PAP Therapy
PAP Therapy FOR Sleep Apnea
Getting the most out of your positive airway pressure treatment

If you have obstructive sleep apnea, (also known as OSA), your upper airway collapses again and again as you sleep. Positive airway pressure (PAP) devices give you just the right amount of pressurized air needed to prevent this collapse. Properly set and used whenever you sleep, PAP machines can eliminate your apnea and snoring so that you get a good night’s sleep.

Where Do I Begin?
Various PAP machines and masks are available, and each person should find the right combination of equipment that works best. In PAP therapy, pressurized air comes through a mask that fits securely over your nose. Some patients find that PAP works best for them when using a mask that fits over both the nose and mouth, or in the nostrils. Most people first try PAP machines that deliver a continuous positive airway pressure (CPAP). Some people prefer two-level PAP machines, which deliver more pressurized air with breathing in and less with breathing out. Self-adjustable PAP will raise pressurized air levels only when apnea occurs,

Should I Try Two-Level PAP?
If you have trouble breathing out against the continuous air pressure of CPAP, a two-level PAP machine may help you. These machines sense when you breathe in and out, and deliver one pressure of air when you breathe in, and a lower pressure when you breathe out. You should consider using two-level PAP if you find that the air pressure with CPAP feels too high or that you are working too hard to breathe out. A lower pressure when you breathe out may feel more natural to you, particularly if you are using a fairly high air pressure when you breathe in. In general, the two-level PAP machines are larger, heavier and more expensive than CPAP devices. If you were not tested in the sleep laboratory on a two-level PAP device, you will probably need another sleep study to determine the correct pressures for you.

Should I Try Self-Adjustable PAP?
PAP devices that raise air pressure when they sense problems with breathing were approved for use in America in 1996. By increasing air pressure intermittently, it is believed that PAP treatment of sleep apnea may be made more comfortable and effective. If air pressure-related complaints limit your use of CPAP or two-level PAP, you should consider asking your doctor about self-adjustable PAP. As with two-level PAP, self-adjustable PAP machines are heavier and larger than CPAP machines.

Side Effects to PAP Therapy

Nasal Discomforts
Nasal stuffiness or congestion is the most common side effect of PAP therapy, and is often a nasal reaction to airflow from the PAP device. More than half of patients experience some increased nasal stuffiness when they first begin PAP treatment. These symptoms often disappear within a month of use. PAP users may report nasal itching; runny nose, nosebleeds, and nose dryness are other frequent nasal problems. In general, PAP-related nasal symptoms are treated with the techniques given below.

Applying a few sprays of nasal saline (a combination of salt and water) in each nostril before using PAP helps nasal symptoms. This solution is available at a pharmacy without prescription. Oral antihistamines and decongestants may also be helpful to control PAP-related nasal discomfort. Some commonly used non-prescription oral antihistamines include Benadryl, Contac, Actifed, etc. Decongestant nasal sprays, such as Afrin and NEO-SYNEPHRINE, may help, but should only be used for a few day since regular nightly use can be habit-forming and can lead to increased nasal congestion. Prescription antihistamines are also available. Consult your healthcare provider before using any prescription or non-prescription medication for PAP problems.

Several prescription medications can be used to combat PAP-related nasal discomforts. Anti-allergic nasal sprays may be of help, particularly if you have nasal allergies. Atrovent nasal spray can be used to combat nasal problems and runny nose not caused by allergies.

Nasal discomforts from PAP devices are usually simple to control with one or more of the suggestions above. If symptoms persist, contact your healthcare professional.

Mouth Discomforts
PAP devices may cause dryness and pain in the throat. Often the discomfort is caused by air blowing through an open mouth. A chinstrap to keep the mouth closed or a mask that covers the nose and mouth can eliminate this complaint. Humidifiers for PAP machines can also help control mouth discomforts.

Mask Air Leaks
Symptoms of mask air leak are red eyes, loss of beneficial effects of PAP, and return of snoring or apnea. Air leaks are most often the result of a poorly fitted mask. Sometimes a different mask or a mask of a different size is needed. If you continue to experience significant air leaks despite using a chin strap, consider a mask designed to fit inside your nostrils (nasal pillows) or one that covers your nose and mouth. A mask that molds to your face may be another option. Remember if your mask and PAP therapy worked well for you in the beginning, you should check to see whether your mask is worn-out or torn. Contact your PAP equipment supplier and ask for help.

Noise Of the Machine
Newer PAP machines are much quieter than older models, but all make some sound. Placing the machine under the bed or on the floor usually solves this problem. Again, the PAP supplier can provide advice and assistance.

