THE ULTIMATE GUIDE TO SLEEP APNEA


I'm not a doctor and this article has absolutely nothing to do with the rest of the Bigroads.com website. I am, however, a writer and a long-time sufferer of obstructive sleep apnea. I made this page to help others that are trying to manage this challenging, chronic condition. I sincerely hope that you find this information helpful and that it reduces your suffering.

I strongly encourage you read this E-N-T-I-R-E page! I realize this is asking a heck of a lot, but I wish somebody had pushed me to do the same when I was trying to figure out why I was no longer sleeping well. Spending 30 minutes to read through this entire page could potentially result in a significant improvement in the quality of your life.

If you have any feedback on this content (things to add, remove, and/or correct), please email me at gparsons66@hotmail.com. My goal is to continuously improve this page, so your feedback is strongly encouraged. This page is only about 80% complete, but I'm sharing it online now hoping that I can quickly help others with sleep apnea as others have helped me.

Author/Contributor: Greg Parsons

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OVERVIEW OF SLEEP APNEA

There are two major types of sleep apnea:
  • #1 - Obstructive Sleep Apnea (OSA)
    • This apnea is caused by a blockage of the airway, typically when the soft tissue in the back of your throat relaxes and collapses during sleep.
  • #2 - Central Sleep Apnea (CSA)
    • This apnea is caused by the brain failing to signal your body to breathe.
Of the two types of sleep apnea, obstructive sleep apnea (OSA) is far more common.

Obstructive sleep apnea (OSA) is more common with men (2x as likely as females) and those over 50/60 years old, although anyone of any age can experience it (including children). Per sleepapnea.org, 70% of individuals with obstructive sleep apnea are considered overweight.

Various sources claim that between 5-20% of adults in the U.S.A. suffer from obstructive sleep apnea (OSA). The majority of these individuals suffer to one degree or another, but are currently undiagnosed.

Sleep apnea is typically diagnosed through an overnight sleep study (polysomnogram). These sleep studies will determine your Apnea–Hypopnea Index ("AHI") score. An AHI score of greater than 5 "events" per hour will suggest a clinical diagnosis of sleep apnea.
  • Normal sleep: 5 or fewer "events" per hour
  • Mild sleep apnea: 5 to 14 "events" per hour
  • Moderate sleep apnea: 15 to 29 "events" per hour
  • Severe sleep apnea: 30 or more "events" per hour
Take note that your symptoms can still be severe even if you are classified in one of the less severe sleep apnea diagnosis categories. My sleep study resulted in a moderate 18 "events" per hour, but I classify many of my symptoms as severe.
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DO YOU HAVE SLEEP APNEA? HERE ARE THE SYMPTOMS

Common symptoms of sleep apnea include the following:

NIGHTTIME SYMPTOMS
  • Wake up choking or gasping for air
  • Loud snoring
  • Pauses in breathing
  • Restless sleep
  • Inability to stay asleep (insomnia)
  • Frequent trips to the bathroom (nocturia)
  • Lack of dreams
  • You are scared or have anxiety about going to bed
DAYTIME SYMPTOMS
  • Brain fog / mental fog
  • Forgetfulness / short and/or long-term memory problems
  • Lack of energy / daytime fatigue
  • General exhaustion
  • Out of breath, especially when exercising
  • Sore and/or dry throat
  • Headaches, especially in the morning
  • Sleepiness throughout the day (hypersomnia)
  • High blood pressure (hypertension)
  • Mood changes / mood swings
  • Poor concentration / worsening of ADHD
    • Some doctors believe that the underlying cause of ADHD in some children may actually be sleep apnea
  • Loss of interest in sex and/or sexual dysfunction
  • New or increased anxiety and/or depression
  • Never feeling well-rested
  • Weight gain
  • Personality or behavioral changes
  • Increased irritability
  • Chest pain / tight chest
    • This symptom often gets confused with gerd / acid reflux.
    • Some patients will say something like "my chest always feels like a 20lb or 30lb weight is on it".
  • Less common symptoms include:
    • Heart palpitations / muscle spasms
    • Clumsiness / balance problems
    • Painful sneezing and/or coughing
    • Upset stomach
    • Night sweats
Like most medical conditions, not all sufferers of sleep apnea will experience all of these symptoms. Prior to using a CPAP machine, I myself suffered from about 80% of these symptoms.
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UNTREATED SLEEP APNEA

