Untreated OSA (obstructive sleep apnea) could result in the patient not having a good quality of life with high chances of it turning into a potentially life-threatening problem. Even though patients buy the CPAP machine, they often have little idea on how to get optimal CPAP treatment.
These patients also have limited options to turn to when they encounter various issues with their machine. In fact, many patients start CPAP treatment but give it up midway due to discomfort caused by the CPAP equipment as well as lack of proper therapy information in any simple understandable terms. This article attempts at providing solutions to some common CPAP machine troubles.
Some of the common snags that a CPAP user faces are briefly explained below:
Aerophagia has been derived from Greek, "phage" connotes "to eat" and the word aerophagia literally means “to eat air.” Aerophagia, in medical terminology, denotes swallowing excessive amounts of air, which can cause users to have a bloated stomach and belching. This is typically a temporary problem that arises as the user gets adjusted to either a new mask or PAP; however, in some patients, it can be a recurring problem.
Symptoms of aerophagia can be both social as well as medical and ranges from being in pain to merely having moments that are socially embarrassing. It is advisable to see the doctor to ensure the user does not have any other digestive disorders. Regrettably, there is not a perfect remedy for this and all the solutions are aimed at finding a middle ground between various CPAP pressures.
Some of the tips to counter aerophagia include:
- Inform sleep doctor about the issue and seek advice with regards to decreasing CPAP level to comfortable level and bear with minor breathing problems if it can reduce the problem of bloating to a significant extent. This is actually a trial-and-error method and sometimes it would click and sometimes it would not. The user can check out with the sleep doctor if an auto CPAP can be considered since these reduce the average pressure that the CPAP user receives. Settings should be changed under supervision as the pressure at the highest level would only make things worse.
- The CPAP user should try to ensure that whenever possible, the chin must be kept at a raised position compared to the torso, as chin at a lower level (near chest ) leaves enough room for air to enter the user’s digestive tract.
- The user should try sleeping in a different position (right side, left side, flat, inclined with pillow support) than the usual pattern, as it would help in keeping the air out of user’s stomach.
- Sleep with head in an elevated position
- Trying to keep the chin at raised level by using a neck pillow, PAPillow, or even a memory foam pillow. But the user has to ensure that it is compatible with his/her mask while he/she sleeps on the side. The golden rule is one should be able to place a fist between the chest and the chin.
- The user can opt for APAP machine. If he/she is already on APAP, they should try to decrease the top pressure or even trying the straight CPAP mode, provided the apnea-hypopnea index (AHI) remains low.
One can also deal with aerophagia in following ways:
- Trying out either auto Bi-PAP or a normal Bi-PAP machine.
- Drinking a fizzy drink or carbonated water in morning hours to enable belching out gas
- Doing yoga, especially wind-relieving postures which can help compress the abdomen
- Trying products such as Gas-X for relieving digestive gas present in the stomach
- Trying activated charcoal pills that are available OTC for discharging digestive gas present in intestines
If a CPAP user is using a pillow (soft or hard) for keeping the face mask in its place, then most probably either the user has an ill-fitting mask or has selected a poor quality mask. The user should try to adjust the fitting or buy a new mask.
On the other hand, if mask is perfect, but the battle is between the pillow and the face mask, then the user could try using a smaller but firm pillow, which would allow mask to hang off on the side; or alternatively can use memory foam pillow, neck pillow or buckwheat pillow that can provide the mask with support.
A point to note is that pillow should have no interference with the facial mask, especially if the user likes sleeping on the sides. While buying a new pillow, the user can preferably check out the pillow to ensure there is no issue which could crop up.
A lower AHI has been reported by CPAP users when they try the bed-wedge pillow. These can be bought both online and from stores. While linen stores might offer lower bed-wedges; online stores and medical stores might offer their customers a memory foam bed wedges as well as higher bed-wedges that can be used along with PAPillow.
For CPAP users who sleep on their sides, hose management is an important issue. Ideally, there should not be any hanging hose between the bed and the CPAP machine as this would put increased weight which would create a side force on the user’s mask, resulting in discomfort and leaks. The best way to reduce the side pressure is ensuring that a portion of the hose is on the bed and not completely hanging.
In order to have a proper hose position, the CPAP machine should ideally be placed below the head level of the user (low footstool, lowest shelf of night-table). This would help in minimizing rainout or condensation from the humidifier as well as reduce noise, thereby preventing water leakage if the humidifier tips over. The hose should be attached to the mattress and subsequently the wall or headboard using clamp, hook etc. or even a hose clip which is readily available both in stores and online.
Having the hose above user’s head would leave enough room for the hose to coil around which would reduce the pressure on the mask, which in turn would reduce leaks. It also allows the user to change positions without worrying about leaks. However, there can be an exception to this (like hose management in nasal pillows, where the hose has to come from below).
Rainout (Condensation) in Hose
When a user uses a heated humidifier (as part of PAP machine) in a cool bedroom, he/she may encounter condensation in the hose between humidifier and face mask. These water droplets can drip onto the user’s face and cause mask leaks as well as discomfort.
