with CPAP and give up on it (or at least want to) are having problems that can be easily overcome by using a heated humidifier (sometimes it's a challenge to get insurance to approve these but there are ways to get results from them). A heated humidifier prevents problems like dry nose in the morning and also nasal congestion. Air forced through your airways will dry you out very quickly, you'll be amazed at how much difference a heated humidifier can make! The main problem people come across with using a humidifier is what's known as "rainout" this means that water starts to collect in the mask and can be noisy and annoying and I guess you could even risk breathing a drop or two in... this occurs when the humidifier temperature is too high for the temperature of the room. You can get around this problem in a couple of ways, firstly, try reducing the heat on your humidifier. You should also try insulating your hose. This can be done with pre-made insulators (you can buy them at www.cpapman.com) or by wrapping it in some other material, bubble wrapping, fleecy fabric etc. Always use only distilled or demineralised water in your humidifier, never use tap or spring water.

Here is a link to a sample "letter of necessity" that may help to get your insurance company to approve your request for a heated humidifier.

MOVING AROUND WHILE YOU SLEEP. A lot of people have trouble with the hose pulling the mask off the face or have trouble with mask leaking when changing position during the night. A great way to help avoid this is to suspend your hose above your head. You can buy special "hose suspenders" from a guy known as CPAPman , but you can easily make your own. I basically have a hook in the wall above my head with a few elastic bands tied to it which are then tied to the hose, this means I can turn over - lie on either side or my back and the hose doesn't get in the way or pull the mask off my face. Very useful.

GETTING THE MASK TO SEAL . Another common problem people have when they start CPAP therapy is that the mask leaks causing noise and unpleasantness in general. There are two important things to know about preventing leaks.

1. Wash your face and the part of the mask (usually the silicon part) that touches your face every night before you go to bed, you can do this with warm water, or with warm water and a light detergent. Our skin is naturally full of oils and the oils can prevent the mask from sealing well.

2. Don't make the mask tight! This is a very common mistake people make, their mask leaks a bit so they make it tighter - but this usually doesn't work, in fact you often need to make the mask looser - especially if you are on a higher pressure. The reason for this is that the mask is designed kind of like a hovercraft (have you seen those?) the pressure of the air actually forms a cushion that holds the mask to your face. SO.......if you're getting leaks, loosen the mask right off.....and then just tighten it a little at a time, it should never be so tight that you get red marks on your face in the morning that stay there for any length of time.

I know I've covered a lot here, but probably haven't answered everything you want to know, or perhaps not addressed the specific problem you are having - but please, ask me anything else you need to know and I'll do everything I can to help out. If I don't have answers myself, I will ask at the sleep disorders newsgroup....which, by the way, is an excellent source of help for not only sleep apnea and CPAP but also other sleeping problems. If you have access to newsgroups through your email program, the newsgroup you want to find is alt.support.sleep-disorder

CPAPMAN - has info on lots of different masks, CPAP machines, humidifiers, hose suspenders and Joe (the guy who runs the place) is reported to be very friendlyand helpful. I've also heard that his prices are good. www.cpapman.com

User Sub mitted CPAP Recommendations
For info on specific CPAP types click here.
If you are currently using CPAP, please help by submitting information about the machine you use by visiting the xpap page. Feel free to also add information on other masks you've tried.

Studies have shown that humidifiers - particularly heated humidifiers - increase CPAP compliance. The reason for this is that humidifiers help to combat nasal dryness & congestion issues caused by the presurised air CPAP delivers. These studies also show that a humidifier can help prevent mouth breathing during CPAP treatment - for the same reasons.

There has been some debate within the newsgroup as to whether pressure & humidifier requirement are related. While it has been stated that any pressure above 12 requires a heated humidifier and anything below that doesn't - this is certainly no hard and fast rule. There have been several members of the group with pressure well below 12 who require and benefit from the use of heated humidification as well as members of the group with higher pressure who do not need a heated humidifier. The main issue to consider is: If you experience problems with nasal congestion or dryness during CPAP use, or if you begin mouth breathing because your nose becomes blocked, you need a heated humidifier.

Generally, it is thought that heated humidifiers are much more effective than passover (non-heated humidifiers). People who have a passover humidifier and still experience problems might find that wrapping the humidifier in a heating pad helps. Heated humidifiers are all pretty much the same with the exception of the new Fisher & Paykel machines which now have new technology that allow the machine to automatically adjust the tempreture in relation to the tempreture in the room, this feature is called ambient tracking.

