An online article "CPAP machines: Tips for avoiding 10 common problems" from May Clinic discusses 10 commn problems with CPAP. Oral Appliances are a comfortable alternative to CPAP. The website www.IHATECPAP.com discusses the dangers of Sleep Apnea and Alternatives to CPAP. A recent study showed 60% of patients abandon CPAP and users average only 4-5 hours per night use resulting in patients who may be dangerously undertreated.
1. The first problem listed by Mayo is that the wrong style ofr size of mask is chosen. The good news is that there are literally hundreds of available masks with many variations. The bad news is that most patients who do not tolerate CPAP in the first month never learn to tolerate. There is a group of patients who love CPAP from the start and this wide variety does improve their comfort. Patients with facial hair including mustaches and beards have a lot of special problems related to CPAP. P:oorly fitting mask often leak and can cause dry eyes, infections or just be annoying to the patient or bed partner.
Problems with masks include skin eruptions and apnea, feelings of claustrophobia, reactions to the material masks are made of. It is also very important to adjust the fit of any mask properly.
2. The second problem Mayo lists are trouble getting used to a mask. This is a deal breaker for many patients. Patients can learn to accomodate the mask by wearing it before going to sleep or when watching TV. Feelings of claustrophobia are often hard for patients to overcome. Many patients never become accustomed to the mask. Studies have shown that patients who tolerate the mask well initiallly will usually do well long term. Patients who cannot mange to become comfortable in the irst few weeks rarly learn to love CPAP but may still learn to tolerate. It is vitally important that there be good support from the sleep team early in CPAP use.
Stopping and starting use of CPAP is rarely successful. CPAP machines placed in the closet rarely emerge and become used on a regular basis.
3. The third problem listed by Mayo is difficulty in tolerating forced air. There are many CPAP machine modifications that address this problem. Ramping is a feature where the machine is set at a low pressure that gradually increase to the proper setting. Studies have not shown that ramping improve CPAP compliance. BiPAP is the use of lower pressure during expiration, as with ramping studies have not shown dratic improvement in Compliance with BiPAP. Patients with very high pressure on their CPAP machines can often tolerate lower pressures better. The use of an oral appliance http://www.ihatecpap.com/oral_appliance.html and CPAP together can substantially lower required pressure with reduction in other problems as well.
4. The fourth issue listed by Mayo is a dry stuffy nose. Other problems can be drying of the sinus membranes and/or sinus pain, sinus infections and/or excessive sinus drainage or stuffiness. Some patients experience dry itchy feelings deep in their ears or chronic dizziness. Many of these problems can be helped with humidification especially heated humidification.
Many problems blamed on the CPAP machine may be due to lack of cleaning of the mask and hose. Itis vitally important to be meticulous in the cleaning of the mask and hoses as dangerous biofilms can form and the pressurized air can seed these bacteria into the nose, sinus cavities, bronchi and lungs. It is an excellent idea to have several mask and hose sets so that the patient can always have a clean assembly available.
5. Claustrophobia and feelings of suffocation and /or panic attacks are also frequent complaints. As with mask comfort spending time getting used to the mask can be very helpful in overcoming these feelings. Relaxation exercises and changing masks can help. Some patients do not tolerate nasal illows but may tolerate a full face mask. Other patiens can only use a nasal mask or nasal pillows.
These problem can be made worse when there is a very high pressure. BiPap machines have lower pressure when breathing out and can be very helpful for some patients.
Patients with deviated septums, very large turbinates or other nasal airway obstructions sometimes tolerate CPAP much easier after nasal surgery.
6. Masks that leak create sores, acne ulcers or skin eruptions are particularly annoying as previously mentioned. Dry eyes from leaky masks can be one of the most annoying conditions. This author had a patient with extremely severe sleep apnea that required a very high pressure that dried his eyes. He had numerous eye surgeries and his opthamologist told him he could lose his eyesight but his plmonologist said the untreated apnea could kill him. That patient decided he would rather be dead than blind and went a long time without treatment. Eventually he made his way to a Sleep apnea Dentist and received an oral appliance. The appliance and CPAP combined allowed him to lower his pressure from 24 cm to 6 cm of pressure. He could still not tolerate the mask leaks an against medical advice wore only an oral appliance that only partially treated his apnea. While certainly not ideal, partial treatment was still better than no treatment an the patient felt considerable improvement in the quality of his life. Using CPAP for only a few hours a night is another dangerous type of partial treatment.
While this patient had a problem with dry eyes other patients complain of teary eyes from mask leaks.
Skin problems vary among patients and may be a simple as msk lines that last only a few hours, outbreaks of acne, whiteheads or blackheads or ulcerated lesions on the face or nose. Sometime changing masks can be of great help as can using a mask liner. There are new cloth masks that have excellent potential in alleviating some of these problems.
7. Difficulty falling asleep is the seventh problem Mayo clinic lists, If you cannot fall asleep with the CPAP machine it will not be worn. Some patients complain of this problem with oral appliances as well but most find they can get used to it by wearing the oral appliance before going to bed. There are many healthy sleep habits that can improve these problems.
I actually had one patient who told me that it was hard to hear the TV when wearing his CPAP and the loud TV volume woke him. It is helpful to make sleep conditions ideal. A dark room with a comfortable temperature is frequently helpful. Set up a standard sleep schedule and if you can't fall asleep give your self 10 minutes and try again. A full stomache can make falling asleep more difficult as well. Frequently ading exercise to your dail routine helps with falling asleep. Reducing caffiene at Noon is an excellent idea. There are various herbal teas that help some patients relax and fal asleep. Biofeedback and relaxation exercises are very helpful to some patients.
8. Dry mouth is another common problem often due to the mouth falling open during sleep. A chin strap or a full face mask may cure the problem. Another option is utilizing an oral appliance with a CPAP thereby lowering pressure and keeping the mouth closed. It is imprtant to chose an applaice that prevents opening.
These patients also complain of leather feel to the tongue, burning tongue, leather feel to the tongue, swollen tongue, tongue sticking to roof of mouth, excessive mucous and many other related problems.
9. A very common complaint is removing of the mask during sleep. This may be do to a poor fitting mask. Many patients never find a cure for this problem. A related problem is waking up for bathroom trips and either forgetting to not put CPAP back on or not being able to go back to sleep after awakening. Many patients have frequent trips to the bathroom to urinate. Medications can sometimes be helpful in reducing these urges. I have had many patients who have switched to oral appliances due to complications related to urinary urgency.
Mask removal may also be due to a REM behavior disorder where patients act out dreams during sleep.
10. Many oatients or their spouses are annoyed by the noise from the CPAP machine or hissing from leaks. Keeping the machine and filter clean can reduce noise and it is possible to wear various types of ear plugs, background noise or white noise generators.
Some patients find that changing masks types can make the noise less of a problem.
There are many other problems that patients complain about less frequently.
Some patients report tinntus or humming noises in their ears from CPAP use that does not go away. I saw a mother and son who both had severe dizziness after just a few nights of CPAP use that took weeks to go away. Another problem that I have heard is nightmares related to CPAP use.
Chonic bronchitis, pneumonia, respiratory infections and sinus infections may be related to inadequate cleaning of the equipment.
Patients who do not tolerate CPAP frequently turn to oral appliances. Patients do not always love wearing an oral appliance but most say they prefer the appliance to CPAP.
A common complaint with CPAP is feeling tired during the day or not refreshed. These patients frequently report feeling much better with an oral appliance. This may be due to sleep disruption associated with CPAP use. Patients frequently also have leg movements that disturb their sleep. These problems can also occur with oral appliances.