If you have already been screened, you have a diagnosis and give a conclusion on the need for CPAP therapy, you can go directly to the selection of equipment. Please note that to configure the purchased equipment must have concluded with the selected treatment pressure, type and size of the mask.

To select a specific model appropriate to answer several questions:

1. What class of equipment to choose or how much you are willing to spend to purchase the device?

2. Which company and which model preferred?

3. What kind of mask you choose?

4. Do you need a heated humidifier?

What class of equipment to choose and how much you are willing to spend to purchase the device?

The cost of a standard set for CPAP therapy, which includes machine, heated humidifier, mask, snorkel, shipping the parts bag and an annual filter ranges from 1500 to 3000 dollars, depending on the class of equipment such as masks and the manufacturer.

The cost of the actual device for CPAP therapy is in the range 1000 – 2000 dollars, depending on the class of equipment. Briefly we can say that there are three classes of equipment: III – the most simple apparatus without additional functions, II – vehicles with compensation for medical pressure, I – machines with automatic pressure and a memory block on the outcome of treatment (Auto-CPAP). For more information on the comparative characteristics of the equipment can be found in a textbook on CPAP therapy.

Before you stop for any class of equipment, check out some thoughts about this. The principle of choice is quite simple and is very similar to purchasing a car. If you go on foot, and then got “Lada”, then your life will seem like paradise. However, reseeding behind the wheel of a Mercedes, you will understand what it is comfortable and safe ride on a modern car. So with devices for CPAP therapy. Anyone, even the most simple device of class III with moderate or severe sleep apnea will give a sufficient effect. However, the use of modern systems of class I (Auto-CPAP) provides significantly greater comfort, efficiency and safety of treatment. This is ensured by the functions avtovmaticheskoy setting pressure relief on exhalation of breath and maintain therapeutic options. Class II devices are intermediate in clinical effectiveness, but significantly inferior to Class I apparatus on opportunities for treatment monitoring.

The difference between the CPAP devices from cars is that the difference in price, “Lada” and “Mercedes” in the tens of thousands of dollars, and the difference between the simplest and most perfect device for CPAP therapy is not more than 1200 dollars. Given the resource of the device (8 years), should be weighed, are you willing to spend an additional approximately 0.5 dollars per night in order to ensure a more comfortable and effective sleep. But we emphasize again that even the most simple equipment can be effectively used in patients with sleep apnea.

Which company and which model preferred?

So, you’ve already decided on the class system. Now turn to the choice of firms and models. In our market officially comes five equipment companies (listed in alphabetical order): Breas (Sweden), Resmed (Australia), Respironics (USA), Tyco Healcare (USA), and Wienmann (Germany). Each firm produces the entire line of vehicles, respectively, in each of the classes there are at least 5 models of vehicles of various businesses.

Fundamental differences between the models in the second and third grades there, as this equipment has no significant additional features. Price devices also differ very insignificantly in the classroom (within 150 dollars).

As for systems with automatic pressure (I class), here the differences can be quite substantial. This article will analyze the current Auto-CPAP systems:

• Auto Set S8 Vantage, Resmed (Australia)
• iSleep 20i, Breas (Sweden)
• Sandman Auto HC, Tyco Healthcare (U.S.)
• RemStar Auto M-series, Respironics (USA)
• Somnobalance e, Weinmann (Germany)

All machines have enough kompatnye dimensions, vstraevyemye heated humidifiers (optional) and mass within 1.3-2.1 kg (complete with a humidifier). The most lightweight model – Sandman Auto HC – especially convenient for travel. The most ergonomic design of the apparatus have Auto Set S8 Vantage. The most powerful algorithms for automatic adjustment of pressure, including the differentiation of obstructive and central apnea, now have the machines Sandman Auto HC and Somnobalance e. These models also provide the most detailed reports for treatment, which is especially important for dynamic monitoring of treatment efficacy. The function to facilitate exhalation, providing additional comfort of breath, have almost all modern machines, except apparatus Sandman Auto HC. However, devices Auto Set S8 and iSleep 20i can use this function only in the case disable the automatic adjustment of pressure, which to a certain extent reduces the advantages of these devices. At the same time sets RemStar Auto M-series and Somnobalance e fully realize the automatic adjustment of pressure in conjunction with the function to facilitate breathing on exhalation. The most quiet machine on the market now is Somnobalance e.

