Here are some Helpful Hints to common problems that users may encounter

 

Mouth leaks are a common problem among many CPAP users.  It may be caused for a variety of reasons.  You may need a better mask to fit the particular contours of your face to accommodate high pressures.  Full face masks can accomplish very easily. Another fix for this problem may be that you need to use a chin strap, which CPAP Shack can provide you with.  Also, another quick fix without having to purchase more equipment may include sleeping on your side. 

Stuffy Noses are common issues for many CPAP users.  Even after a short period of use, this may become problematic.  If this is a continual problem, it would be important for you to purchase a humidifier.  Heated humidifiers are preferable as they are the most efficient.  An alternative choice to the purchase of a humidifier is to use a saline nasal spray before bedtime.  A nasal spray such as AYR can be purchased at any drug store and the generic brands work just as well as name brands.

Open sores on the bridge of the nose or mask marks on the face are common problems.  If the mask is cutting into your face you need a different size or design of mask.  It is ether to small or does not contour to your face well enough.  If you have to make a mask super tight to get it to seal you should try another mask. Try printing out or ordering a sizing gauge before you make a purchase. Some masks are harder then others to size.  If you have any question when choosing a mask please Email us.  If you can email us with 2 pictures of your face we will be better able to make a judgment call on what you should try.  Please send us a frontal picture and a side view of your nose.  It may not be perfect but we will get you closer to a better fit.  The only way to get it perfect is to have an expert size you in person.  You may want to check and see if your doctor can send you to a sleep clinic were they can size you with the correct mask before making your purchase.

Gas or stomach bloating is also a common complaint after using CPAP.  It is nothing to worry about but it can cause discomfort.  One solution to this problem may be that a chin strap is needed to prevent air from building up in your stomach.  It may be that while you were sleeping your mouth was coming open in the middle of the night.  This will continue to build up throughout the night until it becomes quite uncomfortable.  In extreme cases your doctor may want you to take a medication to reduce the gas.  You should always consult your physician for any decisions on your form of treatment.   

 

 

Good Sleep Technique

First off you need to establish a regular routine that includes going to bed and getting up at the same time every day, even on weekends. Being consistent with your sleep is the key along with Regular exercise. This will help you get deep restful sleep.

 Lying in bed tossing and turning worrying about when am I ever going to fall asleep is not the answer. If your have difficulty falling asleep or you wake up shortly after going to sleep, leave the bedroom and read a boring book quietly or do some other relaxing activity. Avoid watching TV or other stimuli like bright lights as this can cue your body that its time to be awake.

If you’re a Clock watcher do not sleep with a clock you can see in the same room. If you need an alarm clock set it and turn it around to face the wall.

Doing activities in bed like watching television or working on stuff  is only  going to get you all wired up. Let your mind associate the bed with sleeping and relaxing only.

Avoid going to bed hungry. A light snack, especially dairy foods, can help you sleep.  For Example the Warm Glass of milk before bed.

Do not drink coffee or Smoke a cigarette 4-6 hours before going to sleep. Stimulants such as these interfere with your ability to fall asleep.

Self Medicating by drinking a beer or a glass of wine before bed to get yourself to sleep. The alcohol may initially make you tired, but alcohol affects your Sleeping pattern giving you a bad night’s sleep in the end. Alcohol will also make your snoring and sleep apnea a lot worse so avoid it before bed.

 Try not to take naps all together this will help to make sure that you are tired at night. A Long nap disrupts the body's ability to stay asleep and your ability to get to sleep. If you feel the need to take a nap even after a good night sleeps you need to get a sleep study to see why you have Day time sleepiness.

Please don’t use sleeping pills if you have obstructive sleep apnea.  Sleeping pills and Sleep apnea can be a deadly Cocktail! Sleeping pills can be very addictive and should not be used beyond a physician’s recommendation.

