Solving Common CPAP Equipment Problems
For people with sleep apnea and for their healthcare professionals, peer coaching article #16, updated 1 December 2011
Hose Management, Venting, Bed Pillows, Rainout, Aerophagia
People give up on CPAP treatment because of discomfort caused by the equipment. Simple therapy information is sadly lacking. Untreated obstructive sleep apnea can lead to a poor quality of life and is potentially fatal. Here are some equipment user tips that can help you successfully manage your therapy. See also Common Side Effects in the Answers section of http://www.cpap.com/ , http://www.cpap.com/cpap-faq/Common-CPAP-Side-Effects.html#FGID-158
Hose Management
Catch Me If You Can
A manufacturer’s product photo shows an incorrect setup, the dangling hose. Help from www.cpap.com: “CPAP hose management becomes more important to side sleepers. The hose should never hang between the CPAP and the bed. This weight will put a side force on the mask, causing leaks and discomfort. A portion of the hose should be lying on the bed so that the forces it places on the mask are minimized.”
Start with the machine set below your head level, on a night table’s lowest shelf or low footstool, to minimize condensation or rainout from the humidifier and reduce noise, and to prevent a flood if the humidifier tips over while you are using it. Attach the hose to the mattress and then headboard or wall. Use a clamp, cup hook, twister tie, or large safety pin holding an elastic ponytail band or Scrunci, then thread in the hose. Or use a hose clip as seen in the discussion thread http://www.cpaptalk.com/viewtopic.php?t=10498
When the hose comes from above your head, it has room to coil on the bed, reducing pulling on the mask which reduces mask leaks. It makes it easier to change positions from side to side or back. It eliminates the problem of keeping the hose under or over your arm or under or over the bed covers. Exception: with the new hybrid (nasal pillows/mouth) mask, the hose must come from beneath, or else it will make the vent noisy.
Mask Vent Blowing Air on Your Arm, Hand, Bed Partner
Strangers in the Night
It’s very important that a mask have a vent to clear exhaled carbon dioxide. Never cover the mask vent with bed covers. Allow it to vent. When you get the mask, ask the technician to show you the vent. Vents may be hard to see. If you don’t know where the vent is, put on the mask, turn on the machine, and feel where air is coming out. Unfortunately, almost all vents are placed to vent forward from your face so air blows on your hand, arm, or bed partner. You can learn to sleep with your arm under a cover or pillow and barricade your partner. You can wear long sleeves and even gloves, if you don’t mind looking like Mickey or Minnie Mouse. Most pharmacies sell soft white cotton gloves, worn for hand ointment, behind the counter. If you have a tolerant and resilient bed partner, you need to find creative options so they don’t get caught in nightly windstorms.
People give up on CPAP treatment because of discomfort caused by the equipment. Simple therapy information is sadly lacking. Untreated obstructive sleep apnea can lead to a poor quality of life and is potentially fatal. Here are some equipment user tips that can help you successfully manage your therapy. See also Common Side Effects in the Answers section of http://www.cpap.com/ , http://www.cpap.com/cpap-faq/Common-CPAP-Side-Effects.html#FGID-158
Hose Management
Catch Me If You Can
A manufacturer’s product photo shows an incorrect setup, the dangling hose. Help from www.cpap.com: “CPAP hose management becomes more important to side sleepers. The hose should never hang between the CPAP and the bed. This weight will put a side force on the mask, causing leaks and discomfort. A portion of the hose should be lying on the bed so that the forces it places on the mask are minimized.”
Start with the machine set below your head level, on a night table’s lowest shelf or low footstool, to minimize condensation or rainout from the humidifier and reduce noise, and to prevent a flood if the humidifier tips over while you are using it. Attach the hose to the mattress and then headboard or wall. Use a clamp, cup hook, twister tie, or large safety pin holding an elastic ponytail band or Scrunci, then thread in the hose. Or use a hose clip as seen in the discussion thread http://www.cpaptalk.com/viewtopic.php?t=10498
When the hose comes from above your head, it has room to coil on the bed, reducing pulling on the mask which reduces mask leaks. It makes it easier to change positions from side to side or back. It eliminates the problem of keeping the hose under or over your arm or under or over the bed covers. Exception: with the new hybrid (nasal pillows/mouth) mask, the hose must come from beneath, or else it will make the vent noisy.