What kind of mask you choose?

Here the answer may be quite simple. If you have already conducted trial CPAP therapy, it should have been picked up by a comfortable size and type of mask. Only necessary to equip your vehicle picked up before the mask.

Each company produces its own mask. At the same apparatus and masks all firms are mutually compatible. That is, for example, the apparatus Somnobalance e firm Weinmann (Germany) can be equipped with a mask Mirage Activa company Resmed (Australia). It should be noted that there are no bad or good masks. There are individually comfortable and uncomfortable mask. And even a very good mask that fits a significant percentage of patients who can not quite fit the individual patient. For example, the mask Mirage Activa (Resmed) provides dynamic protection against leakage of air from under the mask during movements in sleep, which gives extra comfort. But this mask is not acceptable for patients with claustrophobia (fear of enclosed spaces), as it is large enough compared with other masks. In these patients need to use nasal cannula Mirage Swift (Resmed). If the patient concerned noise from the discharge of air through the port of the mask, then the best solution is to use masks Joyce (Weinmann) with a unique quiet exhaust system reset.

Sometimes the problem lies in the fact that some local Somnological laboratory uses only one type of masks. This is justified from an economic point of view, but sometimes leads to the fact that the patient may experience some discomfort from a particular type of mask. In leading laboratories, the patient usually tries to 2-3 types of masks or nasal cannulae and selects the most comfortable. If you have experienced any discomfort from the mask in the trial treatment, and other masks you have no choice, it is advisable to go through the procedure of selecting the most comfortable mask on the acquisition device. This process can take place in and our office.We use a nasal mask Joyce (Weinmann), Mirage Activa (Resmed), Ultramirage (Resmed), Comfort Select (Respironics), nasal cannula Mirage Swift (Resmed).

Do you need a heated humidifier?

Contact with the jet of dry air on the mucous membrane of the respiratory tract can lead to runny nose, cough, dry mouth. Using heated humidifier can effectively address these problems and provide additional prevention of respiratory infections. In this connection, we recommend that all patients to use the heated humidifier.

If the patient refuses originally from a humidifier in order to save , it can be treated without it. In some patients, it does not cause side effects. If within a few days or weeks of treatment the patient noted significant problems with the stimulating effect of dry air, the humidifier can be purchased separately.

In the process of using the device you are likely to arise several questions. To help you navigate to find the correct answer,  we analyzed our experience and that of patients who already have long histories of CPAP therapy, and below you will find answers to questions frequently asked.

1. Do I need to use the CPAP machine therapy every night during the entire time sleeping?

As it turned out, with severe disease (apnea index value / gipopnoe> 30/hour) patients are often themselves observe such a regime, because this immediately improves sleep quality, decrease daytime sleepiness, and improves quality of life. We advise you to focus on their well-being, remember that the interruption of breathing during sleep are likely to worsen after taking alcohol, sleeping pills, hard day.

2. What if the fact of sleeping in a mask disturbs sleep, although it noted a clear positive effect on daily activities and a number of other symptoms.

In this situation, we recommend:

• Use a nasal cannula to reduce the sensation of a closed space.
• Use the machine on a daily basis during the first 3-4 hours of sleep, when there is more deep sleep and virtually no external stimuli are concerned. And in the morning, when sleep becomes more shallow, the mask can be removed and sleep now without it. The positive effect of treatment (decrease in the intensity of snoring and sleep apnea) is retained for the rest of the night.
• Use the device intermittently. The device can be used in those days, when fatigued or need to sleep for a short time. It is particularly important to provide treatment, if last night adopted a substantial dose of alcohol (more than 100 grams of vodka) or sleeping pills. With intermittent treatment is desirable to use the apparatus at least 50% of nights, especially in cases where there is concomitant hypertension or other cardiovascular disease.

3. Where should I place the apparatus for CPAP therapy?

Preferably, the apparatus to put on a stable, fixed base, which helps to reduce the noise from his work at the level of the bed or slightly below.

