Everyday CPAP Safety
For people with sleep apnea and for their healthcare professionals, peer coaching article #19, updated 3 December 2011
Don’t depend only on the DME (Durable Medical Equipment or Home Medical Equipment) provider to provide safety information. Read the user manuals and warnings that come with your equipment and use common sense.
Machine, Humidifier, Hose Safety
If you have an ear or sinus infection or nosebleed, it may be best to stop PAP (Positive Airway Pressure CPAP, APAP, BiPAP) until the infection clears up. Ask your physician.
Put your PAP machine, heated humidifier, and heated hose on a surge protector to protect them from electrical spikes, as you would any expensive electronic equipment. See the discussion thread at http://www.cpaptalk.com/viewtopic/t18447/CPAP-in-lightning-storm.html
Clean or replace air filters at proper intervals, less frequently if your room is fairly clean and oftener in allergy season if you’re allergic to pollens.
Don’t block the air intake of the machine.
To prevent a flooded face if you pull on the hose and tip over the humidifier, and to discourage rainout (condensation) in the hose from backing up into your mask and possibly breathing it into your lungs, place the humidifier and machine below your bed, preferably on a low shelf just above the floor. The floor may be too dusty. Most of the hose should be vertical, not dangling. To minimize rainout, try a hose cover, homemade or bought at places like www.cpap.com To eliminate rainout, use a heated hose from SleepZone in Australia, http://www.sleepzone.com.au/index.html
To prevent mold, mildew, or bacterial buildup in the humidifier and inside the machine – remove, open, empty and air dry the humidifier every morning. It’s not necessary to completely disassemble the humidifier baffle, just shake out the excess water or remove enough to let it dry completely.
Use only distilled water in the humidifier to prevent mold, mildew, mineral deposits and to avoid getting chlorine from tap water in your lungs.
To prevent mildew and critters growing in the hose, disconnect the hose from the machine and mask and let it air dry every morning. In high humidity if the hose doesn’t air dry in a day, alternate between two hoses.
Don’t put additives into the humidifier water. Essential oils and fragrances are made for light dispersion in the air of a room, not in concentrated form in respiratory equipment that forces a high volume of air into your lungs.
Power Outages and Alternative Power Sources
Machine, Humidifier, Hose Safety
If you have an ear or sinus infection or nosebleed, it may be best to stop PAP (Positive Airway Pressure CPAP, APAP, BiPAP) until the infection clears up. Ask your physician.
Put your PAP machine, heated humidifier, and heated hose on a surge protector to protect them from electrical spikes, as you would any expensive electronic equipment. See the discussion thread at http://www.cpaptalk.com/viewtopic/t18447/CPAP-in-lightning-storm.html
Clean or replace air filters at proper intervals, less frequently if your room is fairly clean and oftener in allergy season if you’re allergic to pollens.
Don’t block the air intake of the machine.
To prevent a flooded face if you pull on the hose and tip over the humidifier, and to discourage rainout (condensation) in the hose from backing up into your mask and possibly breathing it into your lungs, place the humidifier and machine below your bed, preferably on a low shelf just above the floor. The floor may be too dusty. Most of the hose should be vertical, not dangling. To minimize rainout, try a hose cover, homemade or bought at places like www.cpap.com To eliminate rainout, use a heated hose from SleepZone in Australia, http://www.sleepzone.com.au/index.html
To prevent mold, mildew, or bacterial buildup in the humidifier and inside the machine – remove, open, empty and air dry the humidifier every morning. It’s not necessary to completely disassemble the humidifier baffle, just shake out the excess water or remove enough to let it dry completely.
Use only distilled water in the humidifier to prevent mold, mildew, mineral deposits and to avoid getting chlorine from tap water in your lungs.
To prevent mildew and critters growing in the hose, disconnect the hose from the machine and mask and let it air dry every morning. In high humidity if the hose doesn’t air dry in a day, alternate between two hoses.
Don’t put additives into the humidifier water. Essential oils and fragrances are made for light dispersion in the air of a room, not in concentrated form in respiratory equipment that forces a high volume of air into your lungs.