Mask Vent Blowing Air on Your Arm, Hand, Bed Partner
Strangers in the Night
It’s very important that a mask have a vent to clear exhaled carbon dioxide. Never cover the mask vent with bed covers. Allow it to vent. When you get the mask, ask the technician to show you the vent. Vents may be hard to see. If you don’t know where the vent is, put on the mask, turn on the machine, and feel where air is coming out. Unfortunately, almost all vents are placed to vent forward from your face so air blows on your hand, arm, or bed partner. You can learn to sleep with your arm under a cover or pillow and barricade your partner. You can wear long sleeves and even gloves, if you don’t mind looking like Mickey or Minnie Mouse. Most pharmacies sell soft white cotton gloves, worn for hand ointment, behind the counter. If you have a tolerant and resilient bed partner, you need to find creative options so they don’t get caught in nightly windstorms.
One well designed mask vents straight upward , like a chimney, towards the headboard. It doesn’t vent on your forehead, arm, or partner. It’s a nasal pillow mask, the Headrest Twilight NP. See http://www.cpap.com/productpage/aeiomed-aura-nasal-cpap-interface.html As time goes on, more mask manufacturers may learn to make masks vent less violently.
Bed Pillow
What Dreams May Come
If you are overly relying on a soft or hard pillow to keep your mask in place, you have a poorly fitted mask or poor choice of mask. Try adjusting the fit or getting a different mask. If your mask is properly fitted and your mask and pillow are fighting, try a smaller firm pillow, so the mask can hang off the side; or a buckwheat pillow, neck pillow, or memory foam pillow which gives the mask some support. Make sure the pillow doesn’t interfere with your mask if you are a side sleeper. When you are pillow shopping, if you don’t mind acting strangely in a store, try out the pillow, imagining what your mask would do.
Consider the PAPillow, described at www.PAPillow.com, in a low wedge pillow or higher double edge pillow, available at http://shop.talkaboutsleep.com/?action=info.display&category=papillow-difference
Similar pillows are available at http://www.cpap.com/simple-find-cpap-products/misc There are also orthopedic, memory foam pillows. Discussion thread on cervical neck pillows: http://www.cpaptalk.com/viewtopic/t16851/Cervical-Positional-Effects-on-Snoring-and-Apneas.html and http://www.targetwoman.com/articles/neck-pillow.html
Some CPAP users report a lower AHI (apnea hypopnea index of events per hour) if they use a bed wedge pillow. Linen stores may sell lower bed wedges; medical supply stores and online stores sell slightly higher bed wedges and memory foam bed wedges, which can be used in combination with a PAPillow. See the discussion thread on silent acid reflux at http://www.cpaptalk.com/viewtopic/t14288/Strange-treatment-question.html
Rainout or Condensation in the Hose
A River Runs Through It
Rainout video: http://www.cpap.com/downloadVideo.php?VGID=16
In a cool bedroom, if you have a heated humidifier as part of your PAP (CPAP, APAP, BiPAP) machine, water may condense in the hose running between the humidifier and your mask. It can drip on your face, causing discomfort and mask leaks. Try several of these remedies to reduce or perhaps eliminate rainout.
- Raise the room temperature, if you can sleep comfortably.
- Place your machine and humidifier well below your bed, near the floor on a low shelf or footstool, so the 6 foot hose and any water have a long vertical run before reaching your headboard. (You may need a 10 foot hose if you have a very high bed.) Hold the hose in place with a hose clip or elastic ponytail band pinned to the edge of the mattress, and another on the headboard. This is a first step, but may not work to eliminate rainout.
- Common advice is to keep the hose under the blanket, which seldom works. If you are using effective hose management, this is not an option, since the hose is coming from the headboard.
- Turn down the heated humidifier to the lowest, coolest setting. If that doesn’t work, turn off the heat but continue to use the humidifier (passive humidification or passover). If your nose gets congested or your throat and mouth get dry, find another remedy.
- Wrap the hose in bubblewrap, light socks or tights with the toes cut open, or make or buy a fleece hose cover like the Snuggle Hose http://www.cpap.com/simple-find-cpap-products/cpap-hose-tubing
- If your mask has its own hose, you may need to cover that also. A light covering made from old pantyhose or tights reduces weight and drag.