4. What if the mask came from skin irritation, especially in the back of your nose?

• Check for proper size selection of masks. Usually smaller masks better tolerated.
• Check for proper installation of catch or gaskets that provide the degree of pressing the mask to the back of the nose.
• Adjust the tension of the fixing belt to reduce pressure on the back of the nose.
• Place cotton pads (circles make up remover) in the contact mask with the nasal bridge.
• Use other types of masks or nasal cannula.
• Perhaps you are allergic to silicone, and then you can use the older vinyl mask.

5. What if the air with the noise comes from under the mask?

In this case we are talking about air leakage, so the mask fits tightly to the face.In this case, you should:

• Check for proper installation of the mask and its size. Usually smaller masks provide less leaks.
• Check for proper installation of catch or gaskets that provide the degree of pressing the mask to the back of the nose.
• Adjust the tension of the fixing belt. It is desirable to provide a minimum pressing, which would eliminate leaks, especially those directed at the eyes. Small leaks in the area of the upper lip can be ignored. They usually do not interfere with sleep and do not reduce the effectiveness of treatment. Excessive pressing can increase the leakage and cause skin irritation.
• Use modern dual-layer types of masks, minimizing leakage.
• To verify the adequacy of the apparatus for treatment of pressure (that it was not too high).
• Use the apparatus with automatic therapeutic pressure (auto-CPAP), or vehicle with two-level positive airway pressure.

6. What if opens his mouth during CPAP therapy?

• Apply nosorotovye mask.
• Ensure normal nasal breathing
• Use special chinstraps, fixing the lower jaw in the closed position.
• Observe the lateral (side on) position during sleep.

7. What to do if worried about dryness of the mucous membranes of the nose, mouth and pharynx.

• Use room humidifier
• Apply installed in the breathing system heated humidifier.
• Ensure normal nasal breathing

8. What to do if you have a stuffy nose.

• Adjust the installation of the masks, as its poor fixation can lead to irritation of the nose and runny nose.
• Install an additional hypo-allergenic filter device for CPAP therapy. This is especially useful when concomitant pollinosis.
• Apply installed in the breathing system heated humidifier.
• Use room humidifier.
• Use nasal decongestant (for Nos Ksimelin, Otrivin, etc.). Duration of treatment should not exceed 5.3 days.
• Use a nasal spray with sea water, such as Aqua Maris Morenazal etc., or to prepare for washing nasal saline solution (1-2 g of salt per 100 ml of water). Type the solution in the pipette and fill in each half of the nose 1-3 times. Clean the nose. Repeat until the resumption of nasal breathing.

9. What if the mask is removed involuntarily during sleep.

• To minimize the discomfort of the mask.
• Conduct a short test treatment calming / sleeping pills.
• Use devices for CPAP therapy with alarm disconnected masks.

10. What to do if you do not have enough air flow and disturbs a need for air?

• You may not correctly chosen value of the initial comfort of pressure.
• Disable a gradual increase in pressure (immediately begin treatment with the “working” pressure).
• Check the work of the staff for technical failure.

11. What to do if you’re concerned about the strong flow of air, difficulty breathing?

• Use function gradually increasing pressure until the working level.
• Use Auto-CPAP device or with two-level positive airway pressure.
• To solve the question of reducing the pressure treatment (improvement of eligibility due to some inefficiency).
• Check the work of the staff for technical failure.

12. What to do if you were snoring when using a CPAP machine?

• You should quickly contact your doctor and to control cardio-respiratory monitoring or polysomnography to clarify the adequacy of therapeutic pressure.
• Check the work of the staff for technical failure.

13. What to do in case of acute respiratory infection?

• You should consult your doctor. Perhaps he will advise you to temporarily lift the CPAP therapy for 3-5 days.
• Every day, wash in soapy water mask and snorkel.

14. How to disinfect the mask?

If using a mask and you alone, it is usually enough to wash it daily with warm soapy water.

CPAP Therapy

The CPAP therapy has been successfully used to treat respiratory arrest, sleep apnea during sleep. In the CPAP (Continuous Positive Airway Pressure) treatment, the respiratory system by light pressure to pneumatic splint and prevents the respiratory arrest.