Left untreated, sleep apnea can lead to any of the following:
  • High blood pressure (hypertension)
  • Obesity
  • Type 2 diabetes
  • Car/driving/work accidents
  • Decreased quality of life
  • Heart disease / coronary artery disease / heart attack / congestive heart failure
  • Cardiac arrhythmias / atrial fibrillation
  • Stroke
  • New or increased depression/anxiety
  • Enhanced desire to commit suicide
  • Diabetic eye disease / blindness
  • Mood disorders
  • Chronic fatigue
  • Morning headaches
  • Shorter life span
  • COPD
  • Poor performance in school and/or at work
  • Changes in behavior (which can lead to things like divorce, loss of friends, loss of your job, loss of social circles, etc.)
As you can see, many of these are very serious conditions. You may have to constantly remind yourself of the severity of untreated sleep apnea if you initially struggle getting used to a CPAP machine.
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RISK FACTORS FOR OBSTRUCTIVE SLEEP APNEA

Major risk factors of obstructive sleep apnea (OSA) include the following:
  • Obesity / overweight
    • One study suggests that 70% of OSA suffers are overweight.
  • Large neck, especially with necks that are greater than 17 inches
  • Large tongue
  • A tongue that falls back and closes off the airway
  • Large tonsils
  • Large overbite
  • Recessed chin
  • Extra tissue in the airway
  • Soft muscle tone in the airway
  • Narrow jaw
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SLEEP APNEA CARE TEAM

Your sleep apnea care team may include some or all of the following:
  • Primary Care Provider
    • This can be a doctor, nurse practitioner ("NP") or physician assistant ("PA").
    • Take note that your primary care provider could be classified as a "Family Practitioner" or "Internal Medicine".
    • Most sleep apnea suffers will first discuss their symptoms with a primary care provider, who will then refer them to a sleep specialist.
  • Pulmonologist that is designated as a "Sleep Specialist"
    • Take note that not all pulmonologists are sleep specialists.
    • For most people, the pulmonologist/sleep specialist will provide the bulk of their sleep apnea care.
  • Neurologist or Critical Care Physician that is designated as a "Sleep Specialist"
    • Take note that not all neurologists are sleep specialists.
I would advise against having your Primary Care provider be the sole provider of your sleep apnea care. Ideally, they would refer you to a Pulmonologist or Neurologist that is designated as a "Sleep Specialist". I personally recommend finding a Pulmonologist or Neurologist that is designated as "Sleep Specialist", and avoiding those that are not.

Additional doctors that may also be involved in your sleep apnea care may include the following:
  • Otolaryngologist
    • These physicians are also known as ENT physicians (aka Ear, Nose & Throat).
  • Cardiologist
    • Heart conditions and sleep apnea often go hand in hand.
Take note that it may take a few different medical office visits before you are properly diagnosed with sleep apnea. For example, my primary care physician initially referred me to a Cardiologist for an X-Ray and an ETT "stress test". After the Cardiologist found nothing, my primary care physician suggested I see a Pulmonologist (who immediately ordered a sleep study upon hearing my symptoms).
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CPAP MACHINES

