Living with positive airway pressure treatment

Transcription

1 Living with positive airway pressure treatment ResMed Corp San Diego, CA, USA or (toll free). ResMed Ltd Bella Vista, NSW, Australia +61 (2) or (toll free). See com for other ResMed locations worldwide. H5i, S8, S8 AutoSet, S8 Elite, S9 AutoSet, S9 Elite, VPAP Adapt SV and VPAP Auto are trademarks of ResMed Ltd. AutoSet, EPR, Mirage, Mirage Quattro, S9, Swift and VPAP are trademarks of ResMed Ltd and are registered in the U.S. Patent and Trademark Office ResMed Ltd. Specifications may change without notice /

2 Treating sleep apnea can help you feel better and have more energy. In this booklet, you will find the information you need to get the most benefit from your sleep apnea treatment. 1 Young et al. Epidemiology of Obstructive Sleep Apnea. Am J Resp Crit Care Med Teran-Santos et al. The association between sleep apnea and the risk of traffic accidents. New Engl J Med Einhorn et al. Prevalence of sleep apnea in a population of adults with Type 2 Diabetes Mellitus. Endocr Pract Becker et al. Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation Babu et al. Type 2 diabetes, glycemic control, and continuous positive airway pressure in obstructive sleep apnea. Arch Intern Med Sjostrom et al. Prevalence of sleep apnoea and snoring in hypertensive men: a population based study. Thorax Logan et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. (JNC 7) Javaheri et al. Sleep apnea in 81 ambulatory male patients with stable heart failure: Types and their prevalences, consequences, and presentations. Circulation Wolk et al. Sleep-disordered breathing and cardiovascular disease. Circulation Buchner et al. Continuous positive airway pressure treatment of mild to moderate obstructive sleep apnea reduces cardiovascular risk. Am J Respir Crit Care Med Yaggi et al. Obstructive sleep apnea as a risk factor for stroke and death. New Engl J Med O Keeffe & Patterson. Evidence supporting routine polysomnography before bariatric surgery. Obes Surg 2004

3 Contents Getting started on the road to healthy sleep 2 What is sleep apnea? 3 What happens in sleep apnea? 4 What are the effects of sleep apnea? 5 What causes sleep apnea? 5 How common is sleep apnea? 6 How can you tell if someone has sleep apnea? 7 Is sleep apnea life-threatening? 8 How is sleep apnea treated? 10 What will I need for CPAP treatment? 11 What kind of device do I need? 12 What kind of mask do I need? 14 Complete solutions to fit your individual needs 15 How will treatment affect my life? 16 Frequently asked questions 17 Caring for your ResMed device 22 Important notes about treatment 24 Contact ResMed 24 1

4 Getting started on the road to healthy sleep If you have been diagnosed with sleep apnea and are about to begin treatment, congratulations. You have taken the first step on the road to improving your health and getting a better night s sleep. The purpose of this booklet is to help you understand sleep apnea and continues positive airway pressure (CPAP) therapy so you can get the most benefit from your treatment. As a new CPAP user, you may be wondering what to expect from treatment. In this booklet we will give you an overview of sleep apnea and answer many frequently asked questions about CPAP treatment. What is sleep apnea? Sleep apnea is a common sleep disorder that affects approximately 1 in 5 people. The most common form of sleep apnea is obstructive sleep apnea (OSA). The term apnea literally means without breath. Sleep apnea can include both apneas (stops in breathing) and hypopneas (shallow breathing). Apnea Hypopnea A stop in breathing of 10 seconds or more A 50% decrease in breathing of 10 seconds or more (shallow breathing) You can also visit our patient website, for more information about living with CPAP, therapy tips and detailed information about ResMed products. If you have any further questions, contact your doctor or home care equipment supplier. They will be able to help and also put you in touch with sleep apnea support groups. 2 3

5 What happens in sleep apnea? During sleep, the tissues in the back of the throat relax, falling against the back of the throat and blocking the airway. With sleep apnea, the airway becomes partially or completely obstructed, causing hypopneas and apneas. What are the effects of sleep apnea? The cycle of suffocating and waking up leads to lower oxygen levels in the body and higher levels of carbon dioxide, creating a toxic environment. As a result, heart rate and blood pressure increase, and there is a significant strain on the heart. Eventually, the body s automatic wake-up system is weakened, resulting in increasingly more severe apneas and hypopneas. Normal open airway Partially closed airway The constant brief awakenings that people experience during sleep apnea reduce their quality of sleep, resulting in sleep deprivation and a variety of symptoms. What causes sleep apnea? There are many factors that can cause sleep apnea. For some people, the unique anatomy of their nose, throat and neck predispose them to developing sleep apnea. Increasing age, obesity and various nose or throat problems may also increase the likelihood of developing sleep apnea. In addition alcohol consumption and sleeping tablets relax the airway muscles, potentially inducing or exaggerating snoring and sleep apnea. Closed airway After a few seconds, the sleeper starts to suffocate. A control center in the brain triggers the sleeper to wake up enough to gasp and resume breathing, until they fall back asleep and the cycle starts again. This can happen several hundred times per night, although the person doesn t usually remember waking up. 4 5