Use Distilled Water
Manufacturer recommendations will always state that you should use distilled water in your humidifier. Not only will this prevent you from inhaling any nasty fumes your water supply might contain, it also reduces the likelyhood of mineral buildup on the base of your humidifier. Some members choose to use tap water and have stated no ill-effects to their health. Never user mineral water.

Cleaning
How often and how well you clean your heated humidifier is an issue of "differing opinions" on the newsgroup. Some say they basically never clean their humidifier (so long as distilled water is used) and some clean it every day. Most tend to be somewhere in between. If you notice any smell, discoloration or buildup in your humidifier, then you need to clean it right away. If you're not using distilled water, you need to clean it much more regularly. If the routine doesn't bother you, clean it every day it certainly won't do you any harm and you will be confident you are getting clean air while you sleep. Generally, rinsing out your humidifier chamber each day is sufficent, but on a regular basis you may wish to do a more thorough clean. Most people use a mixture of vinegar and water to clean. You may also wish to sterilize your humidifier (and mask) using a mild product like Milton - (used for sterilizing baby bottles).

Disposable humidifier chambers cannot be dismantled to clean. You can try using some dry rice along with some water and a little dishwashing detergent or vinegar - swirl around to remove any buildup or scum that has developed. Make sure you rinse well aftewards.

Rainout / Insulating the Hose
If the temperature of your room is cooler than the temperature you require for humidification you can experience a common problem called "rainout". This means that the water cools in the hose and forms water droplets. To avoid this problem there are several options.

1. Increase the temperature of your room
2. Use a hose insulator. You can buy commercially made ones or make your own. Simply sew some fleecy fabric into a long tube (make sure it's loose enough to take on and off easily, use velcro or elastic to keep the ends tight). For extra insulation you can add some quilt batting material.
3. Use a heated hose. These are now commercially available from the SleepZone (Australian Company that ships worldwide - if outside Australia you will need to provide your own power source.)

Suspending Your Hose
Suspending your hose has the benefit of allowing you to move about freely in your sleep without getting tangled up in your hose or having the weight of the hose pull the mask off your face causing leaks.

You can buy commercial products to suspend your hose however they tend to be expensive. They do have the benefit of being easily folded for travel, so if you are a frequent traveller you may find the cost worthwhile. There have also been a number of other suggestions from newsgroup members - some examples below:

• Ezzz Swing Arm - Quality of Life Inc. Made specifically for CPAP
• Plant Hanger - a variety of plant hangers may be suitable for use with your CPAP
• Garden Wall Mount Swivel Hanger - this hanger may be a little long but you may be able to find simliar items at your local garden/hardware supplier
• Ironing Board cord clamp - has a springy arm and can be mounted horizontally on your headboard. Good for travelling, clamp on a headboard or the back of a chair by the bed.
• Towel Holder Rod with swing arm
• Hook in wall with rubber bands attached

Chin Straps
Some mouth breathers will benefit from the use of a chinstrap. First you need to make sure tha the cause of opening your mouth isn't from nasal congestion as a direct result of CPAP use (see humidifiers).

Some newsgroup members have noted that a cheap sweatband will do the trick as well if not better than some of the commercially available chinstraps.

Some of the available chinstraps can be found here:

• CPAP Chinstraps - by Resmed, Respronics, Sunrise Medical, Tiara Medical, etc
• Split Ear Facial Band - not specifically designed for CPAP but apparently works well

Unfortunately, even chinstraps are not the solution for some CPAP users. Even with a good chinstrap, air can still escape from your lips. Some users have mentioned they tape their mouth shut with 3M Micropore or other medical paper tape - but please remember this may not be safe as it prevents the body's natural response to opening the mouth when nasal breathing is blocked. You MUST remember to fold over one end of the tape for quick removal. This method should be used with caution. Don't think of this as a long term option. Some users have expressed the ability to train themselves to keep their tongue pressed against the front of their teeth while sleeping which prevents them from mouth breathing. A chinstrap may still be of use in keeping your jaw shut to make this method more effective.

Failing the methods above, you may require a full face mask. A full face mask covers both your nose and your mouth, eliminating the problem of mouth breathing as the required air pressure will still be delivered, even if you do open your mouth.

