1. CPAP: delivers continuous flow of air at a constant pressure.

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1 What does CPAP stand for? CPAP stands for Continuous Positive Airway Pressure. What does CPAP therapy do? CPAP therapy provides a constant airflow which holds the airway open so that uninterrupted breathing is maintained during sleep. It is traditionally provided through a nasal mask that seals around the nose to maintain the pressure level. Ideal pressure is determined during your sleep study. Many factors can affect your ideal pressure over time, like weight fluctuations and even sleeping positions. What kinds of machines are there? 1. CPAP: delivers continuous flow of air at a constant pressure. 2. Bilevel PAP: permits cycling between higher and lower pressures while the patient breathes in and out. Some patients find it makes exhalation easier, while others dislike the cycling and resulting increased noise. Do these machines cure sleep apnea? No. As is true for most medical treatments, they control sleep apnea, as long as they're used consistently: thus protecting patients from sleep apnea complications and symptoms. Does CPAP/Bilevel PAP treatment remain effective over the years? Yes--unless other factors (such as sedating drugs or new illnesses) make your sleep apnea worse. Also, sleep apnea can worsen with both age and weight change. What if I don t use my machine? Your sleep apnea symptoms will recur quickly, which in some patients can be dangerous. Is part-time use enough for my treatment? NO. One common, potentially serious mistake occurs when the device is removed toward the end of the night and you allow yourself to fall asleep again. Since we experience most of our REM sleep (the stage when most patients' sleep apnea usually reaches its greatest severity) during the final hours of sleep, you will have removed it before you needed it more than ever. Should I use my CPAP/ Bilevel PAP therapy during naps? Ideally, yes. The level of danger for napping without your machine varies both upon the individual patient s sleep apnea severity and also, whether they have a history of heart trouble or strokes

2 Must I take my CPAP/ Bilevel PAP machine with me when I travel? YES. Traveling with these units is usually quite easy. Some travel tips-- Ensure you were given a carrying case, and ask your home care company for extra fuses to take with you. For foreign or air travel, ask your physician for a letter to facilitate its transport through airport check-ins and customs. Carry it on with you: don't check it with your luggage. If you're going overseas, talk with your home care company beforehand. While nearly all units are designated to operate on either 110 or 220 volts, one patient reported his machine was destroyed by British current, and an electric current converter may be advisable. If you will be without access to electricity (ex. while camping/boating) ask your home care company if a battery or DC converter is available for your particular machine. If you also require oxygen (which is difficult to transport), ask your home care company for assistance in arranging rental oxygen at your destination. What maintenance is required on machines? The only care the machines require is that you clean or change the filters in the back of the machines to keep the internal parts from accumulating dust. Proper cleaning can increase the life of your machine. How often should I clean my filters? Washable foam filters should be cleaned as soon as they become discolored. Depending on your environment, that may mean weekly cleaning. Paper filters should not be cleaned, just disposed. How often should I replace my filters? Reusable foam filters should be replaced when they deteriorate and begin to fall apart, much as a sponge does. Disposable paper filters should be discarded as soon as they become discolored, or at least every 30 days. How often should I replace my CPAP hose? CPAP hoses can last a long time, sometimes up to a year if taken care of properly. Signs of wear are dry, cracked places on the inside lining or on the rubber ends; "stretch marks" near the rubber ends; and mineral deposits or mold from water left inside the hose. Your CPAP hose will last longer if you detach it every morning and hang it to air dry. It should be removed by grasping it on the rubber ends, rather than on the hose itself. A "Hose Quick Connect" is available to help remove and replace the hose more easily. Drying the hose each morning will also prevent bacteria from growing in the damp interior and help reduce the possibility of colds and other health issues. If you are not drying the hose daily, then be sure to replace the hose very frequently as negative health issues will result!

3 What is Humidification? Humidification adds moisture to the CPAP air, reducing irritation to the nasal passages caused by the increased airflow. CPAP air is an irritant - to one degree or another - to everyone. In some cases the irritation dries out the nasal passages and may cause bleeding. It may also cause swelling, excess mucous, congestion or sneezing. The irritation also creates a very fertile ground for infections to begin. The irritation may be cumulative, building up over time. The only way to reduce the irritation is to add moisture. Humidification is therefore a critical part of CPAP Therapy. Which CPAP Masks work on which machines? You can safely mix and match nearly all machines and CPAP Masks. What is a nasal mask? A nasal masks seals around the entire nose and is held in place with straps, or headgear. This is a good device for first-time CPAP users. What is a full face mask? A full face mask seals around both the nose and mouth and is held in place with straps, or headgear. Full face masks are good alternative for 'mouth breathers'. For some people the mouth tends to drop open unknowingly during sleep. This allows the treatment pressure blowing through the nose via a traditional nasal mask to escape. If this happens, it renders CPAP therapy ineffective as the pressure intended to hold a patient's airway open instead flows out of the patient's mouth. The full face mask equalizes pressure between the nose and mouth allowing the patient to receive the proper treatment pressure at all times. Sometimes nasal blockages like a common cold or those who have nasal congestion due to illness or allergies might also need a full face for consistent treatment. What is a nasal pillow device? A nasal pillow device seals against the outside edge of each nostril rather than around the entire nose. The pillows open into the nostril but are not inserted inside to seal. This device is helpful for people who sleep on their side or stomach, or for those with facial hair. It is sold with different pillow sizes for ease of fit. What is a total face mask? A total face mask seals over the entire face, at the forehead, down the sides and under the chin. It can only be used when sleeping on the back and is somewhat of a last resort. There are special circumstances or needs for this mask, like patients who leak air out of the corner of their eyes. This mask is like a Full Face mask in that it equalizes pressures for an even treatment, but this mask encompasses every opening on the face where air might escape like the eyes. Did you know that there are pillows specifically designed for CPAP wearers? Hollowed-out areas on the pillow accommodate most masks and hoses. The pillow alleviates mask pressure and helps prevent leaks.

