USING YOUR CPAP AT HOME

USING YOUR CPAP AT HOME You have been provided with CPAP equipment to treat your sleep apnoea. The following information aims to answer any questions you may have about sleep apnoea and the use of CPAP therapy. Use your mask and pump whenver you sleep. If you have any problems you cannot solve yourself do not hesitate to contact the CPAP nurse, or your supplier. PLEASE BRING YOUR CPAP EQUIPMENT TO ALL YOUR SLEEP CLINIC APPOINTMENTS. CPAP Brand/Model: CPAP Pressure: cm H20 CPAP Mask Brand/Model: Humidifier: Chin strap: What is Obstructive Sleep Apnoea (OSA)? Obstructive sleep apnoea is a breathing disorder that occurs during sleep, when the muscles in your throat relax, resulting in a narrower and floppier upper airway. This means your airway can more easily collapse as you inhale, blocking or reducing the flow of air and oxygen to your lungs. Oxygen is usually transferred from the lungs into the blood stream and then carried around the body. All the cells in your body need oxygen to function properly. When the oxygen levels in your blood stream are low, your brain triggers the fight-flight reflex, causing you to briefly awaken so that muscle tone can be restored, opening your throat, increasing airflow and restoring oxygen levels. Although you may not be aware, your sleep could be interrupted hundreds of times during the night and this is why many people with obstructive sleep apnoea feel sleepy during the day. In your sleep study, you stopped breathing an average of times/hour. Things that worsen OSA Substances that sedate or cause relaxation of muscle tone can make your OSA worse. This includes, alcohol, sleeping tablets, some antihistamines, some antidepressants and strong pain relief medication. Gaining weight can make your throat narrower and also worsen OSA. Lack of sleep or sleeping on your back can also make sleep apnoea worse. Why treat OSA? Day time sleepiness and sluggish brain function are the best known consequences of OSA, and have been linked to an increased risk of an accident (car or work related), lower productivity, worsened mental functioning and mood control. Research shows a probable connection between untreated OSA and the occurrence of heart disease, high blood pressure, stroke, and pre-diabetes. Most patients feel less sleepy within only a few days of starting CPAP treatment. Less noticeable but just as importantly, treating sleep apnoea may help prevent, or improve control of these health problems. How does CPAP treat OSA? OSA is most commonly treated with CPAP which stands for continuous positive airway pressure. The CPAP is a small, electrically operated pump which blows room air at pressure, through a mask. This air pressure acts as a splint to keep your throat open while you sleep. When your CPAP is used

correctly your OSA is treated, breathing is normal, oxygen levels are maintained and your sleep quality should improve. Diagram of a Closed Airway, and Airway Splinted Open with CPAP Important information Provision of equipment The Department of Health subsidizes the provision of CPAP equipment to patients who have a current pension or health care card and meet the necessary medical criteria. You may be asked to return your CPAP if you fail to attend your review appointments or to use your CPAP for a minimum number of hours per week. Pensioners and health care card holders provided with equipment from the Repatriation General Hospital will be issued with one CPAP mask at their initial set-up. We will change this mask within the first month if you are unable to get a comfortable seal, provided it is not modified, and it is returned in good condition. All patients are required to purchase replacement CPAP consumables (masks, filters, hoses, and humidifier chambers) as they wear, at their own expense through a commercial supplier. Unfortunately we are not funded to cover these costs. CPAP must be worn every night to be effective. Symptoms may return even if only one or two nights are missed When should I use my CPAP? Wear your CPAP whenever you sleep, including naps. Your breathing problems occur because you are asleep, not because it is night time. Take your CPAP with you when you travel, or are admitted into hospital. Discontinue use if you develop a respiratory tract infection that causes discomfort or coughing when CPAP is used, or if otherwise medically advised. Contact the CPAP Nurse if you are concerned about whether you should discontinue using your CPAP, or if you are having problems using the therapy. CPAP safety Do not eat or drink while using CPAP. You are likely to inhale the food or drink into your lungs. If using a full face mask, avoid large meals 2-3 hours before bedtime CPAP pressure changes Changes to your pressure setting or oxygen flow must be prescribed by your Sleep Specialist. We usually need to perform a sleep study to check your pressure requirements. Sometimes this can be done at home. Changes in your weight A weight gain of 10-15 kg may make your OSA worse, causing snoring and possible re-occurrence of your initial symptoms. A weight loss of 10-15 kg may improve your OSA. You may need to have your CPAP pressure reviewed if your weight changes significantly. Organise an appointment with your Sleep Specialist. You may need another referral from your GP. Surgery and CPAP If you need an operation or procedure which requires an anaesthetic, you must tell the doctor that you have Obstructive Sleep Apnoea (OSA). When you are anaesthetised or sedated, the OSA may affect your breathing. If you are having a hospital procedure, take your CPAP equipment with you.

