7 things you need to know when starting CPAP
Starting CPAP is hard. Getting used to sleeping with the mask is terrible enough. But there’s also the flood of new information on sleep apnea, CPAP machines, insurance, etc. It’s a lot to process.
The worst part is they don’t tell you everything you REALLY need to know — things that could make starting CPAP so much easier. You have to “figure” these out for yourself or hope someone lets you in on the secret.
When starting CPAP myself, I learned those lessons the hard way. But you don’t have to. Here are the seven things I wished I knew when starting.
#1. You can find support today
It can feel like you’re all by yourself when you're first starting. If you’re lucky, you have friends or family there to cheer you on. But do they understand what you’re going through?
Luckily, you’re not alone.
You’re joining approximately 6.4 million Americans who will be diagnosed with obstructive sleep apnea (OSA) this year. That’s how massive this problem is! And with scale comes support.
There are many great resources out there to help answer your questions on sleep apnea, treatment options, CPAP, or other sleep topics as you embark on your sleep apnea treatment. There are also several large communities online to find others like yourself and get support. Even the equipment manufacturers provide helpful information on their sites. Here at Somnea our mission is to help people with sleep apnea find success with treatment.
American Academy of Sleep Medicine. The medical society dedicated to professionals in sleep medicine provides a sleep education portal on a range of topics related to sleep, including sleep apnea.
American Thoracic Society. The medical society dedicated to pulmonology (lung) medicine provides clinically-focused articles on healthy sleep and sleep problems, including sleep apnea.
CPAP.com blog. The world’s largest online reseller of CPAP equipment maintains a helpful blog on CPAP therapy, sleep research, everyday tips, as well as troubleshooting issues. Note: They are incentivized to sell you something, but that doesn’t stop their content from being great.
Reddit. This online community has several channels dedicated to sleep apnea and CPAP support, including over 20,000 members. Here you'll find helpful tips, personal experiences, and help when troubleshooting issues.
CPAPtalk. An online community organized by CPAP.com to connect and support CPAP users. This site has over 20,000 visitors every month, posting and commenting on a range of topics from CPAP tips, troubleshooting support, and even alternative therapies.
Facebook Sleep Apnea Support Group. A private Facebook group with over 20,000 members provides a safe space to discuss your sleep apnea treatment and receive feedback and encouragement from other sleep apnea sufferers.
Fisher & Paykel. This New Zealand-based company, primarily known for its mask products, has helpful content on its website on OSA, diagnosis, treatment, and long-term use. In addition, they have more detailed information and guides on their line of CPAP products.
Philips. Philips’ Respironics brand is one of the major manufacturers in the sleep apnea space, and they’ve created a friendly site to help you navigate sleep apnea from start to finish. This comprehensive site has information on starting treatment and living with sleep apnea.
ResMed. The other major CPAP manufacturer ResMed has a blog with plenty of helpful information to help you start your treatment journey as well as broader information on sleep health and wellness.
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#2. Stop waiting to find out how you are doing on CPAP
Is CPAP really working for you? Wondering whether you’re doing it right? Whether that decision to start sleeping on your side is paying off or not?
Because CPAP is a departure from your usual sleep routine, it often keeps you guessing what’s going on. But just as it would be tough to lose weight without checking a scale — the same goes for sleep. Don’t guess. Get the data.
There are several ways to get more detailed information on how CPAP works for you. This can be done either directly on the device, through the machine manufacturer’s companion app, or even through the clinical data stored on them.
Most CPAP machines will display basic information on the device screen, such as time slept and mask leaks. However, many machines let you view more detailed information from the screen, such as mask leak, your apnea-hypopnea index (AHI), and other stats. However, unless your provider already turned this on, you’ll need to do so from the machine’s clinical menu (see below on how to do so).
There are also companion apps from the machine’s manufacturer for many newer devices. These can be downloaded to your smartphone and use Bluetooth, WiFi, or cellular signal to transmit and report your sleep data.
myAir. If you have a ResMed machine, download their companion app called myAir. This app provides you with a daily score is broken down by time slept, mask leak, AHI, and mask off events to track how you’re doing each night. In addition, it provides helpful videos and information on standard troubleshooting.
DreamMapper. If you have a Philips machine, download their companion app called DreamMapper. Like myAir, DreamMapper provides you with a daily dashboard to track your progress. This app offers similar information such as time slept, mask fit, AHI, and pressure monitoring each night. In addition to helping guide and videos, the app also lets you track and set goals.
SleepStyle. The latest Fisher & Paykel machine has a companion app you can download called SleepStyle. Like the other two machine apps, the SleepStyle app provides you with daily tracking of your night’s sleep with stats on mask leak, AHI, and usage. It also contains troubleshooting videos to help you solve common issues.
