Sleep Bytes & Blog

12 Helpful CPAP Tips You May Not Know - Part 2 Hello, sleep warriors! This is Kenny McCollum at KimberlyMD.com, and this is part two of twelve helpful CPAP tips you may not know, and here we go! #7. Pulling off the mask at night. I hear this a lot. So, one solution is to buy a chin strap and place it over the top of the mask. So, you cannot do this with all masks, but there are several masks that you can place a chin strap over the top of the mask, including a nasal pillow, nasal, and a few full-face tight masks. The other option that is not as popular a solution is just to change to a mask with a sturdier headgear. The example on the left, the P10 nasal pillow mask, does not really have a very sturdy headgear; it is just a loop at the back of the head; it is easy to pull off at night. So, switching to, for example, the mask on the right, the N20 nasal mask, which has a sturdier headgear, can help to keep the mask in place; it is just not as easy to pull off. #8 Irritation from the mass cushion. So, the solution is mask cushion pads, such as the Remzee, Snugz, or other mask cushion pads. There are a few varieties out there. These are just little inexpensive pads that you put over the silicone cushion that acts as a barrier between your skin and the cushion itself, and can help with skin breakdown that the cushion can cause. #9 Breakdown on the bridge of your nose. Solution: Gecko pads, other nose pads, or foam mask cushions like the ResMed N20 or ResMed F20 AirTouch. The ResMed gecko pad is just a little silicone cushion that you place on the bridge of your nose. There are a couple of other manufacturers that make equivalent items. There are also the AirTouch cushions, and they are just a little softer, so they are great for skin breakdown on the bridge of the nose. #10 Headgear causing marks or discomfort. The solution: headgear padding. There are companies like Pad-a-Cheek that design pads specifically for CPAP mask headgear for all masks out there. You can look at these companies online. Just search for CPAP mask headgear pads for custom-made pads. #11 Rainout for a non-heated tube. So, what is rainout? Rainout is when heated air cools in the tube and reaches the mask as water, or when the condensation builds up in your tube. Here are the solutions for a non-heated tubing: Increasing the temperature of your room. Keeping the tube under the blanket with you as much as possible. Lowering the humidity on the machine. Closing any windows and making sure that no fans are blowing on the tube, etc. Tube wraps, which we have already discussed. Basically, keeping the tube as warm and as dry as possible is going to help keep condensation out of the tube and the mask for a non-heated tube. #12 Rainout with a heated tubing. One of the best solutions is to increase the temperature of the tube as high as you can tolerate it. The default range for most tubes on most machines is about 80 to 82 degrees, and on most units, it goes up to about 87 degrees. So, you may need to periodically increase the tube temperature to prevent rain out, it is not a set it and forget it situation. the same temperature that works in the summer may not work in the winter as the seasons change, you are going to have to adjust the temperature to prevent rain out I find this especially true as summer turns into winter. As it gets colder, I usually get a lot of calls about rainouts. I usually tell people to just increase the temperature on their tube, and that takes care of it. I would like to note that the auto tube setting on CPAP machines usually only works well in very static climates or home environments. So, if you live in an environment where the humidity and temperature is always the same or your home environment is always the same, then the auto setting on the CPAP will work well, but that is usually not the case for most people. If you are having issues with rainout or, alternatively, humidity issues, switch your machine over to manual and try that. I have found that they just have not perfected that technology yet. I hope you found some helpful information from this two-part series, I will be working on some additional CPAP tips for upcoming sleep tech bytes until then if you would like additional support Kimberly md.com offers a CPAP 101 course which is designed especially for new CPAP users or, if you prefer a more personalized experience, we also offer group coaching or individual coaching with me, Kenny McCollum. Thank you, and until next time, sleep well!

