The primary reason why nasal passages sometimes dry out from CPAP use is lack of adequate humidification.

CPAP air is an irritant – to one degree or another – to everyone. The irritation may cause the nasal passages to dry out and bleed, or the mucous membranes may try to protect the nasal passages by producing excess mucous and so congestion results. The irritation can be cumulative; the problem may develop over time. Furthermore, dry, cracked or bleeding nasal passages are a breeding ground for infection.

Add a heated humidifier to add moisture to the CPAP air and reduce or eliminate the irritation. A passover humidifier may not offer enough moisture. If you are already using a heated humidifier, try turning it up to a higher setting. If that produces condensation in the six foot hose, you should try an insulating cover for the hose.

Sores inside the nose may be caused by nasal pillow or nasal prong devices that are too big or the wrong shape for your nose.

If you use nasal pillows, try the smallest size available that seals around your nostrils.

Nasal prongs must be inserted into the nostrils and seal tightly, so they may cause irritation or sores. It may be just a matter of your nose “toughening up” over time, so try switching back and forth between the nasal prong device and a nasal mask. If the sores do not heal, we suggest you discontinue using the nasal prongs.

Sores inside the nose may also be caused by the CPAP air drying out the mucous membrane. Adding moisture with a heated humidifier will help alleviate the problem.

Water collects in the six foot hose when the ambient room air is much colder than the heated CPAP air, or when there is too much moisture being produced by the humidifier.

First, be sure that no vents or fans blow directly onto the CPAP hose.

Next, try turning down the temperature on the heated humidifier. If that alleviates the problem but causes irritation to the nasal passages, return the humidifier to the previous setting and add an insulating sleeve to the hose.

If neither response works, try using a heated CPAP hose.

Dry mouth is a sign that you are opening your mouth while you sleep. If you use nasal mask, breathing through your mouth bypasses any humidification you may be using so increasing the heat will not be effective. Breathing through your mouth while using a nasal mask also reduces the benefit of the CPAP therapy.

First be sure the mask is not leaking. If it is six to nine months old and leaking, try replacing it. If it is new and leaking, we can help you get a better size.

If your mask is new and NOT leaking, try a chinstrap to keep your jaw up and mouth closed. If a chinstrap doesn’t solve the problem, try a full face mask that covers your nose and mouth.

If you use a full face mask and have a dry mouth, try adding a heated humidifier to add moisture.

People remove their mask during sleep because they are not getting enough air.

The CPAP pressure may be reduced if your mask is leaking. Your mask may be too big or too old. Take our mask sizing measurements to see if you have the best size. If your mask fits you but is six to nine months old, it should be replaced. In time, the silicone cushion deteriorates and becomes too soft to hold a seal.

If the CPAP air is being delivered effectively, it may be that it is set too low. Pressure settings may require change due to weight gain or loss. The type of sleep study you had and the duration of sleep may indicate that your pressure could be adjusted. You should speak to your doctor if you think your pressure may need to be adjusted.

CPAP is does not normally cause headaches unless there is a sinus related problem or some pressure from the machine acting where it should not be.

Sinus systems are extensive, even going behind your ears. When a CPAP is used and part of the sinus cavities are blocked, a situation is created where there is a pressure differential between the sinus cavities affected. These pressure differences can sometimes be felt as sinus headaches or just plain headaches, even though they are caused by sinus blockages. These can be treated using over the counter medications to open the sinus. CPAP heated humidifiers can also open and maintain sinus systems. If you do not currently use a heated humidifier we strongly suggest you try using one. If this does not correct the problem, visit your ENT.

Air leaks are caused by masks that are too big or too old or just the wrong style.

Air leaking into the eyes is usually an indication that the mask is too big (long) as are leaks at the base of the nose.

Leaks may also occur under the nose due to facial hair. As the silicone in the mask cushion ages, it deteriorates and becomes too soft to hold a seal. You may be able to tighten it enough to stop the leaking when you go to sleep, but during the night it will loosen and leak.

