SoClean 2

CPAP therapy is SC_Cleaning_Process.gifthe most effective treatments for obstructive sleep apnea. However, if you aren’t committed to maintaining a clean CPAP machine, you’re putting yourself at high risk for exposure to germs and bacteria that nests in your equipment. This is why regular CPAP cleaning is an essential part of CPAP therapy. The soap and water method can be time-consuming and it’s almost impossible to reach every inch and corners of the equipment by hand, so your CPAP equipment is unlikely to be completely clean. If you’re looking for the best way to clean CPAP equipment consider SoClean, which quickly and effectively destroys 99.9% of common CPAP germs in your mask, hose and reservoir. It is completely automated, you don’t need to take CPAP equipment apart and no water or chemicals are used. Keep in mind that because SoClean uses a natural gas to clean, even the hard-to-reach spots are thoroughly disinfected. After a simple one-time setup, place your mask inside the SoClean chamber, close the lid and let SoClean’s automated CPAP cleaning cycle do the rest.                                                                                                                                                                                                                                          (click on the picture to see how SoClean works)

SoClean uses ozone (also known as activated oxygen or O3) to clean CPAP equipment. The generator inside the SoClean breaks down the chemical bond of common oxygen (O2) and allows it to recombine into a new molecule that has three atoms of oxygen instead of two. Activated oxygen has a short life cycle. After being generated it automatically decomposes back to oxygen within two hours. Activated oxygen exits the chamber through a special filter, which needs to be replaced every 6months.This filter converts any excess activated oxygen back into the oxygen that we breathe (O2). Ozone is a 100% safe, naturally occurring gas that has been used to purify water and hospital sanitizing for centuries. To get more information about SoClean2 and SoClean 2 go (travel size) contact Cansleep services at 1-844-753-sleep40.

By Bahareh Ezzati (RRT)

Sleep Apnea in Children

In general, since Obstructive Sleep Apnea (OSA) caused lack of restful sleep, kids might have a hard time waking in the morning, be tired throughout the day, and have attention or other behavior problems. As a result, sleep apnea can hurt school performance. Teachers and others may think a child has attention deficit hyperactivity or learning difficulties; therefore, children generally are underdiagnosed or misdiagnosed.  Watch your children for other common sing and symptoms of OSA such as:

  • bedwetting (especially if a child previously stayed dry at night)sleep-apnea-300x238
  • very restless sleep and sleeping in unusual positions
  • snoring, often accompanied with pauses, snorts, or gasps
  • heavy breathing while sleeping

Enlarged tonsils and adenoids are the most common cause of OSA in kids. Other factors include:

  • family history of sleep apnea
  • being overweight and having large neck size
  • medical conditions, such as down syndrome or cerebral palsy
  • defects in the structures of the mouth, jaw, or throat (narrow airway)
  • large tongue (blocking the airway)

If enlarged tonsils or adenoids are causing the apnea, the doctor usually refer the child to an ear, nose, and throat specialist (ENT). The ENT might decide on performing an operation. Surgeries to improve upper airway patency in children are Tonsillectomy (removing tonsil) and/or Adenoidectomy (removing adenoid), which has a success rate of 80-90%; however, 13% of those cured will relapse in adolescence. 

If tonsils and adenoids are not the cause of OSA or if symptoms of OSA remain after the surgery, patient would require continuous positive airway pressure (CPAP) therapy.

When excess weight is a factor in OSA, it is important to work with a doctor or dietitians on diet changes, exercise, and other safe weight-loss methods. Call CanSleep to book a half hour free consultation appointment with our Registered Holistic Nutritionist (RHN) for nutritional support, meal plans, lifestyle recommendation and sleep hygiene techniques for your child if being overweight is the cause of your child’s OSA.

