The reason for a gap in blogging.

This is the reason for my recent neglect of the blog. I'll begin posting again once my home has regained "balance". Her name is Allison Brooke. She was born on 8/16/2010. She weighed 7lbs 6oz and 21 inches tall. Both her and mom are safe, happy and healthy!

Switching from Swift LT to Swift FX

I've been using the Swift LT for 1 1/2 to 2 years. It worked well for me. I put it through its paces. I took it camping, took it to relatives homes, used it on couches, of course used it at home sweet home in my bed, slept on my sides, back and even face!. The LT worked like a champ in all those sleeping arrangements and positions. Why in the world would I give up the LT? Well, to see what new technology offered! The Swift LT was the third or fourth masked I tried in search of the perfect mask for me. I was very impressed at the time. So, once the Swift FX came about, I thought I should give it a try! Let's start by opening the package.

The FX comes with more than any typical CPAP mask. The packaged contained four different sizes: extra small, small, medium, and large. The mask also came with soft wraps. Soft wraps are padding strips that go along the cheek portion of the mask. Last but not least, the FX comes with the User Guide. Enough with looking at it, I wanted to use it!

It was fairly easy to adjust. A quick pull over the head and pull a couple of straps, there, I was sealed and more importantly comfortable. I did this in front of a mirror. This makes adusting it a little easier for me. I found it best to adjust it while I have it on. Also, be sure to adjust your mask well before you want to go to sleep. When you are ready to sleep is not the best time to try and figure out a new mask. Believe me, I've tried it. Next step, don the mask at sleepy time and sleep with it!

No matter how experienced you are with CPAP, new masks always take some getting used to. When I first put it on at bed time with the CPAP on, it felt like "more air" than usual. However, the CPAP machine's setting was the same as before. The only reason I can come up with for the feeling is the following. CPAP masks are shaped differently in many ways. The air flow pattern for a particular mask is unique. What I mean is air is going to flow differently through a full face mask versus nasal pillows. Air will also flow differently in different styles of nasal pillows too. So, maybe the FX gives the sensation of "more air". Well, anyway, this concludes my specultion on this matter. On with the sleep.

Once I was laying in position to go to sleep, I noticed the FX exhaust port vented in a slightly different direction than the LT. I had to move the blanket a little so the exhaust didn't blow onto it making a ssshhhhhh sound. There, one hurdle jumped. This was actually something I had to continue to get used to. When I would roll, I had to adjust things a little to keep the ssshhhh away. As with most any mask, you have to deal with the exhaust flow. It is by no means only with the FX.

Overall, the first night with the FX went well. It wasn't as good as the good ole LT night, but I had some adjusting to do. No worries. I'll get there.

Stay tuned for more FX updates!

When should I have sleep study?

There are a few different scenarios in which a sleep study is needed or recommended. These scenarios include but are not limited to: Undiagnosed Sleep Disorder(s), Retitration, and Requalify.

First, let's look at undiagnosed sleep disorder(s). If you feel tired all the time, your sleep is not refreshing, you can't fall asleep, you can't stay asleep, you can't stay awake at the proper times, someone says you stop breathing while you sleep, or someone says you snore a lot, you are a prime candidate for a sleep study. Many different sleep disorders exist in which countless books, articles and publications are written. For time sake, I won't go into them. But, if you fall into this category, it is well worth your time to get checked out. It may save your life.

For those of you who have already had sleep studies and diagnosed with a Sleep Breathing Disorder, you fall into the Retitration and Requalification categories. Retitration is straight forward as to what is done, the sleep center simply titrates you again on xPAP. Sometimes the Sleep Doc will want to go from CPAP to BiPAP or maybe even a switch to "Fancy PAP". I use that term for everything else like AutoSV, ST, AVAPS, and others. When I first started titrating patients, we only had CPAP and BiPAP. Anyway, back to the topic at hand. How do you know when you are a candidate for a Retitration? Some of the instances may be if you are snoring with your mask on, feeling tired and unrefreshed, and sometimes when you feel it is not working for you in general. Some xPAP users get retitrated every couple of years just to be sure they are receiving optimal therapy. However, with today's technologies, patients and doctors are able to follow the progress because new xPAP machines will provide AHI's and leak data. Ultimately, it is best your doctor determines when you need a retitration. This brings us to Requalification.