There are two main types of CPAP machines:
  • #1 - CPAP (Continuous Positive Airway Pressure)
    • These machines give the same pressure for both inhalation (ipap) and exhalation (epap).
    • Most CPAPs are now "auto CPAPs" (aka APAPs), meaning they can adjust pressures throughout your sleep as needed.
  • #2 - BIPAP (Bilevel Positive Airway Pressure)
    • These machines give a higher pressure for inhalation (ipap) and a lower pressure for exhalation (epap).
    • BiPAPs are often prescribed for patients where CPAP has failed to adequately treat them.
Both of the the following CPAP machines are extremely popular and both have received many praising reviews. Both have humidifiers with water reservoirs, and both are nearly silent while operating. As of 2019, they appear to be the most popular CPAP machines in the U.S.A.:
  • ResMed AirSense 10 Auto
    • This auto CPAP (APAP) machine is what I use. It's completely silent and I highly recommend it.
  • Philips Respironics DreamStation Auto
A maximum air pressure is set on each CPAP machine. This pressure can be adjusted as needed (typically by a medical professional). An October 2018 poll with 222 respondents on the Sleep Apnea Support Group on Facebook showed that sleep apnea patients currently had the following maximum pressures set on their CPAP machines:
  • 4cm max pressure:         2%
  • 5cm max pressure:         1%
  • 6cm max pressure:         5%
  • 7cm max pressure:         6%
  • 8cm max pressure:         6%
  • 9cm max pressure:       12%
  • 10cm max pressure:     16%
  • 11cm max pressure:       7%
  • 12cm max pressure:     16%
  • 13cm max pressure:       3%
  • 14cm max pressure:       8%
  • 15cm max pressure:       6%
  • 16cm max pressure:       4%
  • 17cm max pressure:       3%
  • 18cm max pressure:       5%
As you can see from the poll above, approximately 50% of patients had a max pressure on their CPAP machine of between 9 and 12. It is quite possible that your care provider will start your CPAP machine somewhere in that range.
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CPAP MASKS

There are three main styles of CPAP masks:
  • #1 - Full Face Masks
    • These masks cover the entire mouth plus either the base of the nose or the entire nose.
    • This mask is often the best choice if you are a mouth breather.
    • This mask is optimal whenever you have congestion (e.g. a cold and/or stuffy nose).
  • #2 - Nasal Pillow Masks
    • These masks provide air directly into the nostrils.
    • These masks typically rest on the base of the nose.
    • A nasal pillow mask probably won't be your best option if you’re a mouth breather.
  • #3 - Nasal Masks
    • These masks provide air to the base of the nose.
    • These masks cover the entire nose.
    • A nasal mask probably won't be your best option if you’re a mouth breather.
An October 2018 poll with 427 respondents on the Sleep Apnea Support Group on Facebook showed that sleep apnea patients currently had the following mask styles:
  • Full Face Masks:          51%
  • Nasal Pillow Masks:     26%
  • Nasal Masks:               23%
When you get fitted for your first mask, make sure to try on all three styles (full face, nasal pillow, and nasal ) and ideally a few models of each of the three styles. I also encourage you to try 2 different sizes of the models you like the most (e.g. small and medium, or medium and large).

The entire initial mask-fitting process should take 30-60 minutes. Do not let the Respiratory Therapist (or whoever is fitting the masks with you) to rush this process, and do not leave your appointment until you find a mask that you believe fits well enough. I would also encourage you to take photographs and notes of all of the masks that you tried on so that you can have this information if the first mask you choose to bring home doesn't end up working out well for you. Many people will end up trying several different masks at home.

There are many different models of masks. Take note that many masks will work with a variety of different CPAP machines and hoses.

Here are some of the most popular and well-respected CPAP mask models in the U.S.A. as of 2019:
  • Full Face Masks
    • ResMed AirTouch F20 Mask
    • ResMed AirTouch F30 Mask
    • Philips Respironics DreamWear
    • Philips Respironics AmaraView Full Face Mask
  • Nasal Pillow Masks
    • ResMed AirFit P10 Nasal Pillow Mask
    • Philips Respironics DreamWear Gel Nasal Pillow Mask
    Nasal Masks
    • ResMed AirFit N20 Nasal Mask
    • Philips Respironics DreamWear Under Nose Nasal Mask
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CPAP SUPPLIES

You will need a prescription in order to purchase a CPAP machine. However, you do not need a prescription in order to purchase CPAP supplies.

