Sleep Bytes & Blog

Dry Eyes and CPAP Have you been waking up with dry, irritated eyes since starting your CPAP therapy?  You're not alone. Today, I’m going to explore three common reasons why your CPAP might be causing dry eyes and what you can do about it. Reason 1: Mask Leakage The first and most common cause is mask leakage. If your CPAP mask doesn't fit properly, air can escape and blow into your eyes, leading to dryness and discomfort. To fix this, make sure your mask fits snugly but comfortably. You might need to try different masks or adjust the straps for a better seal. Consider using mask liners or a nasal pad (such as the Gecko) to reduce leaks and enhance comfort. Reason 2: Vented Airflow Sometimes, the vented air coming out of the CPAP mask blows up the cheeks and directly on the eyes. This can be very annoying. Try adjusting the mask so that the angle of the vented air blows away from the eyes. There are also some masks that have these holes around in a circle (such as the Evora nasal mask), which diffuse the air blowing up towards your eye. Other times, just angling the mask differently can prevent air from blowing directly on your face, and that’s the only adjustment you need. Reason 3: Airflow through Tear Ducts Lastly, it's possible that air is blowing from inside your nose through your tear ducts into your eyes. There is a connection between your eyes and your nose - this is why we get the sniffles when we cry. And while this is a less common cause of dry eyes, it can be quite annoying and difficult to treat. One thing you can do is talk to your provider about lowering the pressure in your mask. Alternatively, trying a different mask that blows air at a different angle might help alleviate the issue. If you're experiencing dry eyes, don't hesitate to reach out to your healthcare provider for personalized advice and solutions. Thanks for being here. I’ll see you next week. 

Can I Try CPAP Again? Options After Compliance Failure If you or someone you know has ever received a nasty note from your medical equipment company stating that you need to return your machine or else pay up, you are not alone! In fact, some studies show that up to 40% of CPAP users don’t stick with it (just so you know, I’m hoping to change that!). And this isn’t your medical equipment company trying to be mean; this ‘use it or lose it’ mentality is just enforcing your insurance company's requirements. In fact, if your DME company bills your insurance for a machine that you aren’t using, then they are committing fraud!  There can be many reasons why someone doesn’t meet these inflexible requirements, or sometimes people just need more time. So, if this has happened to you, you might be wondering, "Can I try CPAP again?" Well, the answer is a resounding “yes, you can!”, so listen up for what needs to happen and how you can make your second attempt more successful. First, you’ll need to see your provider to discuss your ongoing symptoms - this can be your PCP or a sleep provider.  Next, if it has been less than 5 years since you returned your machine, your insurance company will likely require you to spend the night in the sleep lab to try again. But don’t fear – during that night, the technicians will be on hand to personally help you and they will likely try a BIPAP machine instead of CPAP. BiPAP offers different pressure settings for inhalation and exhalation, which can be more comfortable for some users. If it has been more than 5 years since you last tried, then you can likely just repeat a home apnea test followed by a new prescription for CPAP.  So, once you get your ‘second chance’, what can you do to increase your chances of success?  The first thing I recommend: try a different mask. The right mask can make a world of difference. Masks come in various styles and sizes, so take some time to educate yourself on mask types and if possible, go into your medical equipment company for a fitting. Also, new masks are being developed regularly, offering more comfort and better fit. So there is a good chance there are more options now than the last time you tried.  #2: Prepare Your Mindset. A positive mindset is crucial. Approach CPAP therapy with a readiness to overcome obstacles. It’s normal to face challenges, but with determination and the right support, you can conquer them. #3: Get ready with my CPAP 101 online course. This course is designed to help you prepare thoroughly. I cover all the necessary steps leading up to and including night one with your new CPAP. From setup tips to troubleshooting common issues, this course is your comprehensive guide and is available right now on the KimberlyMD.com website for only $49. #4: Explore Accessories. Accessories can greatly enhance your CPAP experience. If you have a problem with CPAP, someone has had that problem before and there is likely a solution created around it.  From mask liners for pesky leaks to hose management systems and the SomnoSeal for dry mouth, there are many products to make therapy more comfortable and effective. In fact, I discuss many of these in my weekly Sleep Bytes! Remember, CPAP therapy is a journey, and it’s okay to need a second try. With the right approach and resources, you can find success and enjoy the benefits of better sleep. Thanks for being here. I’ll see you next week. 

