Living with PAP

Living with Positive Airway Pressure (PAP)

Tips to help you get used to the most common sleep apnea treatment

Positive airway pressure (PAP) is the most common form of treatment for obstructive sleep apnea (OSA). OSA occurs when the tissue in the back of the throat collapses and blocks the airway as you sleep. This causes you to stop breathing many times during the night. PAP supplies a steady stream of air that blows gently into the back of your throat. When it is properly set, a PAP unit provides just the right amount of air to keep your airway open. This allows you to breathe normally as you sleep. The level of air pressure needed is different for each person. A CPAP study at a sleep center will determine the level that is right for you.

PAP provides welcome relief when you have been living with OSA. It allows your body to sleep more soundly through the night. This should enable you to feel more refreshed and alert during the day. It will also help your bed partner to sleep better. He or she will enjoy a much quieter night of rest without your loud snoring. Knowing what to expect when you begin PAP treatment will help you get off to a good start. There are also things you need to know to care for your unit and adjust to using it.  Once you are familiar with PAP, it can become a normal part of how you sleep.

Where Do I Begin?

The first thing you should do is to contact your health insurance provider. Many insurance companies now include PAP treatment in their coverage plans. See if your provider is one of them. Knowing this will help you decide what kind of PAP unit you can afford to buy. There are many makes and models of PAP machines and masks that you can buy. Your sleep specialist can help you decide which ones will work best for you. In PAP therapy, pressurized air comes through a nasal mask that fits securely over your nose. Some people prefer a full-face mask that fits over both the nose and mouth. Other people like to use a device that has soft silicone tubes that fit directly in their nostrils. These are called nasal pillows.

Most people first try a PAP machine that delivers a continuous and fixed amount of pressurized air. This is called continuous positive airway pressure (CPAP). After trying CPAP, some people find that they prefer a bi-level PAP machine. This is called Bi-PAP. It lowers the level of pressurized air when you are breathing out. Another option is an auto-adjusting unit. This is called APAP. It raises the level of air pressure only when there is a pause in your breathing. It lowers the level of air when your breathing returns to normal.

Choosing your PAP machine is one important decision. Another crucial step is to determine the level of air pressure that you need. Your unit needs to be adjusted to provide you with just the right amount of air. It needs to work even when you change sleeping positions or enter a deeper stage of sleep. A sleep center can find the right level of air pressure for you. They will evaluate your sleep overnight while you use a PAP device. A technologist will monitor and adjust the air pressure from the PAP machine during the night. This is called a CPAP study. The goal is to eliminate the times when your breathing stops. You may need higher levels of air pressure during some sleep stages and in some sleeping positions. The technologist will work with you to find the best settings and equipment for your sleep needs.

In many cases, a PAP unit can completely control OSA. The key is to use the PAP whenever you sleep. It will take time to get used to sleeping with a PAP machine. At first it may seem inconvenient or troublesome. But you shouldn't give up without making your best effort to adapt to it. It will be well worth your effort in the long run.

Should I Try Continuous PAP (CPAP)?

Most people begin with a CPAP machine. It offers a fixed level of air pressure at a steady rate. This eliminates any concerns about having to adjust the level of air pressure. Many people find that a CPAP unit works well for them.  

Should I Try Bi-Level PAP (Bi-PAP)?

You may find that you have trouble breathing out with a CPAP machine. You have to fight against the continuous air pressure when you exhale. This may be the case if you have severe sleep apnea. This means that your level of air pressure has to be set very high. The result may be that you have to work hard just to exhale. In this case, a Bi-PAP machine may help you. It senses when you breathe in and out. This allows it to deliver a lower level of air pressure as you exhale. This makes breathing easier and more natural for you. You would need to be tested at a sleep center with this type of machine in order to find the right levels. There are some drawbacks to using Bi-PAP.  The Bi-PAP units are larger, heavier, and more expensive than the CPAP models.

Should I Try Auto-Adjusting PAP (APAP)?

If you are unable to adjust to either CPAP or Bi-PAP, then you may want to try auto-adjusting PAP (APAP). These units raise the level of air pressure only when they detect problems with your breathing. You may find that an APAP model makes it easier for you to breathe. Ask your sleep specialist if this kind of machine might work best for you. The APAP units are also heavier and larger than CPAP models.

Are There Any Side Effects To PAP Therapy?

Nasal discomfort

Nasal stuffiness or congestion is the most common side effect of PAP therapy. This is a fairly normal reaction to the airflow coming from the PAP device. More than half of people have some increased nasal stuffiness when they first begin to use PAP.  This congestion often goes away within a month of use.

