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Sleep Apnea, Snoring, Narcolepsy,
Insomnia and Other Sleep Disorders

THE SLEEP SITE

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Treatments, Tips and Techniques.

INFORMATION FOR PATIENTS USING POSITIVE AIRWAY PRESSURE
(CPAP, BILEVEL PAP, ADAPT OR AUTO SV) TREATMENTS FOR SLEEP APNEA

CPAP/ BILEVEL PAP/ ADAPT SV TROUBLESHOOTING GUIDE

PROBLEM: IF ANY OF THE FOLLOWING ARE PRESENT... YOUR PROBLEM MAY BE
DUE TO: ...AND THESE MEASURES MAY HELP.
If not, do not give up! Call your sleep medicine specialist for assistance.

Nasal congestion:

Clear, watery drainage and/or sneezing, esp. if the weather is cold.
Dry mucous membranes
1. Saline nasal spray (buy over the counter)
2. Ensure you're using a humidifier, (connected to your PAP machine), with distilled water. Don't use tap water.
3. Heat the water in the humidifier pan, and put a"stadium cushion" or "lava pack" that you've heated in a microwave oven underneath it to keep the water warm. If this fails, call your homecare company to discuss obtaining a heated humidifier.
4. If you already have a heated humidifier, consider increasing its settings until problem resolves or excessive condensation of water occurs. Ensure that the unit is below the level of your head such that condensed water drains back into humidifier pan.
5. Run a steam vaporizer in your bedroom.
6. Inhale warm moist air before retiring (ex.: take a hot shower, or by using a steam inhaler-available through many pharmacies).
7. If using nasal pillows or another interface that inserts into the nostrils, and the problem continues, call your homecare company to change to a mask.
8. DO NOT USE: over the counter decongestant sprays (ex. Neosynephrine®. Afrin® Spray) repeatedly (they can irritate the lining of the nose and make it more swollen), or sedating antihistamines.

Nasal congestion:

Nose really "plugged up".
Drying, respiratory infections, allergies.
1. All the above measures as recommended for dry mucous membranes.
2. Sleep in a reclining chair with CPAP/bilevel PAP in place.
3. Use Breathe-Right® nasal dilators (available over the counter) with your machine
4. Ensure that you are using distilled water--not tap water--in the humidifier pan.

Nasal congestion:

Fever, chills, yellow or green mucus.
Respiratory infection
1. All the above measures for nasal congestion plus: call your family doctor promptly for specific antibiotic treatment.

Nasal congestion:

Sneezing/runny nose, eyes, watering, itching eyes/nose, especially with season change or exposure to pollen, dust, mold, animals, etc.
Allergies
1. Call your doctor for possible allergy treatments.
2. Try to eliminate allergens, including keeping pets out of the bedroom, and obtain a HEPA filter or ionizer: unit that plugs into standard electrical outlet and filters the air in the room.

Nose irritated by nasal pillows or nasal inserts:

Pain where pillows touch inside of nose.
Local irritation
1. Vitamin A & D ointment® or saline gel (over the counter at local pharmacies).
2. Ro-Ez-It® lotion (ask your physician).
3. Call your homecare copmpany to be resized or to change to a mask.

Mouth dry:

Nasal "stuffiness".
Mouth breathing, because nose congested
1. Try measures above for nasal congestion.

Mouth dry:

Mouth opening without nasal stuffiness
Not using chinstrap
1. Begin using chinstrap (call homecare company or your sleep physician if you don't already have one).

Mouth dry:

Mouth opening without nasal stuffiness
Chinstrap being used but not effective
1. Ensure you're following positioning instructions. If at all possible, ensure you cannot roll onto your back during sleep.
2. If chinstrap slips, try putting it on first, underneath your headgear.
3. Call homecare company to try a different style of chinstrap.

Belching, gas, gas pains, stomach bloated:

Air swallowing from mouth breathing
Air swallowing from pressure
being delivered
1. Try measures listed for dry mouth, above.
2. Try simethacone (ex: Mylicon®, Gas-Ex®) before retiring (available over the counter).