Requalification is more for insurance companies. Depending on the insurance company, an individual needs to be redocumented and titrated every so many years. Especially if you need a new xPAP machine. Redocumentation means they need proof that you still have sleep apnea. So, you have to undergo a polysomnogram without xPAP so they can see how bad you are. This is usually a tough night for someone used to sleeping with xPAP. If the individual is lucky, a split night will be performed. If not, a second night is needed.

These are only very broad categories for when someone should have a sleep study. There are more reasons to have a sleep study that I did not touch on. If your doctor wants or needs you to have one, by all means do it.

If you have any questions or comments, feel free to leave them in the comment section or send me an e-mail. My e-mail is listed in my profile. Until next time, Happy Sleeping!

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What to expect at a Sleep Study

"Will you be able to see my dreams?" is my favorite question from a sleep study first timer. The answer is actually, no. But, we can tell when you are in R.E.M (Rapid Eye Movement) stage of sleep. REM is the stage of sleep in which people dream. But, I'm getting the cart ahead of the horse. Now, what can you expect at a sleep study?

First, showing up to your appointment at the designated time is important. Even though you may not go to bed until 11PM, if your appointment is at 8:30PM, you should get there at that time. Many times, the sleep center staff will want you to fill out some paperwork pertaining to your insurance, basic info about you, and also information regarding how you sleep as well as a basic medical history. If you can, try to get a copy of the questionnaire before hand. It will save you some writing. Some sleep labs will send you a packet before your appointment date with this in it. Enough with the paper work, let's get to the nuts and bolts.

When you get to the sleep center, your technologist or technician will show you to your room. I believe all sleep centers provide their patients with a private room these days. The room usually has a decent bed, bedside stand, a television with remote and sometimes a bathroom right off the room or close by. Once in your room, your tech will explain to you a little about the "hook up" and what we are looking for.

The hook up consists of a series of wires and belts and takes from 45 minutes to one hour to complete. Most of the wires attach to your head. There will be about 25 leads attached all together. This exact number varies from lab to lab, but 25 is pretty close. Most of the leads attach to your scalp. Those leads are picking up brain waves. From your brain waves, we can tell if you are awake or asleep and also the quality of your sleep. When you are asleep, the stage of sleep you are in can be determined. In all, there are 4 stages of sleep: Stage 1, stage 2, stage 3 and REM.

Some of the other things we monitor with the leads on your head are eye movements and muscle activity on your chin. We look at the muscle on your jaw or chin in order to see if you grind your teeth as well as help detect when you go into REM.

Beneath your nose, you will have a cannula or a similar device to detect when you breathe in and when you breathe out.

Moving on farther South, to your neck, you will have a snore microphone taped on or near your throat.

Moving down a little further down, at least 2 ekg patches will be on your chest to pick up your heart beat.

Continuing on, two elastic bands will go around your chest and abdomen. These bands or belts will sense your effort breathing. I'm sure everyone has noticed that when you breathe in and out, your chest goes up and down. That is precisely what these belts pic up. Don't worry, we are almost finished!

Next are the leg leads. Either one or two leads will attach to each shin. These leads detect leg movements. By detecting leg movements, doctors can diagnose Restless Leg Syndrome among other movement disorders.

Okay, last, but not least is the Pulse/Ox. Tech's usually attach this to the finger. I think most of us may be familiar with this, it usually clips to your finger and lights up red. Well, there you have it! You just got hooked up for a polysomnogram! Look at the picture on the top of this page. That is Joe Rogan wired up for a sleep study. Just beneath, is a child hooked up for a sleep study. Note on the picture below, you can see more of the wires attached to your scalp. The lead placement from adults to children is virtually identical. What in the world does all this data look like?

I'll answer that question with a question. Have you ever seen a polygraph test in the movies? It has the pens going up and down as the paper rolls on by. When the person acts or reacts to something, the pens will go up and down more drastically. That is the same technology as what we use for sleep studies or polysomnograms. Except today, we use computers. On the tech's computer monitor, the squiggly lines scroll on by as the test goes on. Take a look at the picture below for an example of what a portion of a polysomnogram looks like.

And now, the million dollar question: How am I supposed to sleep with all this stuff on me? Certainly you know all of that "stuff" is there once you lay in bed. But, once you lay down, you will get used to it. Also, once you lay in bed, you don't feel the weight of the wires pulling. Not that they are heavy. The wires are light. But, you can just tell when something is hanging from you. So, when you lay down, you don't feel it as much is my point.

Do the best you can is all that we ask. We know it won't be the same as crawling into your super king at home along with your significant other, favorite assortment of pillows, and pets. All we really need is a few hours of sleep. But, the more, the merrier.