 

 

 

Components of a Sleep Study

You may be curious about a sleep study that you will soon have or maybe you are interested in learning more about the sleep study you are about to participate in.  In any case, CPAP Shack’s motto is “Educated Clients make better Consumers”.  The more you know, the more comfortable you will feel about some of the changes you are making in your life to improve your health. I hope that the following will help you in making sound decisions about your health!

EKG (electrocardiogram) is a recording of the electrical activity of the heart. An electrocardiogram is a simple, non-invasive procedure.

EMG (electromyogram) is the measurement and recording of muscle activity, particularly under the chin, along the jaw, and on the legs (to detect periodic limb movement disorder).

EOG (electro-oculogram) detects and records eye movements.  This is essential in determining the different sleep stages such as REM or wakefulness.

EEG (electroencephalogram) is a study of the electrical current within the brain.  These are the rhythmic patterns of brain activity which include Alpha, Beta, Delta and Theta Rhythms.  Alpha Rhythms are predominant during relaxed wakefulness, particularly when your eyes are closed or you are in the dark. Beta waves are associated with alert wakefulness.  Delta Rhythms occur chiefly in deep sleep stages 3-4, also known as slow-sleep. Theta Rhythms are associated with the light sleep stage 1 and 2.

Oxygen Saturation is the measure of oxygen carried by hemoglobin in the blood. Normal values range between 90% to 100%.

Snore microphones detect rough rattling noises made while inhaling during sleep.  This is brought on by the vibration of the soft palate (the back of the roof of the mouth) and the uvula (the prominent structure dangling down at the back of the mouth). On inhalation, air travels past the tongue, the soft palate, the uvula, and the tonsils and eventually to the lungs. When a person is awake, the muscles in the back of the throat tighten to hold these structures in place and prevent them from collapsing and vibrating in the airway. During sleep, the soft palate and uvula may vibrate causing the sounds of snoring. Snoring is believed to occur in anywhere from 30% of women to over 40% of men

Body positions are recorded.  There are four basic sleeping positions.  They are: sleeping on your back, on the left side, on the right side or on the abdomen. The time the patient spends sleeping in each position and the number of respiratory events in a particular position is recorded. 

Belts are positioned around your stomach to record breathing effort. 

Air flow is recorded from your nose and or mouth.

 

 

  EPWORTH SLEEPINESS SCALE

The Epworth Sleepiness Scale developed by researchers in Australia is widely used by sleep professionals around the world to measure sleep deprivation.  It is a questionnaire that measures the likelihood of sleep deprived individuals inadvertently falling asleep in certain situations.  Questions are based on how you have felt in the last few weeks . This score will give a good picture as to whether you have a sleep disorder that needs to be checked out by a sleep doctor. Please go HERE for the test.

 

 

 

                                                      SLEEP APNEA 

“ The Greek term "apnea" means "without breath." There are three types of apnea: obstructive, central, and mixed. Obstructive is the most common out of all three.

Obstructive sleep apnea (OSA) is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe. Mixed apnea, as the name implies, is a combination of the two. With each apnea event, the brain briefly arouses people with sleep apnea in order for them to resume breathing, but consequently sleep is extremely fragmented and of poor quality.

Signs and Symptoms of OSA

• difficulty concentrating
• excessive daytime sleepiness
• frequent episodes of obstructed breathing during sleep
• irritability
• insomnia
• high blood pressure
• chest retraction during sleep in young children
• morning headaches
• excessive perspiring during sleep
• dry mouth
• change in personality
• depression
• rapid weight gain
• confusion upon awakening
• reduced libido
• heartburn
• loud snoring
• overweight
• frequent nocturnal urination
• restless sleep
• nocturnal snorting, gasping, choking 

An understanding of the basic terminology used by doctors and clinicians can help you in your quest for better health.  These terms include:  Apnea, which is when you completely stop breathing for 10 seconds or more in adults and at least three seconds in infants; Hyponea, which refers to a reduction but not the cessation of ventilation ( Shallow breath ); Central Apnea  which is when the respiratory control system in the central nervous system does not give the muscles used in breathing the signal to take that breath, lastly, Respiratory Effort Related Arousal, (RERA), which refers to an obstruction that does not meet the criteria for either a Hyponea or Apnea but still can cause an arousal from sleep.