Common Problems See your local doctor immediately if the following symptoms occur: Any chest pain Increased or unusual shortness of breath Regular headache on waking Please contact the CPAP nurse or your local supplier if the following occurs: Skin irritation or break-down caused by your mask Sore eyes Nasal congestion or rhinitis (runny nose) Ear discomfort Stomach bloating Excessively dry mouth Snoring with CPAP, or excessive day-time sleepiness, which may indicate an inadequate CPAP pressure. There is any problem that is preventing you from using your CPAP. Fitting your CPAP mask It is essential that your mask fits comfortably and seals around your face. Assemble your mask and headgear before application. Leaving dentures in place will improve your mask seal when using your CPAP. Follow the manufacturer s instructions to apply your mask. Only apply enough tension to your headgear to eliminate leaks. Over-tightening the straps can introduce more leaks, cause pressure sores, or sore gums. Make final adjustments to your mask when lying down. If you experience mask fitting problems, contact your CPAP nurse or commercial supplier. It is essential that your mask is kept in good working order. It is your responsibility to replace your mask or worn parts as required. These can be purchased from your supplier. Mask leaks: A change in position will often cause a mask leak. Try pulling the mask and frame slightly away from the face and repositioning it. Refer to the manufacturer s instructions, for further advice on adjusting your mask. If you continue to have difficulties in preventing mask leaks, please contact the CPAP Nurse or your commercial supplier. Mouth leaks: Mouth leaks are common with nasal masks or pillows, and need to be addressed to prevent loss of CPAP pressure. Mouth leaks will worsen nasal congestion or rhinitis (runny nose) Signs indicating a mouth leak: excessively dry mouth waking with choking feeling or difficulty breathing If you experience these symptoms, please contact your CPAP nurse or commercial supplier. Getting used to your CPAP (it may take time) Try all or some of the following suggestions if you are struggling with CPAP. Hold the CPAP mask on your face and breathe normally, while sitting in a comfortable chair. (With your pump off initially for brief periods if you are very worried by the feeling of the mask on your face). When you can breathe comfortably through your mask, turn your CPAP pump on and breathe normally while holding the mask on your face. You do not need to take big breaths. If you feel closed in or uncomfortable, remove the mask until the feeling passes, and repeat the process.

Attach the headgear to your mask and practice wearing it with the CPAP off, for brief periods, or remove the mask elbow. Once you are used to the feeling, turn the pump on. Use your CPAP while awake for 30 minutes each day. Practice breathing normally through the mask while watching TV, reading or performing a relaxed seated activity. You may need to use a relaxation tape, or relaxing music to assist in overcoming your anxiety. The Ramp function on your CPAP machine allows it to start at a low pressure, and then gradually increase up to your prescribed pressure. This will allow you to adjust to your prescribed CPAP pressure. Use the CPAP if you have a daytime nap. Most people require at least 2 weeks to become comfortable with their CPAP treatment. Using a humidifier Using a CPAP humidifier may help improve some nasal symptoms by providing extra warmth and moisture to the air. Only use de-mineralised water in your humidifier water chamber. Change your humidifier water every day. Adjust your humidifier temperature control for your own comfort. Experiment to improve your nasal symptoms. Humidifier units should be placed below your head level to avoid condensation running into your mask while you sleep. Do not place any humidifier on top of your CPAP pump. Empty or remove the humidifier water chamber before moving the unit to ensure water does not enter the motor and affect the electrical system. You may be responsible for the cost of repairing any water damage. A build up of scale in the water chamber can be removed by filling it with a solution of 1 part vinegar to 10 parts water and leaving it to soak for up to 30 minutes. Rinse thoroughly with clean water. You may need to repeat, but do not use any scouring pads as they scratch the metal base. Do not add any essential oils etc to the water of your humidifier. Water in the CPAP Tubing Water can collect in the CPAP tubing if there is a large temperature difference between the humidifier and your bedroom. The water condenses as the air cools down while passing through the hose. Water can be very noisy in the tubing, and can change your CPAP pressure, and may dribble into your mask. Lower the humidifier temperature, especially if a very cold night is forecast. Make a tube wrap from a light weight material, long enough to reach from one tubing cuff to the other, and wrap around the CPAP tube. Secure with elastic bands. Remove when cleaning hose weekly. (Possible materials include polar fleece, pure knitted wool). Purchase a ready made tube wrap ($40). Increase the bedroom temperature. Buy a heated hose unit ($170). Humidifier chamber Daily Weekly 3 6 monthly Empty any Wash Check for wear water left in chamber and tear. Replace chamber, with damaged or rinse and warm worn dry. Fill with soapy components. If fresh supply water, scale builds up of demineralised rinse soak for 30mins well. with 1 part water. vinegar and 10 parts water. Rinse well. Wash your humidifier chamber weekly in warm soapy water, and rinse with drinking quality water.