Here are some commonly purchased CPAP and sleeping-related supplies:
  • Replacement CPAP mask parts
    • mask cushions / pillows (typically replaced every 1-3 months)
    • mask frames / headgear (typically replaced every 3-12 months)
    • entire masks / entire mask kits
    • other parts that are specific to your mask model
  • Replacement CPAP machine parts
    • air filter
    • water reservoir
    • hose
    • other parts that are specific to your CPAP machine
  • CPAP mask strap covers or pads
    • These can help prevent mask lines on your face
  • CPAP tube/hose stands
    • These can help prevent wake ups and hose/tube entanglements
  • CPAP tube/hose cover or wrap
    • These can reduce the sound of CPAP tubes/hoses and also prevent "rain-out" in the hose and mask.
  • CPAP mask liners (e.g. RemZzzs Padded Full Face CPAP Mask Liners, Pad A Check Liners, etc.)
  • CPAP cleaning wipes
  • CPAP pillow
  • Chinstrap
  • Sound machine
    • This can help drown out the sound of CPAP machines, mask leakage, tube/hose movements, and other sounds in the bedroom
  • Earplugs
  • Distilled water
Since a prescription is not needed to purchase CPAP supplies, you do have some options as to where to buy you can purchase supplies:
  • Your local Durable Medical Equipment ("DME") supplier
    • This is usually where your provider will refer you to for your first mask fitting (which will likely be done by a Respiratory Therapist).
    • This is usually the most expensive option, but that all depends upon how your health insurance plan is structured.
  • Amazon.com
    • I personally buy nearly all of my CPAP supplies from here because the "out of pocket" amounts from my health insurance plan will end up costing me more than Amazon's extremely low prices. On average, I have found Amazon's prices to be 25-50% of the prices of my local DME supplier.
  • Walmart.com
  • Cpap.com
  • Thecpapshop.com
  • Easybreathe.com
  • 1800cpap.com
  • cpapsupplyusa.com
  • cheapcpapsupplies.com
  • cpapplus.com
  • ....there are many more you can find online
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YOUR FIRST FEW WEEKS WITH A CPAP MACHINE

Here are some tips to help you keep your sanity during the often tough first few weeks of using a CPAP machine:

  • Don't give up using your new CPAP machine, even if positive results are not immediate.
    • It took me two weeks to get used to using the CPAP machine and wearing the mask.
    • It took me 3 months to feel 25% better and almost a year to feel 50% better.
  • Learn everything you can about sleep apnea and CPAP machines and masks.
  • Join one or more Sleep Apnea and CPAP support "groups" on Facebook. These groups are great for (a) obtaining general advice; and (b) their sense of humor, which can help make light of your serious condition.
  • Spend the first few nights or weeks experimenting with your CPAP machine and mask.
    • Adjust the head straps.
    • Adjust the humidity.
    • Adjust the temperature.
    • Consider trying to a different mask style and/or size.
  • Trust that you will slowly grow to love your CPAP machine. You may very well hate it at first, but each day should get a little bit easier.
    • Like any major lifestyle change, it can take a few weeks or months to fully adjust.
  • Wear your mask for 2-3 hours watching TV and/or listening to music before trying to sleep with it on for the first time. This will help you get used to the feel of the mask, reduce claustrophobia, get used to the pressure of the machine, and become comfortable with the concept of sleeping with a mask on.
    • It seems to take most people 1-2 weeks to become fairly comfortable wearing a CPAP mask.
  • Take note that air will leak from the mask connection on the top of your head. This is normal and okay. This helps release CO2.
  • You may experience some side effects from using your CPAP machine, including:
    • Bloating/gas (from the pressure of the machine)
    • Mask lines on your face and/or nose
    • Tender or broken skin on your face and/or nose
    • Thinning hair (from the mask straps)
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SLEEP APNEA TIPS