By Bahareh Ezzati (RRT)

OSA Surgeries

Surgical management of obstructive sleep apnea

In OSA, CPAP is almost inevitably the preferable form of treatment, and therefore should be tried first. Exceptions may be in rare cases of severe psychological aversion, or fitting failure due to cranio-facial anomalies or claustrophobia.Surgery

Type of surgeries:

  • To improve the nasal airway

Septoplasty surgeries are often done to assist with CPAP compliance and it rarely corrects OSA without another intervention. It includes: turbinate reduction, rhinoplasty, polypectomy

  • To improve the palatal oropharyngeal airway

Uvulopharyngopalatoplasty (UPPP) involves removal of tonsils, adjacent soft palate and tightening (by sutures) the lateral and posterior pharyngeal walls. Circumferential narrowing in the airway from excessive scaring is a long-term complication of the surgery.

Laser Assisted Uvulopalatoplasty (LAUP), may be done as UPPP (but without tonsillectomy or suturing) leaving a ‘Roman Arch` palate.

Transpalatal Advancement Pharyngoplasty (TPAP) 1cm of the back of the hard palate is removed

  • To improve the Retrolingual airway

Genioglossus Advancement (GGA) Genioglossus muscle, which is the part of the tongue attaching it to the chin, is brought forward and rotated by about 1 cm.

Hyoid Suspension or Advancement (HS A), Hyoid bone is advanced over the upper thyroid cartilage which involves moderate neck dissection

Direct tongue base surgery: Very dangerous and done in a very few centers

Tongue Base Radiofrequency (TB RF) which destroys tongue base tissue by about 17%

  • To improve both the airway at both the oropharyngeal palatal level and the retrolingual level

Maxillomandibular Advancement (MMA) which pulls the whole face forward at least 1cm. Complications include airway problems with dental and occlusal changes

Most surgery improves only one area of upper airway (at a time) while most sleep apnea patients have multiple areas of airway collapse.  Therefore, multiple surgeries may be required, and despite those surgeries CPAP may still ultimately be necessary. Especially in more severe OSA, surgery is relatively ineffective in controlling the condition when compared to CPAP. Also all surgery carries serious risks, including death, and airway surgery more than many other forms. CPAP carries virtually no risks. Nevertheless, CPAP splints the whole upper airway open and it is the least invasive treatment for OSA. If you have had performed, any of the surgeries above but still have signs and symptoms of sleep apnea, call Cansleep services to book a diagnostic test to see if you still need CPAP therapy or not.

By Bahareh Ezzati (RRT)

ASV

Not all patients benefit from CPAP or BiPAP therapy. For example, patients with congestive heart failure may be candidates for a different PAP therapy. Often their apnea is more complex with Cheyne-Stokes respirations (an abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in an apnea event), and advanced devices are required. Also, patients with central sleep apnea may require more advanced PAP therapy. Central sleep apnea (CSA) differs from obstructive sleep apnea in that, instead of an obstruction causing breathing to become shallow or stop periodically throughout the night, the brain fails to send signals to the respiratory system to instruct it to continue breathing during sleep. ASV machines are meant to treat central sleep apnea (CSA), mixed sleep apnea, and also Cheynes-Stokes respiration.  0000 asv

The difference between ASV therapy and other therapy is that it provides support to regular breathing. It uses an algorithm which detects significant reductions or pauses in breathing and intervenes with just enough support to maintain the patient’s breathing at 90% of what had been normal prior to decreased breathing. The algorithm is based on a set rate of breaths per minute that the patient should be taking. When the patient’s breathing dips below these rates, the ASV delivers just enough air pressure to keep the patient breathing regularly.

Nevertheless, a recent study has shown that ASV may be harmful in patients with a reduced left ventricular ejection fraction (LVEF≤ 45%). For this particular group there is a 33.5% increased risk of cardiovascular death, compared to control patients who are not on ASV therapy.  If you are on ASV therapy and have cardiac problems check with your cardiologist to find out what is your Ejection Fraction and if ASV is safe for you to use. Also, if you have obstructive sleep apnea and recently had cardiac failure contact your clinical therapist at CanSleep services to check if you are a candidate for ASV therapy.

