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Posted by Greg Harper on March 07, 1998 at 08:37:33:In Reply to: Getting Used to CPAP--A Few Questions posted by John on March 05, 1998 at 18:36:58:
John:
There is still improvement to be had. It will most likely take another two weeks to be able to sleep through the night with CPAP. Also, don’t be surprised if you wake up in the morning and have taken the CPAP mask off and have no memory
for it in the morning. This is a very common occurrence and it doesn’t mean that the therapy will not work for you.In my experience, with adults and children, it takes about three months to develop a good sleep-wake cycle. First work on good sleep hygiene, then getting through the night with the CPAP mask in place, then work on getting 8 hours of continuous sleep. Contrary to popular belief, no machine or pill will replace a good night’s sleep over the long haul.
Good Sleep Hygiene
Now that your sleep apnea has been corrected with PAP therapy you will need to develop good sleep habits that will maximize your ability to sleep. Perhaps you will need to unlearn some bad
ones that developed while you were trying to cope with sleep apnea. Here are eleven rules for
better sleep hygiene:1. Sleep as much as you need to feel refreshed and healthy the following day, but not more.
Curtailing the time in bed seems to solidify sleep; excessively long times in bed seem related to fragmented and shallow sleep.2. A regular wake up time in the morning srengthens your circadian sleep cycle and will lead to regular times for falling to sleep.
3. A steady daily amount of exercise probably deepens sleep, but try not to exercise vigorously
within three hours of sleep.4. Occasional loud noises (eg, aircraft flyovers) disturb sleep even in people who are not awakened
by noises and cannot remember them in the morning. A sound-attenuated bedroom may help those who must sleep close to noise.5. Although excessively warm rooms disturb sleep, there is no evidence that an excessively cold
room solidifies sleep.6. Hunger may disturb sleep; a light snack may help sleep.
7. An occasional sleeping pill may be of some benefit, but their chronic use is ineffective in most
cases.8. Caffeine in the evening disturbs sleep, even in those who feel it does not. Nothing with caffine after 7:00 pm.
9. Alcohol helps tense people fall asleep more easily, but the ensuing sleep is then fragmented.
No alcohol after 7:00 pm.10. People who feel angry and frustrated because they cannot sleep should not try harder and harder
to fall asleep but should turn on the light and try to do something different until you feel sleepy again.11. The chronic use of tobacco disturbs sleep.
It is likely that more improvements will be noticed.
Now, about your dealer...try getting your insurance company involved. Nothing
strikes fear into the heart of a medical equipment dealer like the denial of a claim. It is likely that you are renting the equipment for a while. Let the dealer know that for the second rental month you would like to try another type of mask. You might (tactfully) suggest returning the equipment and finding another dealer who will let you try another mask. This should give you some leverage. Don’t do it too often however, the masks do cost the dealer some money and some of them can’t be reused.I suggest using the Monarch Mini Mask from Respironics Inc. It has many features that make superior to other masks, especially nasal masks. The reason that nasal masks are “popular” is that they are the ones that used most often by sleep labs because they can be cleaned and used over again. The Monarch mask is for single patient use so most labs don’t use they because they are not cost effective. The down side of the Monarch mask is that it only comes in one size and they do not work well with small or wide noses.
The epidemiological suspicions are correct. Respiratory therapy equipment has had a notorious history for harboring microbes, especially when humidifiers are added to the circuit between the machine and your nose. Fortunately, your bodys’
own defense for fighting germ invasion...the nose...is still intact. But it’s still
important to clean the circuit (hose, mask, humidifier etc...) on a regular basis. The mask should be cleaned with soap and water every day according to most manufacturers. The large bore tubing can be cleaned with soap and water, rinsed,
and they soaked in a one-to-one solution of white vinegar and water for at least 20 minutes. Then rinse it again to get the vinegar smell out of it. White vinegar has been used for years to clean respiratory therapy equipment in the home. It takes care of most pathogens that can cause respiratory infection. If the smell of vinegar
is too much for you, you can purchase a product called Control III from your equipment dealer. It is more expensive initially than vinegar but is more effective in the long run because it can be stored for a longer period of time and reused.Lastly, if sinus congestion is a problem contact your physician about getting a
prescription for a steroidal nasal inhaler. Nasal congestion is a common problem
when first starting out on CPAP.Good luck! Let me know if I can be of any further assistance.
Sincerely,
Greg Harper, RRT, RCP
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