Can't tolerate CPAP or bilevel PAP--
or don't feel better after using it:
1. Arousals with breathlessness or gasping.
2. Wake up repeatedly for unclear reasons.
3. Bed partner witnesses pauses in breathing while I sleep with it.
4. Feel as though I cannot synchronize my breathing with the machine.
5. Have heart failure or atrial fibrillation.

Central
sleep apneas
are present.
1. Seek sleep re-evaluation and consideration of a trial of adaptive servo-ventilation (ASV).

Recurrent snoring/ sleep apnea symptoms:

Nose congested
Nasal congestion
1. Try measures listed above for nasal congestion.

Recurrent snoring/ sleep apnea symptoms:

Occurs when on back
Failure to use recommended elevation and/or measures to stay off back.
1. Institute those measures.

Recurrent snoring/ sleep apnea symptoms:

Indications of mouth breathing
Chinstrap not being used or ineffective.
1. See measures above re: chinstrap problems.

Recurrent snoring/ sleep apnea symptoms:

Pressure feels too low or equipment not checked recently.
Equipment not functioning properly
1. Call your homecare company immediately.

Recurrent snoring/ sleep apnea symptoms:

Alcohol ingestion
Worsening 2o to alcohol
1. Avoid all alcohol.

Recurrent snoring/ sleep apnea symptoms:

Weight gain
Worsening 2o to weight gain
1. Call your sleep medicine physician promptly.
2. Work at weight loss.

Awakening with a smothering feeling:

Recurrence of
sleep apnea
1. See measures listed under recurrent snoring/ sleep apnea symptoms.
2. Rule out central sleep apnea that has arisen after elimination of obstructive sleep apnea.

Awakening with a smothering feeling:

Anxiety attacks, particularly if correlates with increased stress or you tend to be claustrophobic.
1. Avoid caffeine.
2. Consider relaxation/ stress management training.

Awakening with a smothering feeling:

Other causes of shortness of breath (ex: heart and lung problems).
1. Call your doctor promptly, particularly if you have a history of those problems.

Mask/nasal pillows leak or don't seem to fit.

Mask in place before machine turned on.
1. Turn machine on first, then put mask on.
2. If the above fail, call your homecare company for resizing, replacement or trial of different equipment.

Mask/nasal pillows leak or don't seem to fit.

Nasal pillows not aligned properly.
1. Note that they are not perfectly round--try rotating them.
2. If the above fail, call your homecare company for resizing, replacement or trial of different equipment.

Irritation over nasal bridge.

Overtightening of mask or slipping
of mask with shearing of skin.
1. If skin is broken, change to nasal pillows ("puffs") or another style of interface if possible, at least until healed.
2. If infection develops, apply triple antibiotic ointment three times a day and call your doctor or the sleep medicine physician.
3. Avoid overtightening of harness.
4. Turn on machine before applying mask.
5. Put bandage or Second Skin® (available from pharmacies) over irritated area.
6. Obtain "spacer" for your mask from your homecare company, or ask to try a different style mask if necessary.

Eye(s) reddened/ irritated on awakening.

Leak of air at rim of mask, blowing into eyes.
1. Ensure mask applied properly and chinstrap used if prescribed.
2. Call homecare company without delay for assistance.
3. If eye irritation marked, call the physician immediately.

Mask/"pillows" fall off or are pulled off during sleep.

Nasal congestion

1. See measures above re: nasal congestion.

Mask/"pillows" fall off or are pulled off during sleep.

Harness too loose or not applied correctly.

1. See above measures re: mask leaks/fitting problems.

Mask/"pillows" fall off or are pulled off during sleep.

Chinstrap not used or fits poorly.
Chinstrap may be needed for stability.
1. Use chinstrap regularly; call homecare company to obtain one if necessary. If not effective, refer to suggestions under dry mouth, above.
2. Try putting chinstrap on top of the mask/interface harness.

Mask/"pillows" fall off or are pulled off during sleep.

No evident cause.
(Other).
1. Try to pinpoint anything that seems to correlate with these removals.

FOR TIPS ON MANAGING SLEEP RELATED PROBLEMS--

FROM SLEEP APNEA AND SLEEPINESS TO INSOMNIA
AND ABNORMAL EVENTS IN SLEEP--

CLICK HERE TO VISIT THE NEW SLEEP SITE.