Cleaning and Maintenance These are general instructions only. Please read the manufacturers instructions for detailed information. Unplug your CPAP before cleaning it to avoid electrical shock. Do not use alcohol, anti-bacterial solutions, Baby wipes, disinfectants or solvents to clean CPAP accessories. these products will shorten the expected life of your mask and tubing. Dry all components in the shade. Mask Hoses CPAP filter Humidifier chamber Daily Weekly 3 6 monthly Wipe inside and outside with a clean damp cloth Disconnect and hang in a clean place to dry. Empty any water left in chamber, rinse and dry. Fill with fresh supply of demineralised water. Dismantle into separate components and hand wash in warm water with a mild detergent. Rinse and allow to dry. Wash your hose in warm water with a mild detergent. Rinse and allow to dry. If CPAP dust filter is made of grey foam, wash in warm water with a mild detergent. Rinse and dry. Replace annually. Wash chamber with warm soapy water, rinse well. Check for wear and tear. Replace damaged or worn components. Check for wear and tear (can get pinpoint holes around ends of hose cuffs). Resmed CPAPs: Assess disposable dust filter in CPAP machine and replace if dirty. Check for wear and tear. Replace damaged or worn components. If scale builds up soak for 30mins with 1 part vinegar and 10 parts water. Rinse well. Faults and Repairs If your CPAP is not working properly, stop using it. Only qualified personnel should perform repairs and adjustments. Note: If you have a Respironics C flex + pump, it may switch off with 4 beeps, with a screen message of Service required. Please refer to page 11 in your user manual, noting that the company recommend you can continue to use your pump, unless this continues to occur. Contact us on 8275 1127 and leave your name and daytime phone number on the answering machine Contact us via switch on 8276 9666, and page Sleep Nurse. We suggest you ring as soon as possible after 8 am on weekdays. We are unable to offer an after hours service. If you have a Department of Health (issued by AISH), CPAP, Bilevel pump or humidifier that needs an electrical check or has a fault, you will need to ring the Sleep Nurses. Please do not drop in without ringing as the Sleep Nurses may not be available to assist you.

Good Sleep Habits These guidelines are designed to assist you in developing sleep habits which are helpful to normal sleep. 1. Reduce light, noise and extremes of temperature in the bedroom. 2. Avoid caffeine, nicotine and alcohol before bedtime. 3. Avoid a heavy meal within 2 hours of bedtime; however a light snack may help you if you are hungry. 4. Regular exercise late in the afternoon or early evening may deepen sleep, but do not exercise vigorously within 3 hours of bedtime. 5. In order to achieve relaxation at bedtime, allow about 1 hour of quiet activity prior to bedtime such as reading, watching television, listening to music. 6. Develop a bedtime ritual such as reading or listening to relaxing music, cleaning your teeth etc. so your body knows you are getting ready to go to sleep. 7. Do not go to bed too early. That is, do not go to bed unless you are feeling sleepy. If you try to go to sleep too early, before feeling sleepy, you will have difficulty getting to sleep. This may make you feel irritated and frustrated about not falling asleep and anxious about how you will cope the next day. 8. Do not stay in bed if you are awake. If you go to bed when you are feeling tired and sleepy but do not fall asleep within about 15 20 minutes (estimated time only DO NOT use a clock), get out of bed, go to another room and do something mundane until you feel sleepy again. Repeat this procedure until you fall asleep quickly. 9. Get up at the same time in the morning as this will train your body clock. Do not sleep in on weekends or after a late night. 10. Do not nap during the day as this will reduce your sleepiness. 11. Do not worry if you cannot get to sleep at night because worry and anxiety will delay sleep even more. The harder you try the worse it will be. If you get very little sleep one night you will still function the next day, although you may be a little more irritable and tired than usual. For more information Sleep Nurses Adelaide Institute for Sleep Health Repatriation General Hospital Daws Road, Daw Park SA 5041 Telephone: 8275 1127 8276 9666 and page CPAP nurse if urgent Department of Health, Government of South Australia. All rights reserved. Reviewed August 2010. Next review August 2012