Continuous Positive Airway Pressure (CPAP)

Transcription

1 Continuous Positive Airway Pressure (CPAP) frequently asked questions Turnberg Building Department of Respiratory Medicine All Rights Reserved Document for issue as handout.

2 What is Obstructive Sleep Apnoea (OSA)? Obstructive sleep apnoea means that when you sleep your breathing tubes narrow and may close altogether. This leads to less oxygen getting into your lungs and a build up of waste gases in your blood that can be harmful. Special sensors in your body spot these changes and wake you up so that the breathing tubes will open again. You may not know that you have been woken up as you are often not fully awake. This happens at least 5 times an hour but may be over 100 times per hour. Because you are being woken up over and over again all night long you may not be able to settle into a deep refreshing sleep. You are likely to feel very tired and sleepy the next day. This can cause you to fall asleep without warning during the day which can be dangerous if you are driving or working machinery. What is the treatment and how does it work? The treatment is a machine that gives you a constant flow of air into the breathing tubes during the night. The pressure of the air keeps the breathing tubes open. This means your body does not need to keep waking and you will get a better quality of sleep. It is called CPAP (Continuous Positive Airways Pressure). You have been given an automatic CPAP (also known as APAP). This monitors your breathing and changes the pressure automatically to keep your breathing tubes open. The pressure it will give you will change throughout the night and from night to night. This will depend on your sleeping position, how deeply you are sleeping and whether you have drunk any alcohol or taken medication that affect your sleep such as sleeping tablets or some pain killers. How do I get the best out of using my CPAP? By using your CPAP every time you sleep it will help you to get the best quality of sleep and make sure that you do not have episodes where the breathing tubes close. It is therefore best to use your CPAP all night, every night and also for naps. Hopefully as your night-time sleep quality improves you will find less need for daytime naps. If you find it difficult to keep your CPAP on all night you should try to get at least four hours on your CPAP to begin with and then try to gradually increase this to a full night. If you wake in the night to use the bathroom put your CPAP back on when you get back into bed. The pressure will reset when you stop and restart it. If I wake in the night my CPAP seems to be blowing really hard. Why is this and what should I do? Your CPAP will have increased the pressure in response to your breathing tubes closing. Unfortunately it is rather slow in then reducing the pressure now that you are awake and no longer need the high pressure. If you stop the machine and then restart it will reset back to the minimum pressure (usually 4cm H 2 O), alternatively, you can press the reset button (triangle symbol) which will reset the pressure back to the minimum without turning it off. The blowing will slow and the pressure will only build back up as needed when you fall back to sleep. 1 2

3 When I first put my CPAP on I find it difficult to breathe as if I am not getting enough air. What should I do? Some people, particularly those of larger build, may find that a minimum pressure of 4cm H 2 O is not enough. If you feel this whilst using your CPAP please contact the department or use the drop-in clinic and we will increase the minimum pressure. I am using a nasal mask but find that I am gasping for air or get a panic feeling. What should I do? You are probably trying to breathe through your mouth. This causes air to leak back out of your mouth which can feel uncomfortable. Try to do all your breathing, both in and out, through your nose only. This may take some concentration to begin with but should soon become natural. If you continue to struggle, you could either try a chin strap (a small gusset that fits over your chin) to help keep your mouth closed or you will need a full face mask which covers both your nose and mouth and allows you to mouth breathe. Please contact the department or use the drop-in clinic on Wednesday mornings. Why is my nose, mouth or throat very dry? It is disturbing my sleep This is more common amongst mouth breathers because, unlike the nose, the mouth doesn t add moisture and warmth to the air you breathe in. The high pressure of the air is drier than usual and can cause the mouth or nose to become very dry. If you wake up really dry but your sleep is not disturbed the easiest thing is to have a drink. However, if your sleep is being disturbed by this dryness then you need an attachment for your machine that will add moisture to the air. This involves adding a small water tank to your CPAP so that the air passes through warm water. Please contact the department or use the drop-in clinic if you feel you need this. Why have I developed hay fever type symptoms or have painful sinuses since using CPAP? For some, the dryness of the air from the CPAP causes sneezing and a runny nose. This often gets better after a few nights of use whilst the body gets used to it. However, if this does not clear up, an attachment for the machine with warm moist water will usually help. Please contact the department or use the drop-in clinic if you want to try the attachment. 3 4