COLUMBUS COMMUNITY HEALTH
REGIONAL SLEEP DISORDERS CENTER
Accredited by the American Academy of Sleep Medicine.

Robert W. Clark, M.D., Medical Director
1430 South High Street, Columbus OH 43207

Tel: [614] 443-7800
Fax: [614] 443-6960

e-mail: flamenco@netexp.net

© Copyright 2010 Robert W. Clark M.D. Inc.

INFORMATION FOR PATIENTS USING POSITIVE AIRWAY PRESSURE (CPAP, BILEVEL PAP, ADAPT OR AUTO SV) TREATMENTS FOR SLEEP APNEA CPAP/ BILEVEL PAP/ ADAPT SV TROUBLESHOOTING GUIDE
PROBLEM:	IF ANY OF THE FOLLOWING ARE PRESENT...	YOUR PROBLEM MAY BE DUE TO:	...AND THESE MEASURES MAY HELP. If not, do not give up! Call your sleep medicine specialist for assistance.
Nasal congestion:	Clear, watery drainage and/or sneezing, esp. if the weather is cold.	Dry mucous membranes	1. Saline nasal spray (buy over the counter) 2. Ensure you're using a humidifier, (connected to your PAP machine), with distilled water. Don't use tap water. 3. Heat the water in the humidifier pan, and put a"stadium cushion" or "lava pack" that you've heated in a microwave oven underneath it to keep the water warm. If this fails, call your homecare company to discuss obtaining a heated humidifier. 4. If you already have a heated humidifier, consider increasing its settings until problem resolves or excessive condensation of water occurs. Ensure that the unit is below the level of your head such that condensed water drains back into humidifier pan. 5. Run a steam vaporizer in your bedroom. 6. Inhale warm moist air before retiring (ex.: take a hot shower, or by using a steam inhaler-available through many pharmacies). 7. If using nasal pillows or another interface that inserts into the nostrils, and the problem continues, call your homecare company to change to a mask. 8. DO NOT USE: over the counter decongestant sprays (ex. Neosynephrine®. Afrin® Spray) repeatedly (they can irritate the lining of the nose and make it more swollen), or sedating antihistamines.
Nasal congestion:	Nose really "plugged up".	Drying, respiratory infections, allergies.	1. All the above measures as recommended for dry mucous membranes. 2. Sleep in a reclining chair with CPAP/bilevel PAP in place. 3. Use Breathe-Right® nasal dilators (available over the counter) with your machine 4. Ensure that you are using distilled water--not tap water--in the humidifier pan.
Nasal congestion:	Fever, chills, yellow or green mucus.	Respiratory infection	1. All the above measures for nasal congestion plus: call your family doctor promptly for specific antibiotic treatment.
Nasal congestion:	Sneezing/runny nose, eyes, watering, itching eyes/nose, especially with season change or exposure to pollen, dust, mold, animals, etc.	Allergies	1. Call your doctor for possible allergy treatments. 2. Try to eliminate allergens, including keeping pets out of the bedroom, and obtain a HEPA filter or ionizer: unit that plugs into standard electrical outlet and filters the air in the room.
Nose irritated by nasal pillows or nasal inserts:	Pain where pillows touch inside of nose.	Local irritation	1. Vitamin A & D ointment® or saline gel (over the counter at local pharmacies). 2. Ro-Ez-It® lotion (ask your physician). 3. Call your homecare copmpany to be resized or to change to a mask.
Mouth dry:	Nasal "stuffiness".	Mouth breathing, because nose congested	1. Try measures above for nasal congestion.
Mouth dry:	Mouth opening without nasal stuffiness	Not using chinstrap	1. Begin using chinstrap (call homecare company or your sleep physician if you don't already have one).
Mouth dry:	Mouth opening without nasal stuffiness	Chinstrap being used but not effective	1. Ensure you're following positioning instructions. If at all possible, ensure you cannot roll onto your back during sleep. 2. If chinstrap slips, try putting it on first, underneath your headgear. 3. Call homecare company to try a different style of chinstrap.
Belching, gas, gas pains, stomach bloated:	Air swallowing from mouth breathing	Air swallowing from pressure being delivered	1. Try measures listed for dry mouth, above. 2. Try simethacone (ex: Mylicon®, Gas-Ex®) before retiring (available over the counter).
