Treatment for Sleep Disorders

A continuous positive airway pressure (CPAP) machine uses pressurized air keep your airway open while you sleep. This lets you breathe normally overnight.

CPAP machines include a mask for your nose and mouth or just your nose. Wearing the mask while you sleep can be a challenge at first. It’s common for new users to pull off the mask while they sleep or have trouble falling asleep with the mask on. Most people adjust successfully within a few weeks. If you continue to have trouble, you and your doctor can discuss adjusting your CPAP machine’s pressure or trying a different style of mask.

Learn more about CPAP therapy and tips for common challenges.

Why is it important to use CPAP?

Obstructive sleep apnea disrupts sleep, causing daytime symptoms such as sleepiness, fatigue, concentration difficulties, headaches, and irritability. Sleep apnea also increases blood pressure and risks of strokes, heart attacks and sudden death. Treatment with CPAP has been shown to reduce these risks back to the level of people without sleep apnea.

Mask types

There are 4 main mask types: nasal pillows, nasal mask, full face and pillow full face masks. The nasal pillows are the smallest masks that just covers the nostrils. They often cannot be used with pressures over 15 and are the hardest to keep in place. Nasal masks go around the nose and full face masks cover the mouth and nose. If someone has a very blocked nose or tends to open their mouth during sleep they may require a full face mask. The last type of mask has nasal pillows for the nose, but also a mask to go over the mouth. Chin straps can be used to help keep the mouth shut while using a nasal mask.

EQUIPMENT

The equipment should be washed regularly as directed by the home care company. Masks, tubing and filters should be replaced approximately every 6 months. Many masks do last longer but if a leak develops then the mask should be changed. Insurance companies often pay for replacements every 3-12 months, your home-care company will know this information.

GETTING STARTED WITH CPAP

CPAP does not help most people fall asleep, but it can help people stay asleep. Don’t expect to be able to wear the mask throughout the night immediately. It is normal to have some nights where you can’t fall asleep with it on or need to take it off after a couple of hours. The most important thing is to keep trying every night. For most people this adjustment period takes 1-2 weeks.

MASK FIT

The most important thing for success with CPAP is finding a mask that fits well. It should not hurt or leave significant red marks. Air should not escape from around the mask. Many people can improve mask fit by adjusting the straps or the forehead piece. Sometimes keeping the straps loser rather than tighter decreases leak by allowing a cushion of air to develop. If you can’t get your mask to fit, it is important to let the homecare company or your doctor know as soon as possible so they can either help you adjust it or get a different mask. A dry mouth may be a sign that there is mouth breathing and a full face mask may be needed. Gel pads to go under the mask are available if the mask is irritating your nasal bridge.

CLAUSTROPHOBIA OR MASK FEAR

This is a lifetime process so a few extra days getting used to the mask is more important than never using it. If you feel uncomfortable with wearing the mask at night, start during the day. First practice putting on and taking off the mask until you are comfortable with it. Then try to use it while you are sitting around watching TV. Once you feel comfortable breathing through the mask while you are awake try to sleep with it.

WATER IN THE TUBING

Water can condense out into the tubing if the humidity setting is too high or if the room is too cold compared to the air causing “rain-out”. Insulation sleeves or heated tubing can be used around the tubing to minimize “rain-out.” Increasing the room temperature or room humidity may also help.

RAMP SETTING

If the pressure feels too high when you start using the mask, use the ramp setting to start with a lower pressure which will then gradually increase usually over 5-45 minutes. If you feel like you aren’t getting enough air then don’t use the ramp.

FLEX OR EPR SETTING

If you are having difficulty breathing out against the pressure increase the FLEX or expiratory pressure relief (EPR) setting to 3. This will lower the pressure briefly right as you breathe out making it more comfortable.

HUMIDITY

For most people it is important to use the humidifier. Dry air can irritate the nose leading to more nasal congestion and runny nose. You may need a higher setting in the winter and lower setting in the summer when it is more humid. Distilled water is recommended by the homecare company to decrease minerals from depositing in the humidifier chamber, but tap water is also safe to use.

CHANGING SETTINGS

Most machines give easy access to change the ramp, FLEX/EPR and humidity settings. They do not allow you to change your pressure setting so you will not accidentally change it. If you feel the pressure is too high or too low, talk to your doctor.

SLEEPING POSITION

While we try to adjust the pressure to open the airway whether the patient is sleeping on their side or back, there is often still more obstruction while sleeping on the back. Trying to sleep on your side with the machine is recommended. They are usually not needed, but there are CPAP pillows which have a cut out to fit the mask and help encourage sleeping on the side. There are positioning devices that can also be used to make you don’t sleep on your back.

NASAL CONGESTION

If you have frequent nasal congestion, talk to your doctor about nasal sprays that may be helpful. If you get a cold, you can stop using the machine for a few days until you feel better.

WAKING UP AT NIGHT

If you keep waking up at night despite the CPAP, the pressure or mask may need to be adjusted. Obstruction usually worsens in dream (REM) sleep which occurs every couple of hours, which can be the reason for awakenings.