APAP vs. CPAP: Which One is Right for You? Last week, we explored the differences between CPAP and BiPAP machines. And continuing with our ABCs of PAP therapy, Today, we're focusing on Auto-CPAP and what makes it unique. Auto-CPAP, also known as APAP or Automatic Positive Airway Pressure, is designed to adjust the pressure settings throughout the night based on your needs. Instead of maintaining a single pressure, Auto-CPAP machines can increase or decrease the pressure within a set range.  For instance, your machine might be set to a pressure range of 6 to 15 cm of water instead of a fixed pressure, at say, 12 cm of water.  But how does it work?  The machine continuously monitors your breathing and adjusts the pressure to respond to apneas or hypopneas. If you are having apneas, the pressure increases. If you go for some time without apneas, the pressure lowers. This can be helpful because it is normal for your apnea to get more severe at certain periods during the night, such as when you're in REM or dreaming sleep, sleeping on your back, or after consuming alcohol. The benefit of this technology is twofold: you receive the optimal pressure when you need it most, and you often experience a lower average pressure throughout the night, which can enhance comfort. This dynamic adjustment helps ensure effective treatment without unnecessary high pressure all night long. One thing to keep in mind is that while Auto-CPAP aims to minimize apnea events, you might still experience occasional apneas. After all, it is these apneas that tell your machine to increase the pressure. So, it's essential to check your machine data regularly to ensure your residual AHI (Apnea-Hypopnea Index) is below 5, indicating good control of your sleep apnea. Most new CPAP machines are equipped with Auto-CPAP capabilities, offering flexibility to set a fixed CPAP pressure if needed. This versatility makes Auto-CPAP a popular choice for many users. Thanks for being here. I’ll see you next week!

How Long Does a CPAP Machine Really Last? Hey Sleep Warrior, In our quest for restful nights and bright days, our trusty CPAP machine stands as a silent guardian. But have you ever wondered, "How long will my CPAP machine really last?" Let's unravel this mystery together. A Sturdy Companion for Restful Nights The lifespan of a CPAP machine is a testament to modern engineering and our commitment to maintaining it. Even with regular use, most CPAP machines can last between 8 to 10 years, and I've witnessed many that surpass this with flying colors. This durability, of course, assumes no recalls have been issued for your specific model (don’t get me started!). Beyond the Insurance Timeline It's a common misconception that the need for a new CPAP machine aligns with insurance coverage cycles, typically every five years. After all, it’s usually the CPAP manufacturer or supplier that is making this recommendation. The truth is, this timeframe doesn't necessarily signal the end of your machine's useful life.  As responsible CPAP and healthcare stewards, we should aim to maximize the lifespan of our equipment without compromising our health or comfort. When to Consider a Replacement If your machine has been your nightly companion for over 8 years, it might be wise to start considering a replacement. Talk to your sleep provider and let them know you may need a new prescription soon. If you have been a faithful user, you don’t necessarily need a new sleep study. If you have checked in with your provider and your machine unexpectedly fails, don't worry—a new prescription can be sent over as soon as possible. Some medical equipment companies even offer loaners while you await insurance approval for a new one. Prolonging Your CPAP's Lifespan The secret to extending your CPAP machine's life lies in regular maintenance. Simple actions like cleaning your machine, replacing filters, and using distilled water can make a significant difference. These steps not only prolong the life of your CPAP but also ensure it provides the best possible support for your sleep apnea therapy.Embrace Each Night with Confidence So, continue to use your machine nightly, keep up with your provider visits, and rest easy knowing you're supported by a robust and reliable device. Your CPAP is more than just a machine; it's a key to restful sleep and energetic mornings. So stay diligent, Sleep Warrior!  Thanks for being here. I’ll see you next week.  

