Part 1: Getting the Most Out of CPAP: Changing Perceptions About Therapy

There are many new treatments for Obstructive Sleep Apnea on the market today. But none of them match the efficacy of Continuous Positive Airway Pressure, or CPAP. In this ongoing series, we will explore different aspects of CPAP usage through the eyes of patients. 

A typical story: "I went to my doctor for a checkup and while I was there I mentioned how tired I feel lately. He referred me to a sleep center. I went there and did an overnight sleep study. They told me I have Sleep Apnea and need to wear a breathing mask at night. I want to feel better but I'm not so sure about the machine. A guy at work told me to stay away from those CPAP machines, he had one years ago and hated it."  

The experience above is a common one encountered at sleep centers across the country. Many people's opinions of CPAP therapy are formed by friend's and relative's good and bad experiences in the past. "It's definitely a problem," says Oregon Sleep Associates Durable Medical Equipment Coordinator, Jason Cowlishaw, "We have patients coming swearing they'll never try CPAP because of the horror stories they've heard." Unfortunately, the perception is that the machines are heavy, loud, and uncomfortable to wear. In the past when people would describe CPAP, this perception was unfortunately true. Many of the machines were difficult to transport, noisy, and lacked basic comfort features. The masks seemed medieval, forcing the wearer to conform to a one-size-fits-all mentality. Fortunately, that's all changed now. As more and more people were diagnosed with Sleep Apnea and were left with few care options, manufacturers started taking notice.

The last five years have produced major changes to the field of CPAP equipment. Many modern CPAP machines are often the size of your hand and are whisper quiet. Most have some sort of comfort settings, such as a "ramp" to slowly increase to the prescribed pressure or "pressure relief" to make exhaling easier. "It's amazing some of the features they're coming out with now. They make is so much easier to get used to CPAP." Cowlishaw says, "A lot of the machines have tracking features too. They come with a data card we can download to see whether the pressure is right, if the mask is fitting correctly, and if the patient is getting enough sleep. It's great, people can just bring that in for a checkup without bothering with the whole machine."

One challenge people worry about is getting used to the mask when using CPAP. Many worry that they will be strapped in to something resembling a fighter pilot or Darth Vader. But as with the machines, many advances have been made with masks in recent years. Introductions of better materials and more form-fitting designs have led to a custom tailored experience. "Some of the best designs to come out are the nasal pillow masks," explains Cowlishaw, "They just fit right in the nostrils and are a lot quieter and lighter than older masks. Plus nowadays there are literally dozens of different styles out there, so we can always find something comfortable for everyone."

Trying CPAP for the first time can be daunting, but having the right equipment makes it far easier. Most insurance companies will cover the cost of the CPAP and masks and most DME services should let you try multiple masks until you feel comfortable. Remember to ease in to using the CPAP and not to worry since there are always multiple options to get used to using it.

If you'd like to talk to Jason Cowlishaw about DME options, feel free to call him at 503-972-4692.

Next in our series Getting The Most Out of CPAP: Tips for Compliance.

Part 2: Getting the Most Out of CPAP: Tips For Compliance

In the previous segment of this series, we explored the changing perception of CPAP therapy and how today's CPAPs differ greatly from those of the past. In this segment we delve into the ins and outs of beginning CPAP therapy and offer some helpful tips for success.

CPAP therapy can be an intimidating prospect to many people. The thought of having to wear a mask to sleep every night is not the most appealing. But when first starting on CPAP, there are simple methods to reduce the discomfort or anxiety that you may be experiencing. "First off, it's important for people to know there's someone looking out for them," says Jason Cowlishaw, Oregon Sleep Associates' Durable Medical Equipment Specialist. "Sometimes places will give a patient a CPAP and say 'here's your machine, go home and use it' and it's basically like the patient is on their own."Instead, Jason educates the patient the morning after their study, giving them the details of their equipment and fitting them with the most comfortable mask possible. "I usually send people home with at least two options for CPAP masks, that way they can find out what works best for them. We also swap masks out any time, so the patient doesn't have to worry if one doesn't fit correctly."

Once the proper mask fit is found, the process of easing into using CPAP begins. "When someone comes in my office for a CPAP I always tell them not to run home and expect to use the machine all night right off the bat," Cowlishaw explains. "People will sometimes stress out about that, so I let them know it's better to use the CPAP for naps or for just a few hours a night in the beginning. After a month or so, they can transition into using it for longer periods. All I ask is for the patient to put the mask on each night." 

