Posted by BostonBoy on March 18, 2002 at 16:27:09:

In Reply to: Newbie posted by some guy on March 18, 2002 at 14:17:53:

There are 8 things to checklist in the learning & customizing process: .. water .. hose .. nose .. mask .. machine features .. sleep diary .. persistence .. hygiene. Succeeding with CPAP requires active understanding and take-charge engagement in the use and management of all eight.

- Water: use a heated humidifier. I also advocate the use of distilled water, both to simplify daily sanitation and to extend equipment life.

- Hose: route the hose such that there is no U-bend that can collect runback condensate that can gurgle or actually restrict the airflow. Insulate the hose to minimize rainout. Suspend the hose such that it can move freely without dragging on you headgear.

- Nose: use a prescription low-dose systemic steroid nasal spray if an allergic response is making your nasal tissue swell, such that it is impeding airflow and making you mouthbreathe either chronically or intermittently. NEVER use an Afrin-like non-prescription oxymetazoline hydrochloride nasal spray for more than three consecutive nights. Use a chin strap if you habitually mouth breathe even when using a Flonase-like steroid spray.

- Mask: you are already using nasal pillows, but keep in mind that discomfort due to over-tightening can cause arousals that impair sleep quality. The shell and pillows should float on your nostrils and the pillows should have room to be expanded by the lightly pressurized air.

- Machine feature: Make sure that you understand and master all the features of your hardware. The CPAP is there to do your will, not to enslave you.

- Sleep log: My bedside pad records all the settings, mask hours, sleep hours, use of nose management meds, # of wakings, # of leaks, # of bathroom trips, together with subjective scores (on a 1-5 scale) of sleep quality, mental alertness on waking, and overall benefit felt throughout the new day. It's very encouraging to see oneself making progress - and it's the best way I know to impress the Doc or RT that a performance complaint has a basis in fact, if you have to go back to the DME or doctor. It puts on the table evidence that you are not making expected progress, gives them something to work with, and turns you into a clearly compliant, cooperative and willing patient. In the absence of a sleep log you may be perceived to be a complaining whiner - and the providers may find fault with you, rather than fault with their titration, equipment decisions and advice.

- Persistence: Most people need 3-12 months to acclimate to the hardware and maximize the benefit of using it.

- Hygiene: this comes in two forms. Hose and mask sanitation is made easiest by using distilled water and by using the CPAP to blow dry the (emptied) humidifation chamber and delivery hose. The other form is sleep hygiene: the business of going to bed early and at the same time every night, with the aim of getting 8 zzz-free hours every night and establishing a new sleep habit.

There's little medicine and no magic in CPAP: it's physical therapy with indirect but major medical benefits. Maximizing the benefit and minimizing the hassle isn't achieved by passively lying there and 'being CPAPed' badly - only to complain later to the Doc or RT that it 'just didn't work.' Success requires you to take charge in an informed and thoughtful way - and much like giving up smoking, CPAP success requires pro-active discipline and sustained effort on you own part.

Follow Ups:

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