If you are invited back for a second night with CPAP, BiPAP, or xPAP, you can expect the same thing. All the wires will go on again. The only thing different will be a little practice time with PAP and getting fitted with a mask.

What do you bring to a sleep study? Be sure to bring comfortable clothes to sleep in. Usually shorts or sweats and a t-shirt work well. Some people like to bring a fan while others bring ear plugs. The reasons are many behind the items certain people bring. If it can make you feel more comfortable, bring it! Other items I have seen people bring include: body pillow, eye mask, a book, a flashlight, an i-pod, a lap top computer, a camera, even a framed picture! If you are not sure if it is OK, just give the lab a call.

The most important thing to remember about your sleep study is to relax and not worry. You are not there to perform for the techs or doctors. You are there for yourself and your health. Just kick back and relax. Good Luck!

Too Hard To Exhale

They tell you that you don't sleep well because your not breathing well. Then, they put the mask on you and say that this will help you breathe? All the while you feel like you are struggling to exhale and maybe even feeling smothered.

"It's too hard to exhale." "I feel like I'm being smothered." These are common statements I hear in the Sleep Center from patients new to CPAP or any xPAP. Let me tell you it is normal to feel that way at first.

So, why is it more difficult to exhale? What is happening is you are breathing against a predetermined pressure. When you breathe against the pressure, it increases the air pressure in your airway. When that happens, your airway blows up like a balloon, but not as drastically of course. It opens your airway just enough to allow the free flow of air. This is called Positive Pressure Support. Some refer to this as an air splint also.

If you look at the diagrams above, note the airway is closed off in certain places. This is what happens when somebody is snoring or even worse, having an apnea or hypopnea. With xPAP therapy, doctors have found a way to keep the airway open, or supported, in order to allow air to flow, back and forth, freely.

Take a look at the diagram below. It shows an open airway. The Positive Air Pressure gently forced the tissue apart that was "clogging" or obstructing the airway.





Enough with the mechanics. How is somebody supposed to tolerate xPAP in order benefit from the therapy? When somebody is learning how to ride a bike, training wheels come in handy. Luckily, xPAP machine manufacturers have some training wheels of their own! These are in the form of ramps and pressure relief technology.

Ramping is a feature that most machines have these days. The ramp is usually activated by a button press or even automatically when the machine is turned on. Once the ramp is initiated, the xPAP machine turns itself down to a lower, more comfortable pressure for the user. At that point, the machine gradually increases pressure. After a predetermined time, usually 5 to 20 minutes, the machine reaches the prescribed pressure. Another popular "training wheel" is pressure relief technologies.

Different companies call their pressure relief technologies different names. Respironics has the Flex technologies in the form of CFlex, BiFlex, and AFlex. Resmed calls their's EPR for Expiratory Pressure Relief. They all do basically the same thing. When the xPAP machine senses you exhaling, it lowers the pressure for a quick instant in order for you to start your exhalation breath. It gives you the feeling of a "softer" exhale. For more information on these technologies, take a look at the topics I posted about them on this blog site in June 2010.

In conclusion, researchers and manufacturers are working diligently in order to make xPAP more tolerable and easier to use. If you are having a hard time with xPAP, give these features a try. It makes it easier to transition into a life with PAP therapy. It did for me.

Just like training wheels on a bicycle, you won't need ramps and pressure relief after you learn "to ride". Surprisingly enough, many people turn these features off once they got used to PAP therapy. I did.

Once again, feel free to comment or question. Take a spin around the Internet for more info. Thanks for surfing by here! I am starting to suggest some sites. Look near the upper right of the page of some sites I listed or look around on the page...there are plenty of places to go! Happy Open Airway Breathing!

Swallowing Air (Aerophagia)

Aerophagia occurs in some that are new to CPAP. The individual will experience bloatedness and/or gas pain resulting from swallowed air. When somebody first uses xPAP, you can see how somebody could swallow air. The reason being there is so much more air than usual in your airway and under pressure. Doing normal things like coughing or even swallowing to clear your throat can make you swallow air. Everybody has experienced gas before and everybody knows how the body expells gas(in one form or another). But, don't worry. From what I understand, this usually goes away as you get used to using PAP therapy. However, aerophagia has other causes as well. To see which category you belong in, you should chat with your doctor. Below are some links about aerophagia and cpap with more information.

