Troubleshooting

What is OSA ?

Many people take a good night’s sleep for granted. They sleep peacefully through the night unaware that up to 10% of the adult population has their sleep disrupted by repeated episodes of upper airway collapse, known as Obstructive Sleep Apnea (OSA). Thankfully, OSA is a treatable condition.

Narrowing Airways

During sleep our muscles relax. The muscles in our throat, however, maintain some tone to hold our airway open for us to breathe. For some people these muscles relax too much. This can cause the airway to narrow slightly.

Snoring versus OSA

Partial airway narrowing will often result in snoring - a vibration generated by air passing the soft, floppy parts of the throat during breathing. However, sometimes the narrowing is more significant and causes a partial or complete reduction in airflow to the lungs. This condition is called Obstructive Sleep Apnea (OSA).

Blocked Airways

When the airway is blocked OSA sufferers will wake either partially or completely to breathe again. They are often unaware this even happens. This (apneas) can occur up to several hundred times a night, causing severe disruption to sleep and daytime sleepiness. Untreated OSA may also lead to fatigue related road accidents and other serious health problems including high blood pressure, heart attack and stroke. The good news is that effective treatment is at hand!

---

Treating OSA with CPAP

Continuous Positive Airway Pressure (CPAP) is the most common and effective treatment of OSA. You need two things for successful therapy:

1. The first is a CPAP unit. This supplies a gentle air pressure that splints the upper airway and allows you to breathe (uninterrupted) during sleep. The pressure supplied is continuous and is adjusted to suit individual needs. The addition of a heated humidifier to your CPAP unit will relieve unnecessary drying and irritation of your nasal airways.

2. The second thing you need for successful therapy is an interface (mask). CPAP treatment is administered through a mask that seals either the nose, mouth or both as is pictured here.

When does treatment take effect?

The user will usually experience almost immediate relief of symptoms with CPAP therapy. To continue receiving these benefits the CPAP must be used during every sleep. Sleeping without your CPAP will cause OSA symptoms to return. Symptoms might include loud snoring, breathing pauses and excessive daytime sleepiness. Continued therapy will assist you to wake each morning refreshed and ready to get the most out of life.

Avoiding side effects of therapy

Some people experience side effects from CPAP. These can be resolved if you take the time to understand what might be causing the problem. Below are a list of potential side effects and what can be done to avoid them.

MOUTH LEAK

Mouth leak occurs when someone using positive pressure therapy attempts to breathe out of their mouth and the pressurized air from the CPAP escapes through the mouth. The result is a high unidirectional flow of air through the nose and out of the mouth, which can disrupt sleep and cause excessive drying of the airways.

Solution
To help to reduce mouth leak and its side effects, we recommend using a heated humidifier. Research has shown that heated humidification can reduce the incidence of mouth leak by half. Heated humidification also alleviates upper airway drying caused by mouth leak. The addition of a chin strap, full face mask or sometimes both will help alleviate this problem as well.

GURGLING IN THE TUBE OR CONDENSATION:

Although a humidifier is effective at reducing your nasal symptoms, condensation can accumulate in your tubing as a result of the temperature difference between the inside of the delivery tube and your room. Condensation can cause disruptive gurgling noises and mask pressure instability that adversely affects your therapy.

Solution:
The best solution to avoid condensation is to use advanced humidification technologies such as AmbientTracking® Plus, auto adjusting humidity that minimizes condensation or ThermoSmart®, heated breathing tube technology which completely prevents condensation* (both by Fisher & Paykel Healthcare). If you do not have access to these advanced technologies, the supplementation of a tube insulator, in some instances, could help alleviate this problem. In addition, try turning down your humidifier setting and if possible, keep your tubing under your bed-covers. Your environment is influential in excessive condensation as well. Hard flooring, window air conditioning units, floor vents positioned close to your machine, fanning systems, barometric pressure and ambient temperature fluctuations are all common influential factors in proper humidification techniques. Evaluate your ambient settings for an optimal setting. In the colder months, your homes heating system can reduce the amount of moisture in your air, thus providing a dry ambient setting. It is common to increase the setting on your heated humidifier as the cold weather approaches. Often, the temperature is gradually increased to comfort as the ambient temperature becomes increasingly colder. Under these circumstances, you may need to turn the temperature of your heated humidifier down to reduce excessive condensation collection in your tubing. If after reducing the temperature you still experience excessive condensation collecting in your tubing and your upper airway has become dry and irritated due to a decrease in humidification, it may be advantageous to supplement with a tubing insulator sleeve, which is available from the experts at SLEEP REMedies.

SKIN ABRASIONS/FOREHEAD DENTS:

Damage to the skin on the nasal bridge or forehead is caused from excessive tightening of your mask.

