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Why treat OSA with positive airway pressure
(PAP)?
OSA is a disease of vicious cycles. Because of this, it does not
self-correct, and in fact tends to get worse over time. OSA causes
or exacerbates a long list of other problems.
Older patients with very severe apnea sometimes ask “What’s wrong
with dying in my sleep? It sounds like a good way to go.” Instead of
dying, however, they could have a debilitating stroke or heart
attack, leaving them incapacitated and dependent on others for care.
We also know that untreated OSA contributes to dementia.
Who does what:
- Our office (1521 Cooper St., Fort Worth)
schedules appointments and sleep studies, evaluates and
diagnoses sleep problems, prescribes treatment, and follows up
to ensure ongoing treatment effectiveness.
- Our laboratory (909 8th Ave., Fort Worth)
conducts and analyzes sleep studies.
- Durable medical equipment (DME) companies
or our treatment center (also at 909 8th Ave.) fill
prescriptions for equipment such as PAP machines and headgear.
They are also responsible for replacing or repairing worn out or
broken equipment.
- Medical insurance companies and
Medicare/Medicaid pay for treatment. You may have co-pays or
deductibles.
- You use and benefit from treatment,
maintain your equipment, and call or schedule a headgear fitting
session or follow-up appointment if there are problems.
Getting used to PAP and optimizing your
treatment
Some people adjust very quickly and use it all night from the very
beginning, and others may require as long as a few weeks during
which comfort and treatment are optimized.
We encourage people to experiment with their treatment to see what
works best for them. Some common things to experiment with include:
- Headgear – Insurance typically pays for
new headgear every 3-6 months. If people are not happy with
their headgear (mask and/or chin strap), they use the
replacement schedule to try something different. We prefer that
you schedule headgear refitting sessions with us, but your DME
company may also provide this service. Many people end up with
multiple headgear options that they alternate.
- Humidification – This is an option to
reduce nasal or mouth dryness. Increasing the heat under the
humidifier canister increases the moisture in the air from the
PAP machine. Without heat, you will still get some cool
moisture. Some people never use any humidification, some use it
only in the winter, and some use it every night. Use of a full
face mask (pressure applied to nose and mouth) may reduce or
eliminate need for humidification.
- Chin strap - Experiment with placing the
chin strap on before vs. after your headgear to see what works
best for you. A chin strap is practically always necessary to
keep the mouth closed with nasal PAP, but a chin strap is only
rarely helpful with a full face mask (pressure applied to nose
and mouth).
- Position - You can sleep in any position
you want with PAP, even on your stomach! It’s just a matter of
learning how to use your pillow and position your head, arms,
and hands to minimize headgear air leakage or discomfort.
- Ramp feature – This option reduces the
pressure to a low level, then the pressure slowly rises over the
next several minutes as you fall asleep. This feature is
sometimes helpful during initial acclimation to PAP, but most
patients do not use ramp long-term.
What to expect from treatment
Responses to treatment are as varied as symptoms of OSA, and these
vary widely between patients. Patients and research tell us that
nightly use of PAP treatment:
- Reduces or eliminates bathroom trips at
night
- Reduces or eliminates night-time
heartburn/reflux
- Reduces upper airway congestion and
allergy symptoms (you’re breathing filtered air all night)
- Reduces blood pressure
- Reduces edema
- Increases energy during the day
- Improves stamina
- Reduces daytime sleepiness, including
while driving
- Reduces use of caffeine
- Improves the ability to think clearly and
concentrate
- Improves work performance
- Improves relationships with others
- Improves ability to cope with stress
- Reduces irritability and anxiety
- Reduces or eliminates ADD/ADHD symptoms
- Increases sexual interest and improves
function
- Improves sleep quality for the spouse
Few people experience all of these benefits,
but most report at least some of the above. Rare PAP users perceive
no benefits from treatment, even after we confirm that their
treatment is working, and they are using it all night, every night.