Sleep

In sleep, the sleep of the patients studied by polysomnography. During the night, various vital functions, such as Brain waves, eye movements, breathing, muscle tension and oxygen saturation recorded. The next morning, the results are evaluated by a sleep specialist. The second night sleeping, the patient, if necessary, with a CPAP device. It is tested with the pressures of the sleep apnea can be reduced to a minimum.

CPAP Devices

Detailed records of the data in the device memory to help the doctor to monitor the success of the treatment. The useful life is saved, leaving substantial conclusions on compliance.

Oxygen mask

The most important link between the device and patient’s CPAP mask. They come in various designs and sizes. A distinction between the nose masks, nose masks, olive, and Oralmasken Full face masks. The CPAP mask has to fit to the anatomy of the user, since otherwise there will pressure points and leaks. You can prevent this by choosing the correct size and type of CPAP mask.

Heated humidifier

Due to the continuous flow of air in the CPAP therapy, the airways dry out. If you have already suffered prior to the CPAP treatment in dry air passages, a heated humidifier can bring relief.The Atembefeuchter is inserted between CPAP therapy equipment and breathing tube and moisten the airways during treatment. In the case of using a heated humidifier needs to be given compulsory hygiene, germs otherwise humidifiers, breathing tube and mask.

Douche

1. Identify the sleep apnea and set the CPAP pressure at the same time, divide the patient check into two parts ne to confirm a diagnosis of sleep apnea syndrome, the other set the CPAP pressure value, thus to save the patient’s expenses. But later found that the patients treated through this press setting method often requests to re-set and mask replacement. It actually increased the burden on the patients. Our experience is that a number of severe sleep apnea syndrome patients, this approach feasible, but to mild patients, this method easy leading misdiagnosis and failure treatment.

2. After the diagnosis of sleep apnea syndrome, not based on the results of polysomnography, identify the pressure value in the patients home. The first night, the technician go to the patients home to guide patients to use CPAP breathing machine and oxygen saturation meter, set 5 to 7 cm water column (0.49 ~ 0.69 kPa) of low pressure value. After 1 to 2 hours treatment, the technician can leave. The next day, according to records of  oxygen saturation values and the patient’s condition improvement, determine whether the  pressure is appropriate. If not enough, then daily increase pressure values progressively  until treatment succeeds. This can save 1 / 3 to 1 / 2 of medical expenses, and can reduce the workload of medical staff.

We also applied this method to set up dozens of cases of sleep apnea syndrome pressure value, the specific process is as follows:  After diagnosed as sleep apnea by the multi-channel physiological recorder, the first night with oxygen saturation monitor (only palm-size, easy to use) in the patients home for oxygen saturation monitoring, determination of results as the pre-treatment baseline, and then on the day in the hospital by the technicians to teach patients to use CPAP breathing machine, select and take a good nose mask, based on experience, combined with patient’s size, severity, select one empirical treatment of stress, usually 8 to 12 cm water column (0.785 ~ 1.18 kPa), observe the patients at the lunch break hours (many critically ill patients to fall asleep at any time), then patients with a CPAP breathing machine to go home at night sleep trial.

Most of the patients after 2 to 3 days to learn, test, basic to master the use of machinery and the regulation of nasal mask. And asked the families of patients to pay attention to the occurrence of snoring or apnea, if have, then increase the pressure by 2cm water column (0.196 kPa), and telephone contact with the doctor at any time, report the matters of using, and solve existing problems.

After about 1 week trial, patients can master the skilled use of CPAP breathing machine, snoring during sleep disappeared, again measured oxygen saturation during sleep. Compare the results with that of pre-treatment, if the minimum oxygen saturation above 0.90, no significant fluctuations in blood oxygen, then the pressure is appropriate. Otherwise continue to rise on CPAP pressure.

3. There are already automatically pressure adjustment CPAP machine on the market, which can put the appropriate pressure according the upper airway resistance to maintain the upper airway is always open. Automatically report the optimal range of pressure the next day.

Different sleep apnea patients require different continuous positive airway pressure ventilation pressure, and even the pressure of the same patient in different circumstances required  is not a constant value.

CPAP machine pressure settings:

1. Varies with sleep position

When sleep on back, the pressure must be higher than that of sleep on side.