OhMrsJohnson has submitted this idea for review by members of the group. It seems that putting pressure right under the bottom lip may help the problem of air escaping through the lips when the mouth is closed.

Chin/Lip strap submitted by Tal - a working model of this one has been made - test will be reported on shortly.

Unfortunately Tal wasn't able to test this personally as she has TMJ and the pressure of the chin strap on her jaw was causing problems.

Problems with abdominal bloating and / or wind (submitted by Kit)
Some people experience abdominal bloating and wind (gas) from CPAP. This is caused by swallowing air, called "aerophagia". Some people tend to over-breathe and swallow air while they are adjusting to the machine. It can also start after a change, such as an increase in pressure or a new mask. The good news is that this wears off over time as you become more familiar with CPAP.

If you are experiencing this, talk to your DME or clinic. Sometimes a decrease in pressure will solve the problem. The pressure can be increased once you have adjusted to the machine and are no longer having this problem.

Some other things you may like to try include:

• Using the ramp feature on your machine whenever you are awake on CPAP
  
• Sleeping with your upper body elevated during the adjustment period (e.g. using a bed wedge)
  
• Drinking Metamucil at night. Try this either before or after dinner to find the time that works best for you.
  
• Over-the-counter antacids, used at night.
  
• Try not to sleep on your back, or at least not to lie on your back waiting to fall asleep
  
• If you can find a chinstrap that works it may help.
  
• If you are not using a humidifier you may be swallowing a lot because your mouth is dry. Try either using a humidifier or turning your existing humidifier up.
  
• Keep a food diary to see if episodes can be linked to any particular kinds of food such as red wine or chocolate.
  
• Walking may help to relieve the wind when you wake up in the morning. (if you like yoga, try crow walking)

However if the problem continues for some time you may have an underlying medical condition that the CPAP is aggravating. For example, CPAP forces air into your airways. If your upper oesophageal sphincter is weak, it will allow air into your digestive system and cause problems. Other conditions that may be worsened by CPAP include irritable bowel syndrome and gastroesophageal reflux disease (GERD).

In these cases it is important to work with your medical team to find an appropriate solution. This may involve changing from a CPAP to an AutoPap. Medication and changes in diet may also be prescribed.

The important thing is to discuss the problem with your doctor or clinic - don't give up on your CPAP.

OSA & Asthma or Allergy Issues
If you suffer from Asthma or Allergies there are several things you should be aware of. There is a degree of overlap in symptoms when it comes to asthma and Sleep Apnea including congestion, mouth breathing, irritation of the airways etc. There are issues your sleep clinic will need to be aware of when titrating your CPAP pressure - the link below has more detailed information.

You may find that using superfine filters with you CPAP machine helps to increase your comfort level and reduce congestion resulting from the allergies. You should also trial a heated humidifier to see whether or not you will benefit from the humidified air.

• Asthma & OSA

I wouldn't do it. Not with high quality "true" aromatherapy oils or with perfume grade "false" scent oils. A good quality oil could quite effectively scour away at the plastic in the humidifier, and placing a drop on the sponge could very well eat away at the material..

In addition, aromatherapy isn't meant to be persistent for such a long period of time as an entire night of sleep. The aromatic oil, diluted or full-strength, is to be experienced for a shorter period of time during which the oil is evaporating. I'm concerned that the forceful introduction would overwhelm the healing properties.

If you're talking about real aromatherapy,not perfume oils, some can cause epileptic seizures at remarkably unexpected times. Rosemary, considered by some a "safe" oil has triggered undiagnosed epilepsy. Lavender, supposedly the most safe calming oil known, has caused headaches (esp. in men) when they've been exposed for a longer period of time. Some people are allergic to chamomile, a well-known sleep remedy. There are a whole bunch of people drinking chamomile tea before bed not knowing they are mildly allergic and then wondering why they're not sleeping well.

The last thing to consider is that the scent receptors just shut down after a while. They develop a tolerance, as it were, and one can't smell any more. That why perfumed candle stores and perfumeries offer a whiff of coffee beans to re-ignite the connection.

What I would suggest is doing the aromatherapy while you're setting up the machine for sleep. Take a drop of a calming oil on a cotton pad and set it nearby while you're preparing for bed. 5 minutes is all you need for the true therapy to work.