Here are some general tips for managing sleep apnea:
  • Embrace the weird and vivid dreams that often occur once the CPAP machine starts working well for you. These dreams generally mean that you are getting higher quality sleep!
  • Experiment with a few different masks, even if it costs you a few hundred dollars and you have a few poor nights of sleep as you try the new masks.
  • Try to get over the embarrassment of wearing a mask quickly.
    • Make sure your spouse or partner 100% understands and appreciates that this mask can literally help save your life.
  • Always ensure that you have the next set of replacement CPAP supplies ready at the helm; for example, you don't want to realize your mask cushion is worn out and then have to wait a few days (or more) to receive a new one in the mail.
  • Have a contingency plan for your CPAP machine if the power goes out.
    • Should you purchase a generator or one or more battery backups?
  • If you will be staying in a hospital (e.g. as an inpatient or observation patient), make sure to tell the clinical staff that you require a CPAP machine.
    • Whenever possible, try to bring your CPAP machine with you so that you don't have to use the Hospital's model.
  • Before you go under anesthesia, ensure that the clinical staff are aware that you have sleep apnea.
  • Consider purchasing a sleep positioner belt, which can help you stay sleeping on your side throughout the night.
  • Some people take GAS-X to help control CPAP machine-created gas and bloating.
    • Instead of taking this drug, you may be able to decrease the CPAP machine pressure enough to prevent air from going down the wrong throat passageway.
  • Trim your beard.
    • Long facial hair can result in CPAP mask leakage, but I've had no issues with using a mask with my moderate beard.
  • Don't add anything other than distilled water to your CPAP machine water reservoir. Drinking water or purified water will eventually cause a mineral backup, which can easily damage the CPAP machine.
  • Use your CPAP machine to sleep each and every night. Most people suffer dearly even when they skip a single night.
    • Also use the CPAP machine for any naps that you take during the day.
  • Buy a CPAP tube/hose stand.
    • Health insurance probably won't cover this purchase, but you can purchase them cheaply on retail websites like Amazon.com.
    • A tube/hose stand can help reduce the amount of times the tube/hose bangs against your bed/bed-board and it can also prevent entanglements.
    • A tube/hose stand can work wonders if you toss and turn a lot.
    • Instead of a a tube/hose stand, you can attach a cord bundler (e.g. Command Cord Bundlers: Damage-Free Hanging) to the bed-board above your pillow.
  • Work with your doctor to trial several different CPAP pressures to see what works best.
    • You may need to increase pressure (e.g. 8 > 10) to experience optimal benefits.
    • You may need to decrease pressure (e.g. 10 > 8) to avoid mask leakage and/or to reduce stomach bloating and gas.
  • Plan on replacing your CPAP mask cushions often.
    • Most users seem to need to replace the mask cushions every 1-3 months. The rest of the mask typically needs replacement every 3-6 months.
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MORE GENERAL TIPS FOR IMPROVING SLEEP

  • Wear earplugs and/or use a loud fan or sound-machine to avoid being awakened by your CPAP machine, CPAP tube/hose, and/or any other sounds in the bedroom.
  • Consider sleeping in a separate bed or room from your partner, or perhaps purchase a larger bed with more space between you and your partner.
  • Completely avoid alcohol, sedatives, and tranquilizers (these can all relax the throat muscles, which makes apneas worse).
  • Avoid drinking any fluids, including water, within the final 2-3 hours before bed.
  • Avoid sleeping on your back. Sleeping on your back makes it easier for your tongue and throat muscles to relax, which can then block your airway. Sleep on your side if you can (it only took me 2 nights to get used to sleeping on my side for the first time in my life).
  • Buy room-darkening shades and/or blinds.
  • Avoid or limit TV, smart-phones, and tablets for 1-2 hours before bed
    • Their "blue light" is believed to hurt sleep quality.
  • Try sleeping on your side.
  • Try different pillows (or perhaps even a CPAP pillow).
  • Eat healthier foods (while avoiding foods that disrupt sleep, like fried foods).
  • Prevent pets and/or children from also waking you up.
  • Try adjusting the elevation of your pillow up or down. Put a towel underneath the pillow to add add elevation.
  • Avoid caffeine for at least 4-5 hours before sleeping.
  • Don't exercise within 2 hours of going to sleep.
  • Stop smoking
  • Lose 10%+ of your body weight
    • This is obviously easier said than done, especially for those that are suffering from sleep apnea. I personally find myself craving sugary foods all day long.
    • Losing a few pounds isn't likely to have a huge impact, but odds are fair that you can improve your sleep apnea if you lose 10-20%+ of your body weight.
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ALTERNATIVE & SUPPLEMENTAL TREATMENTS

I have not experimented with any of the following alternative or supplemental treatments, but I do know that they are commonly used as an attempt to improve sleep apnea and/or sleep:
  • Melatonin (sleep aid)
  • Dental devices / oral appliances / mandibular repositioning device
  • Chin straps (this can also help prevent dry mouth if you use a CPAP "nasal" style mask)
  • Breathing or Sleep Strips (e.g. Somnifix)
  • Procedures:
    • Nasal surgery
    • Uvulopalatopharyngoplasty (UPPP) surgery
    • Mandibular maxillomandibular advancement (MMA) surgery
  • Prescriptions:
    • Provigil - promotes wakefulness
    • Modanfanil - promotes wakefulness
    • Soloriamfetol - promotes wakefulness
    • Flonase - improves nasal flow
  • Implants:
    • Inspire (Upper Airway Stimulation (UAS) Therapy)
    • Nyxoah
  • Playing a didgeridoo and/or other wind-instruments
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SOLUTIONS TO SOME COMMON CPAP PROBLEMS