Are you looking for even more detailed information? You can access the more complex clinical details stored on the SD card in your machine. You’ll need to download specialized software to your computer to read the information that’s available there. Two popular free versions available to download are SleepyHead and OSCAR.
#3. Do you have the best equipment for you?
Maybe you’re lucky and have a great provider for your CPAP equipment already. One who took the time to walk you through exactly what every piece of equipment was, explain how to use it, and the range of options you have to choose from. But I’m guessing some of you had your equipment dropped off at your door with no more than a delivery confirmation.
If you’re struggling to get comfortable with treatment, there’s a lot to troubleshoot, but it often starts with the mask you’re using. And many people don’t realize there’s a vast selection of CPAP masks today. So it’s essential to find the mask that works for you. And when you’re first starting, some providers will let you change your mask free of charge if it’s within the first 30 days of starting treatment.
The first place to start is knowing which mask styles are out there:
Full face mask. This is the most common mask style. It is called “full face” because it completely covers your mouth and nose, creating one seal regardless of whether you breathe through your nose or mouth. While traditionally quite large, recent advances have included under-the-nose designs, making them much more compact.
Nasal mask. The second most common mask style. They are called “nasal” because it covers just your nose but not your mouth. This smaller and often more comfortable mask is a good choice if you don’t breathe through your mouth at night. If you are determined to stay with your nasal mask, you can consider a chin strap to help keep your mouth closed at night.
Nasal pillows mask. This mask style is often the smallest as it doesn’t cover the nose but instead uses “pillows” to form a seal around your nostrils. It is also a great choice if you don’t suffer from mouth breathing or decide to control it with a chin strap.
Cradle mask. This is a newer style of mask that sits somewhere between nasal and nasal pillows. It’s similar to a pillows mask in that it sits under the nose. The difference is that this doesn’t rely on the pillow's design to seal but rather a continuous cushion. What you gain in comfort, you lose stability generally.
Conduit mask. Not a particular cushion type as the masks described above, the conduit design is a new style of the mask frame. By turning the frame itself into a “conduit” or tube for the air to reach your mouth and nose, the CPAP tube connects to the top of the head rather than in front of the face. This style is great for restless sleepers, those who sleep on their stomach, or those with partners.
Other masks. New mask styles are released every year, and the designs are constantly changing. While the above describes the major categories, there are several unique styles or twists to the other types. These include foam or fabric rather than silicone material, as well as pillows that tape to your nose rather than using headgear.
Another piece of the puzzle to crack is deciding which tube type to use. There are two primary variants, each offering its benefits.
Normal tube. This is the more basic tube version. This type connects any mask to any machine and provides the air path. They come in various lengths, diameters, and even materials. Because of the simple design, they are often quite flexible and inexpensive.
Heated tube. Unlike the non-heated tube, this style includes heating wire throughout the length of the tube to heat the air as it travels from the machine to your mask. This can provide a more comfortable experience and help prevent condensation from forming in the tube. It also means it only works with a specific machine (though any mask) and is typically more expensive.
#4. Set your machine and yourself up for success
Your provider might have set up your machine with some initial settings, which could be their typical settings, the manufacturer’s default, or even settings explicitly selected for you based on your initial appointment.
But even with custom settings, what you need one night can change to the next. Sticking with static settings means you’re missing out. If you learn how to adjust these settings, you can dial in the perfect sleep every night.
Everything your CPAP machine can do can be set up directly through the menu on the screen. Some of these options are available to you in the standard menu. Others can only be accessed in the clinical menu, which can be entered using a secret handshake. Once you’re in, you can adjust:
Ramp. Set the starting pressure you begin the night breathing on (lower than your therapy pressure setting) and the time it takes to reach your standard setting (usually up to 45 minutes).
Humidification. You can control the amount of heat sent to the humidifier tub and thus the amount of moisture in the air you breathe. Be careful, though; you can add too much moisture and have water condense in your tube depending on your room temperature at night.
Tube temperature. Only available when using a heated tube sets the temperature of the heated tube and thus the air as it travels from your machine to your mask. The warmer the air, the more moisture it can carry to you.
Pressure relief. Many machines have this setting, allowing you to control how much the pressure reduces every time you exhale against it, thus providing “pressure relief.” This can be used when you have difficulty breathing against your machine’s airflow.
Mask style. You can select the mask style on many machines — usually picking between full face, nasal, and nasal pillows mask. This setting tells the device to adjust for pressure, leak, etc., based on the different characteristics of the mask style you’re using.
Additional information. As mentioned above, you can select to show further treatment details such as specific mask leaks, your apnea-hypopnea index (AHI), and other stats. This is either on or off and will control what is shown on your machine’s screen.
Start/stop. Because machines can detect when you are breathing on them, you control whether the machine will automatically start or stop blowing air when it sees your breath or not. This allows you to start and stop therapy without using the machine buttons.