Some quick Q&A about CPAP and Aerophagia:http://www.talkaboutsleep.com/message-boards/viewtopic.php?t=2784

Aerophagia in an informative blog (look near the bottom of the page). This blog also contains a wealth of information about sleep apnea related topics:http://smart-sleep-apnea.blogspot.com/2008/01/solving-common-cpap-equipment-problems.html

Aerophagia in general and its causes and treatments:http://www.articlealley.com/article_187157_17.html

Sudden Movement or Jerk When Falling Asleep

It was summertime, and I was sitting on a plane headed to Detroit from Orlando. It was an early morning flight, so I was still a little sleepy. I remember it was hot out. The air conditioning coming out of the vents on the plane felt good. With nothing else going on, I decided a little cat nap couldn't hurt. The next thing I know, my arms and legs jumped and I took in a quick breath. Once I looked around and realized nobody was trying to get my attention and that the plane wasn't crashing, I concluded that I dozed off for a moment. When I fell asleep, I had a sudden movement or jerk. I think most of us have experienced this at one time or another.

This is called a hypnic jerk or sleep start. This happens when somebody transitions from wake to sleep and is considered normal. If you don't do it, no worries that's normal too.

Here's a link with some more info:http://www.sleepdisordersguide.com/topics/hypnic-jerk.html

Questions and comments are welcome. Remember, a little research goes a long way when it comes to your health and health care. Reading what people have to offer when it comes to healthy sleep is a good idea. The more you know, the more comfortable you can be with your outcome(s) and treatment(s), especially when it comes to sleep.

Which mask is for me? (Conquering Demons)

In real estate, the saying is, "Location, location, location". When you are trying to find the right CPAP/BiPAP/xPAP mask for yourself, the saying is, "Experimentation, experimentation, experimentation". I had to try four different masks before I found the right one for me.

At first, I thought I knew what I wanted. I know I didn't want a Full Face Mask because I don't like to breathe through my mouth. I didn't want to use Nasal Pillows because I felt peculiar about something sticking into my nostrils. The thought was embarrassing to me for some reason. I was absolutely sure the Nasal Mask/Triangle Mask was for me and there was no need for further thought. Boy, was I wrong!!! It was like choosing my favorite book by only looking at the cover.

I started off with the Nasal/Triangle Mask. It felt good. I knew I had to get used to it and it wasn't going to be perfect the first night. I tried it for a few nights and noticed my nose and face were sore here and there. I began looking at other masks then. I found another Nasal/Triangle that was softer on my pressure points and it was more adjustable. Perfect! I gave that one a try for a few days with better results than the previous! I was sleeping better and better.

So, I found a comfortable Nasal/Triangle and I was able to wear it all night. Now I noticed that I'm not sleeping in the position that I am most comfortable in. I like to be on my side with my face more into the pillow than the Nasal/Triangle would allow. Once again, the search was on to find "the perfect mask". My quest then led me to re-visit my embarrassing demon, Nasal Pillows. The more I looked at the variety of Nasal Pillows, the more "acceptable" it was to me and they would allow me to sleep in the position I wanted.

I gave myself a pep talk which included: "you know what you're doing now", "things have gotten better with every try", "what have you got to lose?". Fast forward to my first night with nasal pillows. Things went well. I slept in the positions that I was more comfortable in. I did have to adjust the mask a few times because I was resting more heavily on the side of my face. But, no problem. It went better than I thought! After a couple of nights, I realized I had a recurring problem. The Nasal Pillows kept on popping out the front of my nose. No matter how I adjusted the headgear and the pillows it kept happening. In my head, the gears began turning once again. My research directed me towards a brand of Nasal Pillows that had a specific adjustment for my problem. I tried a set of "those", aka Swift FX, and obtained the balance I was looking for!

The morals of this story are: finding the right mask for you is an evolution, keep an open mind, and do your research for it will pay off. Have a look around the internet at all the suppliers and online stores for masks and gear. They advertise all over the place!

Have a look at my other blog. I'm reviewing and reporting on different masks from different companies. I'm trying to add at least 2 a week. If you don't see one that interests you, be sure to check back. You can find it at:http://www.cpapmaskreview.blogspot.com/

As always, questions and comments are welcome!

Deviated Septums and Sleep Apnea

I've performed literally thousands of sleep studies including titration studies. A recognizable portion of those diagnosed with Obstructive Sleep Apnea (OSA) also had a deviated septum. What is a deviated septum?