Is Your CPAP Working? Hey Sleep Warrior,  Do you ever feel curious about whether your CPAP machine is really working? Well, you have the tools to find out right at your fingertips. And this, my friends, is with something called the AHI - or apnea hypopnea index. One of my patients calls this his ‘tuna’ score - since AHI spells out ‘ahi’.  Let's dive in. First, let's clarify what AHI is. The AHI measures the severity of sleep apnea by counting the number of apneas (complete stoppages of airflow) and hypopneas (partial reductions in airflow) you experience per hour of sleep. These are important because they affect how restful your sleep is and can impact your overall health. AHI categories are: Normal: Less than 5 events per hour Mild: 5 to 14 events per hour Moderate: 15 to 29 events per hour Severe: 30 or more events per hour Knowing your AHI is crucial for diagnosing sleep apnea and is the first step in managing it effectively. The higher the AHI, the more severe your sleep apnea is, and the greater the association with long-term health problems if left untreated.  So when my patients come in for a CPAP follow-up, there are a couple of primary things I need to know. First, how their symptoms are doing—whether they feel more rested and alert during the day, and if they are comfortable on their machine. Second, I need to ensure that their CPAP machine is effectively treating their sleep apnea. The machine AHI gives us this vital information. I want to see that their residual AHI is less than 5. A fun exercise that you can do is to compare the AHI from your initial sleep study to the AHI on your CPAP machine. It's not only about feeling better; it’s about seeing the tangible proof right there in the numbers. For anyone using CPAP, seeing a lower AHI on your machine compared to your initial diagnosis can be incredibly motivating. It's a clear, numerical reminder that your treatment is working and that your sleep—and subsequently, your health—is on a better path. Thanks for being here. I’ll see you next week!

Gas with CPAP? Hey, Sleep Warrior!  Are you or a loved one experiencing excessive gas from using CPAP? Besides being uncomfortable, these issues can be downright embarrassing. No thanks.  This is called aerophagia, and it is a common issue faced by many CPAP users. It occurs when air is swallowed and enters the stomach instead of the lungs, leading to discomfort, bloating, and excessive gas.  This problem can disrupt sleep and lead to uncomfortable or embarrassing gas during the day, ultimately affecting overall therapy adherence.  But why does aerophagia happen, and what can be done about it? Listen up. The primary cause of aerophagia in CPAP users is simply high pressure settings. When the pressure is too high, it forces air into the esophagus rather than just the airway, leading to swallowed air and subsequent discomfort. One potential solution to excessive pressure is the V-Com, a device that reduces inspiratory pressure without affecting the therapeutic pressure. The V-Com can be purchased online without a prescription for about $30. You could also discuss pressure adjustments with your sleep provider – maybe your pressure can be turned down and still be effective. Lastly, you can try sleeping on your side or utilizing the ramp feature on your machine, both of which can lower the overall pressure. Another cause of aerophagia is the type of mask used. Full-face masks are more likely to direct air into the stomach as the air passes over the tongue and esophagus on it’s way to the lungs. Switching to a nasal mask can really help, and you can use a chin strap or the SomnoSeal if there are issues with mouth breathing or dry mouth. You’ll also want to be sure you have a good seal on your mask since mask leaks tend to result in your machine blowing higher pressures to compensate for the leak.  Finally, anatomical factors can play a role. The way your body was built, with the trachea going to your lungs being right behind the esophagus going to your stomach, can make it difficult to completely avoid swallowing air, especially if high pressures are necessary for treating your apnea or you are stuck using a full-face mask. In these cases, if there are no contraindications, over-the-counter gas relief products, like GasX, may provide some relief. Other options include ginger or peppermint tea, known for its natural anti-gas properties. Remember, these are general suggestions, and it’s important to discuss your specific issues with your sleep provider to find the most appropriate solution for you.  By addressing the underlying causes and implementing these strategies, I hope you can reduce the impact of aerophagia and improve your CPAP therapy experience.  Thanks for being here. I will see you next week!