COMPLIANCE DATA

Most machines collect data on mask leak, pressure settings, and obstructive events. We may be able to get data online through a modem, but please bring your machine to all your visits so we can collect the data and make adjustments if needed. This will help us determine whether the mask is working optimally. Your home care company may also have you send the data to them for insurance purposes. Most insurance companies require proof of using the mask regularly for at least 4 hours per 24 hour periods on over 70% of days.

While CPAP machines provide air at a constant pressure, other machines work differently. Bilevel positive airway pressure (BiPAP), adaptive servo-ventilation (ASV) and volume-assured pressure support (VAPS) machines all provide higher pressure when you breathe in and lower pressure when you breathe out.

BiPAP machines may be helpful if you have tried CPAP therapy in the past and had trouble with the CPAP machine’s air pressure. BiPAP and VAPS therapy both increase the amount of air you breathe in and out, which can help if you have one or more of these conditions:

• COPD (chronic obstructive pulmonary disorder)
• Emphysema
• Neuromuscular disorders
• Obesity hypoventilation syndrome (OBS), a breathing disorder that can affect people with obesity
• Reduced central drive, a reduction in the amount of breathing caused by taking narcotic medications

If you have certain types of central sleep apnea, ASV therapy can help stabilize your breathing patterns during sleep.

If you’ve tried CPAP, BiPAP or other treatments for sleep apnea without success, you may be a candidate for a surgical treatment called Inspire (Hypoglossal Nerve Stimulator Implantation). The Food and Drug Administration (FDA) has approved this procedure, also known as hypoglossal nerve stimulation, to treat sleep apnea.

During an outpatient procedure, our surgeons will implant the Inspire device in the chest, along with electrodes that run from the device under the chin and a sensor that will sync the device to your breathing patterns. You’ll work with your doctor after surgery to fine-tune the Inspire device to your needs.

When you get ready to go to sleep at night, you’ll turn the Inspire device on with a small remote control. While you sleep, the device will monitor your breathing and move your tongue out of the way with each breath to keep your airway open. This procedure has been shown to help patients with sleep apnea who haven’t responded well to other treatment methods.

Exposure to light is one way your body regulates its internal clock so you can sleep when you’re supposed to and wake up rested and refreshed. By using light therapy, we can “reset” your internal clock to help you re-establish a normal, healthy sleep schedule.

Some medications you take may keep you awake or make it harder to fall asleep. Some sleep disorders can improve with medication to help you fall asleep or stay asleep.

Some medications can help treat the root cause of a sleep disorder, rather than influencing how you sleep. For example, restless leg syndrome (RLS) can improve with iron supplements or other medications.

You and your doctor will review all the medications you take and discuss whether medication may improve your sleep disorder.

If you have central sleep apnea or certain forms of lung disease, your lungs may not receive all the oxygen they need while you sleep. With oxygen therapy, you will get the oxygen you need during sleep – which may make you sleep better at night and increase your energy during the day.

Oxygen therapy may be given though a small flexible nose tube (also called a nasal cannula), or may be connected to your CPAP or BiPAP device. Oxygen therapy at night is often provided by an oxygen concentrator that enhances the amount of oxygen in the air you breath.

You and your doctor will discuss whether your sleep disorder may improve as a result of certain changes to your lifestyle. Your doctor may recommend that you:

• Set a regular bedtime and wake-up schedule, even on weekends.
• Avoid large meal or drinks two hours before bed. A light snack may be helpful.
• Avoid stimulants — coffee, tea and soda — at least six hours before bed.
• Avoid troubling news right before bed, such as violence on TV or in the newspaper.
• Don’t nap during the day, especially after 3 pm, or take naps that last longer than one hour.
• Don’t smoke; nicotine is a stimulant and can make it difficult to fall asleep.
• Establish relaxing before-bed routines — take a bath, meditate, listen to soft music, or read.
• Exercise regularly and early in the day; this helps keep the body and mind healthy. Avoid vigorous exercise activities right before bed.
• Make your bedroom a quiet, dark environment that is primarily a place for sleeping. Turn off all devices and screens to make it as dark as possible. Make the room cool or a temperature
• that helps you fall asleep. Hide your clock to avoid clock-watching, which can add stress.
• Only try to sleep when you feel sleepy. If you are still awake after 20 minutes, get up and do a relaxing activity until you feel sleepy.
• Keep a sleep log (pdf) to help you identify problems or habits that prevent you from falling asleep.

Problems with your sleep may be related to other health conditions. Your doctor can provide referrals to other experts as needed, such as:

• Allergists if your sleep problems are caused or worsened by allergies
• Cognitive behavior therapy specialists if you have insomnia or a behavioral health issue that affects your sleep
• Sleep dentists if you may benefit from a mandibular advancement device, a type of mouthguard that can improve obstructive sleep apnea
• Surgeons if you have an obstruction in your airway that blocks or disrupts air flow during sleep
• Weight loss specialists if your weight may be involved in your sleep disorder