CPAP 101 Guide for Singapore: Expert Tips For Getting Started with Continuous Positive Airway Pressure (CPAP) Machines
1. What kind of mask should I get for my CPAP?
You should receive specific cleaning/maintenance instructions from the homecare company that delivers your equipment. We recommend taking the mask, tubing and headgear in the shower with you once a week, rinsing it with a mild dish soap (odorless or with a smell you can tolerate), hanging it over the showerhead to dry and remembering to hook it back up the next night. Filters should generally be checked once a month, more often if the environment is dusty. The humidifier chamber should be rinsed daily, and the use of distilled water will keep it clean and free of mineral deposits.
5. How long do I have to wear my CPAP each night for it to be effective?
Studies show that at least 6 hours of CPAP usage per night is needed to reduce the long-term health risks of obstructive sleep apnea. We encourage our patients to put the CPAP on at lights out each night and to make every attempt to put it back on after nighttime awakenings. If there are frequent awakenings or if you are finding the mask on the floor in the morning, then pressure adjustment or a mask refitting may be necessary.
6. Who should I call if there’s a problem?
For technical problems with the equipment, check in with the homecare company. Your doctor/sleep lab should also provide troubleshooting services if the problem has to do with mask fit or pressure adjustments rather than the workings of the equipment itself.
7. What should I do if I am still tired or sleepy despite using my CPAP nightly?
The short answer here is that it is important to make an appointment to see your sleep doctor and go over the possible explanations. Persistent sleepiness may occur in a small percentage of patients with sleep apnea despite nightly use of the device for at least 7 hours. If sleepiness has not resolved after you have been fully adapted to the device for 4 to 6 weeks, then there are several possible explanations:
If you were told you have a high AHI (Apnea Hypopnea Index) after a sleep study, it is likely that you have moderate (AHI 15-30) or severe (AHI >30) obstructive sleep apnoea (OSA).
However, interpretation of a sleep study has to be done by a doctor trained in sleep medicine as it is more than just the AHI.
A CPAP (Continuous Positive Airway Pressure) machine is the gold standard in the treatment of majority of OSA. It works by pumping air through a tube and mask into your upper airway. This keeps the upper airway open (splinted open) while you are sleeping, eliminating the likelihood of your upper airway closing during sleep.
It is great to know that you’ve taken the first major step in your treatment of OSA by deciding to use a CPAP machine. Most doctors managing OSA in Singapore do not sell CPAP machines.
You will likely be referred to a company/vendor and most vendors will carry the recommended/reputable CPAP brands and models commonly used in Singapore. They will go through the selection process with you depending on your needs and lifestyle.
Often, you will need to buy the mask and the company will loan you the machine for a period of 2 weeks or more. At the end of the 2 weeks, you will need to decide if you would like to purchase the CPAP machine and use it long term.
There is no such thing as a “bad” CPAP machine as long as it is from a reputable brand. Having said that, since you will likely be using this long-term, it is best to do your homework and here are some considerations to take into account when making your decision.
Nasal pillow systems, nasal masks and full face masks are available in all sizes, shapes and styles from a variety of vendors. They are all effective. The delivery system selection is very personal. On the night of a CPAP titration study (similar to the sleep study), we encourage patients to try on a variety of different types, guided by our experienced technologists. We ask patients to choose a first and second choice and to let us know if they are uncomfortable during the night so they can make a change. We find that even with maximal attention to mask/pillow fit prior to the first night, about 10-15% of the time patients may have an issue with irritation, air leaks or discomfort and may need to make a change over the first few weeks to optimize adaptation.
2. What should I do if my nose is runny or I have a dry mouth after using the CPAP?
Humidification of the air in your CPAP system can be extremely helpful in managing both dry mouth as well as a runny nose. Most current CPAP setups include humidification chambers. Studies have shown improved comfort and compliance when the humidity is used. The humidity setting may need to be adjusted, with a higher setting required in cold climates during the heating season. A persistently runny nose can be a problem and sometimes this is due to an allergy to the mask materials. Changing masks and brands is sometimes helpful. We have had to send some patients to see an allergist when a runny nose persists despite humidity and multiple mask changes.
3. What if I’m having trouble breathing?
Difficulty breathing with CPAP can be due to the newness of the experience or pressure problems. High prescribed pressures may be uncomfortable initially and low settings, such as 4 cm, may create a sensation of being “air starved.” Contact your homecare provider to check the accuracy of your equipment and discuss the problem with your sleep specialist so they can determine if a pressure adjustment is required.