- A reliable way to completely eliminate rainout is to buy a heated hose. A reliable add-on heated hose is the “Aussie hose” from SleepZone in Australia, http://www.sleepzone.com.au/. Allow up to 3 weeks for delivery to clear US customs. If necessary, cover the heated hose with a second hose cover. The Aussie hose has its own insurance code number, so it may be reimbursable. People use their heated hose summer and winter. Since the heated hose is so effective, some people don’t want to be without it in case of breakage, so they have a second, backup heated hose.
- One Fisher and Paykel straight CPAP machine package includes a heated hose and humidifier. See http://www.cpap.com/productpage/fisher-paykel-hc604-cpap.html
Aerophagia, Bloating, Swallowing Air
Finding Neverland
This may be a temporary condition as you adjust to PAP or a new mask, or it may be recurring or ongoing. Symptoms range from being painful to being merely socially embarrassing. See your doctor to rule out other related digestive disorders.
From www.cpap.com: “AEROPHAGIA. The word "phage" in Greek means "to eat." Aerophagia is literally to eat air. In the modern context, it means swallowing too much air, a common cause of gas in the stomach and belching. This is sometimes a result of CPAP Therapy. Unfortunately, the best solutions for this problem are not a catch all but instead an attempt to find the middle ground between needed CPAP pressures. Here's what you can do:
1. Tell your CPAP prescribing physician. It may be better to decrease the CPAP level a bit and put up with some minor airway problems if we can significantly decrease the bloating. Sometimes this works great, sometimes not at all. An auto adjusting CPAP should also be considered as these machines reduce the average pressure the user receives. Get help setting the maximum pressure on the auto as the highest pressures can make things much worse.
2. As the chin of a CPAP user nears the chest, air has a greater chance of entering the digestive tract. Where possible, keep the chin up in relation to the torso.
3. Sleeping in a position different than normal helps keep the air out of the stomach. Try different sleeping positions. Left side, right side, inclined with pillows, or flat.” More ideas to eliminate aerophagia:
- Try a bed wedge to sleep with the head elevated.
- To keep your chin up, try a PAPillow, neck pillow, or memory foam pillow, but make sure it’s compatible with your mask when you sleep on your side. You should be able to fit your fist between your chin and chest. See http://www.snoringpillow.com/int/index.htm
- Try an APAP machine. If already on APAP, reduce your top pressure, as long as your AHI (apnea hypopnea index) continues to remain low; or try the straight CPAP mode.
- Try a BiPAP machine or auto BiPAP machine.
Ideas to cope with aerophagia:
- Drink carbonated water or a fizzy beverage in the morning to help belch out gas.
- Use wind-relieving yoga postures that compress your abdomen in the privacy of your bathroom or boudoir.
- For digestive gas in the stomach, try over-the-counter simethicone products like Gas-X.
- For digestive gas in the intestines, try over-the-counter activated charcoal tablets.
Bed Pillow
What Dreams May Come
If you are overly relying on a soft or hard pillow to keep your mask in place, you have a poorly fitted mask or poor choice of mask. Try adjusting the fit or getting a different mask. If your mask is properly fitted and your mask and pillow are fighting, try a smaller firm pillow, so the mask can hang off the side; or a buckwheat pillow, neck pillow, or memory foam pillow which gives the mask some support. Make sure the pillow doesn’t interfere with your mask if you are a side sleeper. When you are pillow shopping, if you don’t mind acting strangely in a store, try out the pillow, imagining what your mask would do.
Consider the PAPillow, described at www.PAPillow.com, in a low wedge pillow or higher double edge pillow, available at http://shop.talkaboutsleep.com/?action=info.display&category=papillow-difference
Similar pillows are available at http://www.cpap.com/simple-find-cpap-products/misc There are also orthopedic, memory foam pillows. Discussion thread on cervical neck pillows: http://www.cpaptalk.com/viewtopic/t16851/Cervical-Positional-Effects-on-Snoring-and-Apneas.html and http://www.targetwoman.com/articles/neck-pillow.html
Some CPAP users report a lower AHI (apnea hypopnea index of events per hour) if they use a bed wedge pillow. Linen stores may sell lower bed wedges; medical supply stores and online stores sell slightly higher bed wedges and memory foam bed wedges, which can be used in combination with a PAPillow. See the discussion thread on silent acid reflux at http://www.cpaptalk.com/viewtopic/t14288/Strange-treatment-question.html
Rainout or Condensation in the Hose
A River Runs Through It
Rainout video: http://www.cpap.com/downloadVideo.php?VGID=16
In a cool bedroom, if you have a heated humidifier as part of your PAP (CPAP, APAP, BiPAP) machine, water may condense in the hose running between the humidifier and your mask. It can drip on your face, causing discomfort and mask leaks. Try several of these remedies to reduce or perhaps eliminate rainout.