You may find that PAP makes your nose cold. The air cools as it moves through the PAP hose tubing to your mask. To reduce heat loss, try to run the tubing under your bed sheet or blanket.

PAP users may also report any of the following kinds of nasal discomfort:

• Nasal itching
• Runny nose
• Nosebleeds
• Nasal dryness

Nasal discomfort caused by PAP is often easy to control. Talk to your doctor about trying one or more of the suggestions below. In general, nasal symptoms related to the use of PAP are treated in the following ways:

Nasal sprays
You can apply a few sprays of saline solution in each nostril before using PAP. This solution is simply salt mixed in with water. This will help many of the nasal symptoms. You can find this solution at a local pharmacy. No prescription is needed.

Decongestant nasal sprays may help. This includes brands such as Afrin® and NEO-SYNEPHRINE®. Nasal sprays should only be used for a few days. Regular nightly use can be habit-forming. It can also lead to increased nasal congestion. 

Some sprays are available by prescription to help you if you have nasal allergies. Atrovent® nasal spray can be used to combat nasal problems and runny nose not caused by allergies. Examples of nasal sprays that reduce the symptoms of allergies include the following:

• Beconase®
• Flonase®
• Nasacort®
• Nasalcrom®
• Rhinocort®
• Vancenase®  (12.0)
   

Oral medication
Oral antihistamines and decongestants may also be helpful. Many of them can be purchased without a prescription. Some commonly used brands include the following:

• Actifed®
• Benadryl®
• Contac®

Prescription antihistamines are also available. Some commonly used versions include the following:

• Allegra®
• Allegra-D®
• Astelin®
• Claritin®
• Claritin-D®
• Zyrtec®

Talk to your doctor before using any medications for PAP problems.

Humidifiers
A PAP unit can be connected to a specially designed humidifier. Many newer models come with an internal humidifier. It will add moisture to the pressurized air supplied by the PAP device. This will greatly reduce nasal symptoms. All PAP humidifiers can add cool moisture. Some can also add heated moisture. The heated moisture may help if the cool moisture does not work for you. Your doctor will need to prescribe the PAP humidifier for your use. You will need to carefully maintain it and keep it clean. If you don't, then it could cause you to develop nasal and sinus infections.

Oral discomfort

The use of PAP may cause dryness and pain in your throat. This is often caused by air blowing through an open mouth. A chinstrap can be used to keep your mouth closed. Using a full-face mask that covers both the nose and mouth is another way to eliminate this problem. A PAP humidifier can also help control mouth discomfort.

Facial discomfort

You may develop redness on your face where the mask contacts your skin. These red areas or sores often appear on or above the bridge of your nose. They may also occur on your forehead. You should first check to see if your mask it pressing too tightly to your face. You may simply need to adjust the straps on your mask. Loosen the headgear slightly. It should be tight enough to prevent air leaks. But it should not be so tight that it hurts your skin. Sometimes spacers and air cushions can be used to help ease the pressure points. It is possible that your skin is allergic to the mask. If you think this is the case, try putting paper tape over the areas where the mask touches your skin. See if the redness goes away. Today's PAP masks are made of materials that should minimize the chance of an allergic reaction. Contact your PAP supplier if your problems continue. He or she can help you find the right type, size, and adjustment for your mask.

Eye discomfort

Your eyes may become sore, dry or red from using PAP. These problems are often the result of an air leak from your mask. Try adjusting the headgear on your mask to gain a better fit. If the problem continues, contact your PAP supplier. He or she can help you find a solution to your problem. This may involve a different mask size, another type of mask, or different headgear.

Mask leaks
Some problems may result when air leaks from your mask. Problems caused by mask leaks include the following:

• Red eyes
• Snoring
• Pauses in your breathing

If your mask worked well when you first started, then you should check to see if it is worn-out or torn. Otherwise, air leaks occur most often when a mask is poorly fitted. Adjusting the straps may be a simple solution for you. If this does not help, then you may need a different size mask. If your mask continues to leak, then you may find that a different type of mask works better for you. A full-face mask that covers both your nose and mouth might work without leaking. You may also be able to buy a mask that molds to the shape of your face. The mask that works best for you might be one that uses soft tubes that fit directly into your nostrils. These are called nasal pillows. Contact your PAP equipment supplier for help with mask leaks.

Noise of the machine

Older PAP machines were much louder than the current models. Although today's models are quieter, they still make some noise. Placing the unit under the bed or on the floor usually solves this problem. Again, your PAP supplier can provide you with help.

