Getting Used to CPAP

It sucks to have sleep apnea!  Untreated sleep apnea frequently leads to chronic fatigue, weight gain, headaches, being tired all the time, chronic diseases like congestive heart failure, dementia and premature death.  The best treatment for reversing all this badness is CPAP (Continuous Positive Airway Pressure). Adjusting to CPAP is hard. Only about 20 % of people use their CPAP routinely which is why Medicare requires documentation that a patient is using it at least four hours a night or they come to the patient’s house and take away the $1000.00 medical devise.

Humans are very adaptive to that which we have to adapt to, but not so much if we are not convinced we have to.  For instance, I can put on my mask and eventually fall asleep but if my sub-conscious doesn’t believe I have to wear it then I will remove it in my sleep.  The computer in the CPAP monitors the time of use and leak of mask use.  Studies show it takes one to three months to learn a new habit.  The first thing you have to do is to convince yourself you have to do this.  There are worse things than death and a slow spiral into Congestive Heart Failure and Dementia are one of them.  The significant risk of that fate convinced me.  

Once you are convinced consciously and subconsciously you have to win this battle, then you commit the necessary resources to win.  If my childs’ life depended on me using my CPAP every night all night long then it would be reasonable for me to staple-gun, gorilla glue or duct tape it to my head.  I’m not recommending the staple-gun or gorilla glue but the duct tape is still on the table. 

Studies show Ambien, which is a sleeping pill, significantly increases the success rate of getting use to CPAP and I usually encourage its use for the first 1-2 months, but in a special way.  I have my patients break it in half and leave it by the bedside with a glass of water.  If they are not asleep in 15 minutes, they take the first half, if they aren’t asleep in 30 minutes later, they take the second half.  Over time they wean themselves by being asleep.

An AutoPAP is a CPAP that automatically adjusts to give you more pressure when you need it and less when you don’t.  I try very hard to get my patients an AutoPAP instead of a CPAP from the beginning.  You might need 10 cm of pressure to prevent apnea at your most relaxed state of sleep – Rapid Eye Movement (REM) but you don’t need that much to prevent apnea when you are just lying there thinking that you don’t like this thing on your face and how unfair life is.  A CPAP will ramp up from 4 to whatever you need in REM over 5 to 15 minutes but most of us still aren’t asleep by then, especially when we first are getting used to it.  An AutoPAP will give you more when you’re on your back, less when you’re on your side, adjust for nasal congestion, weight gain or loss, alcohol use, etc.  The AutoPAP is exactly the same machine on the outside, just with a smarter computer chip and its usually within 5% of the cost of the CPAP.  Plus, the pressure settings need to be adjusted on the CPAP involving one to four thousand dollars in sleep studies so it even saves money as well as increases compliance.

The right mask makes a huge difference in tolerating it especially as you are getting used to it.  I always try different sizes and types but after a while I’ve gotten good at predicting what will work best but it involved a fair amount of discussing and trying it on.  Do you like a snug fit? Are you claustrophobic so smaller is better?  Are you a mouth breather and need a full-face mask or would it be better to use a chin strap to keep your mouth closed?  I favor a chin strap because once you get use to your CPAP, you usually stop being a mouth breather.  Almost all people with sleep apnea have adapted to sleeping on their side or abdomen and mouth breathing in trying to avoid apnea in their sleep.  I also recommend a different mask for different occasions.  

And for God’s sake, you don’t have to become a back sleeper just because you’re wearing your Auto-pap mask.  You just need pillows, lots of pillows, multiple size and shape pillows.  Don’t be cheap on the pillows.  I’m sure you’ve  heard the saying that you should be creative and experimental in bed.  They were talking about finding a position you can sleep on your side or abdomen with that silly mask on your face.  It takes pillows, lots of different size and shape pillows. Unfortunately, I haven’t figured out how to spoon my partner because the vent inevitably blows cold air down her neck and she doesn’t like that.  But I haven’t given up.

You will want a good seal against your face and mask.  As the mask gets older the double lumen seal starts to lose its elasticity and becomes a single lumen seal which then requires cranking that mask harder to your face.  Not a terrible thing to do in a pinch but not a good long-term practice.  It can really take a toll on head, ears, face and nose.  Also, hair gets in the way but I wouldn’t shave my mustache so I just use a little Vaseline on my lower lip and around my nose.  The Vaseline breaks down the mask a little faster but I’m worth it.  You can also use K-Y Jelly, Aquaphor, Calmoseptine Cream or Keri Lotion to just name a few.

Nasal congestion happens and I strongly recommend prescription Atrovent Nasal Spray prior to bedtime routinely while you are first getting use to your machine.  It is also helpful to get rid of the nose hair.  Especially if you have a “pillows mask” that sticks up the nose.  I always recommend a heated hose because in Alaska, the humidity is so low you really need to use distilled water in a heated chamber and if the hose is not heated the water vapor condenses in the lower section of the hose and gurgles partially obstructing airflow and getting things wet.

Don’t forget to clean your chamber and mask weekly.  Simply run it through the dishwater and clean your hose and headgear monthly.  I have a 10% bleach and I spray it at the beginning of my shower and rinse it at the end of my shower with water and let it hang to drip dry.  I also have two sets so I can rotate them while things dry.  They really do want you to change the filters as well.

These are just the minimal recommendations I have for a patient just starting out on treating their sleep apnea.  I also recommend close follow- up, for example; like within 2 days, 10 days and 30 days for the first month because you only get one first shot at this and it’s a lot easier to teach a person how to ride a horse if they haven’t been bucked off.  
Good luck and don’t give up.  It’s only a matter of life and death or worse.


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