Acclimating to CPAP for the Treatment of OSA – Part Two
Obstructive Sleep Apnea (OSA) is a disorder manifest by snoring and pauses in breathing during sleep that results in poor quality sleep, daytime fatigue or sleepiness and can lead to high blood pressure, heart attack, stroke, congestive heart failure, cardiac rhythm disturbances such as atrial fibrillation, diabetes, increased cancer risk and death.
In part 1 of this blog on acclimating to CPAP I told you why we have such a high rate of success? In today’s blog I will offer solutions to many of the most common difficulties patient have in acclimating to CPAP.
I feel claustrophobic when wearing my CPAP mask Many patients complain of feeling claustrophobic when they first have a CPAP mask place over their face, especially with the full face mask and nasal mask styles. A smaller, lighter style known as nasal pillows may solve this problem. If claustrophobia is problematic with any style of CPAP mask, it is often advisable to try to adapt to wearing just the CPAP mask during periods of wakefulness without the connecting tubing or turning the blower on. Once you can comfortable wear the CPAP mask by itself, connect the tubing and the blower and turn it on using a 20-40 minute ramp time. This will allow you to gradually adapt to the sensation of air pressure blowing through the mask. If you find you are not getting enough air, try turning the ramp feature off and turn back on at your prescribed pressure setting. Once you can wear CPAP for 15-30 minutes while awake, it should be much easier to fall asleep and stay asleep wearing CPAP.
I feel like I am suffocating or cannot exhale against the incoming pressure from my CPAP. Here again is where the ramping feature may be helpful. If using the ramping feature does not alleviate these sensations, you may want to adjust the EPR (expiratory pressure relief), C-Flex or other similar feature depending upon which brand of CPAP you are using. These options allow you to start your exhalation a fraction of a second earlier making it easier to exhale. If this does not solve your difficulties, then you may be a candidate for a different type of machine called BiPAP which allows us to adjust the inhalation and exhalation pressures separately to make it easier to breath out against the positive airway pressure. This will solve complaints about difficulty exhaling in most circumstances.
I wake up in the morning feeling bloated or have abdominal pain, belching or flatus. This is usually due to swallowing air during the night while wearing CPAP. Measures that can help include elevation of the head of the bed, use of a chinstrap, taking Simethicone (Gas-X) before bedtime, lowering CPAP pressure (if feasible) or changing to BiPAP.
I awaken with a sore / dry throat during the night or in the morning. This is usually due to not using a humidifier or opening your mouth while wearing CPAP. Because CPAP blows air at a high velocity, you cannot adequately humidify the air and oral dryness is a frequent complaint. This is usually resolved by utilizing the humidifier on your CPAP. Mouth breathing will allow air to escape through the mouth and create additional dryness. This can be alleviated by using a chinstrap.
I have difficulty using CPAP when I have a cold. Anytime a patient has nasal congestion, whether from a cold or allergies, there may be difficulty using CPAP. Use of nasal steroid sprays, nasal antihistamine sprays, oral antihistamines or decongestants will allow most patients to utilize their CPAP even during periods of increased nasal allergy symptoms or colds. OTC nasal sprays are to be discouraged as they often improve symptoms initially, only to worsen congestion over the next few days of use.
I start each night wearing my CPAP mask only to find that I have unknowingly removed it at some point during the night. This is most often due to your sleep being disturbed or lightened and then you become aware of something on your face and either scratch at it or inadvertently remove it. This can occur if the seal around your mask loosens, you become uncomfortable during the night from a variety of reasons, a noise awakens you, a pet in the bedroom, movement from your spouse or other disturbances such as periodic limb movements during sleep or gastro-esophageal relux disease. Assuring a proper fitting mask, a comfortable bed and bedroom environment, removal of pets from the bedroom and treatment of any associated medical disorders that can affect your sleep will often resolve the problem of mask removal during the night.