You can adjust one more group of settings to your machine’s therapy settings. But first, a word of caution — if you tried CPAP in a sleep lab, then the machine settings have been determined by your physician specific to what worked that night. Or they were selected based on which events were observed in your diagnostic test. So change these settings at your own risk.
Therapy Mode. Depending on your machine model, you have therapy settings such as CPAP, APAP, or BiPAP. And within each of these modes, there are specific pressure settings that can be adjusted.
CPAP machines have advanced quite a bit in the last several generations. Many devices now offer an “Auto” mode for just about every setting: humidification, ramp, and even therapy. Using the machine’s sensors will intelligently determine what’s best for you every night. So if you’re struggling to find the right setting, you can always let the machine figure it out for you.
#5. Yes, your equipment does need replacing
None of your equipment is designed to last forever.
Everything, including the machine, will start to wear out over time — some things faster than others. The more you use the equipment, the quicker that happens. Your mask. The filter. The tube and tub. Just about every part of the machine except for the device itself can and should be replaced on a regular schedule.
Luckily for most, replacement equipment is typically covered by insurance. The specific frequency will vary based on your insurance, but many replacement schedules follow Medicare’s, which is:
Mask cushion. This depends on which type of mask you use. Full face mask cushions can be replaced monthly, while it's twice a month for nasal and nasal pillows masks.
Mask frame. Every three months, you can replace the mask frame regardless of the mask style.
Mask headgear. This is designed to be more durable, so it’s only scheduled to be replaced every six months.
Machine filters. It’s essential to change these frequently. They are the first line of defense, protecting the incoming air against particulates. They can be replaced twice a month.
Tube. These can be replaced every three months whether you have a standard tube or a heated tube.
Humidifier tub. Another more durable item, the tub, can typically be replaced every six months.
In recent years the number of providers proactively replacing equipment has increased, which is a great thing. However, some providers have abused the system and will ship replacement equipment whether you want it or not.
It’s always your choice. I recommend frequently replacing your equipment to have the best experience but whether you follow the most frequent schedule is a choice that’s ultimately up to you.
#6. Are you still using distilled water?
I’m probably not supposed to be saying this.
But you don’t have to use distilled water with your CPAP. Good old tap water will typically do just fine.
You are told to use distilled water because that’s what the equipment has been tested with. Equipment manufacturers can’t experiment with every water sample, so they use distilled water, which is the most controlled and has the lowest number of impurities.
But, if you live in an area with potable tap water — it’s probably OK to use. Every person has to choose whether you’re comfortable using tap water — after all, you will be breathing it in every night. But unless something is seriously wrong with your water source, it shouldn’t damage your equipment.
#7. Clean up after yourself
Ok, so they told me this one when I started, but I want to stress the importance.
I know another chore is the last thing you want to hear about. But, it would help if you cleaned your equipment. I know it sucks. But it honestly makes a difference. Imagine if you never washed the underwear you wore every day? Gross.
Cleaning your equipment will help it perform better and last longer. Using your standard hand soap is a great place to start. At a minimum, you should let everything air dry every day. Also, avoid putting your equipment in your dishwasher, as most pieces won’t withstand the dry cycle.
Here’s what I recommend and what you’ll get if you stick to the habit of cleaning:
Mask cushion. Cleaning this daily will help it last longer and help it fit better on your face, reducing mask leaks. Your skin deposits oils on the silicone, which degrade the material and cause acne. Wash with hand soap and warm water as often as daily.
Humidifier tub. Ensure to empty this every day and let air dry to prevent mold or bacteria growth. You can also wash it with your dishes — just not in the washing machine.
Mask headgear. You wash your pajamas, right? The same goes for your headgear which you wear every night. Remove it from the frame and throw it in the laundry at least once a month for a quick fix.
Tube. Cleaning your tube at least monthly will prevent bacteria from growing in the moisture and keep you from getting a head cold. The easiest way is to bring the tube in the shower with you and use shampoo or body soap.
Machine filters. It’s better to replace these often, as the air pollutants build up. But you can rinse these under water to wash away the loose particulates and improve the performance between cycles.
Now get a good night’s sleep
Reading this was the first step towards improving your sleep apnea treatment.
Know there are plenty of resources to help answer all of your questions and better understand how things are going. Don’t be afraid to seek out more help — you’ll find the CPAP community is a supportive one.
There’s a lot of pressure (pun intended) when you’re starting and getting used to your equipment. But it’s your equipment, and you’re going to be using it most nights. Make sure you have the right equipment, it’s set up right for you, and you’re cleaning or replacing it as needed.
And remember that getting used to CPAP takes time. No one is initially used to sleeping with a mask and air pumped at you. But it does get better. And these simple things can make your life that much easier starting out and over time.