1. Keys to Success with your CPAP or BiLevel Machine
2. Webinar and CEC InstructionsSend an email to confirm your attendance to: email@example.comSurvey invite will be sent tomorrow – new formatCertificates emailed at end of month PLEASE MUTE!
3. Why GreenU? Provide more seamless patient care Maintain educational contact Promote DME accountability Build the sleep network through mysleepworld.com
4. What is CPAP? Continuous positive airway pressure or CPAP therapy is a prescribed treatment delivered to the upper airway to keep it open during the night. The pressure is delivered through tubing attached to a mask and held in place by a headgear
5. Bi-Level Bi-level therapy is similar to CPAP but it uses two pressures  Inspiratory pressure  Expiratory pressure With Bi-Level therapy, inspiratory pressure is higher than the expiratory, making it easier to exhale because the pressure is decreased • Why is Bi-Level Therapy used?
6. Therapeutic or Treatment? Humidification  Active humidification monitoring  Heated Circuits Electronic pressure relief Use & Compliance Data  Event detection monitoring  Compliance  Wireless
7. What is the number one causeof people failing PAP Therapy? Issues With Their Mask
8. Mask Fit: Keys to Success• Masks must fit properly• People stop using PAP when they have mask related problems• Early (first week) problem solving improves PAP compliance• Variety of masks on the market• 30 day mask guarantee• New masks available• Shop before you buy• Replace early or every three months
9. Common mask related problems Pressure points where mask meets skin  Blisters  Most common on the bridge of the nose  Blisters may break open and become infected Leaks – air blowing around ‘seal’ of mask  Most machines will compensate for a small leak  Eye leaks  Beards/moustaches Worn Mask Dryness
10. Signs of a worn mask Ask patient to bring with them to lab Increased leaks Tears or rips Change in texture of the mask Gel masks  become soft  lose shape Silicone masks  Develop ‘dry rot’ and crack  Stretching
11. Replacing Supplies General rule of thumb (most insurance providers)  Replace filters monthly  Replace mask every three months  Replace headgear every six months  Replace tubing two to three times per year * Contact your home care company for details on your coverage
12. Prevention of Pressure Sores Do not over tighten your mask Have your mask as loose as possible without having a leak Wash your mask daily with warm, soapy water If you do get pressure sores: Don’t Wait!  Contact your home medical equipment provider, you may need a different mask  You cannot keep using the same mask as it will cause the sore to open  Neosporin, Moleskin or other OTC remedies
13. Care and Cleaning Tubing should be cleaned weekly  Submerse tube in warm solution, rinse well, hang to dry Headgear should be cleaned weekly  Wash in warm solution, rinse well, hang to dry Clean more regularly in warm weather or when you have a cold or respiratory infection Adjust the straps and headgear on your mask to obtain a better fit.
14. Care and Cleaning (continued) If you have had your mask for a while, check to make sure that it is not worn or torn. You may need to try a different size mask. A different type of mask may work better for you. Either a full face mask or nasal pillows may eliminate the air leaks. Talk to your PAP supplier if you continue to have problems with air leaks.
15. Distilled + Distilled = Success Distilled water in humidification chamber  More likely to be sterile  No dissolved solids  Fluoride, calcium, phosphorus Distilled white vinegar for cleaning  50/50 Solution  Inexpensive and safe  No perfumes or moisturizers Inexpensive and replenishable
16. Five Common Problems
17. Problem #1: User seems to have morenasal congestion after using PAP. This is the most common side effect of PAP therapy. User may also have a runny, dry nose or nosebleeds. Nasal congestion often goes away after your first month of use. Suggest that the patient talks to their doctor if their congestion is severe or if they are experiencing nasal, sinus or ear pain. These tips can also help reduce nasal problems: • Try using a saline nasal spray. Apply a few sprays in each nostril before using PAP therapy. • Try a nasal decongestant. Some types require that the patient has a prescription from their doctor. • Try using/adjusting Heated Humidifier.
18. Problem #2: The patient is having troublebreathing with so much air coming inthrough the mask. This problem is common if the OSA is severe and the patient need a high level of air pressure to keep the airway open, there is also an acclimation period for most users. Try these tips:  Begin using PAP for short periods of time during the day  TV  Reading  This can help the body begin to adjust to the air pressure  One may need to start by using it for only a few minutes at a time  Gradually increase the length of the sessions. Focus on breathing at a nice, slow pace  Use the units ‘ramp’ setting
19. Problem #3: The patient is experiencing adry or sore throat after using PAP. Anyone who breathes through his or her mouth during sleep may have this problem. These tips may help relieve throat irritation caused by PAP:  Try a chin-strap, available through a home-care company.  Heated humidity is a feature on many machines that requires adjustment. If available, turn the humidity up one night at a time.  In some cases, a full face or different style of mask will help.