6 How common is sleep apnea? It is estimated that about 20 percent of the population suffer from sleep apnea, a figure similar to that of asthma or diabetes. 1 Although it is generally believed that sleep apnea is more common in men over the age of 40, increasing evidence has shown sleep apnea to be widespread in men and women of any age, even including babies and children. Sleep apnea often goes hand in hand with other significant health conditions, including high blood pressure, diabetes, heart disease and obesity. How can you tell if someone has sleep apnea? People with sleep apnea usually find out because a spouse or loved one noticed they snored or stopped breathing during sleep. Some people with sleep apnea do not snore and it is usually other symptoms, such as excessive daytime sleepiness, that indicate someone is suffering from sleep apnea. However, they might also have other symptoms that cause them to worry about their health. Common symptoms of sleep apnea: Excessive daytime sleepiness Loud, disruptive snoring Stopping breathing during sleep Poor concentration Forgetfulness Morning headaches Sexual dysfunction Depression Frequent urination Night sweats Weight problems High blood pressure 6 7

7 Is sleep apnea life-threatening? Sleep apnea has been linked to a number of serious life-threatening conditions including high blood pressure, diabetes, obesity, heart disease and stroke. In addition, drivers with sleep apnea are six times more likely to have a traffic accident. 2 Diabetes Approximately 48% of diabetes sufferers have sleep apnea. Treating sleep apnea can help you control your glucose, reduce your blood pressure and improve your overall health. 3-5 High blood pressure Approximately 37% of all people with high blood pressure have sleep apnea. 6 That number increases to 83% for people taking four or more medications for their blood pressure. 7 Studies have shown that untreated sleep apnea can actually cause high blood pressure. 8 If you have high blood pressure and sleep apnea, CPAP treatment can help you prevent high blood pressure or reduce your levels significantly. 4 People with untreated sleep apnea have more than twice the risk of heart failure than people who don t have it. 9 Untreated sleep apnea also has a negative impact on heart function in general. It can lead to high blood pressure, irregular heartbeat and stroke. 10 All of these risk factors can be improved in patients who receive therapy for their sleep apnea. 11 Stroke Sleep apnea may increase a person s risk of stroke. 12 It is also worth mentioning that almost 70% of those who have had a stroke also have sleep apnea. Stroke patients with sleep apnea are at a major disadvantage during recovery from stroke. Recovering from a stroke takes incredible energy and motivation, but the sleepiness and fatigue caused by sleep apnea can make it difficult for a person to follow rehabilitation programs, resulting in poor recovery. In fact, stroke patients with OSA have higher post-stroke mortality rates than others do. 12 Obesity Sleep apnea affects up to 77% of bariatric surgery patients. 13 Overweight people with sleep apnea should be particularly concerned because sleep apnea makes weight loss more difficult. The sleepiness caused by sleep apnea may cause people to overeat, sleep more and exercise less. Some people, as a matter of habit, will eat to wake up when they feel drowsy during the day. That, in turn, causes them to gain more weight, which makes sleep apnea even worse. Getting treated for sleep apnea can help obese people gain the energy to exercise more and lose weight. And weight loss has been shown to improve sleep apnea for some obese patients. Other symptoms of sleep apnea may include morning headaches, depression, memory lapses and sexual dysfunction. CPAP treatment has been shown to reduce these symptoms and improve overall quality of life in sleep apnea sufferers. 8 9

8 How is sleep apnea treated? Sometimes losing weight or reducing alcohol intake can help reduce the severity of mild sleep apnea. Some surgical and dental procedures can also be used to treat mild sleep apnea, though such procedures have a high risk of complications and a low success rate. The most simple, effective and well-recognized treatment is CPAP therapy. What will I need for CPAP treatment? You will need a CPAP device, a mask system and air tubing to connect the device to the mask. Mask systems include the mask cushion that you wear over your nose or nose and mouth, a mask frame and headgear. Humidifiers that add moisture to the air before you breathe can also improve the comfort of your therapy. CPAP therapy involves wearing a mask, which is connected by tubing to an electric motor device that delivers air at positive pressure. This air pressure acts as an air splint to keep the upper airway open and prevent apneas