4. How do I clean my CPAP?
2. What should I do if my nose is runny or I have a dry mouth after using the CPAP?
Humidification of the air in your CPAP system can be extremely helpful in managing both dry mouth as well as a runny nose. Most current CPAP setups include humidification chambers. Studies have shown improved comfort and compliance when the humidity is used. The humidity setting may need to be adjusted, with a higher setting required in cold climates during the heating season. A persistently runny nose can be a problem and sometimes this is due to an allergy to the mask materials. Changing masks and brands is sometimes helpful. We have had to send some patients to see an allergist when a runny nose persists despite humidity and multiple mask changes.
3. What if I’m having trouble breathing?
Difficulty breathing with CPAP can be due to the newness of the experience or pressure problems. High prescribed pressures may be uncomfortable initially and low settings, such as 4 cm, may create a sensation of being “air starved.” Contact your homecare provider to check the accuracy of your equipment and discuss the problem with your sleep specialist so they can determine if a pressure adjustment is required.
4. How do I clean my CPAP?
You should receive specific cleaning/maintenance instructions from the homecare company that delivers your equipment. We recommend taking the mask, tubing and headgear in the shower with you once a week, rinsing it with a mild dish soap (odorless or with a smell you can tolerate), hanging it over the showerhead to dry and remembering to hook it back up the next night. Filters should generally be checked once a month, more often if the environment is dusty. The humidifier chamber should be rinsed daily, and the use of distilled water will keep it clean and free of mineral deposits.
5. How long do I have to wear my CPAP each night for it to be effective?
Studies show that at least 6 hours of CPAP usage per night is needed to reduce the long-term health risks of obstructive sleep apnea. We encourage our patients to put the CPAP on at lights out each night and to make every attempt to put it back on after nighttime awakenings. If there are frequent awakenings or if you are finding the mask on the floor in the morning, then pressure adjustment or a mask refitting may be necessary.
6. Who should I call if there’s a problem?
For technical problems with the equipment, check in with the homecare company. Your doctor/sleep lab should also provide troubleshooting services if the problem has to do with mask fit or pressure adjustments rather than the workings of the equipment itself.
7. What should I do if I am still tired or sleepy despite using my CPAP nightly?
The short answer here is that it is important to make an appointment to see your sleep doctor and go over the possible explanations. Persistent sleepiness may occur in a small percentage of patients with sleep apnea despite nightly use of the device for at least 7 hours. If sleepiness has not resolved after you have been fully adapted to the device for 4 to 6 weeks, then there are several possible explanations:
- You may need more pressure. Speak to your healthcare professional about this. If changing the pressure is not helpful and other causes are ruled out, then a return to the sleep lab to confirm that your equipment is adequately managing the apnea is sometimes necessary.
- If you have had longstanding severe sleep apnea, especially when there have been significant episodes of low oxygen levels at night, you may have a subtle injury to the brain’s alerting pathways that may take a much longer time to improve. The use of a wake-promoting agent to enhance daytime alertness may be indicated. These symptoms should be discussed with your sleep specialist. Daytime Multiple Sleep Latency Testing (MSLT) can be obtained to assess the extent of sleepiness and the need for intervention with medication.
- You just might not be allocating enough time for sleep. CPAP will not make you feel great in the morning if you are getting less than the necessary 7 to 9 hours of sleep per night! CPAP does not substitute for adequate sleep.
- Some individuals with obstructive sleep apnea may also have other underlying medical conditions. If an increase in CPAP pressure has not been helpful then further workup with a daytime Multiple Sleep Latency Test (MSLT) to assess the severity of your sleepiness may be helpful.
- Other medical conditions may be present, such as thyroid dysfunction, thus a good check up with your primary care doctor is always helpful.
- Depression can be a fairly common problem in patients with obstructive sleep apnea. If adjustments to the equipment are not effective or not indicated and the MSLT is normal then workup for a mood disorder may be necessary.
- Inspection of the CPAP equipment including checking the tubing for pinholes or leaks is important to confirm that you are being treated with the prescribed pressure.
If you were told you have a high AHI (Apnea Hypopnea Index) after a sleep study, it is likely that you have moderate (AHI 15-30) or severe (AHI >30) obstructive sleep apnoea (OSA).