20. Problem #4: The patient has redeyes, continues snoring or stops breathingduring sleep.• These problems are all signs that air may be leaking out of the mask.• These tips can help correct the problem: • Loosen the straps slightly so that they are not too tight. Make sure the mask is still snug enough to prevent air leaks, but not so tight that it hurts the facial skin. • Consider buying pads that slip over the straps. Made of fleece or other soft material, they keep the straps from rubbing against the skin. • Talk to the CPAP supplier if the mask continues to irritate skin or cause soreness.
21. Problem #5: Air delivered through the mask iscold and disrupts sleep. The environmental elements may affect the use of PAP therapy. Room temperature, humidity and bed location can all affect the air flowing from the machine through the mask. The following suggestions may help:  Try heating the room  Placing the tubing under the bedclothes  Obtaining a Snuggle Hose  Heated humidification
22. Frequently Asked Questions
23. How long will it take to get used to CPAP? Most people adjust to CPAP in one to two weeks but it may take up to a month or more to adjust.  Many factors affect adjustment period:  Severity of Apnea  Pressure  Mask  Humidity  Bed Partner  Patient Education
24. How soon after the patient begins using treatment that they may notice improvement? Many patients notice an immediate improvement, some people may take a little longer to recognize improvement. Several health conditions are affected by sleep apnea including:  Hypertenstion  Cardiovascular Disease  Type II Diabeties  Depression  More
25. How often will the patient need to usetheir treatment? The patient will need to attempt to use their equipment each time they sleep. If they do not, they will return to the previous level of snoring, sleep apnea, and daytime tiredness.
26. Will the pressure on the device ever need changing?• It may. There are a few things that affect the need for a pressure change, and it’s important to keep in communication with the ordering physician about the treatment of apnea. Some items that may affect the amount of pressure required are:  Weight loss/gain  Snoring returns  Daytime sleepiness returns  Changes in your overall health
27. Will the patients’ blood pressure improve afterstarting treatment? One of the positive effects of PAP compliance is the possibility of lowering blood pressure. The patient needs to discuss this further with their physician before making any medication changes. The ordering doctor should review blood pressure regularly even if the patients mediation does not change initially.
28. Is it easier to lose weight when using PAPtherapy? It may be. One should find that his or her energy levels will increase. It is also likely to notice more motivation to take part in many activities that previous sleepiness has prevented. Permanent weight loss requires long-term lifestyle changes to diet and exercise.
29. The patients nose gets blockedregularly, so he or she has to breathethrough their mouth. The nose is often the point of entry when using PAP therapy.  Nasal Decongestant  Please note that overuse of nasal decongestants can also cause a blocked nose over time and are really only a temporary solution. Full Face Mask  A full face mask covers both the nose and mouth so that the patient can continue to receive effective therapy, even if they are breathing through their mouth.
30. The patient feels air leaking out of his orher mouth as they fall asleep. The mouth needs to be closed while sleeping to prevent any air escaping from the mask.  A full face mask that covers the nose and mouth will ensure that the patient will continue to receive effective therapy as he or she falls asleep.  A chin strap, obtained through a medical supplier, can help to keep the patients mouth closed.
31. Can the patient use PAP treatment ifhe or she has a cold? If the patient is experiencing an infection of the upper respiratory tract, middle ear, or sinus, he or she should consult your physician before continuing treatment.  One may be advised to discontinue until the infection has cleared.  If the patient continues with treatment during infection, it is advisable to wash the mask and tubing more often.  A full face mask may be good alternative at this time, as it covers both the nose and mouth so the patient can continue to receive effective therapy.
32. Should the patient take his or her device tothe hospital with them, if hospitalization is everneeded for any reason? Yes. If the patient is having surgery, it is very important that they tell both the surgeon and the anesthetist that they wear a PAP device. Do this before the date of the surgery, if possible. One should also inform the physician treating the patient for sleep apnea that he or she is going to be in the hospital.
33. Will the patient ever be able to stoptreatment? Will he or she ever be cured ofsnoring and sleep apnea? OSA is a long-term condition for which there is presently no known cure. The good news, however, is that PAP therapy will effectively control sleep apnea-as long as the patient continues to use it. Technology continues to improve, making PAP more effective and comfortable.
34. The patient often takes the mask off in theirsleep. How can the patient avoid this? It may indicate that the treatment pressure is not enough to completely control sleep apnea and a slight increase in pressure may solve the problem. Speak with the ordering physician about this issue. Often it can be corrected quite easily – but it is important that the doctor is aware of this problem. Mask alarms available on some PAP machines
35. Why is the patient having difficulty breathingout during CPAP? When first using CPAP, most people find they experience a need to push against the airflow when they breathe out. It may take a little time to get used to breathing out against the pressure. Practicing sessions in the daytime while relaxing or listening to music may help overcome this feeling. However, breathing out against the flow of air will happen automatically when the patient is asleep. Don’t forget about Ramp.
36. Can the patient use their machine in othercountries? Most devices have a switch mode power supply. Please note that the patient will still need to use the correct adaptor for the type of power outlet in the country he or she is visiting. Contact the patients home care company or Sleep Solutions Home Medical Equipment for equipment options before the trip.