By Bahareh Ezzati (RRT)

Comfort features on some popular CPAP machines

CPAP treatment can be highly effective in treatment of obstructive sleep apnea. For some patients, the improvement in the quality of sleep and quality of life due to CPAP treatment will be noticed after a single night’s use. Often, the patient’s sleep partner also benefits from markedly improved sleep quality, due to the amelioration of the patient’s loud snoring. The question that usually rises is what other features CPAP has to make CPAP therapy more comfortable? The topics that this blog will cover is CPAP features such as ramp, pressure release function,  and the difference between pressure release and BiPAP will be discussed.

Ramp may be used to temporarily lower the pressure if the user does not immediately sleep. The pressure gradually rises to the prescribed level over a period of time that can be adjusted by the patient and/or the provider. The Symbol for ramp is a triangle. Ramp

Breathing out against the positive pressure resistance (the expiratory positive airway pressure component, or EPAP) may also feel unpleasant to some patients. Some machines have pressure relief technologies that make sleep therapy more comfortable by reducing pressure at the beginning of exhalation and returning to therapeutic pressure just before inhalation. The level of pressure relief is varied based on the patient’s expiratory flow, making breathing out against the pressure less difficult.

The question that rises is that why not use CPAP with pressure release Instead of BiPAP?

Pressure release is similar to BiPAP therapy in that it offers pressure relief as the patient exhales so that they don’t feel like they’re fighting against the incoming airflow during expiration. However, pressure release is more of a comfort feature for CPAP machines that only offers pressure relief up to 3 cm, whereas BiPAP pressure relief starts at 4 cm and goes up. For those who need only a little pressure relief, a CPAP with pressure might be the right choice.

Another difference between BiPAP and CPAP with pressure release is that the pressure relief from pressure release is not a fixed amount, and the pressure drop can vary from breath to breath, whereas the BiPAP maintains a set, prescribed exhalation pressure. If you have difficulties breathing out against pressure, talk to your clinician at Cansleep to see if you would benefit from pressure relief feature or/and BiPAP.

By Bahareh Ezzati (RRT)

BiPAP

Did you know there are different types of PAP (Positive Airway Pressure) therapy? BiPAP which is also known as BiLevel is a common type of PAP therapy. This blog is going to talk about BiPAP and the difference between BiPAP and CPAP therapy.CPAP_vs_BiPAP_1

CPAP machines deliver a steady, continuous stream of pressurized air to a patient’s airways to prevent them from collapsing and causing apnea events. One of the complaints about CPAP devices is that some patients find the constant singular pressure difficult to exhale against. For patients with higher pressure strengths, exhaling against the incoming air can feel difficult, as if they’re having to force their breathing out. BiPAP machines are often prescribed to sleep apnea patients with high pressure settings or low oxygen levels as well as people with lung disorders or certain neuromuscular disorders. The main difference between BiPAP and CPAP machines is that BiPAP machines have two pressure settings: the prescribed pressure for inhalation (IPAP), and a lower pressure for exhalation (EPAP).

BiPAP generates inspiratory (IPAP) and expiratory (EPAP) pressure gradients that complement the patient’s own respiratory cycle, optimising the lungs’ efficiency and reducing the work of breathing. BiPAP has been shown to be an effective management tool for COPD (Chronic Obstructive Pulmonary Disease) and acute and chronic respiratory failure. The difference in pressures helps to eliminate extra CO2 (carbon dioxide) gas from the body. This offers relief to the user’s typically overworked muscles of breathing. On some BiPAP units exhalation time is also set. COPD patients generally have long exhalation times due to loss of lung elasticity and setting exhalation time allows them exhale fully.

 If you’ve tried CPAP and find the pressure settings too difficult to manage exhaling against, talk with your therapist at Cansleep to see if a BiPAP machine is right for you.