The golden rule to eliminate rainout is to keep hose under blanket used by users, however, this rarely works. Some remedies to either reduce or completely eliminate rainout include:
- Raising room temperature (should not be uncomfortable to user)
- Placing the humidifier and the machine below bed level, ideally on a footstool or a low shelf, so that the hose (6-foot long), as well as any water droplet in it, would have to travel some distance before reaching headboard. The user might need 10-foot-long hose in case the bed is very high. The hose can be held in place using clips or hooks or ponytail band that is pinned to mattress’s edge and another hook or clip on the headboard.
- Turning the heated humidifier to a setting that is coolest and lowest might help. If this is not helpful, then the user can turn off the heat but can continue using the humidifier (Passover or passive humidification). However, if the user develops nasal congestion or dryness in mouth or throat, seeking medical advice is advisable.
- The user can try wrapping hose in light socks, bubble wrap, tights that have toes cut, or either buy or make a fleece hose cover. If the face mask has a hose, then that should also be covered. A light covering decreases the drag on the hose as well as weight.
- One method of eliminating rainout completely is purchasing heated hose. If required, the heated hose can be covered with a second hose cover. Users can use this heated hose both during winter and summer.
One of the most important equipment in a CPAP machine is the mask and it is very important that mask has an outlet for clearing the exhaled CO2. One should never cover the opening with covers. The mask should be allowed to vent.
When the user gets the face mask, then he/she should inquire about the vent and make a note of its presence since vents can be very difficult to see. If unsure about the vent, then one way to determine the location is - turn the machine on, wear the mask and feel the place through which the air comes out.
Of note, nearly every vent in the mask is placed forward from the user’s face, which results in the air blowing out to user’s arms, hands and/or even the bed partner. To avoid this the user can either sleep with arms placed under the pillow or covers, wear long sleeves or gloves as well as place some protection for the bed partner.
More creative options are required to tackle the vent problem, and one hopes that mask manufacturers develop a design that would help in eliminating this issue.
Other Common Problems with CPAP Mask
Besides the above-mentioned, there are other common problems when it comes to using CPAP mask. These include taking off the CPAP mask inadvertently while sleeping, having issues using masks in people who have long hair, drooling, skin irritation and nasal pillow issues.
Inadvertent Removal of CPAP Mask During Sleep
Many CPAP users inadvertently remove their CPAP mask in their sleep. As such, ideas for preventing this problem from occurring are very few and the ones present are mostly developed by users through trial and error. Basically, removing the mask from the face while sleeping indicates that the body has still not accepted the mask and treats it as a foreign substance. There are few ideas which can be used to avoid this problem. These include:
The user should wear a mask (not connected to machine) one to two hours before going to sleep. While wearing it, one can indulge in activities which he/she enjoys ranging from reading books to listening to music and even watching television. This essentially tricks the brain into linking the mask with enjoyment and chances of brain accepting it and not commanding to remove it subconsciously are more.
A user can fix the mask to his/her head using a tape or hair clips. This way when a mask is being removed subconsciously, it would pull hair making one get up and reattach the mask
If the user has a nasal mask, a CPAP chin strap can be used which would help to keep the mask in place.
Issues With Long Hair
- If the user has long hair, it can be kept in a ponytail and pulled under the mask’s top strap. Once the bottom strap of the mask is secured, then the hair is held securely in place
- Users can also try strapping the mask over the hair while laying down, flipping the hair up and adjusting the pillow to help secure the bottom strap in place. This would, however, require the user to get up to adjust either the mask or strap during the night
- One can also opt for a shortcut to avoid issues with the mask
Drooling happens when the mouth is open. In case a user has drooling issues while wearing the mask, then the mask is not an ideal fit. To avoid drooling, the user can try a chin strap and if using a full face mask, can use a mask with a chin cup. These help in preventing the mouth from opening too much.
- One has to pay proper attention to the cleaning products used for cleaning the CPAP mask.\
- Every single CPAP manufacturer stresses on using mild soap for gently cleaning the CPAP mask frames and cushions.
- Many mask manufacturers specifically instruct their mask users not to use any antibacterial or harsh products for cleaning the masks.
- In case of any skin sensitivity or allergy issue, users can opt for mild products like Ivory Dish Soap liquid.
- Finally, to remove any odor present or soap residue that can be left behind in the humidifier chamber or the mask, the user can give the mask and the chamber a thorough rinse with vinegar water, which has proven to be the only effective remover of the residue developed over a period of time.
Issues With CPAP Nasal Pillows
- If nasal pillow is leaking, then the pillow is not an ideal fit and the user can go one size up
- Many nasal pillow users complain of nostrils getting irritated, which indicates that the nasal pillows were “forced” into the user’s nostrils. The nasal pillow should be placed just into the nostrils and not forced too deep.
- If the user’s nose is being pushed up while using the nasal pillow, then the interface is being worn incorrectly. Readjustment can solve the problem.
- If the users feel their nostrils are getting irritated, they can apply Neosporin, which would not only help in lubricating the nostril but also help in healing it.