CPAP TREATMENT Patient information September 2007

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1 LUNG FUNCTION UNIT CASTLE HILL HOSPITAL MEDICAL DIVISION CPAP TREATMENT Patient information September 2007 Working in Partnership to Provide a Quality Healthcare Service INTRODUCTION This leaflet has been produced to give you general information about CPAP treatment prior to your appointment at the Sleep Clinic. Most of your questions should have been answered by this leaflet/booklet. It is not meant to replace the discussion between you and your doctor, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the heath care team who has been caring for you.

2 CPAP Treatment Patient Information 0 Sleep Clinic, Lung Function Unit, Castle Hill Hospital Tel Clinic hours: Tue , Wed & Thur

3 What is snoring and how is it different from Obstructive Sleep Apnoea? During normal sleep, the muscles that control the tongue and soft palate hold the airway open. If these muscles relax the airway becomes narrower, partially blocking off the air passage. Breathing in makes the soft or floppy part of the throat vibrate, making the noise of snoring. If the throat is particularly narrow, or the muscles relax too much, the airway can repeatedly become completely blocked briefly, preventing breathing. This condition is Obstructive Sleep Apnoea (OSA). After a period of time, anywhere between 10 seconds and 2 minutes, the brain realises there is a lack of oxygen and alerts the body to wake up. Although the sufferer is often not aware of it, this cycle can occur several hundred times a night, severely disrupting sleep. There are several different causes and aggravating factors that cause the throat to narrow during sleep and create snoring or OSA. Some of these include obesity, alcohol intake, nose or throat problems or even sleeping tablets. How can you tell if some has OSA? You can often tell if someone has OSA. If you listen while the person sleeps you will hear snoring followed by a period of silence. There may then be a loud snort or a gasp as he or she starts to breathe again. How is OSA treated? Sometimes losing weight or reducing alcohol intake may help reduce the severity of OSA for mild sufferers. However the most effective treatment for OSA is the CPAP system. It involves wearing a mask over the nose, or nose and mouth, which is connected by tubing to an electrically driven pump. The pump delivers air continuously at a slightly increased pressure (hence the name Continuous Positive Airway Pressure). This flow of air acts as a splint to keep the upper airway open and prevent apnoeas. How common is OSA? OSA is the most common sleep disorder, affecting people at any age, from newborn babies through to adults of either sex. Around 4% of women and 9% of men in the age group have treatable levels of OSA.

4 How will CPAP treatment affect my life? CPAP treatment should not greatly interfere with your life style. CPAP systems are fully portable so you can take them with you when you travel. Most CPAP machines run on virtually any power supply in the world without the need for special adjustment and can also be run from 12v or 24v batteries using an appropriate adapter or inverter. Some airlines have also approved the use of CPAP on long haul aircraft. Please contact the department for more information. Frequently asked questions. How long will it take to get used to CPAP? Most people adjust to CPAP in 1 to 2 weeks. Occasionally it may take a little longer if, for example, you are sensitive to noise or the feel of the mask on your face. How soon after I start using CPAP will it be before I notice an improvement? You should notice an immediate improvement once you start using CPAP treatment, however some people take a little longer. How often will I need to use my machine? You should use your machine each night or you will return to your previous level of snoring, sleep apnoea and daytime sleepiness. Will the pressure on my machine ever need changing? The pressure on your machine will remain set to suit your requirements although sometimes there is a need for fine tuning. If you find your pressure difficult to tolerate, it may be dropped slightly for a short time. The unit will review you if your symptoms of snoring and daytime sleepiness return. For people who have lost weight a lower pressure may be possible. Will my blood pressure improve after I start CPAP? Sometimes, but do not alter your medication without consulting a doctor. Is it easier to lose weight when you are using CPAP? It may be. You will find that your energy levels will increase and you will feel motivated to take part in many activities that your previous sleepiness has prevented you from doing.

