CPAP: Getting Started & Troubleshooting Guide - Questions to Ask your Healthcare Team

Tracy R. Nasca, February 14, 2011

Destiny; are you destined to succeed or fail on CPAP?  Destiny is not a chance, it’s a choice and you are in control.  Each decision you make is a choice that shapes your destiny.  How do you know if you made the right choice?  You must be well informed and understand your options before you make your decision.  Ask questions, you have a voice, use it!

Do you want to be in control of your life?  Of course you do.  As a sleep apnea patient, do you want to be in control of your sleep health and CPAP therapy?  Of course you do!  No one cares more about your life and health than you.  Why would you let someone else choose your mask, machine or humidifier?

When you are sleep deprived, you can easily fall in to the trap of letting others make decisions for you by simply receiving the equipment they give to you.  CPAP adjustment is very challenging; so is choosing the right tools for your therapy.  YOU must take responsibility to choose what works best for you.  Destiny is not a chance, so don’t take chances!  Make educated choices!

Do your own research before blindly accepting what is given.

As you begin CPAP therapy, it helps to have a positive attitude.  Is it easy for you to accept change, can you adapt?  Don’t feel overwhelmed at the thought of having to learn about the prescribed equipment for your sleep apnea therapy.  It’s really quite simple, as easy as ABC … 1-2-3.

AutoCPAP – auto titrating continuous positive airway pressure
Bilevel – bi level meaning 2 distinct pressures set, one for inhalation, one for exhalation
CPAP – continuous positive airway pressure, the most common flow generator prescribed

1. Flow generator – AutoCPAP, Bilevel or CPAP
2. Interface – mask choices are comprised of nasal mask ( over nose only), nasal pillow mask ( soft pillows that slip gently in to the nostrils) or full face masks for mouth breathers ( covers nose and mouth
3. Humidification – a separate and optional tool that I believe should be considered a necessity, not a luxury.  This is a key element to using CPAP successfully.

BEFORE you accept your equipment, use your voice and ask questions about the prescribed equipment.  The following questions are offered as a guideline as you begin your education process.

Ease of use should be a number one consideration when choosing your cpap machine, mask and humidifier.  Sleep is an activity that most of us take for granted until we get too much or not enough!  If sleep apnea is a complication; peaceful, restorative sleep is our goal.  We don’t need complicated equipment to add anxiety or negate our goal of quality sleep.

So far, all you know is of your experience in the sleep lab.  You may have felt overwhelmed by wearing a mask; and anxiety ridden as you tried to sleep with the constant flow of air being delivered to you.  You may have felt that your sleep was disrupted due to the mask discomfort or  machine delivered air pressure, so how is this new therapy going to result in that goal of peaceful, restorative sleep?

Getting Started:  Troubleshooting Guide and Questions to Ask your Healthcare Team

Your healthcare team is comprised of your sleep doctor, your CPAP equipment provider and of course YOU are the most important part of this team.  It’s up to you to report your successes as well as your challenges regarding your prescribed CPAP therapy.  You are not alone; your healthcare team is there for you.  The best way to learn is by asking questions.  To get you started, I offer the following suggestions:

Questions about Flow Generators

Ask your healthcare team what the difference is between AutoCPAP, CPAP or Bilevel and why you were prescribed a particular choice.  Ask if the prescribed machine does not work, will you be able to try one of the other choices.

I am frightened by having to use a medical device and it is causing or adding to my anxiety!

You have choices and some CPAP devices appear less intimidating. Ask to see the units so you can determine which fits best in to your lifestyle and bedroom environment!  In fact, one manufacturer, Fisher & Paykel has taken this in to consideration and integrated a clock in their Icon CPAP’s making them less medical looking more like it belongs on anyone’s nightstand.

Too much air pressure, what can I do? 
Ramp is a patient controlled comfort feature.  Ask how it works, and learn how to use it.  Often this feature must be enabled by your healthcare team, is yours enabled?

Questions about Humidifiers

Why have I been prescribed humidification and what are the key factors of using humidification? 

If you were able to sleep with your mouth closed before your osa diagnosis and cpap, you should be able to continue to sleep with mouth closed. Improper humidification can lead to mouth breathing  

How do I know if I am a mouth breather? 

Chances are, your bed partner knows if you are a mouth breather, because they can hear the snoring or noises made when the air is escaping from your mouth.  Waking with a dry mouth is an indicator that you are a mouth breather.  Report this to your healthcare team to resolve.

I am experiencing painful nasal dryness, what can I do?

Proper use of humidification should resolve runny nose, bloody nose of stuffed up nose.

Why am I waking up during the middle of the night?

If you are able to fall asleep easily, but find that you are waking up during the night, one cause may be transitioning as you change your sleeping position during the night.  This might cause an awakening; consciously or unconsciously raising your level of sleep to a lighter stage.  You may be more sensitive to the delivered air pressure and this may be when you want to pull off the mask.   You should be aware of a device on the market that can respond to these waking moments and allow you to easily fall back to sleep.   The feature is called SensAwake click here to learn more.   Other manufacturers offer expiratory pressure relief, ask your home healthcare team about this feature.

Questions about Interfaces

A prescription is required for nasal masks, nasal pillow masks and full face masks.  Ask your physician to provide you with a physical prescription that you can keep in your wallet when you travel.  If you are on the road and break your mask, you will need a prescription to purchase another if you are in a different city, state or country!
Preferably, the prescription should not be brand specific and should not have an expiration date.  This will allow you to choose a mask of your choice when and where the need arises.

My mask is uncomfortable and sometimes leaks, what can I do?

If you have addressed all issues such as mask size, fit and adjustment features of your mask and still have problems, know there are programs like SureFit™ such as offered by Fisher & Paykel Healthcare.  Most equipment providers offer a 30 day mask exchange program that allows the patient to try a mask at home and if it does not work, it can be exchanged for another of the same brand/manufacturer.   Ask your healthcare team about 30 day mask exchange programs.

The mask I wore in the sleep lab was fitted for me, but hurts my face at home, why is that?

What happens in sleep lab titration and mask choice – may not be the same for you at home.  The sleep lab only has a short time to titrate or determine the optimal machine pressure to eliminate your sleep apnea events.  Therefore, some sleep labs may size down to assure less chance of mask leak.  Since you were not accustomed to wearing any mask on your face, you may not have realized that the mask you wore felt tight.  So when you visit with your healthcare team, don’t assume the mask you used in the sleep lab is the best choice for you face!  Try on as many masks as you can to determine which one feels comfortable.  Consider choosing masks that are packaged with all 3 cushion sizes which makes fit assurance easier for you.

In summary, my take home message for you is:  be a prepared patient; learn all you can about your sleep apnea condition and the equipment available to you.  Be proactive; don’t sit back and wait for others to help you when challenges arise.  Use your voice, ask questions, and take responsibility to choose what works best for you.  Destiny is not a chance, so don’t take chances!  Make educated choices!