Some people are immediately tolerant of both their CPAP machine and mask. However, most people seem to struggle with one and/or the other for a while. Here are some common CPAP-related problems as well as some recommended solutions:
  • Mask is not comfortable
    • Solution: Try a different mask model (e.g. Philips Respironics DreamWear to ResMed AirTouch F30 Mask)
    • Solution: Try a different mask style (e.g. some people will initially use a nasal mask, but will then switch to a full face mask).
    • Solution: Try a different mask size (I was originally sized as a medium, but I eventually (and permanently) switched to a large).
    • Solution: Adjust some or all of the mask straps. If your machine has full power/pressure testing capability (or "run mask fit" as some machines call it), use that feature to test the mask leakage as you adjust each of the straps. Test the pressure in all of the exact positions that you know you sleep in (e.g. on your side, etc.).

  • Mask straps are too tight or too loose
    • Solution: Adjust some or all of the mask straps. If your machine has full power/pressure testing capability (or "run mask fit" as some machines call it), use it to test the mask leakage as you adjust each of the straps.

  • Mask is leaking too much air
    • Solution: Adjust some or all of the mask straps. If your machine has full power/pressure testing capability (or "run mask fit" as some machines call it), use that feature to test the mask leakage as you adjust each of the straps. Test the pressure in all of the exact positions that you know you sleep in (e.g. on your side, etc.).
    • Solution: Replace the mask cushion. Mask cushions typically need to be replaced every 1-3 months since the flimsy materials tend to wear out rather quickly.
    • Solution: Clean the mask cushion, the mask headgear, and the hose/tube. I know that if I go longer than 1 week without cleaning the mask cushion, it starts leaking more and more.
    • Solution: Try a different mask model (e.g. you could try a Philips Respironics DreamWear mask or a ResMed AirTouch F30 Mask)
    • Solution: Try a different mask style (e.g. some people will initially try to use a nasal mask, but will then switch to a full face mask).
    • Solution: Try a different mask size (I was originally sized as a medium, but I eventually (and permanently) switched to a large).
    • Solution: Wear an eye mask to that the air doesn't go into your eyes.

  • Wearing the mask is uncomfortable and/or it makes me feel claustrophobic
    • Solution: Watch TV and/or read with the mask on for an hour or two before bed for the first few nights.
    • Solution: Try a different mask model (e.g. you could try a Philips Respironics DreamWear mask or a ResMed AirTouch F30 Mask)
    • Solution: Try a different mask style (e.g. some people will initially try to use a nasal mask, but will then switch to a full face mask).
    • Solution: Try a different mask size (I was originally sized as a medium, but I eventually (and permanently) switched to a large).

  • CPAP Machine pressure is too high or too low
    • Solution: Ask your doctor to adjust the CPAP machine pressure. You shouldn't need to schedule an office visit to change the pressure. Call the medical office or submit a request through their online health portal if they have one.

  • CPAP Machine needs a different "ramp up" setting (e.g. start at "8" pressure instead of "10" pressure)
    • Solution: Ask your provider to adjust the ramp up settings. You shouldn't need to schedule an office visit to change the pressure. Call the medical office or submit a request through their online health portal if they have one. Some machines may also allow you to adjust these settings.

  • CPAP Machine humidity and/or temperature needs to be adjusted
    • Solution: You should be able to adjust the humidity (on/off) and temperature (e.g. 70 > 74 degrees) on the CPAP machine yourself (assuming the CPAP machine has such settings, of course).

  • Mask lines are appearing on your face
    • Solution: See separate "CPAP Mask Lines" section below.