These ventilation issues are measured using the frequency and the number of events per hour of sleep. Most labs report this as AHI or Apnea Hyponea Index. Another way to report it is utilizing (ROI) Respiratory Disturbance Index which measure Apneas, Hyponeas and RERAs.  The severity of OSA is determined by the ROI's per hour. A  mild sleep apnea is 5-15 events, moderate is15-30 and severe cases are indicated when more than 30 events are observed.

Sleep Apnea has the potential to be one of the most devastating influences on your health  implicated in various health problems such as cognitive disorders, cardiovascular disease, high blood pressure, memory loss, stroke, heart disease, right sided heart failure, heart arrhythmias and, lastly, daytime sleepiness. 

While daytime sleepiness may seem to be the least in the list of possible poor outcomes for sleep disorders it can, in fact, play one of the most significant roles in your health.  Potential  consequences include accidents, negative economic and public health outcomes, reduced work and academic performance, and impaired psycho-social functioning.  Historically and environmentally significant instances include major industrial disasters such as those at Chernobyl, Three Mile Island, and Bhopal.  Also included in this horrific list of catastrophes involve the Exxon Valdez and Challenger events.  After investigation, these accidents have been officially attributed to errors in judgment caused by excessive sleepiness in the workplace. Statistics demonstrate that each year, in the US alone, car crashes involving drivers falling asleep at the wheel exceed 100,000 in number and result in at least 1,500 deaths. This death rate may even surpass alcohol-related crashes.

 

 

SLEEP APNEA AND SLEEP STAGES

Often times, new users of CPAP begin their night on the right track, using their CPAP.  Sometimes, however, compliance is not continued throughout the night.  Failing to use CPAP for the entire night is a great disservice to your health. The large part of REM sleep, the most restful part of sleep, is toward the end of the night between the hours of 4 to 6 am. REM sleep commonly termed 'Dream Sleep' is essential to getting a full night's rest.

There are 5 stages of sleep beginning with stage 1 and ending with stage 5.  Stage 1 lasts approximately 1-7 minutes at the onset of sleep. It is a transitional stage between wakefulness and sleep. Stage 2 takes up the largest portion of your sleep time.  While it is a bit deeper than stage 1, it is still considered to be a light shallow stage of sleep.  Stages 3 and 4 are deeper  slow wave sleep. Stage 3 is more of a transitional stage to 4 some where between 2 and 4. REM sleep is Stage 5 Sleep.  During this stage, muscles go completely slack. The most significant OSA events occur on your back in REM sleep due to this loss in muscle tone. The muscle tone still present in stage 1-4 has disappeared and so it no longer keeps the airway open.

Your first REM appears about 90 minutes after you go to sleep.  Then the cycle begins again back to stage 2 as the night progresses stage 3 and 4 get shorter and your REM gets longer.  At 5 am your REM is at its peak lasting up to 1 hour long.  By this time of the night, your stage 3 and 4 are almost non-existent.

A normal sleep pattern has about 4-5 REM cycles. The night would go something like this Stage 1 – 2-3-4 -REM then back to stage 2 -3-4 –REM then back again to 2 repeat 4 to 5 times with the last one have very little to No stage 3 and 4 in it and the REM time getting longer and longer while the Deep sleep stage 3 and 4 get shorter.  What sleep apnea does is disrupt this cycle. The deeper the Sleep the more OSA your going to have. You have to come out of those deeper stage back to stage 1- 2 to take a breath this fragments your Deep sleep and REM. By not allowing you any deep sleep or very little you will never feel refreshed.  A sleep apnic person will get a lot of stage 2 light sleep and very little Deep or REM sleep. So even though you say How can I not be sleeping well I sleep all the time 9-10 hours your getting a lot of sleep but not the quality that counts to feel rested and not be falling asleep every chance you get.

