a. Use your CPAP all-night, every-night
(Experts seem to have a mantra: “CPAP or Suffocation”. This keeps them on the straight and narrow.)
b. Watch for the development of sleep apnea symptoms or the worsening of sleep apnea related diseases.
(Talk to your Family Doctor if they occur. Apnea often gets worse over time.)
PAP machines measure all sorts of useful information for you that can tell you about the success of your use (or the lack of such). It is important for you to monitor this. It can be an important guide that will help you get the best out of your treatment, help you maintain the use of PAP machines as the years go by, and protect you from the negative consequences of untreated, or partially treated, sleep apnea. This information gives you control over your disease that is seldom seen in other medical conditions.
You should monitor the following 3 features regularly:
a. Your Apnea Score (Check your status at least every month or two.)
i) this is the number of apneic (breath-holding) events per hour that you had on that night. It is often called the AHI (Apnea-Hypopnea Index) or Events in your download data. If the events are below 1/hr that is excellent. You are basically normal. If less than 5/hr, that is great. Well Done. There are no medical problems at this level.
ii) There will be nights occasionally when the number goes up to 9 or 10 or 11. Do not worry about this. Apnea gets worse usually when you sleep on your back and when you dream. This is normal. Do not try to avoid sleeping on your back or your side. Find a comfortable position and sleep in it, at least, until it gets uncomfortable, then change to another position that is comfortable. Because you have heard that sleeping on your back when using a PAP machine, does not mean you need to try to stay on your back all night long. Always sleep in your most comfortable position. Your PAP system (air-pump+hose+mask+headgear) has been designed to allow you to sleep in all your positions. Well, not all really. Sleeping flat on your face does pose certain challenges. Your machine has been put at a pressure that will keep your average events number, over the whole night, below 5. Some nights you might sleep longer on your back. Some nights you will have more dream sleep. These will put your numbers up a bit. Some nights you will sleep on your back and, while on your back, you go into a dream. That will give you even higher event scores. Don't worry, just watch your event number over the next few nights; it will most likely come down to where it usually is.
iii) You need to keep a good eye on it, if it goes up and does not come down. This means that your current pressure is not strong enough to keep your average event rate down. So, if it goes up and stays up over 10-15 for a few weeks, then you need to go to your Family Doctor. Your doctor will check for things that may be causing the increase such as weight gain (you should know that), low thyroid, sedative medications etc. Such things could be checked out and treated if necessary. If nothing is found then your doctor will probably refer you back to your sleep doc.
iv) If your numbers go above and stay above 20 / hr for a week or so, then you should be referred back to a sleep doctor.
v) Do not panic if your numbers are up for a few weeks. You will not suffer any significant damage from this, but you might start having daytime problems such as sleepiness, fatigue, trouble at work with attention and concentration problems. You might feel a bit cranky, anxious, or depressed even. If you get drowsy while driving, then you should take extra care and get back to your doctor sooner.
vi) PAP machines do not usually eliminate all of your apneic events – just interpret then as above.
b. Your Leak Score (Check your status at least 3 monthly.)
i) In the beginning of your PAP use, a high leak number can tell you that you are not fitting it properly or you are bumping or pulling your mask off in the night.
1. If you are not fitting it properly, then speak to your Respiratory Company. They can help you with this.
2. If you are bumping it off, it usually requires you to train yourself further. You need to find ways to make it less likely that you will bump it in your sleep:
* change your pillow - use only one or a thinner one - you can purchase special PAP pillows with hollows at the sides that your mask can fit into allowing you to sleep with your head a little more rotated. You can buy these from your Respiratory Company or online.
* elevate your hose [hose elevators are available],
* practice rolling in the bed in the daytime when you are fully awake. You can see how far you can snuggle into your pillow without breaking the mask's seal. Your brain will, in time, find ways to roll around in bed without bumping your mask. It does not like you to wake up in your sleep time. It is a waste of energy; so you will get better with the passage of time. If, when you go to bed and the headgear is not very tight and your mask is not leaking when you lie down, then when you wake up at 2 am and it is leaking, you can be pretty sure it is not an equipment problem. Don’t tighten your mask – I can assure you – your head has not shrunk. You have just bumped it. Pull it off your face a bit and straighten it. And go back to sleep. You will get better at not bumping it.
3. If you are pulling it off in your sleep,then you need to be a little more proactive. Most brains are apprehensive about having things on your face that cover your breathing orifices (nose and mouth). It will usually object to this and wake you up many times a night in the beginning. If you did not learn how to train your brain to ignore this thing stuck on your face in the beginning (skill # 4 above), then you have to try again.
When you slept with the mask on for a hour or so and then took it off and went back to sleep, your brain became sensitive to when the mask was on and it dislikes this. It does not understand that the mask is delivering air and, therefore, oxygen to you. Lots of oxygen to you. It thinks, just the opposite, that the mask is making it harder for you to breathe. You may wake up and feel that you are choking and it is difficult to take a breath. You take the mask off and feel much better and find it is much easier to breathe. So, you know that it was choking you.
Unfortunately that is not true. All that you know is that your brain was anxious when you woke up (when you are anxious it is harder to breathe, your brain needs to pant to prepare you to run away or to fight, basically to get this thing off your face. Once you do that, your brain calms down and you feel better. Once you have spent some nights doing this, your brain learns that you are going to wake up take if off. It does not like waking up; that takes energy and it needs all its energy to do what it needs to do at night to refresh itself for the next day. It, therefore, learns how to get control of your arm muscle in your very light sleep and use it to take your mask off in your sleep. You just wake up in the morning and find your mask lying on the bed next to you. You have no idea how it got there. You did not take if off in the night. True. Your brain took it off in your sleep. It is a clever little organ. Very helpful in many things but rather pesky at times.
So, you need to help it learn not to take it off. You do this by waking it up every time it tries to take your mask off when you are asleep. Oh yeah! I must wake it up when I am the one who is sleeping. Precisely. Your brain is already awake. It is working furiously through the night. That is the point. It does not want to use some of its limited energy, that it has to do its work, to wake you up. If you make it wake up every time it tries to take your mask off when you are asleep. it will stop taking it off. All you need to do is to buy a roll of medical tape from your Pharmacy and stick your mask to your skin. When your brain tries to take your mask off while you are still unconscious/asleep, it will pull on your skin and wake you up. In a week or 10 days your brain will stop taking your mask off in your sleep. You will have given yourself the gift of consolidated sleep.
ii) Occasionally, a new mask may be necessary.
If your mask is getting old, usually after about 12 to 18 months or so, then it will start leaking more; when this happens and you see your leak rising over some months, it is probably time to consider getting a new mask
c. Your nightly Use Meter Reading (Check your status at least 2 monthly.)
i. This will tell you the hours that you have breathed into the machine. It does not tell you how long you slept. Ensure it is reading correctly.
ii. It is important for you to know that your Use Meter is working properly in case you need to prove that you are using it regularly for medical or legal reasons.
Ask your partner or others who observe your sleep, to let you know if you start snoring again or if they hear you stopping breathing in your sleep, or gasping, or choking. They sometimes need encouragement to do so. This can alert you to the fact that your current pressure may no longer be sufficient to keep your throat open. If they tell you, check your apnea rate for the last few months. If it is also rising, discuss it with your Family Doctor.
Weight gain plays a big role in making sleep apnea worse. It is not just wisdom that accumulates with age; abdominal dimensions also seem to expand with each passing year. This may be good for hugging but it’s not good for breathing.