Power Outages and Alternative Power Sources
For a few people with certain types of heart disease or extremely low blood oxygen saturation levels, nightly PAP is absolutely essential. If the electricity goes off, their life could be in danger. Find out from your doctor if you are likely to be one of those people. For them, power backup is essential. The power company has a form, to be signed by your doctor, to indicate that it’s life threatening for you to go without power, although they can’t promise to restore your power sooner than anyone else.
Some electric companies may give discounts to PAP users. See http://www.cpaptalk.com/viewtopic/t23864/Possible-Discount-on-Electric-Bill-with-CPAP.html
For emergency preparedness during a power outage lasting several days, talk in advance with your local police department, fire department, hospital, Recreational Vehicle owner, or any place that has its own generator. Find out if you could use their power overnight during an outage. A doctor’s letter of medical necessity or copy of your CPAP prescription or sleep study will be helpful documentation.
For most PAP users, especially those with severe sleep apnea, an alternative power source may not be essential but is desirable to avoid fatigue, sleepiness, or drowsy driving after power outages. A few PAP machines have a built-in power battery. All PAP machines can run on DC power from a car battery, or better yet, recreational vehicle or marine deep cycle battery, including an AGM, Absorbed Glass Mat or gel battery, or universal power supply. A generic DC power cord probably won’t fit your machine. Get a battery and power cord before they are needed. www.cpap.com sells machine-specific batteries and machine-specific DC power cords. See the discussion threads at http://www.cpaptalk.com/viewtopic.php?t=9599&postdays=0&postorder=asc&start=0
http://www.cpaptalk.com/viewtopic/t17394/what-if-the-power-goes-out.html
If your PAP machine broke, how long would it take to get a loaner during repair or a new machine? Do you still have the prescription in hand to order a new machine? Could your local DME promptly provide a loaner? If you have an old PAP machine, perhaps it can still serve as a backup. Or you may want to invest in a smaller machine for travel or camping and as a backup with its own built-in battery. When a storm is coming, some PAPers put their battery-operated machine next to their usual machine, in order to make a quick switch if the power goes out.
Keep and travel with extra spare parts, such as a hose, mask, filters, rubber hose gasket (to connect the hose to a machine opening), extension cord and small surge protector for hotel rooms.
Mask Safety
All masks have vents to clear the carbon dioxide you exhale. When you get a new mask, ask the respiratory technician to show you the vents. If you have a mask and don’t know where the vents are, put the mask on under pressure, and use your hand to feel the exiting air flow. (Make sure you’re not feeling a leak from a poor fit.) Never block the vents with anything! Make sure your pillow, your bed partner’s pillow, bed covers, or any improvised mask adaptations aren’t blocking the vents. If your hose rotates in front of a vent, it may be noisy, but it won’t block the vent.
If your machine is set at the lowest pressure, 4 or 5 cm H2O, you may be breathing in some of your exhaled carbon dioxide. This is usually not a safety concern, but it may lead to discomfort interpreted as mask intolerance, insomnia, or a mild feeling of suffocation. Some people are more comfortable with 6 or 7 cm H2O or more as their lowest pressure setting, to make sure all the carbon dioxide is cleared from their mask.
If your machine has an alert alarm for a mask or hose disconnect, considering turning it on. If your mask often disconnects from your hose, get a longer 10 foot hose or an 18 inch hose extension. There are hose-to-hose connectors and right angle connectors sold at www.cpap.com
With a nasal mask or nasal pillows, if your machine stops because it breaks or because of a power outage, you could breathe through your mouth. Mouth taping or sealing is unsafe. For people who have a stuffy nose, or whose nose becomes stuffy during the night, mouth taping makes no sense, since they need to breathe in air through their mouth. Mouth breathers need a full face mask, covering both nose and mouth. For those who leak exhaled air through the mouth, there are two safe options. One is to train yourself to close your mouth while sleeping, since opening your mouth while on PAP is an unpleasant sensation. Another solution is to use a full face mask.
