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Positive Airway Pressure Therepy - download this document in Microsoft Word format

-Positive airway pressure machines, which keep your respiratory tract open when you sleep, can be very effective in treating your sleep apnea. This information is designed to help people who use PAP find solutions to the problems often encountered when beginning PAP treatment. If you have obstructive sleep apnea, your upper airway collapses again and again as you sleep. Positive airway pressure (PAP) devices give you just the right amount of pressurized air needed to prevent this collapse. Properly set and used whenever you sleep, PAP machines can eliminate your apnea and snoring so that you get a good night's sleep.

-Various PAP machines and masks are available, allowing each person to find the combination of equipment that works best. The pressurized air comes through a mask, which fits securely over your nose. Some patients will find PAP works best for them using a mask that fits over the nose and mouth or in the nostrils. Most people first try PAP machines that deliver a continuous fixed amount of pressurized air called continuous positive airway pressure (CPAP). Some people prefer two-level PAP machines, which deliver more pressurized air with breathing in and less with breathing out. Self-adjustable PAP will raise pressurized air levels only when apnea occurs.

-Your PAP machine needs to be carefully adjusted to provide just the proper amount of pressurized air you need in all body positions, no matter how deeply you sleep. To determine the amount of air pressure right for you, your sleep is monitored in a sleep center while you use a PAP device, and the pressure of air is raised in small amounts until your apnea is eliminated. You may need higher pressure during some sleep stages and in some sleeping positions. The sleep center technologist is experienced in helping people get used to sleeping with PAP.

-Obstructive sleep apnea can usually be completely controlled with PAP, but you must use it whenever you sleep. Getting used to sleeping with a PAP machine takes time. While at first you may find it inconvenient or troublesome, you shouldn't abandon it without a good try. It can really help you.

Nasal discomforts
Nasal stuffiness or congestion is the most common side effect of PAP therapy, and is often a nasal reaction to airflow from the PAP device. More than half of patients experience some increased nasal stuffiness when they first begin PAP treatment. These symptoms often disappear within a month.

Mouth discomforts
Dryness and pain in the throat may be caused by PAP devices. Often the discomfort is caused by air blowing through an open mouth. A chin strap to keep the mouth closed or a mask that covers the nose and mouth can eliminate this complaint. Humidifiers for PAP machines can also help control mouth discomforts.

Mask air leaks
Symptoms of mask air leak are red eyes, loss of beneficial effects of PAP, and return to snoring or apnea. Air leaks are most often the result of a poorly fitted mask. Sometimes a different mask or a mask of a different size is needed. If you continue to experience significant air leaks despite using a chin strap, consider a mask designed to fit inside your nostrils, or one that covers your nose and mouth. A custom mask can be made for you if necessary.

Noise of the machine
Newer PAP machines are much quieter than older models, but all make some sound. Placing the machine under the bed or on the floor usually solves the problem.

Sore, dry, or red eyes
These problems can result from an air leak from your mask. Try reapplying the mask and readjusting the headgear. If the problem continues, contact your PAP supplier to determine whether you need to try a different mask size, nasal pillows, or a different headgear.

Redness on the face where the mask contacts the skin
If you develop reddened areas or sores on or above the bridge of your nose or on your forehead, first check to see whether your mask is pressed too tightly to your face. Your mask needs to be fitted and adjusted to eliminate air leaks without undue pressure on the skin. Sometimes spacers and air cushions can help ease the pressure points. If you need to loosen your mask so much that leaks develop, ask your PAP supplier whether your mask is the right type and size and is properly adjusted.

Too much air
Especially when first using PAP, some people complain that the pressure of air through the nose seems too high. If this sensation makes it difficult for you to fall asleep, try using a pressure ramp. Most PAP machines have ramp capability. The ramp starts the machine at a very low pressure and gradually raises it to the right amount over a period of minutes. Most PAP machines will allow you to adjust your ramp time.

Should I try a two-level PAP?
If you have trouble breathing out against the continuous air pressure of CPAP, a two-level PAP machine may help you. These machines sense when you breathe in and out, and deliver one pressure of air when you breathe in, and (usually) a lower pressure when you breathe out. If you were not tested in a sleep laboratory on a two-level PAP device, you will probably need another study to determine the correct air pressure for you.

Should I try self-adjustable PAP?
PAP devices that raise air pressure only when they sense problems with breathing were approved for use in America in 1996. By increasing air pressure intermittently, it is believed that PAP treatment of sleep apnea may be made more comfortable and effective. If air pressure-related complaints limit your use of CPAP or two-level PAP, you should consider asking your doctor about self-adjustable PAP.

Cleaning PAP devices
Regular cleaning is essential to assure proper function and safety of PAP devices. The method and schedule for cleaning hoses and masks and for changing filters may be different for each PAP device, so you should refer to the manufacture's instruction. Improper care of PAP devices, filters, mask and hoses can lead to nasal and sinus problems (congestion, infection, etc.).

Can I travel with this machine?
Most PAP machines available today come equipped with transformers which allow them to be used with international (220v) voltages when you travel to foreigh countries. Current PAP models are lightweight and portable. A travel case for the device and accessories often comes with the machine, or can be purchased from the manufacturer. A battery power option is available for those who camp. High altitudes can affect the performance of your PAP machine.

Cold nose
The air cools as it moves through the PAP hose tubing. To reduce heat loss, try repositioning the tubing so that it runs under your bed or bed coverings.

Should I wear my dentures?
Some people with dentures find that if they sleep without their upper dentures, the PAP mask does not fit properly and air leaks develop. Try sleeping with your upper dentures to eliminate this infrequent but difficult problem. If you have no upper teeth, consider trying a mask that fits inside or just under your nose.

Can I use it when I have a cold?
You may find your PAP machine more difficult to use when you have a cold. You may need more humidity, or a decongestant. Contact your healthcare provider for recommendations if you find you cannot sleep with your PAP when you have a cold. If you develop nasal, sinus, or ear pain when using your machine, this could be a sigh of developing infection.

Some people experience feelings of claustrophobia, difficult breathing, choking, or suffocation when first using PAP. Let your doctor, sleep technologist, or PAP machine supplier know about these felling. Spend some time practicing with your PAP machine during the day while awake. You may need to start by wearing the PAP device for only a few minutes at a time and gradually increase the time you spend breathing with it until you feel comfortable.







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