The septum is the divider inside your nose (between your nostrils roughly). When your septum is deviated, that means it is not in the normal position. This can be caused from trauma or could be a developmental abnormality. Take a look at the image below. Notice the septum (center of the nose) is not straight up and down directly in the middle of the nose. This constitutes a deviated septum. Does a deviated septum cause sleep apnea? I can't say for sure. But, I can offer some logic.

Looking at the term "Obstructive Sleep Apnea", the term obstruction stands out. Dictionary.com defines obstruction as "something that obstructs, blocks, or closes up with an obstacle or obstacles; obstacle or hindrance." Looking at the image, you can see how the deviation or bend in septum can hinder airflow. If the airflow is limited here, any other obstruction in the airway could reduce airflow that much further. Intuitively, it seems a deviated septum may make one more susceptible to OSA.

When is comes to xPAP treatment, OSA, and a deviated septum, it is no problem. XPAP works well when it comes to this. It is the perfect device to make sure enough air goes through the airway, no matter how small. I've seen many successful titrations on patients with deviated septums.

Your questions and comments are always welcome. Remember, education is the best way to make your treatment more successful. Have a surf around the Internet!

Expiratory Pressure Relief (EPR)

EPR is a way to make xPAP more tolerable by relieving pressure. Many xPAP users complain about the difficulty of exhaling. EPR works similarly to C-Flex, which is mentioned in a previous topic. Once the xPAP machine senses the patient exhaling, it turns the pressure down for an instant in order for the patient to exhale more easily. Once the person has the exhale started, the machine will go back to the original CPAP setting or EPAP setting depending on what kind of machine you have. The best word I can come up with for how it actually feels, is that it is softer or more smooth. You will have to try it to find out for yourself!

There are many companies that sell xPAP machines with the EPR feature. The manufacturer is Resmed. But, Resmed products can be purchased from many places online. There may be some listed on this page. Have a look around!

Here's a link to Resmed's page on EPR:

http://www.resmed.com/au/patients_and_families/improving_therapy/expiratory-pressure-relief.html?nc=patients

Central Apneas...normal?

The short answer is, yes! Let me provide an explanation, without going too far into detail.

When somebody falls asleep, they typically have what we call a "transitional event". That is a respiratory event which happens when somebody transitions from wake to sleep. This transitional event is usually a central apnea. Transitional events can even happen when somebody transitions from one sleep stage to another sleep stage.

People with untreated obstructive sleep apnea tend to have a high central apnea count. This is because they are transitioning from wake to sleep much more often than a normal person. This is because of the obstructive apneas and hypopneas fragmenting their sleep. So, with all the obstructive apneas, hypopneas, waking up and falling asleep, there will be more central apneas than usual. Once a person receives xPAP treatment, the central apneas usually subside to more acceptable levels. However, there are some instances when central apneas persist.

From observations in the sleep center concerning xPAP titrations and central apneas, I've found central apneas can be related to mask discomfort and leakage. Sometimes a person can't tolerate a certain mask the entire night. This can be from a few reasons ranging from a poor fit to the mask irritating his/her skin. Also, mask leaks can disturb a patients sleep. In general, being uncomfortable with the xPAP mask can fragment your sleep. This sleep fragmentation will result in transitional central apneas as the person transitions from wake to sleep during those troublesome times. Even though this discussion is about "normal" central apneas, there are times when it is not.

Make no mistake, central apneas can be serious too. Central apneas can be attributed to Congestive Heart Failure, COPD, and the list goes on.

As always, your comments and questions are always welcome. When you are in the market for anything from sleep studies to xPAP equipment, it pays to do research. The internet is a great place to start! Have a look around.

Alcohol As A Sleep Aid Q&A

Another good question from a reader which reads:

I feel as if I can't goto sleep unless I have a few drinks. My mind start to race and think to much. I dont really have the snoring issues, but would really like to know is there another way of relaxing my brain without having to drink a six pack before I can goto bed?

My response:

The Sleep Doctors I worked with in the past would recommend to some people to have a glass of wine or two in order to help get to sleep. Personally, I think this is a better way to get to sleep than taking any kind of pills. Let me add a caviot here: DON'T MIX SLEEPING PILLS(or any pills for that matter) AND ALCOHOL!!!

Considering today's fast paced, high stress, and generally busy way of life, it is understandable that people get stressed and have difficulty getting into a sleepy state of mind. To a certain extent, it's okay to have some alcohol to help unwind and let go a long day's toil.