Solution:
Loosen the straps on your mask. You should not have to tighten your mask excessively to prevent leaks into or around the eyes. If your mask is not sealing well it may need replacing (masks should be replaced at least once a year). If you have a mask that has multiple layers on the cushion, try placing the mask on your head and tightening the top straps first to comfort. Make sure these straps are anchored snug but comfortably before proceeding. Turn on your CPAP device. In most circumstances, this will cause a large leak due to the bottom straps not being tightened down and this is acceptable for now. Your mask will leak from all areas, this will allow the cushion to fill up with air thus requiring less tension on the headgear to form a seal. Lastly, gradually tighten the bottom straps until the leak stops. Once the leak stops, stop tightening the headgear and place the straps appropriately on the headgear. This will allow the lowest amount of tension without having a leak. When you wake up, make sure you loosen all straps before taking the mask off. This will prevent the headgear from stretching out which will typically cause over tightening.

Sleep Tips

Besides using your CPAP system routinely, taking care of your general health is also important to the quality of your lifestyle. Below are a number of tips for how to achieve a good night's sleep.

Take your time with your sleep therapy regimen:

Sleep therapy is not a race. Your sleep disorder did not appear over night and nor should the therapy ordered be expected to cure it overnight. Most people do not realize that it takes time to acclimate to a mask and CPAP device and expect to be able to sleep the entire night the first night of therapy. In most instances, it takes 30 days or more to acclimate to the machine and be able to utilize it all night without incident. This can be accomplished by gradually increasing your usage each night. Wear your machine longer than you did the night before and you will eventually wear it all night, even if it is just 15 minutes more than the previous night! This technique is called “desensitization” and it works! Wearing your machine during the day for 15-30 minutes while awake will help you acclimate to the feel of the pressure and mask effectively as well. For more information on desensitization, feel free to call the experts at SLEEP REMedies.

Maintain a Regular Bed and Wake Time:

Different people require a different number of sleeping hours each night to feel refreshed. The average person needs 5-7 hours. You should try to go to bed and wake-up at a similar time each day to ensure a good sleep pattern is maintained.

Use Your Bedroom For Sleeping Only:

It is best to keep work materials, computers and televisions out of the sleeping environment. This strengthens the association between bed and sleep.

Make your Sleeping Environment Cool, Quiet and Dark:

A sleeping environment which is at a cool temperature and is quiet and dark will promote better sleep quality.

Refrain from eating 2 Hours Before Bedtime:

Your metabolism slows during sleep so leaving 2 hours between eating and bedtime will give your stomach time to digest your most recent meal before it slows down during the night.

Avoid Cafffeine Close to Bedtime:

Caffeine is a stimulant and therefore produces an alerting effect. The effects of caffeine can last for 3-5 hours and even if you don't think caffeine affects you, it may be disrupting or changing your sleep quality.

Exercise at Least 20 Minutes, 3 Times a Week:

Getting your body moving keeps you healthy and agile while promoting better sleep quality and better living. It is best to exercise during the day or early evening and not during the last 3 hours before bedtime.

---

Cleaning your mask:

To ensure you get maximum comfort and use from your mask, it is important that you follow the cleaning instructions outlined in your instruction sheet. This will prolong your mask's performance.

Be sure to follow the instructions below:

Before first use:
When you get your mask, hand wash the headgear in pure soap dissolved in lukewarm water. Do not soak for longer than 10 minutes. Then rinse in fresh water and allow to dry out of direct sunlight.

Before each use:
Every night, before you use your mask, inspect it for deterioration. Do not use if damaged. After each use:

1) Disassemble the cushion(s) from your mask
2) Wash the cushion(s) with anti-bacterial soap and water
3) Rinse the cushion(s) thoroughly with water but do not immerse in water.
4) Leave all parts to air dry, away from direct sunlight, before reassembling.

Every seven days:
Hand wash the headgear in pure soap dissolved in lukewarm water. Do not soak for longer than 10 minutes. Then rinse in fresh water and allow to air dry, out of direct sunlight.

When will I start to notice an improvement once I start using CPAP?

You and your family should begin to notice immediate improvements once you start your treatment. However it is important to continue using your CPAP every time you sleep in order to maintain the improved quality of life.

Can I travel with my CPAP?

The Fisher & Paykel Healthcare CPAP system has a switch mode power supply allowing it to automatically operate on various power supplies in all parts of the world. You will still need to use the correct plug adaptor to fit the power outlet in the country you are visiting. For more information on traveling with your CPAP

Why does my nose and throat become dry and irritated after using CPAP?