Important Update: Understanding the Philips CPAP Machine Halt Hey Sleep Warrior!  Today I’m bringing you an important update from Philips Respironics. When I was off working in Saipan, Philips announced a significant decision to halt sales of new CPAP machines. This news has left many in our community with questions, especially those currently using Philips CPAP devices. Today, we're diving into what this means for you and how to navigate the situation. Why Did This Happen? Review of CPAP Recall Information: First, let's talk about the "why" behind Philips Respironics' decision. The company previously issued a recall for certain CPAP, BiPAP, and ventilator devices due to potential health risks from the foam used in these machines. This foam, intended for noise reduction, was found to potentially degrade and release harmful particles or gases. The health implications prompted a global recall to ensure user safety. Recently, Philips has extended this caution by stopping the sale of new CPAP machines - meaning the Dreamstation 2. While this move indicates a commitment to addressing issues thoroughly before continuing to supply the market, what should you do if you are currently using the Dreamstation 2 replacement device? Here's what you need to know: Continue Using Your Device: Despite the halt in sales, there is no current recommendation to stop using recalled Philips CPAP machines. Ongoing research aims to assess the risks more comprehensively. However, the dangers of untreated sleep apnea, including increased risk of heart disease, stroke, and other serious conditions, typically outweigh the potential risks from using these devices. Consult Your Sleep Medicine Provider: It's essential to discuss any concerns with your sleep medicine provider. They can offer personalized advice based on the latest information and your specific health situation. Your provider may suggest continued use under close monitoring or explore alternative therapy options if necessary. In light of the Philips CPAP machine recall and sales halt, staying informed and consulting with your healthcare provider is paramount. Remember, your well-being is the top priority. Untreated sleep apnea poses significant health risks, so it's crucial to weigh your options carefully and follow professional guidance. Thanks for being here. I’ll see you next week. 

Delivering CPAP Therapy in Saipan This week, I'm coming to you from the beautiful island of Saipan.  As you may or may not know, I've been working here on the island since 2007, when we lived here for a year.  In fact, I helped to open the only sleep and neurology center on the island to address the vital needs of patients with neurological disorders and sleep apnea. Now that I am back in Oregon, I travel to Saipan annually to treat patients. Sleep apnea in Saipan is much like what we see in the mainland U.S., but the journey to awareness and treatment here has its unique challenges.  Despite these challenges, we've seen incredible success stories.  Today, I'm thrilled to share a quick video from one of our inspiring patients who has been using her CPAP machine with remarkable results. I hope that you feel a sense of solidarity with CPAP users around the World.  Thanks for being here. I’ll see you next week.

Snoring While on CPAP Today, let’s tackle a common concern among CPAP users: snoring. Is it just a nuisance, or a sign of something more?  Snoring while using your CPAP might seem contradictory. After all, isn’t the CPAP supposed to prevent that? Well, it's not always straightforward. Snoring suggests that there is mild obstruction - or blockage - in the back of the throat, resulting in vibration of the soft palate. So it IS true that CPAP at the correct setting should eliminate snoring. And hopefully, you snore a whole lot LESS with CPAP than you do without it.  But snoring in the absence of apnea is not necessarily a problem (although try telling a bed partner that!). Fortunately, most modern CPAP machines are Auto-CPAPs, meaning that they will automatically adjust the pressure up if apneas are detected. Likewise, if apneas are not detected over a period of time, the pressure will drop down. When this works properly, your machine’s residual apnea-hypopnea index, or AHI, should be below 5 events per hour.  So, if you snore with your CPAP on, the first thing to do is check your machine’s AHI. This crucial number is found on your machine’s data app or can also be found on the CPAP machine itself. An AHI above 5 suggests that your CPAP might not be optimally adjusted. If you find your AHI is consistently high, it’s a signal to talk to your healthcare provider. They can adjust your CPAP settings to better suit your needs. Some of you might notice snoring at the beginning of the night. This could be due to the ramp feature, which gradually increases pressure as you are falling asleep. You may notice snoring during this time until the pressure gets to its goal. You can always turn this feature off to eliminate the snoring. But here's some good news: occasional snoring, especially with an AHI below 5, is generally not a problem. It doesn’t always indicate a failure in your CPAP therapy, and if it isn’t bothering anyone, it can be overlooked.   Interestingly, lifestyle factors can play a role. Alcohol consumption, the use of muscle relaxants, or weight gain can lead to snoring, even with CPAP use. If you consistently snore and notice a return of daytime sleepiness or non-refreshing sleep, it might be time for a reevaluation with your sleep medicine provider. Remember, understanding your CPAP and how it interacts with your body is key to effective sleep apnea management.  Thanks for being here. I’ll see you next week.