This is a difficult subject to comment on in general. Only you know how alcohol effects you and if you should be drinking at all. Before you go open the wine bottle, have a look at the topic entitled, "Alcohol and Sleep Apnea".

As far as finding another way to relax your brain before you sleep, well that's a tough one. Some people read, some people watch TV, and some even sit quietly outside and look at the stars. Only you can find what makes you relax. Some experimentation may be in order.

As always, your comments and questions are welcome. As you can see the questions can be diverse around here.

C-Flex and Bi-Flex

C-Flex and Bi-Flex are pressure relief technologies. The pressure relief feature helps the user transition from inhale to exhale with less effort. This feature came about because a common complaint amongst xPAP users is it is difficult to exhale when you are using xPAP. Respironics developed the Flex technologies in order to make patients feel more comfortable when using PAP therapy and to increase compliance or PAP usage.

C-Flex was developed for CPAP machines. When a user is breathing on a CPAP machine with C-Flex, the machine will sense when the user exhales and adjust the pressure. The machine will drop the PAP pressure for an instant in order for the patient to start the exhalation process with more ease. "Softer" is a common description of how it feels.

Bi-Flex is similar to C-Flex but designed for BiPAP. When the Bi-Flex feature is initiated on a BiPAP machine, the machine senses the inhalation and exhalation process. Just like C-Flex, the machine will drop the pressure for an instant when an exhale is sensed or EPAP. When the inhale is detected, the machine will switch to the predetermined IPAP, but will start with a drop in the IPAP pressure for a quick instant so the user can start the inhale breath more "softly".

A-Flex is designed for APAP machines and works very similarly to C-Flex.

For more information on the Flex technologies, a surf around the web will probably reveal much more than what I mentioned here. Happy reading!

As always, questions and comments are welcomed.

What is APAP?

Another good question posed from a reader. If you haven't read "What's the difference between CPAP and BiPAP?", you may want to do that before continuing with this topic. Now, off to the topic at hand.

APAP stands for Auto Positive Airway Pressure. By the term "Auto", the manufacturer means self adjusting, self titrating, auto adjusting, etc. Modern APAP machines can be programmed to auto adjust in a pre-determined range. For example if it is found that the optimal range for a certain patient is 8 to 12, then the machine's output pressures will range from 8 to 12. This brings us to why it has a range and when will it "auto adjust".

We will continue with the patient example just mentioned. When the patient whose ideal PAP range is 8 to 12, turns on his/her machine at home, it will start at CPAP 8 (I'll get to BiPAP and APAP in a moment). As the person sleeps, if the APAP machine senses snoring or breathing events like apneas or hypopneas, the APAP machine will increase the pressure by 1. For our example, the APAP machine will increase to CPAP 9. If snoring, hypopneas, or apneas are continuing, then the machine will increase the pressure up to CPAP 10 and so on, up to the upper limit. The upper limit in our case is 12. The APAP machine will usually allow a few minutes to elapse before making each change. It takes a little time to see if the new pressure is effective. Now, suppose our example patient was auto adjusted to CPAP 12 and is now breathing freely for some time without snoring, hypopneas, or apneas.At this point, the APAP machine will decrease the pressure by 1. The new pressure is now CPAP 11. If the patient continues to breathe without snoring, apneas, or hypopneas, then the APAP machine will decrease the pressure by 1 again, bringing it down to CPAP 10. This process may continue, depending on the patients perfomance down to the minumum of CPAP 8.

Auto BiPAP machines are very similar. They have pre-set ranges for IPAP and EPAP typically with a spread of 3 or 4. As an example, say a patient's ideal BiPAP range is 10/6 (IPAP=10 EPAP=6) to 13/9 (IPAP=13 EPAP=9). When turned on, the machine will start at 10/6 and, if necessary, increase from there to 11/7. If warranted again, increase to 12/8. If snoring and breathing events continue, the maximum will be reached at 13/9. Just like the APAP machine, the AutoBiPAP will decrease pressure as needed.

There is much more to APAP and AutoBiPAP machines and their software. These were only very simple examples to illustrate the basics of what they do.

Keep the questions and comments coming!

What's the difference between CPAP and BiPAP?

A fellow PAP user asked me this the other day. The terms CPAP and BiPAP are used frequently in the sleep apnea world but rarely defined. I'll first define CPAP and then go into BiPAP.

CPAP stands for Continuous Positive Airway Pressure. That is, the machine pumps out the same pressure constantly. The user inhales at a predetermined air pressure and then exhales at the same pressure. This leads us to BiPAP.