9 What kind of device do I need? Your sleep center will usually recommend the type of device that suits you. There are three different forms of air delivery: CPAP (Continuous positive airway pressure) CPAP devices, including ResMed s S9 Elite and S8 Elite II, deliver air at a constant pressure. The pressure you receive is determined by your sleep doctor. During your sleep study, the sleep doctor will determine what pressure is required to keep your airway open and prevent apneas and hypopneas while you are sleeping. CPAP pressure requirements can vary from person to person. Pressure requirements can also vary for one person throughout the night. S8 Elite II APAP (Automatic positive airway pressure) For people whose pressure needs vary throughout the night due to medications, seasonal allergies, changing sleep position or other reasons, APAP may help them to feel more comfortable. APAP devices, including ResMed s S9 AutoSet and S8 AutoSet II, continually adjust pressure breath by breath to give you the lowest, most comfortable pressure necessary to keep the airway open and prevent apneas. VPAP Adapt SV Bilevel Bilevel devices deliver two set pressures: a higher level for when you breathe in and a lower level for when you breathe out. Devices like ResMed s VPAP Auto 25 and VPAP Adapt SV include unique algorithms to detect what pressure is needed to normalize your breathing and maintain a comfortable breathing pattern. This type of treatment is ideal for people who require ventilatory support, such as COPD sufferers, people who need very high pressure levels, or people who find it difficult to breathe out against one fixed pressure. For more information about ResMed s full line of high quality treatment devices, visit 12 S9 AutoSet 13

10 What kind of mask do I need? Using the right mask is essential to the success of your treatment. You need a mask that is comfortable and fits properly. It should form a good seal on your face so that air doesn t leak out, as mask leak can be uncomfortable and make your therapy less effective. ResMed is world-renowned for mask systems that are comfortable and effective. All systems are easy to fit and care for and come fully assembled with the cushion, mask frame and headgear. For more information about ResMed s masks, visit Complete solutions to fit your individual needs Some people sleep with their mouth closed when using therapy; others may find that air escapes from their mouth, resulting in mouth leak. Mouth leak is a problem that can make your treatment uncomfortable and less effective. There are a number of options to help this situation: Nasal pillows rest gently at the edge of the nostrils and offer a clear field of vision in a very lightweight design. Swift FX Nasal Pillows A nasal mask covers only your nose. Nasal masks are the most popular type of mask. Mirage SoftGel Nasal Mask For people who breathe through their mouth, a full face mask covers both the nose and mouth to prevent air leaks. Mirage Quattro Full Face Mask 14 15

11 Some ResMed devices automatically compensate for leak so that your treatment remains effective. They can also record mouth leak levels throughout the night to pinpoint when mouth leak is a problem. A humidifier can help relieve symptoms of nasal dryness. It can also help to moisten your airway so that you keep your mouth closed while you sleep. This helps to keep mild leaks under control. How will treatment affect my life? S9 Series S9 with H5i Humidifier CPAP treatment should not interfere with your lifestyle. ResMed devices are fully portable so you can take them with you when you travel. They also run on virtually any power supply in the world with a suitable inverter or adapter. Most airlines have approved the use of ResMed devices on a long-haul aircraft; you may need to take a letter from your doctor or sleep clinic confirming that you need therapy. It is advisable to check with your airline before travel. For complete information on traveling with CPAP, and to download documents to assist in air travel and battery usage, visit Frequently asked questions How long will it take to get used to CPAP? Most people adjust to CPAP in one to two weeks. Occasionally it may take a little longer if, for example, you are very sensitive to the feel of the mask on your face. However, it is important to continue using your treatment even if it seems awkward at first. How soon after I start using treatment will it be before I notice an improvement? You should notice an immediate improvement when you start treatment, though some people may take a little longer. How often will I need to use my treatment? You will need to use your treatment every night of the week while you sleep. If you do not, you will return to your previous level of snoring, sleep apnea and daytime tiredness. Will the pressure on my device ever need adjustment? If you are using CPAP or bilevel (VPAP) therapy, the pressure will remain set at levels that suit your requirements. Sometimes, however, there is a need for fine-tuning or adjustment to pressure levels (for example, if you lose or gain weight). If you find your pressure difficult to tolerate, it may be lowered slightly for a short time at the beginning of therapy at the discretion of your doctor or sleep physician