4 Why is the bridge of my nose getting sore? Some redness is normal, but if this does not disappear within a few minutes of taking off your mask or if you are getting soreness whenever you wear your mask then this is a sign the mask is not fitting properly. Firstly try loosening the straps. If this causes leaks into your eyes try adjusting the forehead pad on those masks with an adjustable forehead support. Bringing the mask forwards and then reposition (straighter position) will put more pressure on the bridge of the nose but will cause less leaks into the eyes which may mean you can have the straps looser. If this does not work you may need a different mask that does not fit over the nose. I wake up and find my CPAP has turned itself off Your CPAP has an auto-off feature which will make it switch itself off if there is a high leak. This is usually left in the off position, so that your mask will continue to leak, which will hopefully wake you up so that you move it into a position where it fits. Please make sure that this autooff feature is switched off - see the manufactures manual or contact the department if you are not sure. If the problem continues when the auto-off feature is turned off please contact the department as there may be a problem with your machine. I m going away on holiday or business. Do I need to take my CPAP with me? You should treat your CPAP like any other medical treatment that should be used every day. Missing nights on CPAP often or for long periods could cause your symptoms to return very quickly. It also means that you will not be protected from the risks of heart attacks and strokes. Read the section on problems caused by not using CPAP. You may also put your driving licence at risk if you are found not to be using your CPAP. I am finding it really hard to sleep with CPAP and get very stressed or anxious when trying to fall asleep with the mask on Some people find it difficult to get off to sleep when wearing CPAP. It may take time for you to get used to wearing your mask and right at the point when you are desperate to get to sleep might not be the best time to start trying. If you are finding this difficult it may be easier to first start trying to wear your CPAP during daytime naps or gradually build up the amount of time you use it for until you are comfortable to go to sleep with it on. Please contact the department and we will try to help with your specific difficulties. 5 6

5 I have really tried to use CPAP but can t get on with it. What should I do? Please contact the department as soon as possible. There may be something we can do, but if you absolutely can t use CPAP please make arrangements to return your machine and all the accessories to the chest clinic. We will then be able to give the machine to another patient. Chasing unused machines takes time. This takes the team away from other patients and their needs. It also means there will be fewer machines to hand out to patients that need them. If you are not able to get on with your machine no matter how hard you try, even with help from the team then you will be discharged from the nurse-led clinic. The team will discuss with you if any further action needs to be taken, such as an appointment with the consultant. This will depend on why you were being treated and how bad your OSA is. I have been told I have severe OSA but am not particularly sleepy. Why should I use CPAP? Sleepiness is just one of the symptoms of OSA. The number of times that you stop breathing in the night is the way in which it is decided how bad the OSA is. It is known that the more times that you stop breathing in the night the higher the risk of health problems such as stroke or heart attack. Regular use of CPAP lowers the risk of stroke and heart attack. It can also help with the symptoms of OSA. These will be different for all patients and may include sleepiness, snoring and poor concentration. Do I need to tell the DVLA and my insurer that I have OSA? If you have been diagnosed with OSAS - that is you had a sleep study that shows you stop breathing more than 5 times per hour and you have symptoms of being very sleepy you must inform DVLA or risk a 1000 fine. If you are using your CPAP and are no longer sleepy you are OK to drive, but you must tell the DVLA that you are now on the CPAP treatment. See the separate DVLA and Driving and OSA the facts leaflets. You should also tell your insurance company, as they may not pay you for a claim if you have haven t told them about any medical conditions that could possibly affect your ability to drive. An unused CPAP sat on a shelf is not helping anyone Please remember that we are here to help. We can only help if you let us know about any problems you may have and make every effort to use your CPAP regularly. If a member of the team is not available immediately when you call please leave a message on the answer phone and we will be in touch with you as soon as possible. 7 8

6 What problems will I get if I don t use CPAP? You may have increased risk of heart attack, high blood pressure and stoke. You may also be at a higher risk of accidents when driving on the road or operating machinery. If you don t use CPAP then your symptoms will continue. These may include sleepiness and napping, snoring, choking sensation, morning headaches, poor concentration and memory loss. Notes Drop-in clinic is: Wednesday 9.00am 11.30am

7 G W. Design Services Salford Royal NHS Foundation Trust All Rights Reserved 2014 This document MUST NOT be photocopied Information Leaflet Control Policy: Unique Identifier: MED104(14) Review Date: December 2016 For further information on this leaflet, it s references and sources used, please contact Copies of this information are available in other languages and formats upon request. If you need this interpreting please telephone In accordance with the Equality Act we will make reasonable adjustments to enable individuals with disabilities, to access this treatment / service. Salford Royal operates a smoke-free policy. For advice on stopping smoking contact the Hospital Specialist Stop Smoking Service on Salford Royal NHS Foundation Trust Stott Lane, Salford, Manchester, M6 8HD Telephone If you would like to become a Foundation Trust Member please visit: for-members If you have any suggestions as to how this document could be improved in the future then please visit: for-patients