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Adjusting to CPAP, first draft

Posted by TeleBlaster on April 02, 2001 at 08:41:26:

On 3/30, I suggested we collaborate to put together a message about adjusting to XPAP treatment for newbies, perhaps for the "Best Of" forum. Here's my first draft; feel free to respond with further suggestions. This may end up as a FAQ, which wouldn't be a bad thing either.

So, you've got yourself a CPAP/BiPAP/AutoPAP machine!

Well, there is a significant adjustment period necessary to get going with your treatment. Below are some of the more common experiences reported by our readers.

1. Sleepless nights. Let's face it, you've never tried to sleep with a Darth Vader mask blowing air up your nose before, except during your sleep study. It is normal to have difficulty sleeping the first few nights with your machine. Instead of pressuring yourself to sleep with it, try to simply relax with the machine on. If you can learn to relax with it, you can learn to sleep with it. Some folks assist their adjustment with medications: Benadryl or other antihistamines can make you good and drowsy, others swear by Ambien (a prescription-only sleeping pill). It is probably smart to use medications only for the first few nights, rather than to rely on them to get you to sleep on a regular basis, as some medications can worsen the symptoms of apnea.

2. Sores on my nose. When you start wearing glasses, it is normal to get a bit of a sore on your nose where the glasses rest, even though the glasses are light and don't put much pressure there. Same with your mask. To adjust, some people use moleskin, tape (micropore paper tape, athletic tape, etc.), or even band-aids to help decrease the pressure on your nose until it toughens up a bit. My respiratory therapist recommended alternating nights with and without tape to help my nose toughen up faster. But don't ignore it, she says she has seen people with large, open sores on their noses, even with the gentlest masks!

3. Adjusting the mask (or nasal pillows). Everybody's face is different. That's where it is essential to find the right mask. Ask your DME which masks they have seen a lot of success with. If you can't seem to work the leaks out of your mask, your DME should work with you to help you find the right mask. Your first instinct will be to tighten the mask to try to work out leaks, but that is not always the smartest idea. You will probably wake up with your whole face sore if you carry that too far. Try loosening it as well. Also, try to work with it during the day, when you're not trying to sleep. Once you find a comfortable setting, try to leave your headgear adjusted that way. Also be sure to clean and dry your face before bedtime. A clean, dry mask on a clean, dry face works best!

4. Humidity and mouth-breathing. Is your mouth dry? Perhaps you need a humidifier. There are 2 basic types - cool, passover humidifiers (the air passes by a tank of water between the machine and your mask) and heated humidifiers (the water is heated, thus releasing even more moisture into your airstream). A lot of folks have success with one or the other. Talk to your doctor or DME. Or your dry mouth is not caused by lack of humidity at all, you may be mouth-breathing. Chin straps or full-face masks seem to help with this. Chin straps can be purchased from your DME, the Sleep Mall, or homemade. Do a search on this forum for suggestions.

5. I feel funny inside. Some people experience a bit of discomfort in the chest after beginning PAP therapy. Usually this is simply because you are breathing deeper and with more effort than you are used to. If you experience this, discuss it with your doctor. You don't want to mistake this for a heart attack! Some folks also have difficulty with swallowing some of the forced air, thus causing a lot of "gas." This isn't really gas, which is caused by the fermentation of digested food, but just swallowed air. Raising the head of your bed a couple of inches, adding a bed wedge, or AutoCPAP are common solutions for this. It is called "aerophagia" and there are many posts about it on this forum. You can search the forum for this topic and learn a lot.

6. I'm not sleeping enough! According to my respiratory therapist, a common experience is to go from 7-8 hours of sleep without CPAP to 4-5 hours of sleep with CPAP. This is because your body has gotten all the rest it is used to, and decides it's ready to go. You have gone from a good quantity of low quality sleep to a lower quantity but higher quality sleep. She says this problem usually goes away by itself, as your body eventually realizes it can catch up on the sleep it has missed over the years.

7. I take the mask off at night, and don't realize I'm doing it. This is common until you get used to sleeping with it on. Again, most people report that this problem usually goes away by itself as you adjust to wearing it.

8. Cleaning my gear. Don't get too obsessed with hygiene here. The recommendations I have seen include cleaning the mask and headgear with something mild, like baby shampoo or Neutrogena, once a week or so. Stronger, perfumed, or antibacterial soap can harden the soft parts of your mask and decrease its life span. My RT recommended using a clean, damp cloth on the mask daily, with baby shampoo once a week or so. Clean the hoses and humidifier tank with vinegar and water, but that doesn't have to happen too often either. Using distilled water for your humidifier tank can make it last longer, too as you'll not have to worry about lime scale, sediment, chlorine or fluoride.

9. How soon will I feel better? Some people report immediate relief from the first good night's sleep, some people report it took 4-6 months to notice a difference. Most people report something in-between. Give it a few weeks, and try to notice small improvements along the way. It is likely that others will notice the difference in you before you do.

10. Always use your machine when you sleep, including naps and travel. There is a lot of information on the web and in your owner's manual about this. It is essential to get a good-quality extension cord and a power strip for hotel stays. Never run your machine through baggage check, always pack it as carry-on. As it is medical equipment, it shouldn't count toward your carry-on baggage limit according to the Americans with Disabilities Act (ADA). There is information on that in our forum too, do a search. Your owner's manual should let you know how to hook up to DC power for camping, etc. If not, there's good info on the web and in this forum as well.


Whaddaya think? --- Willie

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