BiPAP is almost the same as CPAP but with one difference. The user inhales at a certain predetermined pressure and when the user exhales, the BiPAP machine senses this and lowers the pressure to a predetermined pressure. Hence the "Bi" in BiPAP stands for bi-level or two pressures. The inhale pressure is termed IPAP ("I" is for inspiratory). The exhale pressure is termed EPAP ("E" is for expiratory). The spread or difference between IPAP and EPAP is usually 3 or 4 (cmH2O). I say "usually" because there are special circumstances when the spread is larger.

xPAP is another term used frequently on internet forums. xPAP refers to CPAP or BiPAP. It is just a simple and quick way to refer to CPAP or BiPAP when the distinction is not important for the idea at hand.

Some of the newer xPAP's out there include ASV, AVAPS, etc. These are more sophisticated CPAP's and BiPAP's, usually the latter.

Sleep Walking and Sleep Apnea Q&A

The following is a question sent to me. I actually hear this one frequently in the sleep lab.

Have you ever dealt with someone with sleepwalking caused by apnea? During my initial consultation, the doc said that the sleepwalking could be caused by "micro-arousals" which were triggered by the apnea, and subsequently scheduled my sleep test for next week. My reason for going to the sleep doc was constant fatigue, headaches, mental fog, and I'm just generally irritable. Is this doc just trying to blow sunshine, or is the "micro-arousals" line true? Also, am I going to wreck the equipment if I get up and start moving around during the test? Thanks for your help

My response:

Good questions. In my experience as a sleep tech, I've performed many studies on people with your same complaints. People with sleep apnea tend to be active in bed from rolling around often to arms and legs flailing like they are fighting. Some people that move like the latter say they sleep walk too. What the doctor says is true. Your sleep is so disturbed and you are so sleepy or half asleep at these times, you may not realize what you are doing. You sound like an excellent candidate for a sleep study. I think they will be able to help you out dramatically. I've seen the before and after of similar people myself. As far as the actual sleep study, you will be fine. It is normal for a wire or two to come off during the study on someone active. The tech probably has performed a sleep study on someone like yourself before. Good luck on your sleep study! Let me know how it goes.

Thank you for reading and keep your questions and comments coming!

Alcohol and Sleep Apnea

Has anyone noticed that you snore more when sleeping after a night with a couple of drinks? Well it's probably true! Alcohol makes your airway swell which may in turn cause you to snore. If you snore already, it may worsen your snore. If you have sleep apnea, it may worsen that too.

If you are currently using xPAP, be sure to use it after a night on the town. It is understandable why somebody would not want to after a fun night out. But this is a very important time to use it or else you may be in for a rough night!

A little research goes a long way when you are in the market for a mask or machine.

Mouth Leaks and Congestion

Congestion can be caused by many different things. One way is through a mouth leak. As air blows out of your mouth, it dries your mouth out. In other words, this is dehydrating you. The body's natural reaction to this is congestion. So, what do you do?

What I do in the sleep lab setting is to increase the humidity and control the mouth leak. Humidity can be increased by going to a higher number on your heated humidifier. I usually start at a setting of 1 or 2. If somebody complains of congestion, I will increase it to 3 or 4. Sometimes I use 5 but only for a short time. To control the mouth leak, I usually add a chin strap. Sometimes I switch to a full face mask, but rarely.

At home, you probably don't have the liberty of going to the supply room and picking out different masks and chin straps. You probably don't even feel like getting up. No worries however, all is not lost! A simple trick is to put a pillow under your chin to keep your mouth closed. Luckily at home you CAN adjust your humidity setting too. If you are not sure how to, it is probably in the owners manual or look on your machine for a setting that goes from zero (0) to five (5). Zero is no heated humidity, but you will still be getting humidity as long as you have water in the reservoir. Setting 5 is the maximum heated humidity setting. It is okay to experiment with the humidity. At home, sometimes I need it high if I'm feeling congested or sometimes I need it low for when I don't want to breathe warm air. Experiment and you will find what you like!

A thought from literature

But the tigers come at night,
With their voices soft as thunder,
As they tear your hope apart,
As they turn your dream to shame.
-From Les Miserables

Some consider this a metaphor for sleep apnea. It really does turn one's life upside down.

Mouth Breathing Myth

When my patients return for their titration sleep study, I mainly use nasal masks. Many patients explain to me, "but I breathe through my mouth when I sleep." Don't let the title of the blog fool you. These people are right! I even witnessed it during their first night. Why do I say "Mouth Breathing Myth" then? First, a short explanation.