One of the key functions of the nose is to warm and moisten (humidify) the air we breathe. CPAP treatment can at times overwhelm the ability of the nose to do this job. Inadequate levels of humidification can result in unpleasant irritation or congestion of the upper airways. If you do not currently have a humidifier with your CPAP call your healthcare provider to arrange one. If you already have a humidifier, try turning up the setting ½ to 1 full setting to increase the heat and moisture. If you do not have a heated breathing tube with your CPAP/humidifier you may start to experience condensation in the tubing with an increased setting. If this becomes a problem see the question below about resolving condensation

Do I need to use a heated humidifier with my CPAP?

Yes, it is recommended that every patient uses heated humidification in line with their CPAP machine as it will make treatment more comfortable. CPAP therapy can at times overwhelm the nasal airways affecting its ability of adding heat and moisture to the incoming air. The use of a heated humidifier will lessen any airway irritation that causes unpleasant nose and throat symptoms.

I live in a humid environment - do I still need to use heated humidification?

Yes. Often houses in humid environments have air conditioning systems that reduce the temperature and humidity of the air. The only way to sufficiently heat and humidify the air from your CPAP is to use a heated humidifier.

How do I prevent water from collecting in my CPAP tube?

Water collecting in your tube is a result of condensation formed as the room temperature decreases during the night. Condensation in the delivery tube will cause tube vibrations and disruptive gurgling noises as the air passes through which can disrupt your sleep. More importantly condensation can affect your therapy by causing an unstable mask pressure. It is therefore important to prevent condensation forming. Fisher & Paykel Healthcare has developed advanced humidification technologies that aim to improve CPAP therapy by controlling condensation.

Do I need to use distilled water in the chamber?

It is strongly recommended that you use distilled water in your humidification chamber as it is free of minerals and will prolong its life and prevent mineral build up on the inside making it appear dirty. Distilled water is "pure" and therefore the most suitable to use. However, each morning it is necessary to empty out any residual water from your chamber. Stagnant water cultures bacteria and is to be avoided.. (Note: if your chamber begins to leak replace it immediately)

Do I need to remove the humidification chamber from the CPAP when filling it with water?

Yes, for your safety the humidification chamber should be removed for filling and then re-inserted onto the heater-plate. It should also be removed for emptying.

Can I still use CPAP if I have a cold?

If you experience a common cold you can still use your CPAP as long as you find breathing comfortable. If you find breathing difficult or you experience a middle ear or sinus infection you should consult your physician before continuing treatment.

How often do I need to change the filters? Why do they become dirty?

The filter in your CPAP machine and in some masks needs to be changed when they become significantly discolored. The machine filters need to be replaced at least once every three months or after 1000 hours machine running time. The filters get dirty with time as the air we are breathing is not 100% clean. When the air is drawn in the back of the machine, the filter traps dirt and dust particles so you do not breathe them in, thus discoloring the filter.

If I go into to hospital for any reason should I take my CPAP system with me?

Yes, if you stop using CPAP when you sleep your general well being will deteriorate. If you are having surgery for any reason it is important to inform your surgeon and anesthetist that you use CPAP treatment.

Traveling with your CPAP

Fisher & Paykel Healthcare CPAP machines are light-weight and compact and come in a custom carry bag, allowing for easy transportation when traveling. All of our CPAP units have a universal voltage feature which allows them to operate on any domestic AC mains voltage between 100-240V. You will still need to use the appropriate pin/plug adaptor for the relevant country you are visiting. For your ease we have included examples of relevant country plugs for commonly visited countries. Plug adaptors can be purchased at your local electronics store.

---

Air Travel Tips

Below are some handy tips to help you plan your travels overseas.

• All Fisher & Paykel Healthcare CPAP units have a universal power supply so the device can be used around the world. Remember that you will still need to use the appropriate pin/plug adapter for the relevant country you are visiting.
• When booking your flights, ask your travel agent to contact the airline well in advance of the flight as you may need to provide them with documentation such as a letter from your doctor.
• If traveling throughout the night you may wish to use your CPAP on the flight while you sleep. Fisher & Paykel Healthcare CPAPs are approved for use on several airlines but be sure to check with the relevant airline.
• If you are able to plug your CPAP into the aeroplanes power supply ask for a seat near a power outlet. In business class, most seats will have a power outlet near the armrests. Remember that you may need a specific adapter for the flight – check this with the airline.
• Store your CPAP in the travel bag that came with your CPAP or an alternative good-quality bag that protects your CPAP.
• In most countries, the custom officials are familiar with CPAPs. Your CPAP will need to be scanned, but this does not harm the device.
• Be sure to check your hand baggage allowances with the airline well in advance of flying, as some airlines may classify your CPAP as one piece of luggage even though this is a medical device.