Too much air

When first using PAP, you may feel like the pressure of the air through your mask is set too high. It feels like you are getting too much air. This feeling can make it hard for you to go to sleep. In this case, try using your PAP for short periods of time during the day. A good time to do this is while you are watching TV. This will help you adjust to it so it starts to feel normal. If it still feels like too much air, then try using your unit's "pressure ramp" setting. Most PAP models have ramp capability. The ramp starts the machine at a very low level of pressure. It slowly raises the pressure to the right amount over a period of minutes. This gives your body time to get used to breathing with the mask.

Most PAP machines will allow you to adjust your ramp time. You may prefer a longer ramp time of 10 to 20 minutes when you first start using PAP. As you get used to it, you can begin setting your ramp to shorter times. Eventually you should have a very short ramp time, if any at all. You want to be able to get the full benefits of the correct PAP pressure from the beginning.

What Do I Need To Know About My PAP Machine?

Cleaning PAP devices

Your PAP device must be cleaned on a regular basis. This will assure that it functions properly and safely. The method and schedule for cleaning may be different for each PAP model. You should refer to your unit's instruction manual for details about how to care for your PAP machine. Improper care of a PAP device can lead to nasal and sinus problems. This includes congestion and infections. Regular cleaning tasks include the following:

• Cleaning the hoses
• Cleaning the mask
• Changing filters

Traveling with your PAP machine

You need to use your PAP whenever you go to sleep. This means that you need to be able to take your unit with you when you travel. Current PAP models are lightweight and portable. A travel case often comes with the machine. You can also purchase one separately. Airport x-ray devices do not harm PAP devices. But your unit may attract attention from airport security. Ask your doctor to provide you with a letter that explains the nature and purpose of your machine. Show this letter to security if they have any questions.

Using PAP at high altitudes can affect how it performs. This can be a problem if you are traveling to a location that is at an altitude much higher or lower than your home. Some models have an internal pressure sensor. This allows the unit to self-adjust when the altitude changes due to travel. Talk to your doctor or PAP supplier to see if an upcoming trip will affect your model.

Most PAP machines can also be used outside of the United States, where the voltage standard is 110v. They have internal power converters. This allows them to be used with the common voltage level (220v) found in many other countries. Consult your instruction manual before traveling to another country. You may also want to call your supplier to make sure your model can be used where you are going.

Your unit may also be able to operate on battery power if you go camping.

Other Concerns About Using PAP Machines

Dentures

Some people find that their PAP mask does not fit properly if they sleep without their dentures. This poor fit causes the mask to allow air leaks. To correct this problem, try keeping your upper dentures in when you sleep. You may also want to try a mask that fits just under the nose. Another option is a version that has soft silicone tubes that fit directly in your nostrils. These are called nasal pillows.

Colds/congestion

Your PAP may be hard to use when you have severe congestion due to a cold or allergies. You may not be able to breathe through the mask very well. Using a humidifier or a decongestant may help. Talk to your doctor if you are unable to sleep with your PAP when you have a cold. You may be developing an infection if you have nasal, sinus, or ear pain when using your PAP. Contact your doctor for further advice.

Claustrophobia

Some people have feelings of claustrophobia when using PAP. This is when you have a fear of being in narrow or enclosed spaces. This may cause the following symptoms when you first use PAP:

• Having trouble breathing
• Choking
• Suffocating

Talk to your doctor if you are having any of these problems when using your PAP. Take some time during the day to get used to breathing with your mask. Use the PAP while you are awake and watching TV or reading. You may need to start by wearing the mask for only a few minutes at a time. Gradually increase the time you spend using it until you feel comfortable. Practice breathing at a nice, slow pace. At first, some people feel a sense of pressure and respond by breathing too fast. This can cause them to hyperventilate and possibly faint.

If you don't like the mask over your nose, try a mask that fits just under the nose. Another option is a version that has soft silicone tubes that fit directly in your nostrils. These are called nasal pillows. If the level of air pressure seems too high, then try using your unit's "pressure ramp" setting. The ramp starts the machine at a very low level of pressure. It slowly raises the pressure to the right amount over a period of minutes. This gives your body time to get used to breathing with the mask. You may also find that a Bi-PAP or APAP model works better for you. Learning a relaxation method is another way to help you get used to wearing the mask. Consult a self-help book or tape, or visit a psychologist. It is normal to feel some of this discomfort when you begin the PAP treatment. Do not let this discourage you. PAP can work for you if you give it a chance.

Summary

PAP is an effective treatment for many people with obstructive sleep apnea. Most of the common complaints about PAP involve nasal dryness and how the mask fits. In most cases these problems can be easily corrected. Talk to your doctor or PAP supplier if you have ongoing problems. PAP helps most people with sleep apnea, but it can take some time for you to get used to using it. Once you are comfortable with PAP, you may find that you never want to sleep without it again.

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