People with sleep apnea have a "clogged" airway, to put it simply. Imagine if somebody pinched your nose closed. You won't suffocate because you know you can breathe through your mouth! So, when your nasal airway closes off, your mouth will open to get the breath that you need. This makes one a mouth breather.

Hence with Positive Airway Support (xPAP), you will be getting the air you need through your nose to open the airway and give you the air you need. This is the purpose of the titration night, to find the pressure that breaks through your clog. It is a natural tendency to breathe through your nose. Once you are able to breathe freely through your nose, your body will revert back to that tendency instead of being in survival breathing mode.

Some patients have a strong habit of breathing through their mouth even though I have them fixed on xPAP. With these people, I add a chin strap. The chin strap usually works well. The mouth breathing habit usually subsides after a short time.

There are some true mouth breathers out there however. These are people who have a deviated septum (severe) or someone who has had their nose broken several times or maybe just once, but severely. It is for these individuals that I break out the full face masks. I usually only have to do this 2 or 3 times a year.

My point being...give the nasal masks a good try before you go to full face. Nasal masks are much more comfortable, they give you more mobility in sleeping positions, and they keep a better seal. It has been shown compliance is low when somebody uses a full face mask vs. a nasal mask.

CPAP Forever?

I actually hear this question a lot. Before I address the question directly, let me make one point. When it comes to a person wearing glasses or corrective lenses or contacts... who really wants something on your face or in your eyes? I don't think anybody does. But, people tolerate glasses and contacts because it makes the quality of life much better. The quality I speak of is vision of course. So, with CPAP, I tolerate it because it makes my sleep better which in turn makes me happier in many ways. So, once you get glasses, you probably need them for the rest of your life. Now, back to the original question.
Will I have to wear CPAP forever? The answer is...it depends. There are three general categories people fall into that use CPAP: airway architecture, large tonsils, and obesity.
Some people need CPAP because the architecture of their airway is constricted. This can be genetic in that is how you are "designed" or the genetic material inherited from your parents determined your airway size. A simpler way to look at it is some people are tall. Some people have small hands. Some people have bigger airways and some people have smaller airways. If somebody falls into this category, most likely you should use CPAP for the rest of your life.
Another category for constricted airways is large tonsils. Most likely this category of CPAP user will have to use CPAP for the rest of his or her life unless you have surgery to remove your tonsils. Removal of the tonsils is not a guarantee to get off of CPAP.
The last category of CPAP users is obesity. Most people on CPAP fall into this category. When a person gains weight, his neck becomes thicker or weight is gained beneath the chin. Weight is gained in other areas of the body too of course. But, when the neck and face become thicker, that adds to the constriction of the airway causing sleep apnea in some people. What actually is happening is more complicated than this but for our purposes I'll leave it at that. So, people gain weight and people lose weight. When you lose weight, some of that weight is taken off of your airway. So, theoretically, you can lose enough weight to get off of CPAP. I have been doing sleep studies on people for 10 years now and I've only seen 1 person able to do this. But don't let that burst your bubble. There is probably others that have done it, they either just don't come back to get re-tested or go to another sleep lab...or the possibilities go on.
In general, once you are on CPAP, most likely you will need it indefinitely. But, don't let that deter you from trying to lose weight or maybe even getting surgery. When it comes to surgery, there are some caviots which I may touch on later if there is interest. I hope this helps!

Tip of the night.

When wearing your mask, be sure it fits comfortably. Make sure it is not too tight or too loose. How do you know? Experiment! You may have to do this in front of a mirror or with a helper. First, go ahead and start your machine and put your mask on. Next, adjust the straps in different ways, either tightening or loosening in order to get different feels of fit. This is the part where you may need a helper or the mirror. If you find a position that feels more comfortable, then lay down with it to ensure that you maintain your seal, that is, no leaks. If it leaks, continue to adjust and experiment with the straps or holding mechanism until you feel a more comfortable fit. Good luck with your mask and happy sleeping!

Introduction

I have been in the sleep business for 10 years now performing sleep studies and applying CPAP and BiPAP in different ways. I've used most masks on the market either on myself or on patients. I also rely on CPAP myself to help me with my sleep apnea. My intention with this blog is to post tips and hints for a positive experience either with a sleep study or with CPAP and BiPAP itself. I look forward to blogging and hearing feedback.