CPAP (Continuous Positive Airway Pressure) is a wonderful therapy, which can reduce your chances of having a stroke or heart attack. Diabetes, high blood pressure, depression, and insomnia are usually easier to control. Night time sleep and daytime alertness are often improved. Here are tips to help you adjust.
THE NOSE IS THE KEY TO SUCCESSFUL CPAP USE!
The nose filters and humidifies air as it enters the airway. However, the airflow from CPAP can be very drying. The nose reacts to this dryness with an “inflammatory reaction”. Nasal tissues swell in the attempt to humidify the air. Some people will react to CPAP as if they have allergies – with sneezing and a runny nose. If noses get congested, it can result in mouth breathing, dry mouth, air swallowing and sometimes, bloating and belching. Stuffy noses may interrupt sleep. Some folks will feel claustrophobic and want to remove their masks during the night without realizing it. A few people will even get nosebleeds from the dry air. These problems can be avoided with a few simple steps:
1) Increase the humidity. Try turning up your humidifier. If you notice some water or condensation in the tube, and have a newer machine, increase the temperature of your heated tube. You can also insulate your tubing by wrapping it with some fleece, putting it under your blankets, or buying a CPAP “cozy”. Keeping the CPAP lower than the level of your head will help any condensation run back into the reservoir.
2) Use a saline (salt water) rinse in your nose. If your nose is still stuffy, consider using a saline rinse. NeilMed’s Sinus Rinse is easy to use. Some people prefer a Neti Pot. Or, you can make a home solution of 1 pinch salt (preferably non-iodized) with ½ pinch baking soda to 1 cup of warm water. Using a blue baby bulb syringe, tilt your head back, and let the warm salty water rinse inside your nose, then spit out. It will be messy, but it will clear up your nose. For mild dryness, Ocean and Ayr are two brands of saline spray which are available without prescription.
3) Use antihistamines or a nasal steroid spray. If you have allergies, over-the-counter antihistamines Allegra (generic: fexofenadine), Zyrtec (cetirizine) and Claritin (loratadine) have few side effects besides occasional mild sedation. If these are not enough to help congestion, we can give you a prescription for a nasal steroid spray. Blow or rinse your nose first, and then apply the steroid spray. These sprays have almost no systemic effects or drug interactions. Side effects are generally mild, such as nasal irritation or bleeding. These sprays are very effective at reducing congestion and are best used daily for at least two weeks. Nasalcrom spray is available over the counter. With frequent use, it also reduces allergy symptoms. Some patients find that Mucinex can decongest nicely.
4) Breathe-right strips, Brez, Nasivents and other similar products may also be helpful, but only for those with tight nasal passages. They help prop open small nasal airways.
5) Nasal moisturizers: DO NOT USE VASELINE OR OIL BASED PRODUCTS! They can cause problems in your lungs, and break down the seal in your mask. If your nose is dry, use Nasogel (available in The Corvallis Clinic pharmacy), Ayr Nasal Saline gel or plain K-Y Jelly in your nostrils.
If you have increased the humidity setting and still have a dry mouth, Biotene gel (not the toothpaste, spray or mouthwash) can help. It works best by putting a nickel-sized blob between your teeth and cheeks. It will seep into the mouth overnight. Also helpful are Xylimelts and Oramoist, tablets that adhere to the check, and help address dry mouth during the night (and day, if you wish). If dryness persists, you may be opening your mouth during sleep, and a chinstrap may be very helpful. If air bubbles out of your lips, a bit of denture cream on your lips can provide tackiness and help stop it.
Usually, getting a better fitting mask helps by eliminating small air leaks. Eye drops don’t last very long, but Gen-Teal and Systane water-based eye gels are much longer lasting. Eye ointments last even longer but can leave smeary vision in the morning. Tranquileyes, thin silicone goggles can provide even better dry eye protection—these are available online at eyeeco.com and at The Corvallis Clinic’s optical department.
Over tightening CPAP masks can actually prevent a good seal. Over-tightening the lower strap can force it away from the bridge of the nose, causing leaks near the eyes. If you dislodge it during the night, just pull it away from your face, then re-seat it. If you develop deep red marks or sores your mask is too tight or you have the wrong style for your face. Call your medical equipment company!!!
CPAP EQUIPMENT CLEANING
CPAPs only need a small amount of attention. Wash the masks and equipment every few days with a few drops of dish detergent like Dawn; be sure to rinse completely. If the mask is completely clean, it will seal better. Using distilled water in the reservoir cuts down on cleaning. Open up the reservoirs and air dry them frequently. Dark, moist environments grow things you would probably not want to breathe! Change the disposable filters monthly. Breathing through a dirty filter is worse than using no filter, and can restrict air flow!
Most people will feel much more alert while using CPAP- but many people can still feel sleepy even with adequate treatment. Brains respond differently, and much depends on your general health, the medications you are taking and whether or not you are getting enough sleep. CPAPs ARE EFFECTIVE IN LOWERING STROKE AND HEART ATTACK RISK WHETHER YOU FEEL BETTER OR NOT!
GETTING USED TO WEARING CPAP
CPAPs can be hard to get used to. If you are claustrophobic, you may benefit from practicing with your CPAP for a day or two when you are awake and watching TV. Then you can adjust the mask and practice relaxing with the CPAP on before you even wear it at night. At first, you may not be able to wear it the entire night. Patience is key! With time, you will be able to wear it longer and longer through the night. If you rip the mask off accidentally during the night, you likely need a pressure adjustment—call us!
DO NOT DRIVE WHILE SLEEPY! You are seven times more likely to have a car accident if you are sleepy. Just being drowsy can impair you as much as – or more than – being drunk! If you are sleepy when driving, pull over and take a brief nap. We need to know if you are too sleepy to be a safe driver!
MORE RESOURCES: To get on the confidential email list for AWAKE meetings, a free support group, call Samaritan Sleep Lab at 541-812-5470 and leave a message.
More info can be found at www.sleepeducation.com and www.sleepapnea.org.