Sores at the bridge of the nose or below the nose are usually due to tightening the headgear straps too much. The pressure will create soreness, then a bruise, and may eventually create an open sore if left untreated.

Headgear is usually tightened too much to reduce or eliminate air leaks. A small degree of this may be necessary, but too much is an indication that the mask is too large, too old or just the wrong style.

If your mask is six to nine months old and the silicone is becoming too soft to hold a seal, try replacing it.

It is usually necessary to stop wearing a mask to allow these sores to heal. Nasal pillows are an option in the meantime.

An allergic reaction to the mask usually appears as redness or a rash all around the nose and on the forehead.

Most masks are made of silicone, which is an inert substance. Silicone is manufactured in chemicals to which some people are allergic. The chemicals normally degrade and disperse over time, but may cause a reaction when first used. The solution is to remove the chemicals and gasses before using the mask.

Washing the mask will reduce or eliminate the problem. This process can be accelerated by long soaks in warm soapy water. This is true with all masks and other types of nasal prongs and cushions.

Allergic reactions are often confused with the pressure bruises, bumps and open sores that can result from tightening headgear straps too tightly. If the problems are only at the bridge of the nose or beneath the nose, it is probably a pressure issue and a new size or new mask is needed.

Air leaking from the mask at the bridge of the nose and over the eyes during sleep will cause the eyes to dry out. The most common reason for air leaking at the nose bridge is that the mask is too big or too long for the nose.

We would suggest you try our measurements for sizing your mask to be sure you have the best size. A mask that has an adjustment at the bridge may also be helpful in getting a good fit. Nasal pillow or nose cushion devices which do not rest on the nose are also an option.

It is not advisable to tighten the headgear to eliminate the air leak. Pressure from a mask that is too tight will cause bruises and even open sores if applied long enough.

The primary reason why congestion sometimes develops from CPAP use is lack of adequate humidification.

CPAP air is an irritant – to one degree or another – to everyone. The irritation may cause the nasal passages to dry out and bleed, or the mucous membranes may try to protect the nasal passages by producing excess mucous and so congestion results. The irritation can be cumulative; the problem may develop over time.

Add a heated humidifier to add moisture to the CPAP air and reduce or eliminate the irritation. A passover humidifier may not offer enough moisture. If you are already using a heated humidifier, try turning it up to a higher setting. If that produces condensation in the six foot hose, you should try an insulating cover for the hose.

Air leaks from the mouth whenever the mouth is opened during CPAP therapy. This occurs for many reasons, but a very common one is due to nasal irritation from the CPAP airflow.

The correlation to a lack of humidification and mouth leaks is a topic being heavily researched. Studies are now being conducted on the hypothesis that a large amount of mouth leakage is caused by the following cycle:

1. CPAP therapy is used with ineffective or no humidification.
2. The nasal membranes are unable to adequately condition the increased airflow and after a few minutes the airway and nasal passages become dry.
3. To remedy the dryness and obtain moisture, the body uses the mouth to breathe.
4. CPAP air follows the path of least resistance and leaks out of the open mouth.
5. The air leaking through the mouth causes more dryness.
6. Patient wakes up feeling tired with significant dryness in mouth and dry, swollen nasal passages.

The answer to this cycle is humidification. If the mouth continues to open during sleep, a chinstrap may be needed to hold the jaw up so that the mouth can close. If mouth breathing continues, a full face mask that covers the nose and mouth is recommended.

CPAP software allows the downloading of information from certain CPAP machines. Information on breathing, pressure levels delivered, apneas, etc. is available to help determine the effectiveness of CPAP therapy. Software is not required to operate a CPAP machine.

Each CPAP manufacturer maintains a proprietary software package that is only compatible with their machines.

Washable foam filters should be cleaned as soon as they become discolored. Depending on your environment, that may mean weekly cleaning.

Paper filters should not be cleaned, just disposed of.