It's important that the DME office also stays in contact with the patients on a regular basis. "Usually I'll call them within a week of getting the CPAP just to see if everything is working properly. After a month, we do a follow-up with the doctor and download the data from the machine. We're also here to answer any questions or help anytime, just give us a call." Patients can also mail in their CPAP cards for downloads to make sure their machines are functioning at optimal levels.

Here are some helpful tips to make it easier to start using a CPAP:

• Remember that this therapy is to help improve your health and make you feel better. Nothing bad or dangerous will happen to you as a result of CPAP.

• Try a distracting activity such as watching television or reading while wearing just the mask without the pressure. This will let you get used to having the mask on your face.

• At first, ease yourself into using the CPAP for naps, then move on to a few hours a night, slowly working up to wearing it all night.

• Educate your bed partner about your CPAP so they can be aware of any problems such as a mouth leak or a loose mask.

• If one mask is not comfortable, contact your DME provider to try a different style. If they are not helpful, don't hesitate to ask for a different DME service.

With a little patience and an open mind, many people soon find out that CPAP can be very comfortable and easy to use. "We have over an 80% compliance rate on CPAP", says Jason. "That is really a testament to how well this therapy works when people are introduced to it correctly. It can definitely change people's lives for the better."

If you'd like to talk to Jason Cowlishaw about CPAP, feel free to call him at 503-972-4692.

Part 3: Getting the Most Out of CPAP: Keeping Up With New Technologies

There are many new treatments for Obstructive Sleep Apnea on the market today. But none of them match the efficacy of Continuous Positive Airway Pressure, or CPAP. In this series, we will explore different aspects of CPAP usage through the eyes of patients.

In the previous segment of this series, we looked at tips to help patients get started on CPAP therapy. In this segment, we’ll explore what happens once you are using CPAP regularly. How often should it be checked or serviced, what kind of equipment options are out there, and what does the future hold?

Every year, thousands of people begin CPAP therapy to treat their Sleep Apnea. Some may struggle to get used to the treatment but most are able to adapt to it fairly quickly. But once a person is on CPAP and using it every night, what comes next? “A lot of times there’s a sense out there that ‘OK, I’ve got my machine and I use it, I’m good to go’ and people don’t think about what their equipment is going to be like in a couple of years,” explains Jason Cowlishaw, OSA’s Durable Medical Equipment Coordinator, “Some sleep labs even have that philosophy too. They dispense the CPAP and never bother to see the patient again.” But the reality of CPAP use is that it is a dynamic and ever-changing therapy. In order to maximize the benefit of the therapy, equipment needs to be kept in running order or replaced with newer technology. “I’ve had people come in with leaky 5-year-old masks literally covered in duct tape,” Jason says, “It sounds crazy, but it’s born out of people not being educated initially about the options out there.” For instance, many CPAP users don’t know that their insurance companies will often cover new mask replacement parts and cushions every 2-3 months and new CPAP machines every few years. Many times people are stuck struggling with outdated equipment unnecessarily. At OSA, Jason tells all his patients about the mask replacement program he runs. “Basically, we keep track of what mask and machine you have and automatically send out replacement parts on a schedule or when needed.” This way the patient’s equipment is always up to date.

It’s also important to know about the latest technologies available in PAP therapy. Not only are newer machines far quieter and more portable than older ones, they also have features to make life easier on the patient. “Some people out there are still using CPAP without a heated humidifier,”remarks Cowlishaw, “adding that moisture to the air makes it so much easier to use CPAP.” Also, Bi-level or BIPAP machines, which allow for one pressure when inhaling and a lower pressure when exhaling, are better suited for some patients than regular CPAP. Jason says there has also been a lot of progress lately with Auto CPAP machines, “We set a wide range of pressures for the machine and it automatically senses when you’re having a breathing event and adjusts the pressure to fix it. The rest of the time you breathe at a lower pressure.”

With manufacturers often coming out with new machines every year or so, the future of CPAP is a bright one. “With each generation they keep getting better and better,” says Cowlishaw, “for example, a few years ago, the data from the machines was limited. Now all a person has to do is send in their memory card and we can tell all sorts of things like patient usage, whether the pressure is sufficient, or even if the mask is fitting correctly.” Predictions for future CPAPs include more automatically adapting machines that can produce a more natural breathing pattern, remote connections for CPAPs, and increased portability. Masks have also evolved dramatically in recent years with the advent of new design ideas and materials. “Pretty much the industry has gone from a one-size-fits-all approach of trying to force people to adapt to the masks and now has changed into a completely individually customizable approach,” says Jason, “It’s great because it affords the patients a lot more freedom in their treatment options than there used to be.”

For more great articles about sleep, check out our educational newsletter: Better Sleep, Better Health