2. Varies with sleep phases

Set different pressure value with the different sleep phases. In REM sleep, the pressure need to higher than NREM sleep.

3. Patients after weight gain,  demand on the increased pressure value.

4. After heavy drinking, require for higher pressure value.

5. Attack of a cold or rhinitis, nasal resistance increases, higher pressure required.

Study also found that after a period of CPAP treatment, patients need to decrease stress levels, which may be associated with improved respiratory control and upper airway edema.

CPAP breathing machine set the pressure value too high, which were not easily tolerated, easily lead to treatment failure; Too low pressure may can not eliminate sleep apnea to achieve the best therapeutic effect. As in the early stage of CPAP treatment, there will be significantly longer REM sleep, if the settd  pressure is not enough, part or all of the upper airway obstruction will occur, even cause severe hypoxemia.

Set the appropriate CPAP pressure is the key to secure to successful treatment, the ideal pressure is to secure the minimum required pressure level at different sleep position and sleep phases, and pressure is also able eliminate snoring, keep the oxygen saturation in the normal level (such as greater than 0.90) all through the sleep.

The traditional CPAP pressure setting method is after the diagnosed sleep apnea syndrome, re-examination in the sleep room with PSG monitoring, using nasal continuous positive airway pressure. When sleep, set a lower pressure level firstly, such as 4 to 6 cm water column (0.39 ~ 0.59 kPa), with the patient sleep deeper, according to snoring, apnea, oxygen and other changes in a gradual increase in sustained pressure level. The general increase of 2 cm each water column (0.196 kPa) until the sleep apnea and snoring all disappeared, normal oxygen saturation, continuous above 0.90. At the same time closely observe the sleep period, particularly breathing changes at REM sleep,  increase pressure value if necessary.

In order to eliminate the sleep apnea occurs at different position and the adverse effects of drinking, it can be to increase the set value of 2 cm water column (0.196 kPa), as a final treatment of stress under the patient tolerance. Our experience is that, in order to ensure that patients can sleep well, when setting the CPAP pressure, switching to a more comfortable BiPAP breathing machine. The IPAP value as the treatment of stress, which have better effect. As this method cumbersome and more expensive, some people apply some new setting way to replace it.

Click here to view the new CPAP pressure setting method.

The main principle of CPAP treatment of OSA is through increasing the pressure within the pharyngeal cavity to resist negative pressure suction to prevent airway collapse. Increased lung capacity and air flow on the upper airway stimulation of certain reflex may also play a role. Since the first application in 1981, CPAP has become the preferred treatment of sleep apnea syndrome .

In addition to CPAP treatment to eliminate snoring and apnea, improve sleep quality and timely results, there are so many other benefits of CPAP for sleep apnea.

1. Respiratory

Oxygen rise during the day, CO2 decreased pulmonary arterial pressure decreased, improve the sensitivity of the respiratory center in some patients, increase  respiratory muscle contraction.

2. Cardiovascular system

Correct the OSA-related arrhythmia and high blood pressure, increase cardiac ejection and improve myocardial blood supply, increase right ventricular function and reduce cardiovascular disease mortality. However, if the pressure of the CPAP is too high, it may reduce venous return. So for patients with pathological hypotension, shock, a large number of diuretics, can not eat and drink, need to closely observe the blood pressure and heart rate changes.

3. Digestive system

For the patients with merging night gastroesophageal reflux, CPAP can reduce the number of reflux symptoms.

4. Urinary system

CPAP can reduce the number of urine at night of the sleep apnea patients.

5. Blood system

CPAP can reduce red blood cell formation, increase  blood volume of sleep apnea patients, thereby reducing the hemoglobin content and blood viscosity.

6. Neuropsychiatric system

The memory, reaction ability, thinking ability of the OSA patients some or all back to normal.

7. Endocrinology and Metabolism System

CPAP treatment has a broad impact on endocrine and metabolic systems of the body, which can increase the secretion of GH and the male hormone, improve male sexual function of patients and decrease the obesity weight.

At present, the various CPAP machine treatment is based on the same principle, which is through the nasal mask connected to ventilator and the patient, continued to have a positive pressure ventilator flow, acting on the upper airway, so that the upper airway open during sleep state, thus avoiding the occurrence of apnea and hypoxia.