Sore, Dry, Or Red Eyes
These problems can result from an air leak from your mask. Try reapplying the mask and readjusting the headgear. If the problem continues, contact your PAP supplier to determine whether you need to try a different mask size, nasal pillows, or a different headgear.

Redness In the Face Where the Mask Contacts the Skin
If you develop reddened areas or sores on ore above the bridge of your nose, first check to see whether your mask is pressed too tightly to your face. Your mask needs to be fitted and adjusted to eliminate air leaks without extra pressure on your skin. Sometimes spacers and air cushions can help ease the pressure points. If you need to loosen your mask so much that leaks develop, ask your PAP supplier whether your mask is the right size and type, and is properly adjusted.

If redness occurs wherever the mask touches your skin, loosen the headgear slightly, but not so much as to cause an air leak. If you think you might be allergic to a mask, try applying a paper tape over areas where the mask touches the skin. If that eliminates the problem, contact your PAP supplier to find out whether a different mask or nasal pillows might be beneficial. Fortunately, modern PAP masks are made of materials designed to minimize allergic responses.

Too Much Air
Especially when first using PAP, some people complain that the pressure of air through the nose seems too high. If this sensation makes it difficult for you to fall asleep, try using your PAP for short periods during the day or while watching TV to get used to it. If that fails, try using a pressure ramp. Most PAP machines have ramp capability. The ramp starts the machine at a very low pressure and gradually raises it to the right amount over a period of minutes. Using lower pressures at the beginning may help you fall asleep more easily.

Did you know that most PAP machines will allow you to adjust your ramp time?
Many people find they prefer longer ramp times (10 to 20 minutes) when they first start using PAP. As you get used to PAP, or if the air pressure doesn’t bother you, set your ramp to shorter times so you get the full benefits of the correct PAP pressure from the beginning.

What Do I Need To Know About My PAP Machine?
Cleaning PAP Devices: Regular cleaning is essential to assure proper function and safety of PAP devices. The method and schedule for cleaning hoses and masks and for changing filters may be different for each PAP device, so you should refer to the manufacturer’s instruction manual for details about the maintenance of your PAP equipment. Improper care of PAP devices, filters, mask, and hoses can lead to nasal and sinus problems. (congestion, infection, etc.).

Traveling With Your PAP Machine
Most PAP machines available today come equipped with transformers that allow them to be used with international (220v) voltages when you travel to foreign countries. Current PAP models are lightweight and portable. A travel case for the device and accessories often comes with the machine, or can be purchased from the manufacturer. A battery power option is available for those who camp.

Airport x-ray devices do not harm PAP machines. Your healthcare professional can provide you with a letter describing the nature and purpose of your PAP machine for security personnel unfamiliar with the equipment. High altitudes can affect the performance of your PAP machine. You should consult your healthcare professional or PAP supplier is your travel plans call for sleep at altitudes much higher or lower than those at home.

Other Concerns About Using PAP Machines

Cold Nose
The air cools as it moves through the PAP hose tubing. To reduce heat loss, try repositioning the tubing so that it runs under your bed or bed coverings.

Dentures
Some people with dentures find that if they sleep without their upper dentures, the PAP mask does not fit properly and air leaks develop. Try sleeping with your upper dentures to eliminate this infrequent but difficult problem. If you have no upper teeth, consider trying a mask that fits inside or just under the nose.

Colds/Congestion
You may find your PAP more difficult to use when you have a cold or severe congestion. You may need more humidity, or a decongestant. Contact your healthcare professional for recommendations if you find you cannot sleep with your PAP when you have a cold. If you develop nasal, sinus, or ear pain when using you’re machine, this could be a sign of a developing infection. Contact your healthcare professional for further advice.

Claustrophobia
Some people experience feelings of claustrophobia, difficult breathing, choking, or suffocation when first using PAP. Spend some time practicing with your PAP machine during the day while awake and watching television or reading. You may need to start by wearing the PAP device for only a few minutes at a time and gradually increase the time you spend breathing with it until you feel comfortable. At first, some people fight the pressure and tend to hyperventilate. Practice regular breathing. If you don’t like the mask over your nose, try a mask that fits in or just under the nose. If you find the air pressure is too high, consider a longer ramp time or two-level or self-adjustable PAP. If these measures fail, consider learning a relaxation technique, either from a self-help book or a tape, or from a professional trained in relaxation methods (e.g., a psychologist). Some amount of this discomfort during the initial therapy is not unusual. PAP can work for you if you give it a chance.

Summary
Most of the common complaints about PAP relate to how the mask fits and to drying of the airway. The remedies we have suggested should solve the majority of these problems. If your symptoms continue or recur, consult your healthcare provider or PAP supplier. PAP helps most people with sleep apnea, but feeling comfortable with it requires time. Once you have become familiar with PAP, you should find it to be a great help.
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