Since a full face mask covers both nose and mouth, it is designed to let you breathe through the mask in case pressure is lost by a hose disconnect, machine failure, or power outage. If your full face mask has a safety valve rather than vent holes, make sure it works properly. With a full face mask, to avoid regurgitating food and aspirating it into the lungs, a dangerous condition, don’t eat food less than three hours before sleeping and don’t use the mask if nauseous. Practice removing the mask quickly in case you need to suddenly vomit or have acid reflux. Don’t use a full face mask if you can’t remove it quickly because of sedation, poor dexterity, or decreased mental alertness. (Source: T.S. Johnson, MD, Sleep Apnea – The Phantom of the Night, pages 166-7)
Alcohol and Sedatives
Alcohol is first a relaxant, so it may make your throat close up even more. Then it acts as a stimulant, which could lead to awakening later at night. Alcohol may help you fall asleep quickly, but keeps you in the lighter stages of sleep so you miss the deep, restorative sleep stages. If you wake up groggy, it’s because of dehydration and loss of quality sleep. If you drink alcohol, it may be easier on your sleep to have a drink at lunch instead of dinner; or at least avoid alcohol three to four hours before bedtime. Drink a glass of water for every glass of alcohol, which will help clear the alcohol out of your system and reduce dehydration.
Sleep doctor T.S. Johnson warns that all sedatives, hypnotics (tranquilizers), and sleeping pills, except antihistamines, worsen apnea and should be avoided. Consult your sleep doctor if you use them. (Source: Sleep Apnea – The Phantom of the Night, page 134)
Medic Alert
You may want to carry a card in your wallet with emergency medical information, stating that with obstructive sleep apnea, “airway management may be difficult – avoid sedatives, narcotics, and tranquilizers” and similar information. List your physicians’ contact information and type of PAP and pressure. A wallet card is provided in Appendix A of Sleep Apnea – The Phantom of the Night Medic alert cards and bracelets can be found online. See See http://www.cpaptalk.com/viewtopic/t28102/Medical-ID-bracelet-for-OSA.html
With common sense, your CPAP equipment should give you many years of safe use.
Sources: Based on personal experience with obstructive sleep apnea and gleaned from the collective wisdom of cpaptalk.com contributors.
Some electric companies may give discounts to PAP users. See http://www.cpaptalk.com/viewtopic/t23864/Possible-Discount-on-Electric-Bill-with-CPAP.html
For emergency preparedness during a power outage lasting several days, talk in advance with your local police department, fire department, hospital, Recreational Vehicle owner, or any place that has its own generator. Find out if you could use their power overnight during an outage. A doctor’s letter of medical necessity or copy of your CPAP prescription or sleep study will be helpful documentation.
For most PAP users, especially those with severe sleep apnea, an alternative power source may not be essential but is desirable to avoid fatigue, sleepiness, or drowsy driving after power outages. A few PAP machines have a built-in power battery. All PAP machines can run on DC power from a car battery, or better yet, recreational vehicle or marine deep cycle battery, including an AGM, Absorbed Glass Mat or gel battery, or universal power supply. A generic DC power cord probably won’t fit your machine. Get a battery and power cord before they are needed. www.cpap.com sells machine-specific batteries and machine-specific DC power cords. See the discussion threads at http://www.cpaptalk.com/viewtopic.php?t=9599&postdays=0&postorder=asc&start=0
http://www.cpaptalk.com/viewtopic/t17394/what-if-the-power-goes-out.html
If your PAP machine broke, how long would it take to get a loaner during repair or a new machine? Do you still have the prescription in hand to order a new machine? Could your local DME promptly provide a loaner? If you have an old PAP machine, perhaps it can still serve as a backup. Or you may want to invest in a smaller machine for travel or camping and as a backup with its own built-in battery. When a storm is coming, some PAPers put their battery-operated machine next to their usual machine, in order to make a quick switch if the power goes out.
Keep and travel with extra spare parts, such as a hose, mask, filters, rubber hose gasket (to connect the hose to a machine opening), extension cord and small surge protector for hotel rooms.
Mask Safety
All masks have vents to clear the carbon dioxide you exhale. When you get a new mask, ask the respiratory technician to show you the vents. If you have a mask and don’t know where the vents are, put the mask on under pressure, and use your hand to feel the exiting air flow. (Make sure you’re not feeling a leak from a poor fit.) Never block the vents with anything! Make sure your pillow, your bed partner’s pillow, bed covers, or any improvised mask adaptations aren’t blocking the vents. If your hose rotates in front of a vent, it may be noisy, but it won’t block the vent.