Nevertheless, they understand what treatment protects them from, so
they are happy to use it.
Helping us help you
Always bring your machine and headgear to follow up visits. We check
your machine to ensure it is working properly, we collect data from
it concerning your respiratory function and treatment quality, we
check your headgear for problems, and we can immediately make
changes to your treatment that the doctor may order to improve
effectiveness and comfort.
Please don’t wait for us to contact you to schedule follow-up,
especially if you’re having problems with your treatment. Be
proactive with your medical device company and with us. Yearly
follow-up with us ensures that your treatment continues to work well
for you.
Your lines of defense are:
- You (see “Optimizing your Treatment”
above)
- Your medical device provider regarding
simple equipment-related problems
- An office visit with our hardware
person/respiratory therapist for more complex equipment problems
such as trying different headgear options
- A follow-up visit with the doctor
Sometimes, problems can be solved with a
simple phone call to your DME company or to us.
Troubleshooting
A few factors can interfere with PAP treatment. Common problems and
potential solutions include:
Mouth venting - This is the most common
problem encountered by people who use nasal headgear (air pressure
applied only to the nose). Solutions include:
- Increasing humidification
- Tightening the chin strap (within comfort
limits)
- Trying a different chin strap
- Changing to a full mask
Condensation - Use of heated
humidification sometimes leads to water condensation in the hose or
mask, especially in the winter. Solutions to this include:
- Placing the machine below your head so
condensed water drips back down into the humidifier canister
- Insulating the hose
- Reducing heat or stopping humidification
completely
Note: excessive headgear air leakage can cause
condensation problems, so correcting excessive air leakage can
reduce condensation
“I just can’t sleep with it on!” – You
should schedule a follow-up visit with the doctor for this
complaint. Many things could be causing this. Possible causes
include restless legs syndrome and claustrophobia. Claustrophobia is
corrected though a process called desensitization, and restlessness
sometimes requires medication.
Miscellaneous
Headgear, chin straps, filters, etc. need to be replaced
periodically by your medical device provider as necessary to work
properly. You will receive care instructions and a replacement
schedule.
Looping the hose around a bedpost keeps the hose out of the way and
allows you to turn from side to side during sleep without hose
interference. If you don’t have a bedpost, you can place something
else at the head of the bed (a hook, lamppost, etc.) to loop the
hose around.
Your headgear should be just as comfortable when you wake in the
morning as when you put it on at bedtime. None of the headgear,
including the chin strap, should be on tight enough to cause
discomfort. If it needs to be uncomfortably tight to prevent leaks,
then it doesn’t fit your face/head, and you should try other
headgear.
A full mask (over nose and mouth) is the only sure way to prevent
mouth venting. Never place tape over your mouth!
To simplify going to the bathroom at night, many people simply
disconnect the hose from their mask instead of taking everything
off.
With PAP, you can go all the way under the covers in the winter:
your air is piped in to you! In the same way, you can hide under a
sheet from mosquitoes in the summer.
For bothersome mouth dryness at night, some people keep a bottle of
water by their bed with a straw. Those using a full mask can get a
drink without removing their mask by slipping the straw under the
mask to their lips.
Tips to facilitate drying of hoses and humidifiers include
reattaching the cleaned items to your PAP machine and turning the
machine on to “blow-dry” the gear, or holding one end of the hose
while rotating it rapidly overhead.
If a power outage occurs while you are asleep with PAP, you will no
longer be treated for OSA. You will probably wake up. A valve on
your headgear prevents you from rebreathing your own exhaled air.
After they become acclimated to PAP treatment, many people report
that they can’t tell if it’s on when they wake up. This is actually
a good indicator that they have adapted to treatment well and that
it is working well for them.
PAP therapy won’t help you if you don’t use it, and it will help you
only as much as you use it during sleep. Those who get the most
benefit use PAP all the time they sleep, including naps. However,
some treatment is better than none.
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