4 Solutions to Common Discomforts Getting accustomed to PAP therapy can take some time. Not everyone can immediately use their equipment all night, every night. It is important to your health and well-being that you try, but be patient with the process that it takes for your body to become accustomed to therapy. The following are common problems that you could experience when getting used to PAP therapy and the solutions that may work for you. Never hesitate to call your equipment provider for assistance or with questions about therapy. Eye Irritation Skin Irritation Be sure the mask is fitted correctly to your face. Be sure the headgear is tightened evenly (and not over-tightened). Contact your equipment provider for a mask refitting. Stuffy Nose Make sure you are properly cleaning the mask and rinsing thoroughly. Your mask should be washed or wiped down daily. The oils from your face build up on the mask and can cause skin rashes if not removed from the mask between uses. There is a learning curve for your body to adjust to PAP therapy and usually stuffiness will resolve over time. Your physician may recommend nasal sprays or decongestants to help you or address any specific issues you may have with congestion. Humidifiers can greatly help with congestion. Dry Mouth or Throat This may be corrected with the use of a humidifier. Avoid sleeping on your back. This may be caused by your mouth coming open while you sleep. Using a chin strap may be a possible solution. What is the purpose of a chinstrap? Nasal delivery devices are the preferred mode of delivering CPAP air. They are smaller, lighter and usually more comfortable, with many styles and sizes to choose from. When using a nasal device with a CPAP, it is imperative that the mouth remain closed for the pressure to be maintained and the therapy to be effective. Most people will automatically keep their mouth closed while on CPAP, but some are unable to do so, at least in the beginning of the therapy. Use of a chinstrap is the first response to opening the mouth during sleep. It is worn in addition to the CPAP mask to hold the jaw up and help keep the mouth closed. Even with the use of a chinstrap, some people are still able to breathe through their teeth and lips. If so, a full face mask is an option worth considering.

5 Caring for my CPAP Equipment. The following chart will help you properly care for your equipment. Proper cleaning can increase the life of your mask and machine. Daily Weekly Monthly Mask Rinse with warm water to remove face oils. Clean with mild (baby) soap and water. Rinse thoroughly. Inspect mask-replace if worn (every 6 months) Hose Hang up so it is able to dry Soak for 20 minutes with a 1:3 Inspect hose-replace if worn Water Soak for 20 minutes with a 1:3 Check chamber for leaks- Filter Cleaning your machine: Rinse under running water. Do not reinstall until completely Cleaning Schedule Check and replace if gray Unplug the PAP machine and wipe off with a damp towel as needed. Be sure machine is completely dry before plugging it in. NEVER immerse the machine in water. Doing so may cause serious electrical shock. When should I replace my CPAP mask, machine, and accessories? The life of your CPAP mask or machine can vary greatly depending on the care they are given, the brand and style of the equipment, or the amount of use. The following are signs to look for to alert you to consider replacing your mask or machine: If your mask or nasal pillow system is older than 6 months. Most masks show some signs of breakdown at this point. Insurance payers will usually cover the expense of a replacement mask at this point. If your mask or nasal pillow system begins to leak excessively. If there is a tear in the cushion of your mask or nasal pillow system. If your mask becomes uncomfortable to wear. If you begin to snore again while using PAP therapy (this can also be due to other factors and you may need to consult your physician to address this). If your machine rattles or makes other noises as it is running. Disposable filters should be replaced after 3 months and non-disposable filters should be replaced every 6 months. Note: Your CPAP/BiPAP machine should be checked every year to make sure it is maintaining the prescribed pressure. Stay Informed. The market for CPAP goods and services is competitive and dynamic. Manufacturers are frequently coming to market with products that make CPAP therapy more comfortable and effective. You do not want to be stuck using an inferior product!

6 Troubleshooting The following are a list of possible problems and possible solutions. Do not hesitate to call your equipment provider regarding problems with your equipment. Air blowing in your face. Tighten the straps evenly on your mask from one side to the next. If your mask has a swivel exhalation port, make sure it is turned away from your face. Check the mask or nasal pillows for obvious tears or holes. Check the connection of the tubing to the mask. There is a whistle noise coming from the mask. Be sure the exhalation ports are not partially occluded. If using a humidifier in line with the CPAP, be sure there is no excess water accumulation in tubing. Condensation or rain-out in your tubing or mask. Increase the temperature of your bedroom. Decrease the setting of your heater on the humidifier. Use a cloth wrap to insulate your tubing or tuck the tubing under the covers with you. These suggestions are designed to equalize the temperature difference between the room air and the air being warmed through your tubing, which causes condensation. Machine does not turn on. No air is coming out of machine. Or machine runs intermittently. Be sure the power cord is firmly attached to the machine in the back as well as to the wall outlet. Make sure the power cord is connected to an outlet that has power. Verify by plugging in another appliance to that outlet. Contact your equipment provider. The air from the machine seems hotter than normal. Check the filters. They may need to be cleaned which will allow air to cool the unit. Be sure there is at least one foot of air space around the entire machine, and no vents are obstructed.