If your machine is set at the lowest pressure, 4 or 5 cm H2O, you may be breathing in some of your exhaled carbon dioxide. This is usually not a safety concern, but it may lead to discomfort interpreted as mask intolerance, insomnia, or a mild feeling of suffocation. Some people are more comfortable with 6 or 7 cm H2O or more as their lowest pressure setting, to make sure all the carbon dioxide is cleared from their mask.
If your machine has an alert alarm for a mask or hose disconnect, considering turning it on. If your mask often disconnects from your hose, get a longer 10 foot hose or an 18 inch hose extension. There are hose-to-hose connectors and right angle connectors sold at www.cpap.com
With a nasal mask or nasal pillows, if your machine stops because it breaks or because of a power outage, you could breathe through your mouth. Mouth taping or sealing is unsafe. For people who have a stuffy nose, or whose nose becomes stuffy during the night, mouth taping makes no sense, since they need to breathe in air through their mouth. Mouth breathers need a full face mask, covering both nose and mouth. For those who leak exhaled air through the mouth, there are two safe options. One is to train yourself to close your mouth while sleeping, since opening your mouth while on PAP is an unpleasant sensation. Another solution is to use a full face mask.
Since a full face mask covers both nose and mouth, it is designed to let you breathe through the mask in case pressure is lost by a hose disconnect, machine failure, or power outage. If your full face mask has a safety valve rather than vent holes, make sure it works properly. With a full face mask, to avoid regurgitating food and aspirating it into the lungs, a dangerous condition, don’t eat food less than three hours before sleeping and don’t use the mask if nauseous. Practice removing the mask quickly in case you need to suddenly vomit or have acid reflux. Don’t use a full face mask if you can’t remove it quickly because of sedation, poor dexterity, or decreased mental alertness. (Source: T.S. Johnson, MD, Sleep Apnea – The Phantom of the Night, pages 166-7)
Alcohol and Sedatives
Alcohol is first a relaxant, so it may make your throat close up even more. Then it acts as a stimulant, which could lead to awakening later at night. Alcohol may help you fall asleep quickly, but keeps you in the lighter stages of sleep so you miss the deep, restorative sleep stages. If you wake up groggy, it’s because of dehydration and loss of quality sleep. If you drink alcohol, it may be easier on your sleep to have a drink at lunch instead of dinner; or at least avoid alcohol three to four hours before bedtime. Drink a glass of water for every glass of alcohol, which will help clear the alcohol out of your system and reduce dehydration.
Sleep doctor T.S. Johnson warns that all sedatives, hypnotics (tranquilizers), and sleeping pills, except antihistamines, worsen apnea and should be avoided. Consult your sleep doctor if you use them. (Source: Sleep Apnea – The Phantom of the Night, page 134)
Medic Alert
You may want to carry a card in your wallet with emergency medical information, stating that with obstructive sleep apnea, “airway management may be difficult – avoid sedatives, narcotics, and tranquilizers” and similar information. List your physicians’ contact information and type of PAP and pressure. A wallet card is provided in Appendix A of Sleep Apnea – The Phantom of the Night Medic alert cards and bracelets can be found online. See See http://www.cpaptalk.com/viewtopic/t28102/Medical-ID-bracelet-for-OSA.html
With common sense, your CPAP equipment should give you many years of safe use.
Sources: Based on personal experience with obstructive sleep apnea and gleaned from the collective wisdom of cpaptalk.com contributors.
Want more? See the peer coaching articles at http://smart-sleep-apnea.blogspot.com , http://www.cpap.com FAQ Learning Center, or search http://www.cpaptalk.com or post a message there.
Not written by healthcare professionals. The information and opinions offered are not intended or recommended as a substitute for professional medical advice.
© Mile High Sleeper, August 2006 - 2011. All rights reserved. You may make copies of this message and distribute in any media for free educational purposes, as long as you credit the author and include this copyright notice and the web address smart-sleep-apnea dot blogspot dot com
Labels: CPAP safety, power outage, vent
posted by Mile High Sleeper Gal | 2:45 PM
<< Home