Yes, all CPAPs use at least one filter that is usually a type of foam material and washable. Some CPAPs offer finer filtration with the addition of a disposable paper filter.

The filters are located at the back of the machine at the air intake.

Cleaning and changing filters is the only maintenance required for a CPAP machine.

A heated humidifier uses heat to produce moisture. The heat is adjustable for more or less moisture, and the chamber is much smaller than a passover humidifier.

It is our experience from over ten years of specializing in CPAP equipment, that patients who use heated humidifiers have a much higher rate of compliance to CPAP therapy.

Humidification adds moisture to the CPAP air, reducing irritation to the nasal passages caused by the increased airflow.

CPAP air is an irritant – to one degree or another – to everyone. In some cases the irritation dries out the nasal passages and may cause bleeding. It may also cause swelling, excess mucous, congestion or sneezing. The irritation also creates a very fertile ground for infections to begin. The irritation may be cumulative, building up over time. The only way to reduce the irritation is to add moisture.

Humidification is therefore a critical part of CPAP Therapy.

Masks should be washed daily in warm water with baby shampoo and left to air dry.

Medicare allows for mask cushion replacement every three (3) months and complete mask system replacement every six (6) months. CPAP manufacturers and vendors suggest these replacement schedules as well.

In our experience, most mask cushions begin to deteriorate after about three to six months of use. The silicone eventually becomes too soft to hold a seal and headgear straps must be tightened more and more to get the same quality seal.

We strongly suggest replacing cushions and pillows as soon as they start to soften. Air leaks may reduce the effectiveness of CPAP therapy and headgear that is too tight may cause facial sores at pressure points.

A BiPAP (Bi-Level PositiveAirway Pressure) alternates blowing two set pressures, a higher pressure for inhalation and a lower pressure for exhalation.

A BiPAP ST Machine is a non-invasive ventilator. ST stands for Spontaneous Timed.

A BiPAP has two set pressures, but some patients require a back-up timed response in which the BiPAP will initiate a breath if a breath is not taken within the set timed parameters.

For example, a BiPAP ST might be set with an inhale pressure of 10 and an exhale pressure of 5 with a BPM (BPM=Breath Per Minute) of 12. A BiPAP ST will not breathe for you but will initiate a breath if you do not inhale 12 times a minute.

An APAP (Automatic Titrating Positive Airway Pressure) machine automatically adjusts on a breath by breath basis to blow the minimum pressure needed to keep your airway open during sleep. This allows your machine to provide you with your ideal pressure nightly.

APAPs tend to be more advanced, more feature-rich and more expensive than CPAP machines.

C-Flex/EPR is a feature that makes breathing back against CPAP pressure easier to do. Independent studies conducted by leading universities indicate that patient comfort, and therefore, patient CPAP compliance, is higher with machines that use this.

CPAP stands for Continuous Positive Airway Pressure. CPAP therapy provides a constant airflow which holds the airway open so that uninterrupted breathing is maintained during sleep. This eliminates Sleep Apneas and allows the patient to get a restful sleep. A CPAP machine blows one constant pressure. Your ideal pressure was determined during your sleep study. However, many factors can affect your ideal pressure over time, like weight fluctuations and even sleeping positions.

CPAP therapy is traditionally provided through a nasal mask that seals around the nose. However, more innovative, comfortable and better sealing options are beginning to emerge.

Obstructive Sleep Apnea (OSA) is a condition in which a patients breathing passage seals during sleep, causing the patient to stop breathing. Apnea is Latin for “without breath”. The body responds to this lack of oxygen by arousing, or waking from sleep. This cycle leads to the patient being unable to get the needed quantity of restful sleep and results in:

• Constant Fatigue
• Difficulty Focusing
• Irritability

Untreated Sleep Apnea is potentially fatal and frequently results in the following serious health problems:

• Heart Attacks
• Strokes
• High Blood Pressure
• Diabetes