Posted by Frank Howard, content courtesy of Frank Barnhill, M.D.
Continuous positive airway pressure (CPAP) has been used for years to help keep premature baby’s lungs inflated long enough to clear mucous and other fluids and improve blood oxygen levels. A constant amount of air pressure is provided by a pump in such a manner as to barely open collapsed lung air sacs making the work of breathing much easier. As the baby exhales, that air escapes through a vent on the CPAP mask to allow for loss of carbon dioxide and oxygen exchange.
CPAP works much the same way in adults. Since sleep apnea affects men more than women, most wives are grateful for a good night’s sleep, finally after all these years. So, It’s not always used to help remove fluid or mucus, but often helps make the work of breathing easier and provides a constant pressure to prevent or treat sleep apnea.
Sleep apnea is a condition in which a person literally stops breathing for 10 to 30 seconds several times an hour, resulting in low blood oxygen levels, daytime sleepiness and fatigue. It is often accompanied by very loud snoring and the affected person may awake with “air starvation” several times in a night. A lot of wives do refer to freight trains, chainsaws, and grizzly bears when describing their husbands sleep problem.
Sleep apnea can cause high blood pressure and damage to the heart, as well as dispose one to frequent accidents from sudden sleepiness. It can be a major cause of poor attention span in kids and adults, responsible for poor work and classroom performance, and disrupt marriages and family life. For more information please see our article "Snoring, chainsaws and sleep apnea".
CPAP is the treatment most persons with sleep apnea choose, since no surgery is involved. The unit consists of a vented plastic mask or nasal prongs attached by semi- flexible plastic tubing to a filtered air pump set at a pressure level determined by a sleep study. The mask either covers just the nose, or both nose and mouth, or nasal prongs are inserted just into the nose. The mask or prongs are worn at night or any time one goes to sleep. Most persons find discomfort in the fact that the mask must fit firmly and it’s difficult to lay on your stomach with either in place. Some persons can’t tolerate the feeling of claustrophobia they get when the mask is intact. I've had patients jerk the mask off in the middle of the night feeling smothered.
Since CPAP therapy is so important, let’s review these problems and look at a few solutions and tips on using CPAP.
Probably 60% of persons starting CPAP therapy have difficulty sleeping for the first four to five days. About 15% of these will continue having difficulty after ten days. For these patients, most doctors prescribe a mild sleeping pill for a few days or up to two weeks. This seems to decrease what I have termed “mask claustrophobia and anxiety” or the feeling of suffocation caused by the CPAP mask. Probably 90% of CPAP users adjust to the presence of the mask by the third week and most can go right to sleep. These patients often say it is often the best sleep they've had in years. They feel energetic the next day and have less daytime sleepiness.
If you have been using CPAP and notice a sudden unexplained decrease in your energy level, have started snoring again or experience “air hunger”, then your mask is not fitted properly, or the CPAP pressure is not set properly. You should contact your doctor or the technician who supplied the equipment. When choosing a supplier, you want someone who is knowledgeable and fits ten to twelve masks a week, not one or two a month.
Another common problem with CPAP is excessive drying of the nasal passages resulting in nighttime stuffiness or nosebleeds. This can be corrected by placing a cool mist humidifier in the line tubing ($50), at the bedside ($30) or using a two dollar treatment. For two or three dollars you can buy saline nasal gel at your local pharmacy and use a cotton tip swab to “paint” the inside of your nostrils with gel before applying your mask. The saline gel will slowly convert to salt water and moisturize your airway most of the night.
If you frequently awaken with a dry eye, red eye or a painful eye, your CPAP mask is leaking. The face seal may be damaged or fit poorly. I've cured many cases of pink eye by refitting a CPAP mask. Once again, discuss it with your supplier or doctor.
A common complaint is “Doc, I can't sleep on my back all the time!” “I just have to sleep on my stomach and when I roll over the stupid mask comes off.” This is a more difficult problem to solve, but not impossible. Special over the back of the head plastic tubing is available that doesn't cause a problem when lying on one cheek. This lets a person sleep on their stomach with the head turned to one side. Most CPAP users tend to sleep on their right or left side with their cheek at the edge of a very firm pillow. That allows the tubing to trail off to that side.
Another complaint is “Doc, sometimes I wake up in the middle of the night and my lungs feel so cold that my throats on fire.” The CPAP machine sucking in and delivering very cold air usually causes this problem. I advise these patients to place the machine on a nightstand at the same height as the top mattress. Air drawn from the floor under the bed tends to be much cooler. In addition, I find a lot of patients place as much of the delivery tubing as possible under the covers with them. This tends to preheat the air a little and lessen “freezer burn”.
If your mask is often pulled off or to the side when you roll over in bed, ask your supplier for a ten to twelve foot delivery tube. The extra length will give you room to roll and lessen the possibility you will experience frequent awakening.
Hopefully, these tips will help you while using CPAP in treating your sleep apnea. Keep in mind that overweight persons can significantly improve sleep apnea symptoms by losing 30 to 45 pounds. We'll discuss other treatments, such as surgery, in “Sleep Apnea Quick Fixes”. Here’s to a good night’s sleep!
If you have any tips on using CPAP, please share them.
Dr. Frank
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