Can't tolerate CPAP or bilevel PAP-- or don't feel better after using it:	1. Arousals with breathlessness or gasping. 2. Wake up repeatedly for unclear reasons. 3. Bed partner witnesses pauses in breathing while I sleep with it. 4. Feel as though I cannot synchronize my breathing with the machine. 5. Have heart failure or atrial fibrillation.	Central sleep apneas are present.	1. Seek sleep re-evaluation and consideration of a trial of adaptive servo-ventilation (ASV).
Recurrent snoring/ sleep apnea symptoms:	Nose congested	Nasal congestion	1. Try measures listed above for nasal congestion.
Recurrent snoring/ sleep apnea symptoms:	Occurs when on back	Failure to use recommended elevation and/or measures to stay off back.	1. Institute those measures.
Recurrent snoring/ sleep apnea symptoms:	Indications of mouth breathing	Chinstrap not being used or ineffective.	1. See measures above re: chinstrap problems.
Recurrent snoring/ sleep apnea symptoms:	Pressure feels too low or equipment not checked recently.	Equipment not functioning properly	1. Call your homecare company immediately.
Recurrent snoring/ sleep apnea symptoms:	Alcohol ingestion	Worsening 2o to alcohol	1. Avoid all alcohol.
Recurrent snoring/ sleep apnea symptoms:	Weight gain	Worsening 2o to weight gain	1. Call your sleep medicine physician promptly. 2. Work at weight loss.
Awakening with a smothering feeling:		Recurrence of sleep apnea	1. See measures listed under recurrent snoring/ sleep apnea symptoms. 2. Rule out central sleep apnea that has arisen after elimination of obstructive sleep apnea.
Awakening with a smothering feeling:		Anxiety attacks, particularly if correlates with increased stress or you tend to be claustrophobic.	1. Avoid caffeine. 2. Consider relaxation/ stress management training.
Awakening with a smothering feeling:		Other causes of shortness of breath (ex: heart and lung problems).	1. Call your doctor promptly, particularly if you have a history of those problems.
Mask/nasal pillows leak or don't seem to fit.		Mask in place before machine turned on.	1. Turn machine on first, then put mask on. 2. If the above fail, call your homecare company for resizing, replacement or trial of different equipment.
Mask/nasal pillows leak or don't seem to fit.		Nasal pillows not aligned properly.	1. Note that they are not perfectly round--try rotating them. 2. If the above fail, call your homecare company for resizing, replacement or trial of different equipment.
Irritation over nasal bridge.		Overtightening of mask or slipping of mask with shearing of skin.	1. If skin is broken, change to nasal pillows ("puffs") or another style of interface if possible, at least until healed. 2. If infection develops, apply triple antibiotic ointment three times a day and call your doctor or the sleep medicine physician. 3. Avoid overtightening of harness. 4. Turn on machine before applying mask. 5. Put bandage or Second Skin® (available from pharmacies) over irritated area. 6. Obtain "spacer" for your mask from your homecare company, or ask to try a different style mask if necessary.
Eye(s) reddened/ irritated on awakening.		Leak of air at rim of mask, blowing into eyes.	1. Ensure mask applied properly and chinstrap used if prescribed. 2. Call homecare company without delay for assistance. 3. If eye irritation marked, call the physician immediately.
Mask/"pillows" fall off or are pulled off during sleep.	Nasal congestion		1. See measures above re: nasal congestion.
Mask/"pillows" fall off or are pulled off during sleep.	Harness too loose or not applied correctly.		1. See above measures re: mask leaks/fitting problems.
Mask/"pillows" fall off or are pulled off during sleep.	Chinstrap not used or fits poorly.	Chinstrap may be needed for stability.	1. Use chinstrap regularly; call homecare company to obtain one if necessary. If not effective, refer to suggestions under dry mouth, above. 2. Try putting chinstrap on top of the mask/interface harness.
Mask/"pillows" fall off or are pulled off during sleep.	No evident cause.	(Other).	1. Try to pinpoint anything that seems to correlate with these removals.