According to the work mode, CPAP machine can be divided into three types:

1. Common type of manual regulator CPAP

Treatment stress need to manually set, the pressure does not change after setting in the entire treatment process, which is the simplest sleep machine.
Advantage: relatively cheap
Disadvantage: Patients need higher treatment pressure, poor comfort.

2. Intelligent automatic voltage sleep apnea machine (Auto-CPAP)

The most important feature of this machine is that it can continuous monitoring of the degree of airway obstruction in the treatment of patients, and adjust the treatment stress timely based on the degree of airway obstruction.
A: lower average pressure treatment, patients feel more comfortable and have a higher treatment compliance.
D: higher price.

3. Bi-level sleep machine (BiPAP)

The kind of machine is characterized by inspiratory and expiratory pressure can be adjusted separately, that is CPAP machine sends high default inspiratory pressure when inhaling air and help patients inhale more air， in contrary, CPAP machine switches to a preset lower expiratory pressure, help patients with easy gas exhaled. The CPAP machine pressure should seted according to the condition of patients through experienced professionals. BiPAP is suitable for cardiopulmonary failure, or patients who required higher pressure treatment .

4. Low resistance CPAP machine

This is a new ventilator mode, which is based on the common CPAP mode. The pressure with a certain degree of reduction within a short time at the start of the expiratory phase, so that patients breath easier and comfortable. This CPAP machine is particularly suitable for patients who need a higher treatment pressure or with chronic heart failure.

Application of CPAP machines, 15% to 45% of patients appear nasal symptoms, mainly the feeling of nasal blockage, poor ventilation, few showed nasal dryness. The following reasons:

1). If you have nasal polyps, nasal septum deviation, your nose area may feel uncomfortable when using CPAP machine, which can only be applied after the surgical correction of the deformity. Patients with severe sinusitis should be treated accordingly  ENT first.

2). The cold air produced by the CPAP machine can stimulate the nasal mucosa, causing vasodilation and mucosal congestion and edema occurred in some patients with allergic rhinitis would be of acute onset. First of all, to strengthen the humidifier, if necessary, heating the water in the humidifier bottle, or even use the thermostat humidifier, nasal drops ephedrine in sleep and other agents also play a role in nasal mucosa contraction.

3) symptoms of dry nose sometimes performance is outstanding, strengthening of wet and warm gas inhaled will have better effect. Mandibular care to reduce the use of mandibular leakage is also important.

Many sleep apnea patients may have dry mouth as they often breath through their mouth. Generally, after the treatment of CPAP machine, their dry mouth will disappear if CPAP machine used properly. However, their may still have dry mouth if the air leak through mouth when using CPAP machine. So what cause mouth leakage ? The possibility of leakage through the mouth as the following:

1).  CPAP ventilator pressure is not enough, they can not overcome the upper airway obstruction, which occurs by mouth breathing, just the appropriate pressure to improve CPAP breathing machine can solve the problem.

2). CPAP  machine was too high to make patients feel discomfort and mouth breathing, should decrease the pressure, sometimes in order to ensure that treatment you can be change  another  CPAP  machine.

3).  some patients used to mouth breathing, can be used at this time asked the mandibular jaw hold up, of course, proper drinking water can also play a role.

1).  Change a bubble-type nose mask.

2) Pad sponge pad on the forehead.

3) place a cushion between the skin and nasal mask

4) Before each use of nasal mask should wash your face, wash nasal mask.

If the skin skin ulcer, should consult a doctor, if necessary, disable the CPAP machine. In particular the bridge of nasal ulceration occurs, which is difficult to heale, should pay more attentions on prevention. Recently, nasal congestion are directly plugged nose, CPAP machine generated airflow through the hole into the upper airway can also play a therapeutic effect, while avoiding the side effects of nasal mask.

Note that in the eary stage of the application of CPAP machine, many sleep apnea patients have local indentation or skin redness in the face and nose, which is caused by nasal mask pressure and nasal mask out breath stimulate. If there are no other symptoms, do not worry, get up on their own after a few hours can be dissipated. A few days later, and skilled with technology and adapt to the skin will naturally improve.