Tracy R. Nasca
From my patient perspective, heated humidification with cpap therapy is under prescribed and under appreciated by patient and physician alike. Not only do I believe in humidification, I believe it should be used 365 days a year and not just thought of as a seasonal solution. Benefits of heated humidification might be misunderstood.
With CPAP failure rates still alarmingly high at 50-60%, patients should be provided all of the tools they need to ensure successful compliance. Heated humidification not only makes CPAP therapy more pleasant, it also resolves many compliance issues.
For nearly 20 years, I have considered myself a successfully treated apnea patient. That means I use BiLevel every night without fail. That treatment provides me with the oxygen and healthy sleep I need to live a fully energized life. It does not mean my therapy is perfect nor do I lack challenges. One of those challenges is nasal dryness. The nasal lining is highly vascular and the continuous night time application of PAP air flow can wreak havoc. Humidification is essential. Even if one uses a CPAP humidifier, the water chamber only holds so much and when it depletes of water during the night, nasal lining dryness can occur quickly and I can attest to the painful result. Over the years, I have rarely had a night when the water chamber did not run dry before my alarm clock sounded.
With my IPAP (inhalation positive airway pressure) at 20, heated humidification is a necessity, not a luxury. The higher the CPAP pressure, the more water is used and so the water chamber capacity should be large enough to provide humidification for the entire night's sleep no matter what one's pressure setting is. I am awed by the duel performance of my ResMed VPAP Auto with the new H4i™ humidifier. With the chambers increased water capacity along with its larger heater plate, for the first time in my sleep apnea life, I now have a truly remarkable sleep experience. I no longer worry about the water chamber depleting. I no longer awaken with a burning sensation in my nostrils.
Manufacturers like ResMed are committed not only to providing the highest quality CPAP products, but they are committed to patient education which includes a focus on the necessity of heated humidification. Significant improvements have been made over the years as manufacturers have brought exciting new CPAP equipment to the market. Long gone are the days of enormous, heavy, loud flow generators and stand alone humidifiers. Today's sleep apnea patients are indeed fortunate and I am grateful that the importance of heated humidification is becoming a recognized priority.
The body has its own natural humidification system but CPAP therapy can place it on overload and may not be able to sustain the increased demand. When we experience an apnea episode, stop breathing and oxygen levels drop, our brain sounds an alarm causing us to snore, snort, or otherwise gasp for breath. When our body experiences nasal or oral dryness, the natural humidification system steps in to produce the needed moisture. This is why some patients find that CPAP use causes nasal congestion or even a runny nose and many complain of excess mucus in the nose or mouth. These patients will find resolution with heated humidification.
When we fire up our furnace during winter months, it causes dryness throughout the house. Our bodies feel the effects of that dryness. We pay special attention to dry skin and chapped lips during the winter months and many people use room humidifiers to compensate. Living in Minnesota, where winter typically lasts 6 months, even my wood furniture suffers visible effects of dryness. As I take special care to apply furniture oil to keep it properly hydrated, I also apply moisturizers to my hands and face on a daily basis to fend off dry and cracked skin. It makes me wonder what my nasal lining and airway must be dealing with.
Should we consider the need for CPAP humidification the same way we consider humidifying our homes? During winter, we clearly understand the concept of cold and dryness therefore the need for a room humidifier. Is this same logic used by patients and physicians who think CPAP humidification is strictly a seasonal solution? Ambient temperature is the answer. Any sleep expert will tell you that the optimum sleeping environment should be cool temperature. For simplicity sake, think of CPAP as a fan in a box. The delivery system takes the air from your room in through the unit and delivers it directly to your airway via your mask. Depending on what part of the country you live in, and what temperature you keep your heat or air conditioning set on during any given month, will determine the comfort level of your CPAP experience. So when I lived in humid Florida, and ran my air conditioning nearly every month, my home was always cool. BiLevel delivered a blast of that cool air directly in to my nostrils all night long. I required humidification to warm that air. While living in Florida, I thought of the climate as being hot and humid or cool and humid; a two season state.
Granted, it might be easy to understand why a patient such as me, on high pressure settings would benefit from the use of nightly humidification. Patients on lower settings benefit as well. Living in Florida when I was first diagnosed, my prescribed CPAP pressure was 7. Within months, it increased to 10 and eventually over the years to 20. Painful nasal dryness was an issue for me even at those lower pressures. I was not provided with a CPAP humidifier with first issue of equipment but when compliance issues became known, humidification was prescribed and that addition resolved many compliance problems for me. From Florida, I relocated to the Memphis, Tennessee area where there are four distinct seasons. Even there I recognized the need to use CPAP humidification year round.
At diagnosis, most patients are good about following the guidelines for equipment care: change filters often, rinse mask daily, wash mask a few times each week, only use distilled water, empty humidification chamber of any unused water daily, thoroughly clean and disinfect water chamber a few times weekly. Then we get lax, we fall off the wagon. We may even skip a night or two using the humidifier because we forget or don't want to fool with it. I can relate. I quickly surmised that despite the inconvenience of having to fill a water chamber every night, I simply could not have a reasonable and comfortable night's sleep without it. I made it part of my required routine and never looked back.
I write this article to share my experiences and to further the patient education process. We learn by trial and error and the nearly 20 years of sleep apnea treatment has been an eye opening journey. My “successful compliance” status is not something I take for granted. I came by it honestly. I honestly started with a bad attitude; a “poor me, why me” resentfulness of my diagnosis and treatment plan. I then tried a little harder and failed. Faced with a probable early death, I found myself at a crossroad and knew I had two choices. I chose life.
Over the long years, challenges presented, were dealt with and eventually overcome. Had I not been exposed to nor used heated humidification, I am certain I would have been one of those patients who gave up. It was not always easy, I still have my struggles and I don't expect perfection. When I share my story with other patients, the important take home message is “don't expect perfection” but do everything in your power to understand your sleep apnea condition and surround yourself with all of the available tools you need to achieve a level of successful compliance. Treatment provides you with the oxygen and healthy sleep you need to live a fully energized life. CPAP success does not mean perfection, it means life. Life is good!