Central vs. Obstructive Sleep Apnea The other day, my patient was anxious to talk to me, “Doc, the AHI on my CPAP machine jumped from 4 to 12, mostly due to 'clear airway' events. What should I do?” Calmly, I encouraged him to relax and invited him to join me in unraveling the secrets between central and obstructive sleep apnea and when to be concerned. Now, you probably know that sleep apnea is a common sleep disorder that affects millions of people worldwide. And you may be aware that there are two primary types of sleep apnea - the very common obstructive sleep apnea (OSA) and the less common central sleep apnea (CSA). But did you know that many, if not most, people have some degree of both? Let’s explore this a bit deeper… First, let’s understand what central sleep apnea is. Central sleep apnea occurs when the brain fails to send proper signals to the body to breathe during sleep. Unlike obstructive sleep apnea, CSA is not caused by physical airway obstructions in the back of the throat. Instead, it stems from underlying medical conditions, such as heart failure, stroke, or brainstem injury. It can also occur in people taking certain medications, such as opioids for pain. Think of CSA as an issue with the breathing “switch” in your brain - the switch could be faulty itself from something like a stroke or brain injury, or it could be simply acting erratically due to receiving mixed messages from the body, such as what happens in heart failure or with certain medications. Similarly to OSA, people with CSA experience repeated interruptions in their sleep as well as oxygen desaturation. So, it’s not surprising that people with CSA may not feel rested in the mornings or experience daytime symptoms, such as sleepiness and fatigue. The good news is that most of us have some degree of central sleep apnea, and it isn’t always problematic. In fact, it can be a normal response after a deep breath.  However, if you are using CPAP and you notice an increase in the “clear airway”, aka “central” apnea events, here are some of the circumstances when you would want to bring this to the attention of your healthcare provider: If you have more central apneas than obstructive apneas. This may suggest that the pressures on your machine may need to be adjusted If you are having a return of sleep apnea symptoms You’ve developed a new medical condition, such as heart problems You’ve started new medications So, in conclusion, the primary difference between CSA and OSA lies in their underlying causes. CSA is driven by a lack of proper brain signals for breathing, while OSA is a result of physical airway obstructions. So, what happened with my patient? Well, after our discussion, he said he had recently strained his back and had been taking one narcotic pain pill before bed each night to help him sleep. Aha! The new medication was the likely culprit, and I asked him to switch to extra-strength Tylenol. Sure enough, he noticed right away that his machine’s AHI number returned to normal. Thanks for being here. I’ll see you next week! Disclaimer: This information is for educational purposes only and not intended to be direct medical advice.

12 Helpful CPAP Tips You May Not Know - Part 1 Hello, Sleep Warriors! This is Kenny McCollum with KimberlyMD.com.  Today is going to be part one of a two-part series called “12 Helpful CPAP Tips You May Not Know!" #1 Hose entanglement.Solution:A CPAP tube holder.So, this is basically just a pole with a little flap that usually slides between the box spring and the mattress with a little strap at the top that holds your CPAP tube above your head. Now I've seen a lot of DIY methods as well. People will attach it to their headboards or to the wall. That works great as well. These tube holders are relatively inexpensive, though. You can pick them up online, and they are a great way to hold your tube out of the way! #2 Your hose is not long enough.Solution:Heated hoses are about six feet long, but with non-heated hoses, you can get up to ten feet in length. Ten feet is the maximum length that you can have for a CPAP machine, though. You do not want to string multiple hoses together; 10 feet is the maximum length that you can have for a CPAP machine. Once you reach ten feet, you're going to have to move the CPAP machine closer to your bed. #3 The mask will not fit on the end of the hose.Solution:All tube ends, or cuff sizes, are universal at 22 millimeters. So, you can see here, the tube on the left here, what you have is the mask swivel stuck at the end of the tube. So sometimes people pull the mask off the end of the tube, and that swivel gets stuck in the end of the tube. So, the solution to this problem is just to pull that swivel out of the tube, and then your new mask will fit into the end of the tube. #4 The mask will not stay on the hoseSolution:So, the mask cuff is either worn or stretched out, or needs to be cleaned, or the mask swivel needs to be cleaned. You can do that usually with just a little soap and water, or just a washcloth, and just clean it well. If that does not work, it needs to be replaced; it has become so stretched out your mask will not stay on any longer. This usually happens after a few months. #5 The hose is cold.Solution:So, this is a non-heated hose, so it's cold, and maybe getting some condensation inside of the hose, or it's cold up against your skin. So, the solution to this is a tube wrap. So, this is what a tube wrap looks like. This is a basic one that just has Velcro at both ends. There are also other wraps that have zippers that go all along the edge of the tube wrap. You can find these just about anywhere, either online or at a CPAP store. #6 The hose is cold on a heated hose. Solution:The hose heating element is no longer working. So, if your hose is cold and it's a heated hose the heating element on it is probably not working anymore, and this can happen any time after you purchase the hose. Sometimes they stop working a week after you purchased them; you just purchased a lemon. Also, sometimes you may just have the heat turned down too low. Turn up the heat if it feels too cold. All right, thank you for joining me. I'll see you next time for part two!