However, interpretation of a sleep study has to be done by a doctor trained in sleep medicine as it is more than just the AHI.
A CPAP (Continuous Positive Airway Pressure) machine is the gold standard in the treatment of majority of OSA. It works by pumping air through a tube and mask into your upper airway. This keeps the upper airway open (splinted open) while you are sleeping, eliminating the likelihood of your upper airway closing during sleep.
It is great to know that you’ve taken the first major step in your treatment of OSA by deciding to use a CPAP machine. Most doctors managing OSA in Singapore do not sell CPAP machines.
You will likely be referred to a company/vendor and most vendors will carry the recommended/reputable CPAP brands and models commonly used in Singapore. They will go through the selection process with you depending on your needs and lifestyle.
Often, you will need to buy the mask and the company will loan you the machine for a period of 2 weeks or more. At the end of the 2 weeks, you will need to decide if you would like to purchase the CPAP machine and use it long term.
There is no such thing as a “bad” CPAP machine as long as it is from a reputable brand. Having said that, since you will likely be using this long-term, it is best to do your homework and here are some considerations to take into account when making your decision.
- Type of pressure required – There are 3 kinds of positive airway machine – CPAP, BiPAP (Bilevel positive airway pressure), APAP (Automatic positive airway pressure machine). It is beyond the scope of this Q&A to discuss the indications of each but most commonly, CPAP is most commonly recommended for OSA and you need to ensure that the machine that you are purchasing provides this type of positive airway pressure
- Comfort – This is important to make sure that you are compliant with the machine. You just have to try it out to find the machine that is most comfortable to you
- Humidification function – A CPAP machine with an attached/built in humidifier reduces nasal congestion/nosebleed
- Size/weight – If you are a frequent traveller, it is important to choose one that is portable
- Cleaning/maintenance – Most machines are easy to clean/maintain but some are easier than others
- Display option – Some machines can show you your parameters/statistics or pressure readings in real time.
- Pressure support or relief setting – This allows people to breathe out against less air pressure during CPAP, making it more tolerable
- Auto-ramp feature – This function allows your device to detect your breathing changes and allows you to fall asleep to a lower pressure and once asleep, the machine “ramps up” to higher pressure
- Leak compensation – This allows the correct pressure to be applied during CPAP despite leakage around the mask
- Alarm system – Alarm systems are important to alert you of any problems while using the CPAP machine, e.g. Mask off alarm (if your mask is no longer on your face), suffocation alarm (if there the carbon dioxide/oxygen are out of balance), respiratory rate alarm (if your breathing rate is too high or low) etc.
- Data recording – This is important so you and your doctor can monitor your CPAP usage, respiratory events, change in pressure and snoring data during sleep. The ease of which the data is retrieved is also an important consideration. Some machines require the patient to bring a “digital card” to the sleep center for analysis, some can be done via a USB drive and others wirelessly (through WIFI or Bluetooth)
- Automatic on/off switch – This smart option will automatically turn on or turn off the machine the moment you put on or remove your mask respectively.
Below is a list of some of the reputable brands (most good CPAP brands/models used in Singapore are from United States) and summarize the recommendations by ConsumerAffairs (in brackets):
References:
Related:
- ResMed (often known locally as the Rolls Royce in CPAP – best for those looking for a variety of machines and mask to choose from)
- Philips Respironics (best for those looking for a quiet, comfortable sleep therapy system)
- Devilbiss (best for patients looking for a variety of CPAP machine options)
- Fisher & Paykel (best for patients looking for a variety of CPAP machine options for maximum comfort)
- Transcend (Best for frequent travellers or those who camp in remote locations)
- Apex (Best for those looking for a compact CPAP design)
- InnoMed Technologies (Best for those with a CPAP machine looking for a comfortable mask options)
- SleepNet (Best for children and adult patients looking for a comfortable mask)
- 3B Medical (Best for those looking for a high-tech CPAP machine)
- Circadiance (Best for those looking for a comfortable CPAP mask)
References:
- https://www.sleepfoundation.org/articles/cpap-101-expert-tips-getting-started-continuous-positive-airway-pressure-cpap-machines
- https://www.doctorxdentist.com/questions/what-are-some-recommendations-on-cpap-machine-in-singapore-for-sleep-apnea
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