5 I've just started CPAP and it is irritating my nose. The cool dry air of CPAP can cause a runny nose and sneezing in some people, but it usually settles down within a few days to a week. If it doesn't settle down, you should contact the department. I find the air through the mask is cold and disrupts my sleep. Some people experience dryness of the nose, mouth or throat when on CPAP, particularly during winter months. If air through the mask is cold and disrupts your sleep, the alternatives are heating the room or placing the tubing under the bedclothes (as body heat will increase the temperature of the air passing through the tubing). If symptoms persist contact the Sleep Clinic as humidification may help. My nose gets blocked regularly, so I have to mouth breathe. What do you advise? Discuss using a nasal decongestant with your GP. Please note that over use of nasal decongestants over time can also cause a blocked nose, this is known as the rebound effect. Contact the Sleep Clinic as a Full Face mask may be more appropriate. I feel air leaking out of my mouth as I fall asleep. If you are using a nasal mask, your mouth needs to be closed while you sleep to prevent any air escaping from the mask. This can feel unpleasant although nothing to be alarmed about. The delay timer can be used to prevent this, as the pressure of the machine will gradually build up over a period of time before you fall asleep. A chin strap may help to keep your mouth closed. The department will assess the need for this. If you continue to have any problems, please contact the department as you may be more comfortable with a mask that allows you to breathe through your mouth. If a mask makes you feel slightly claustrophobic, you could try an interface with soft prongs that deliver air directly into your nostrils. Can I use CPAP if I have a cold? If you experience an infection of the upper respiratory tract, middle ear or sinus, it may be advisable to stop CPAP until the infection has cleared. If you continue with CPAP during an infection, it is advisable to wash your wash mask and tubing more often and to sterilise with a sterilising solution like Milton. Do I need to take my machine into hospital with me if I need hospitalisation for any reason? Yes. Your condition may take longer to improve if you stop your CPAP treatment and your general well being starts to deteriorate. If you are having surgery, it is very

6 important that you tell both the surgeon and anaesthetist that you are being treated with CPAP. Medical alert cards are available from the Humber Sleep Apnoea Support Group (HSASG), details available from the Sleep Clinic. Will I ever be able to stop using CPAP? Will I ever be cured of my snoring and sleep apnoea? OSA is a long term condition for which there is no known cure. The good news, however, is that CPAP will effectively control sleep apnoea as long as you continue to use it. Quite often I wake and find I have taken my mask off in my sleep. How can I avoid this? This may indicate that your CPAP pressure is not enough to completely control your sleep apnoea. Discuss this symptom with your sleep clinic. A slight increase in pressure may solve the problem. Why do I feel that I have to push against the air when breathing out oncpap? Some people find they experience a need to push against the airflow when they breathe out. In case you may feel the pressure makes it hard to breathe out but this is merely a sensation. Breathing out against the flow of air will happen automatically when you are asleep. Caring for your CPAP system To increase the life of your CPAP machine, it will require annual servicing. You will be called back to the Sleep Clinic at the appropriate time for this to be done. The headgear, mask, cushion and air tubing all require regular washing to prolong their life and prevent infection and will be replaced at your annual visit if required. The mask and cushion requires hand washing in warm soapy water daily. Washing the headgear regularly helps to prevent it becoming too stretched. Before going to sleep wash your face to remove any excess oil or traces of make-up. The air tubing needs cleaning regularly too. Warm soapy water will do but don t hang it outside to dry - the UV rays will break down the plastic. Do not use any bleach compounds, eucalyptus oils, or chlorine compounds. After cleaning all products, rinse thoroughly so as not to leave a soapy residue. Ensure all consumables are thoroughly dried before using them again.

7 Side-effects relating to CPAP treatment If you experience any of the following symptoms during the course of your CPAP treatment, consult your GP immediately. Headache Middle ear or sinus discomfort Chest pain Feeling slightly bloated. This is usually the result of excessive swallowing of air in response to pressure sensation from your CPAP system while you are awake. Using the delay timer may help but contact your GP if symptoms persist. Please do not hesitate to contact the Sleep Unit should you experience any problems with CPAP. You can contact us on our direct line during Sleep Clinic hours: Tue , Wed & Thur Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Lung Function Unit on General Advice Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with your doctor Information about you As part of your care, when you come to the hospital, information about you is shared between members of a health care team, some of whom you may not meet. It may be used to help train any staff involved in your care. Information we collect may also be used after you have been treated to help us to maintain

8 and improve the quality of our care, to plan services, or to research into new developments. We may pass on information to other health organisations to help improve the quality of care provided by the NHS generally. All information is treated as strictly confidential, and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you. Under the Data Protection Act (1998), Hull and East Yorkshire Hospital Trust is responsible for maintaining the confidentiality of any information we hold on you. This leaflet was produced by the (Lung Function Unit).Hull & East Yorkshire Hospitals NHS Trust and will be reviewed in September Ref: 07_235

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