By Bahareh Ezzati (RRT)

Steps to take to get used to CPAP therapy

First try CPAP during the day

Before you try to fall asleep with a new CPAP try to get used to the mask by itself.hcnoctn452-u1p-global-001

  1. Hold the mask in front of your face (with no headgear or tubing) and breathe normally for 1 minute.
  2. Then connect the mask to your CPAP machine, turn the air on and hold it in front of your face for 1–2 minutes (still with no headgear). Focus on breathing normally. If the air pressure is uncomfortable, remove the mask from your face and try again after a few minutes.
  3. Now put your headgear on, sit and practice breathing through the mask and air pressure for 2 minutes at a time.
  4. Try reading or watching TV with your mask, headgear and air pressure on for 30 minutes at a time (but not in your bedroom).

Then take CPAP to bed

  1. Have everything set up. Therapy can be a hassle to set up when you’re tired. It’s best to have everything set up when you’re ready for sleep.
  2.  It’s ok to use it for just 30–60 minutes on your first attempt. Try to add 30 minutes each time you use it to stay motivated. Remind yourself that CPAP takes patience and perseverance. Remember your body needs time to adjust to the therapy and may not feel better right away.
  3. Keep a diary of your efforts and challenges. This helps patients see how far they’ve come, notice when issues become trends that need addressing and accept the idea that CPAP therapy is a process.
  4. Have your bed partner and family members help motivate you and keep you on track.

If you ever feel discomfort or that something’s not right, talk to your clinical therapist at CanSleep services; don’t forget we are also here to support you and share our experiences with you.

By Bahareh Ezzati (RRT)

 

Auto CPAP vs. Straight CPAP

CPAP uses air pressure (not flow) to keep the airway open and control sleep apnea. The CPAP pressure is delivered either as automatic positive pressure or fixed (straight) pressure. Let’s discover what is the difference between
straight and auto CPAP therapies.davidpol_1467088358_cpapvsapap

An automatic positive airway pressure device (APAP, AutoPAP, AutoCPAP) is set at a variable pressure and adjusts the pressure based on the patient’s needs using an internal algorithm. The pressure is monitored and adjusted automatically breath to breath, measuring the resistance in the patient’s breathing, to treat the obstruction in the airway. Straight CPAP on the other hand uses constant pressure throughout the night, regardless of whether you’re experiencing an apnea or not.

Many patients have positional apnea, meaning in the supine position (sleeping on back), their apnea may be worse than if they were non-supine. Due to paralysis of muscles (including tongue) during REM sleep, apnea may be worse in supine position. Other causes of sleep variability may be alcohol intake, sedating medication, weight changes, congestion and testosterone replacement therapy. Each of these circumstances can worsen sleep apnea leading to an increase in pressure requirements. AutoCPAP can accommodate for these changes and adjust during the night without disturbing the patient, yet controlling their sleep apnea.  It is also reported that patients experience less arousal (getting to shallower stages of sleep) with AutoCPAP therapy. Many also report an improvement or resolution in aerophagia (swallowing of air), as seen more with higher pressures.

On the other hand, many people notice fewer mask leaks and therefore less dryness in the morning using straight CPAP therapy. In AutoCPAP when there is mask leak the pressure may falsely augment, therefore increasing leak, and again increasing the pressure. This vicious cycle may continue throughout the night, causing the patient discomfort. Alsa with AutoCPAP, if the minimum pressure is too low, the patient must experience apnea before the pressure will increase to a therapeutic setting. This may make therapy less tolerable and patients may complain of feelings of suffocation. Some patients also have issues tolerating the higher pressures, even if that pressure is warranted. Some feel the algorithms of auto CPAP are too sensitive and therefore the pressure continues to increase during sleep and causes discomfort. Therefore these patients find straight CPAP more comfortable than AutoCPAP.  Talk to your clinician at Cansleep to find out which CPAP therapy is more suitable for you.

by Bahareh Ezzati (RRT)

How does CPAP work

This blog covers what CPAP stands for and how it works. CPAP stands for Continuous Positive Airway Pressure. It is a therapy device that applies mild air pressure on a continuous basis to keep the airway continuously open. CPAP is the most effective treatment for obstructive sleep apnea. In fact, CPAP is a more effective treatment than an oral appliance or surgery due to CPAP opening up the entire airway no matter what the cause of the obstruction. Oral appliances and surgery target particular areas of the airway, so are sometimes not as effective.cpap

Obstructive sleep apnea occurs when the upper airway becomes narrow as the muscles relax naturally during sleep. This reduces oxygen in the blood and causes arousal from sleep. The CPAP machine stops this phenomenon by delivering a stream of compressed air via a hose to a mask splinting the airway (keeping it open under air pressure) and prevent the airway from collapsing.