  • Mask is giving you minor skin irritations
    • Solution: Use a moisturizer.
    • Solution: Wash the mask (at least 1x per week is recommended).
    • Solution: Try a different mask model (e.g. you could try a Philips Respironics DreamWear mask or a ResMed AirTouch F30 Mask)
    • Solution: Try a different mask style (e.g. some people will initially try to use a nasal mask, but will then switch to a full face mask).
    • Solution: Try a different mask size (I was originally sized as a medium, but I eventually (and permanently) switched to a large).

  • Mask is blowing air into your eyes
    • Solution: Tighten or loosen the mask straps.
    • Solution: Buy an eye mask and wear it under the mask straps.
    • Solution: Replace the mask cushion. Replacements are typically needed every 1-3 months since the flimsy materials tend to wear out quickly.
    • Solution: Try a different mask model (e.g. you could try a Philips Respironics DreamWear mask or a ResMed AirTouch F30 Mask)
    • Solution: Try a different mask style (e.g. some people will initially try to use a nasal mask, but will then switch to a full face mask).
    • Solution: Try a different mask size (I was originally sized as a medium, but I eventually (and permanently) switched to a large).

  • You wake up with a dry and/or sore mouth
    • Solution: Hydrate more during the day.
    • Solution: Purchase a CPAP machine with a built-in humidifier and water reservoir (e.g. ResMed AirSense 10 Auto or Philips Respironics DreamStation Auto).

  • You have a cold and/or stuffy nose
    • Solution: Swap out your nasal mask or nasal pillow mask for a full face mask. I highly recommend that you purchase a full face mask now so that it is ready to be used if you do get a cold and/or stuffy nose.

  • Your hair is thinning from the mask straps
    • Solution: Wear a silk sleep cap, satin pillow case, or hair net on your head.
    • Solution: Put your hair in a bun and put the straps over or under it.

  • Cpap hose is getting tangled and/or it bangs around a lot and is noisy
    • Solution: Buy a CPAP hose stand or devise some sort of hack to attach the hose to the top of your bed-board (e.g. Command Cord Bundlers, clothes hangers, etc.).

  • You wake up bloated
    • Solution: Ask your doctor to adjust the CPAP machine pressure. You shouldn't need to schedule an office visit to change the pressure. Call the medical office or submit a request through their online health portal (if they have one).
    • Solution: If you use a nasal mask or nasal pillow mask, try a full face mask instead. You could be breathing in additional air through your mouth if you are using a nasal mask or nasal pillow mask.
    • Solution: Ask your doctor if your CPAP machine has expiratory pressure relief features.
    • Solution: Try sleeping at a higher degree of incline.
    • Solution: Upgrade from a CPAP to an auto CPAP (aka APAP).
    • Solution: If all else fails, you may need to be prescribed a BiPAP machine instead of a CPAP machine.
Cpap.com also offers some excellent tips on how to help manage CPAP problems and related side effects. You can read their articles here.
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CPAP MASK LINES

Here are some suggestions to help you combat any annoying and embarrassing CPAP "mask lines" that are appearing on your face:
  • MY #1 TIP: Purchase CPAP mask strap covers.
    • Here is the model that I use: link
  • Ensure that you are well-hydrated each and every day.
  • Hydrate immediately in the morning. Literally as soon as you wake up. Consider even putting a water bottle next to your bed each night.
  • Loosen the mask straps, so long as that doesn't increase air leakage too much.
  • Wake up earlier in the morning so there is more time for the skin to even out and for the mask lines to disappear (or at least decrease) before you leave your house for the day.
  • Men are encouraged to grow and maintain a thin or moderate beard (but avoid growing a heavy beard as they can cause mask leakage).
  • Purchase and use CPAP mask liners.
  • Give your face a deep and long massage/rub during a morning shower to increase circulation.
  • Make your own straps to surround the mask straps (e.g. make something out of fleece, silk, felt, cotton, etc.).
  • Try a different CPAP mask style and/or model.
  • Put a folded tissue or menstrual pad under the mask straps.
  • As a last resort, you can always add some makeup to your face to hide any visible mask lines.
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CPAP TRAVEL MACHINES

If you travel a significant amount, or if you enjoy camping and/or backpacking, you may want to consider purchasing a travel CPAP machine. These travel CPAP machines lack some of the bells and whistles of the everyday models you'll use at home, but they are generally significantly smaller and lighter. Some models even allow you to attach portable batteries.