In conclusion if you’re taking your CPAP off at 2 or 3 am your doing yourself a disservice just before you need it the most. Your apnea is going to be at its worst and your reparative sleep at its best.

 

 

 

 WHY EVERYONE NEEDS A DIFFERENT PRESSURE

Everyone Needs a Different CPAP pressure to open there Airway. Think of it like a balloon. Some balloons are hard to blow up and hurt your cheeks others are slightly easier. An airway that is hard may not even move to open until you get into the upper pressure ranges. Your weight and severity of your obstructive sleep apnea (OSA) does seem to play a large part in how high of a pressure you may require. The pressure acts like a cushion of air to hold up what gravity is trying to push in.

Gravity seems to be a big player in OSA. This is why most OSA patients train themselves to sleep on there sides rather then there backs. Because of this some OSA patients can be treated with positional therapy there airway will stay open as long as they do not lay on there back.  The more weight you carry the harder it is to keep your airway from collapsing under your own body weight because gravity is pulling down on it. That’s why a good indicator of OSA is your neck circumference. There is of course a number of other reasons to have OSA for example your tongue falling back into your airway when you’re on your back once again due to gravity. Then there is you’re over weight stomach pushing up against your diaphragm again relieved by lying on your side to keep gravity from pulling it into your diaphragm. The stomach instead lies to the side along with your tongue. This is all compounded by your sleep stages and what happens in them . There are also the genetic reasons the shape of your Jaw, the size of the airway opening and the size of your tonsils / adenoids. These are just a few reasons for a patient to have OSA.  As you can see it is not so cut and dry that you’re over weight and that’s why you have sleep apnea. Sure it does not help but it’s not the only reason. Most people who are moderate to severe have more them one problem going on. This is why fixing one problem through surgery or weight loss may lower the pressure you need but not always fix the entire problem all together.  This is not to say that for most moderate to severe apnea patients that losing the weight will not get you off of CPAP. It may just get you into the realm of Very Mild which can be then treated by alternative measure such as positional therapy, surgery or possibly a dental piece. Each person has there own combination of problems which they would need to discuss with there doctor but the first thing you need to do is get on CPAP loose the weight and then go from there. There are the lucky one’s out there you hear about who correct one problem and our fixed for ever but like all things we all can’t be that lucky. My advice to you is when you do correct something through surgery or weight loss you go back for a repeat sleep study to get an idea if you truly are with out OSA. You may think you’re all fixed only to find out you need a lower CPAP pressure.

 

 

 

A LITTLE HISTORY OF CPAP

 

The first use of pressure support was in 1912 for maintenance of lung expansion during thoracic surgery. Then in 1967 we started using intermittent positive pressure ventilation for the treatment of Adult respiratory distress syndrome. Then in 1971 was when the term CPAP was first being used in the treatment of premature babies with HMD. The modern definition of CPAP as an effective treatment for OSA started in 1981.

CPAP or what it stands for Continues Positive Airway Pressure although not a cure is the only method that will assure the airway stays open during sleep for people with moderate to sever sleep apnea

 

 

 

 SLEEP DISORDERS TREATMENT

 

 

There are a number of different ways to help your sleep apnea losing weight and or sleeping on your side are often suggested by pysicians. There are also Dental Devices that help to keep your airway open . They help by bring the jaw forward elevating the soft palate and holding down the tongue from falling back into your airway.

Moderate to severe Sleep Apnea is best  treated with a CPAP (Continuous Positive Airway Pressure).  CPAP gives you a single set pressures through a nasal mask worn over the nose and or mouth. It puts a pillow of air into your airway to hold it open from collapsing .

Bi-level (BI = two pressures or BIPAP and VPAP)  is an air compressor that gives you two pressures. It works the same as a CPAP but allows you  to exhale at a lower pressure.  A BIPAP is generally for people who cannot adjust to the constant pressure of a CPAP or are on very high pressures that are difficult to adjust to on CPAP.