CPAP also may be used to treat preterm infants whose lungs have not yet fully developed. For example, physicians may use CPAP in infants with respiratory distress syndrome. In some preterm infants whose lungs haven’t fully developed, CPAP improves survival and decreases the need for steroid treatment for their lungs. CPAP is also used in the hospital setting for adults to improve the ability of the lungs to exchange oxygen and carbon dioxide and to decrease the work of breathing.

The CPAP machine blows air at a prescribed pressure (also called the titrated pressure). The titrated pressure is the pressure of air at which most of apneas (stops in breathing) and hypopneas (shallow breathing) have been prevented, and it is usually measured in centimetres of water  (cmH2O). A typical CPAP machine can deliver pressures between 4 and 20 cmH2O.

The mask required to deliver CPAP must have an effective seal, and be held on very securely.  There are three types of masks. Nasal pillow, nasal and full face mask. Nasal pillow masks maintain its seal by being inserted slightly into the nostrils and being held in place by straps around the head. Nasal masks cover the nose and full face masks cover your nose and mouth.  Both masks “float” on the skin like a hovercraft, with thin, soft, flexible “cushion” made out of silicone. Headgear is used to keep the masks secure on the face. For more information on CPAP and masks and their features check http://www.cansleep.ca/products/.

By Bahareh Ezzati (RRT)

Heart Diseases and Sleep Apnea

Did you know about one half of patients who have essential hypertension have obstructive sleep apnea? Research shows that obstructive sleep apnea increases both daytime and night time ambulatory blood pressures. Heart failures, Strokes, Coronary heart disease, and Pulmonary hypertensions are other cardiovascular diseases related to OSA.heartSleep apnea affects many of the complex systems of our bodies and is associated with other serious conditions like high blood pressure. Many people think sleep apnea is as simple as snoring, but it’s really much more than that.

Constantly depriving your body of oxygen each night has a tremendously negative impact on your body. Normally, your blood pressure falls at night. If you have sleep apnea, your blood pressure may not fall, which can lead to high blood pressure. Every time your oxygen level drops, this raises your blood pressure and causes an adrenaline surge. This puts increased stress on your heart because it has to work harder to normalize your blood pressure. The more severe your sleep apnea, the greater the risk of high blood pressure. Nevertheless, treatment of OSA with CPAP significantly reduces daytime blood pressure in patients with resistant hypertension.

OSA affects the heart in 3 different stages of apnea episodes. The first during systemic hypoxemia (drop in oxygen level in blood stream). As a result, sympathetic nervous system activity (fight and flight effect) increases, which in turn increases peripheral vascular resistance and increases heart rate and blood pressure. The second effect is due to negative intrathoracic pressure. During apnea episodes respiratory effort is still ongoing, which creates suctioning effect in your thoracic cage. This suctioning mechanism affects cardiac preload and after load due to which cardiac blood output is affected. The third effect is during patients arousals from sleep. Arousals occurs to terminate apnea’s episodes and it associates with high level of cardiac and respiratory activity. This may also contribute to the development of post-apneic surges in blood pressure and heart rate as well as sleep fragmentation.

High blood pressure, like sleep apnea isn’t normally something you can detect on your own. If you have sleep apnea, you likely don’t know about it unless other people tell you that you’re keeping them up at night by snoring or temporarily stopping breathing when you sleep. If someone tells you that you do either of these things, it’s important to take it seriously because sleep apnea is linked to so many other life-threatening conditions like high blood pressure. To discuss your signs and symptoms and/or to do diagnostic tests contact Cansleep Services Inc.

By Bahareh Ezzati (RRT)