Are there other options beyond the traditional CPAP machine? Today I’m excited to introduce you to the most common non-CPAP treatment for obstructive sleep apnea: oral appliance therapy, or OAT for short. Oral appliance therapy involves wearing a custom-fitted mouthpiece that advances the lower jaw and tongue forward to keep the airway open during sleep. Its key feature is that the degree of movement can be titrated - meaning it can be adjusted to more or less protrusion of your lower jaw. Advantages of oral appliance therapy include its portability, its ease of use, and of course, there is no mask. The disadvantages include the potential for jaw soreness and teeth movement, along with overall reduced effectiveness when compared to nightly CPAP use. The best candidates for oral appliance therapy include people with mild or moderate sleep apnea, those who are not obese - meaning normal weight or mildly overweight, and those whose sleep apnea is worse when sleeping on their backs. In order to be fitted for an oral appliance, you need to see a sleep dentist. These are dentists with specialized training and experience in sleep apnea. There is a wide range of prices for the appliances, but they usually run between $2,000 and $3,000 US dollars + plus visits with the dentist for adjustments. Fortunately, if your sleep study shows that you have sleep apnea, most medical insurance do cover some or all of the costs. If you do choose oral appliance therapy to treat your sleep apnea, and if you have anything more than mild sleep apnea, it is important that you repeat your sleep study with the device to be sure it is effectively treating your apnea. If you’d like to get more information on oral appliances and hear about other non-CPAP treatment options for OSA, join me for a FREE sleep workshop titled Non-CPAP Treatments for Sleep Apnea on May 9th at 4:30 PT / 7:30 ET, where I will discuss several non-CPAP treatments for sleep apnea, including oral appliance therapy, positional therapy, and surgical options, including Inspire. I’ll also answer any questions you may have in a Live Q&A over Zoom. Sign up HERE

Free Upcoming Workshop Hello, sleep warriors! I’m Kenny McCollum with KimberlyMD.com. Are you struggling to understand the complexities of sleep apnea treatment? Maybe you or someone you care about has been diagnosed with sleep apnea, and you're on a quest to find the most effective solution. Don't miss out on an incredible free opportunity to enhance your understanding of sleep apnea treatment and take control of your sleep health. We will be having a free workshop, "The ABCs of PAP Therapy: APAP vs. BiPAP vs. CPAP"  on Tuesday, April 11, at 7:30 pm Eastern time and 4:30 pm Pacific time. In this workshop, sleep experts will unravel the mysteries behind these 3 prominent types of positive airway pressure devices. From the comfort of your own home, you'll be guided through an engaging and informative learning experience covering the functionality and unique features of each therapy. Our experts will also be available to answer any questions you may have during the interactive Q&A session following the presentation Simply visit KimberlyMD.com to reserve your spot in the online workshop. Again, that’s the "The ABCs of PAP Therapy: APAP vs. BiPAP vs. CPAP"  on Tuesday, April 11, at 7:30 pm Eastern time and 4:30 pm Pacific time.  It's time to take the first step toward a better night's sleep. See you there!

Sleep Your Way to Vaccine Protection Did you know that getting enough sleep may play a crucial role in the effectiveness of your vaccine? According to a recent study, which used statistics to review 7 prior studies, sleeping for fewer than six hours per night around the time of vaccination can significantly decrease the body's antibody response. The study, published on March 13 in the journal Current Biology, analyzed data on the association between sleep duration and antibody responses for the influenza and hepatitis vaccines. The analysis revealed that adults who slept between seven and nine hours per night before and after the vaccine showed a more robust antibody response. I’ll note that these findings were primarily seen in men, which may be a result of not accounting for hormone fluctuations in women, which are known to affect immune function. The researchers suggest that large-scale studies are needed to determine the specifics around when people should get sufficient sleep to promote an optimal vaccine response, but for now, if you’re sleep-deprived, jet-lagged, work a night shift or otherwise have swings in your sleep-wake cycle, consider delaying the vaccination until you can get a full night of sleep. Thanks for being here. I’ll see you next week!