Diagnosed with sleep apnea and CPAP your chosen therapy?

Courtesy of FDA.gov

How to optimize your CPAP or BiPAP use

So you have been diagnosed with sleep apnea, and you and your doctor have chosen CPAP or BiPAP (continuous or bilevel positive airway pressure) as your mode of therapy. Going forward, I will use CPAP to reference both modes of therapy. So what are some of the next steps to successful use of your CPAP? 

Is CPAP for forever?

I am often asked when someone is placed on CPAP if they will need to use it for the rest of their lives. The shortest and most truthful answer is yes. 

Generally as we get older there is more collapse of the soft tissues surrounding the airway, increasing body mass index or weight, less ability to sleep in positions other than supine secondary to musculoskeletal aches, all adding to more collapse of the airway and therefore more development of sleep apnea. 

Patients with sleep apnea can reduce their chances of chronic long-term use of positive pressure devices by becoming more physically active on a daily basis, focusing on exercises that improve endurance such as swimming or weight lifting, and adequate rest.  

How often should I use my CPAP?

Once diagnosed with sleep apnea, you should use your CPAP machine on a nightly basis.  Oftentimes I hear patients not wanting to use it when they have an upper respiratory infection, believing that they do not want another thing to deal with while getting better. I emphasize to them that using their CPAP will actually help them to recover faster and breathe better.  

They will, however, need to be more diligent with cleaning it, including more often on a daily basis to minimize contaminating the machine, which may then lead to prolonged illness.  Only distilled water should be used in the machine.

Your sleep apnea is always with you, and treating it on a nightly basis is the best thing for your long-term health.

From an insurance standpoint, if you are not using your CPAP 70% of the time for more than four hours, your insurance company may decide to not continue paying for your CPAP machine or supplies. If you are having any issues with tolerating the machine or mask, please contact your dispensing DME provider for trying different masks as well a download.

What is a download?

A download is an appointment during which your DME provider either remotely or using your CPAP machine reviews data of your usage and then is able to make appropriate changes so that the machine is set to most closely match your respiratory needs. This can be done remotely or in person. 

Ideally it is first done less than a month after you have been dispensed a CPAP machine, then at three months of use, then at six months and then one year after initiation of treatment. If CPAP is adequately correcting your respiratory events, then you and the provider may decide to go to yearly visits. 

Your machine should be downloaded at least yearly to ensure that no adjustments are needed to your CPAP therapeutic settings and, if you are not followed routinely by a primary care doctor, to obtain at minimum a blood pressure reading. During the visit you can address any lack of use concerns or mask leaks or fittings and review the cleaning of parts and supplies.

How often should I get supplies for my CPAP?

Your DME provider should give you a schedule for getting new supplies with an option for you to decline. Please remember, however, that the machine works best with proper maintenance and supplies that are not faulty.  

Filters should be changed monthly, masks and cushions every three-plus months depending on the type, and a humidifier every year or so.

Please reference my prior articles regarding cleaning your CPAP machines. Use of machines such as So-Clean and Lumin are not approved by the manufacturers and do void your machine’s warranty.

How often should I clean my CPAP machine and its supplies?

Your mask should be wiped with a baby wipe daily and the CPAP humidifier reservoir emptied of water, wiped, and allowed to dry. The tubing should be rinsed in warm water using a non-abrasive dish soap and/or vinegar at least weekly unless respiratory infection symptoms are present; then more frequent cleaning is warranted.

Should I use my CPAP after surgery?

This is probably the scariest question I am asked by patients and other healthcare providers alike. Absolutely you should use your CPAP after surgery unless your surgeon tells you that there was some communication between your nose and your brain such as getting a cerebrospinal fluid leak during sinus surgery or after having some middle ear surgeries. 

More than any other time, your sleep apnea is at its absolute worst after surgery! The general anesthetics that were administered all by themselves worsen sleep apnea, including causing temporary development of central sleep apnea. Any narcotic pain medication further adds to worsening of apnea. 

If you already, for example, had moderate sleep apnea, most likely in the postoperative period the effects of general anesthesia with or without the effects of narcotic pain medications would then make your apnea severe. Therefore, please use your CPAP machine after surgery— even sinus surgery with a bloody nose—just accepting that you will need to clean your mask more often.

How do I know my CPAP machine is working well for me?

Ideally you should feel rested when awakening in the morning after six or more hours of sleep with better energy during the daytime. Most machines will also give you a green happy face or a thumbs-up if they are working correctly and you used it for more than four hours. 

The life expectancy of a machines is about five years, but if at any time you feel that the machine is malfunctioning—not pushing out enough power, or you have a sense of air hunger where you do not feel you are getting enough air for breathing—then please contact your treating sleep provider as soon as possible.

Dr. Inell Rosario is a board-certified ENT and sleep physician practicing at Andros ENT & Sleep Center in Inver Grove Heights, Minnesota. She has many times been recognized as a Top Doctor and Best Doctor in various Minnesota magazines and can be reached at drrosario@androsent-sleep.com or 651-888-7800.

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