12 If you are using APAP (AutoSet) therapy, the device will automatically adjust the pressure levels to suit your continuously changing needs. This type of treatment is particularly recommended if your weight fluctuates, or if you regularly consume alcohol or sleeping tablets. Will my blood pressure improve after I start treatment? Yes it may, but please do not alter your medication without consulting a doctor. Your doctor should review your blood pressure regularly even if your medication does not change initially. Is it easier to lose weight when using treatment? You may find that your energy levels increase and you may feel more motivated to take part in many activities that your previous sleepiness has prevented you from doing. However, permanent weight loss requires long-term lifestyle changes to diet and exercise. I ve just started treatment and it s irritating my nose. The cool, dry air of treatment can cause a runny nose and sneezing in some people, but it usually clears up within a few days to a week. If it continues, you should consider using a heated humidifier, which will help by adding warmth and moisture to the air. Consult your home care provider about what your options may be. ResMed offers a range of high performance humidifiers to reduce nasal symptoms for maximum comfort. Can I use my treatment if I have a cold? If you experience an infection of the upper respiratory tract, middle ear or sinus, you should consult your physician before continuing treatment. You may be advised to discontinue until the infection has cleared. If you continue with treatment during an infection, it is advisable to wash your mask and tubing more often. A full face mask may be a good alternative at this time as it covers both your nose and mouth so you continue to receive effective therapy. Do I need to take my device to the hospital with me if I need hospitalization for any reason? Yes. Your recovery may take longer if you stop your treatment and you may experience a return of your sleep apnea symptoms. If you are having surgery, it is very important that you tell both the surgeon and the anesthesiologist that you are being treated. You should also inform the physician treating you for sleep apnea that you are going to the hospital. Will I ever be able to stop treatment? Will I ever be cured of my snoring and sleep apnea? Sleep apnea is a long-term condition for which there is presently no known cure. The good news, however, is that CPAP therapy will effectively control your sleep apnea as long as you use it regularly

13 Why do I feel that it is difficult to exhale out when using CPAP? When first using CPAP, some people may feel a need to push against the airflow when they exhale. It may take a little time to get used to exhaling against the pressure. Practice sessions in the daytime while relaxing or listening to music may help overcome this feeling. However, breathing out against the flow of air will happen automatically when you are asleep. For people who have more difficulty getting used to breathing out against the air pressure, some of ResMed s CPAP devices have options such as the Ramp feature. This feature allows you to fall asleep at a lower pressure while your device ramps up to your full treatment pressure over a period of time. You may also benefit from expiratory pressure relief (EPR ), which lowers pressure on exhalation so breathing feels more natural. Alternatively, you could consider using an APAP device or a bilevel device such as ResMed s AutoSet or VPAP. I m going overseas can I use my device in other countries? ResMed devices have a switch mode power supply, which means they will operate on the various power supplies in different parts of the world. They accept V, Hz without any special adjustment. * Please note that you will still need to use the correct adapter for the type of power outlet in the country you are visiting. With the use of a suitable inverter unit, your device can operate from a battery supply (eg, in a truck, recreational vehicle or boat). The inverter should be capable of supplying mains voltage in the V range and should be of sufficient capacity. Your ResMed distributor can assist in your choice of a suitable inverter for your device. Note: A rated capacity of up to 200 W may be necessary with some brands of inverters to ensure satisfactory operation. For more information about traveling with CPAP and battery usage, visit *C-Series Tango humidifiers function only at 110 V

14 Caring for your ResMed device To increase the life of your machine, air filters should be changed every four to six months, depending on how much dust there is in the environment. A blocked air filter may reduce your pressure. We recommend you check your filter every month for holes or dust buildup. Before going to sleep, wash your face to remove excess facial oils prior to fitting the mask. This will help prevent oil from getting onto the mask and cushion. We also recommend that you do not apply moisturizers near areas where the mask will touch your face. This will help prevent oil buildup on your mask. Facial oils eventually cause mask materials to deteriorate and may cause leakage or skin irritation. Your mask and air tubing should be cleaned using warm water and mild soap. Don t hang it outside to dry the UV rays will break down the plastic. Do not use any bleach or chlorine compounds, as these can discolor or deteriorate the plastic. After cleaning all products, rinse thoroughly so as not to leave a soapy residue. Please refer to the user instructions for details on caring for your mask system

15 Important notes about treatment If you experience any of the following symptoms during treatment, consult your physician immediately. Headache Middle ear or sinus discomfort Chest pain A slightly bloated feeling is usually the result of excessive swallowing of air in response to the pressure sensation from your device while you are awake. Using a Ramp feature may help, but contact your physician if symptoms persist. If any of the symptoms of sleep apnea recur during the course of your treatment, consult your physician. You may experience sneezing, a runny nose or nasal obstruction, especially during the first few weeks of therapy. This may need treatment such as a nasal spray, or if the symptoms persist you may need a humidifier. Consult your physician or equipment supplier for advice. Do not stop your CPAP treatment without the approval of your physician. Always consult your physician if you expect to be in a situation where you cannot use your therapy for more than a few days. Contact ResMed ResMed has offices and distributors throughout more than 68 countries. Please visit our website at for details of locations. 24