Take note that health insurance will typically only cover the cost of your first CPAP machine, which would likely be used to purchase an everyday CPAP machine instead of a travel CPAP machine. This probably means that you will need to purchase a travel CPAP machine out of your own pocket. Travel CPAP machines typically run $700-$1,000 in the U.S.A., which doesn't include the cost of any battery packs or optional humidifiers.

As of 2019, the general consensus seems to be that the two best travel CPAP machine on the market include the following two models::
  • ResMed AirMini AutoSet Travel CPAP Machine
    • This machine is significantly smaller than the Dreamstation Go model. It is almost 1/2 the size.
    • This machine can only use three specific masks and one specific hose. It is very likely that your current mask and hose will not be compatible.
    • Many people complain about the loud noise that is generated when you combine this machine with the only full face mask that works with it (the F20 mask). The machine is slightly quieter with the other two masks that work with the unit (the N20 and P10 masks).
  • Dreamstation Go
    • This machine is significantly larger than the ResMed AirMini model. It is almost 2x the size.
    • Unlike the ResMed AirMini, the Dreamstation Go will accept a universal hose and any CPAP mask.
    • Some users claim it is quieter than the ResMed AirMini.
    • An optional portable battery (1.5 pounds, up to 13 hours of power) can be purchased that easily connects to this model. One portable battery can allow you to go to camping or backpacking for a night or two. You could purchase additional batteries for extended trips.
    • An optional humidifier can be purchased that easily connects to this model. Unfortunately, you cannot connect both a portable battery and humidifier at the same time to this model though.
A good review of these two travel CPAP machines can be found on this YouTube page. And here is another one. I've watched probably six or several of these review videos, and the Dreamstation Go seems to be the general winner of the two.

Other travel CPAP machines on the market as of 2019 include the following models:
  • Transcend 365
  • Transcend 3
  • Z1 Travel CPAP Machine with Z-Breathe
  • Z2 Auto Travel CPAP Machine
A good article about backpacking with a travel CPAP machine can be found here.
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TRAVELING WITH A CPAP MACHINE

Here are some general tips if you will be traveling with a CPAP machine:
  • Carry your CPAP machine (and all its related supplies) onto the plane. It will be considered a "medical device" and will not count towards any carry-on limits.
  • Plan on purchasing distilled water once you reach your destination. If you think it will be difficult or impossible to obtain distilled water, you can put some distilled water in your "checked" luggage. If you do this, I would use leak-proof hard plastic bottles, such as Nalgene bottles. Don't use any bottles that have a straw or bite-valve components as they could leak).
  • Consider bringing an extension cord when you travel. There may or may not be an outlet near the bed where you will be sleeping.
  • If you are traveling internationally, don't forget to consider the impact of different plug outlets. You may need to purchase an adapter ahead of time.
  • If you don't want airport security touching your CPAP supplies (e.g. hose, mask, etc.), put them into one or more zip-lock bags for them to analyze.
  • Consider bringing a backup mask cushion as you never know when yours could fail or start leaking air.
  • Consider purchasing a CPAP travel machine since they are lighter and smaller.
  • People can and do use their CPAP travel machines on overnight flights.
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CLEANING YOUR CPAP MACHINE & SUPPLIES

  • I personally believe that washing your mask cushion, headgear, hose, and water reservoir once per week with a mix of warm water and vinegar is sufficient enough to prevent mold/mildew. I've doing doing this for 15 months so far and all is well.
  • Consider purchasing a SoClean 2 device.
    • Here is a good article that explains how this device works.
  • Some people use mask wipes to clean their mask cushion and other CPAP parts on a daily basis.
  • Don't use boiling water to clean any CPAP part or supply. Warm water is enough.
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SLEEP APNEA RESOURCES

  • National Sleep Foundation = link
  • American Sleep Apnea Association = link
  • Mayo Clinic: Sleep Apnea = link
  • MedlinePlus: Sleep Apnea = link
  • Cpap.com = link
  • Sleep Apnea Books
    • Hacking Sleep Apnea (Brady Nelson)
    • Totally CPAP: A Sleep Physician's Guide to Restoring Your Sleep and Reclaiming Your Life (Steven Park)
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