- Raise the room temperature, if you can sleep comfortably.
- Place your machine and humidifier well below your bed, near the floor on a low shelf or footstool, so the 6 foot hose and any water have a long vertical run before reaching your headboard. (You may need a 10 foot hose if you have a very high bed.) Hold the hose in place with a hose clip or elastic ponytail band pinned to the edge of the mattress, and another on the headboard. This is a first step, but may not work to eliminate rainout.
- Common advice is to keep the hose under the blanket, which seldom works. If you are using effective hose management, this is not an option, since the hose is coming from the headboard.
- Turn down the heated humidifier to the lowest, coolest setting. If that doesn’t work, turn off the heat but continue to use the humidifier (passive humidification or passover). If your nose gets congested or your throat and mouth get dry, find another remedy.
- Wrap the hose in bubblewrap, light socks or tights with the toes cut open, or make or buy a fleece hose cover like the Snuggle Hose http://www.cpap.com/simple-find-cpap-products/cpap-hose-tubing
- If your mask has its own hose, you may need to cover that also. A light covering made from old pantyhose or tights reduces weight and drag.
- A reliable way to completely eliminate rainout is to buy a heated hose. A reliable add-on heated hose is the “Aussie hose” from SleepZone in Australia, http://www.sleepzone.com.au/. Allow up to 3 weeks for delivery to clear US customs. If necessary, cover the heated hose with a second hose cover. The Aussie hose has its own insurance code number, so it may be reimbursable. People use their heated hose summer and winter. Since the heated hose is so effective, some people don’t want to be without it in case of breakage, so they have a second, backup heated hose.
- One Fisher and Paykel straight CPAP machine package includes a heated hose and humidifier. See http://www.cpap.com/productpage/fisher-paykel-hc604-cpap.html
Aerophagia, Bloating, Swallowing Air
Finding Neverland
This may be a temporary condition as you adjust to PAP or a new mask, or it may be recurring or ongoing. Symptoms range from being painful to being merely socially embarrassing. See your doctor to rule out other related digestive disorders.
From www.cpap.com: “AEROPHAGIA. The word "phage" in Greek means "to eat." Aerophagia is literally to eat air. In the modern context, it means swallowing too much air, a common cause of gas in the stomach and belching. This is sometimes a result of CPAP Therapy. Unfortunately, the best solutions for this problem are not a catch all but instead an attempt to find the middle ground between needed CPAP pressures. Here's what you can do:
1. Tell your CPAP prescribing physician. It may be better to decrease the CPAP level a bit and put up with some minor airway problems if we can significantly decrease the bloating. Sometimes this works great, sometimes not at all. An auto adjusting CPAP should also be considered as these machines reduce the average pressure the user receives. Get help setting the maximum pressure on the auto as the highest pressures can make things much worse.
2. As the chin of a CPAP user nears the chest, air has a greater chance of entering the digestive tract. Where possible, keep the chin up in relation to the torso.
3. Sleeping in a position different than normal helps keep the air out of the stomach. Try different sleeping positions. Left side, right side, inclined with pillows, or flat.” More ideas to eliminate aerophagia:
- Try a bed wedge to sleep with the head elevated.
- To keep your chin up, try a PAPillow, neck pillow, or memory foam pillow, but make sure it’s compatible with your mask when you sleep on your side. You should be able to fit your fist between your chin and chest. See http://www.snoringpillow.com/int/index.htm
- Try an APAP machine. If already on APAP, reduce your top pressure, as long as your AHI (apnea hypopnea index) continues to remain low; or try the straight CPAP mode.
- Try a BiPAP machine or auto BiPAP machine.
Ideas to cope with aerophagia:
- Drink carbonated water or a fizzy beverage in the morning to help belch out gas.
- Use wind-relieving yoga postures that compress your abdomen in the privacy of your bathroom or boudoir.
- For digestive gas in the stomach, try over-the-counter simethicone products like Gas-X.
- For digestive gas in the intestines, try over-the-counter activated charcoal tablets.
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: aerophagia, hose management, rainout, venting
posted by Mile High Sleeper Gal | 7:05 PM
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