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)


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

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)

Difference in men and women’s sleep apnea

womanWhen it comes to obstructive sleep apnea, men and women often experience varying symptoms. While men often report symptoms such as snoring, waking up gasping for air or snorting, many women report symptoms like fatigue, anxiety and depression. Of course, some women also experience shortness of breath and snoring too, but, in many cases, the telltale signs of sleep apnea in females may not be as obvious.

Research has also documented sex differences in the upper airway, fat distribution and respiratory stability in OSA. Women with conditions such as anxiety and depression, and have increased mortality risk since OSA have greater endothelial dysfunction compared with men. These women are more likely to develop comorbid women with sleep apnea are more profoundly affected in the areas of the brain that regulate mood and decision-making.

Women are less likely than men to be diagnosed with obstructive sleep apnea as well. Women experience shorter obstructive events and are prone to more upper airway resistance and flow limitation. Women also have predominantly REM-based (deepest stage of sleep) events and experience more arousals from sleep. Women tend to have less severe OSA than males, with a lower apnea-hypopnea index (AHI) and shorter apneas or hypopneas. Episodes of upper airway resistance and flow limitation that do not meet the criteria for apneas are more common in women. Women’s dominant sign and symptoms of OSA are headaches, depression/anxiety and mood disturbances. Therefore, sleep apnea in women is commonly mistaken for depression, hypertension, hypochondria or other disorders.

In general women require lower CPAP pressure than males as well. If you couldn’t tolerate the pressure and failed CPAP therapy, contact Cansleep and start the trial over for a more precise pressure titration that meets your needs.

By Bahareh Ezzati (RRT)

Who needs longer sleep men or women?

Did you know that new research shows that women need more sleep than men? Did you know women’s sleep apnea symptoms are also different than men? The focus of this blog is women and their sleep.

According to researchers at the Loughborough University (U.K.-based Sleep Research Centre) women tend to multi- task more which is mentally and emotionally draining. This could also be the reason women need more sleep than men. According to Jim Horne, sleep researcher: “Women’s brains are wired differently, so their sleep need will be slightly greater. Women tend to multi-task—they do lots at once and are flexible, and so they use more of their actual brain than men do,”

Hormonal differences are partly to blame for the distinctions in women’s sleep patterns, while anatomical differences also play a role. Women are more likely than men to experience insomnia, depression and daytime fatigue and women also benefit from more deep sleep than men. Women’s circadian cycles typically run slightly shorter than men’s and women tend to fall asleep and wake up earlier.

Sleepiness in women also presents differently than sleepiness in men. Studies were done with 210 middle-aged men and women and found that poor sleep is more associated with high levels of distress, hostility, depression and irritability in women. Oddly enough, these symptoms of poor sleep were not as intense in men.

The answer to how much more sleep do women require is as little as 20 minutes or more. So, go ahead ladies, enjoy that extra sleep!

Next month the focus of the blog is the difference in men and women’s sleep apnea.

If you believe that your sleep troubles may be due to sleep apnea rather than another sleep disorder, contact CanSleep to book your free consultation and pick up a diagnostic monitors.

By Bahareh Ezzati (RRT)

OSA–COPD overlap syndrome

COPDDid you know: At least 1 in 10 people with obstructive sleep apnea (OSA) also have COPD (chronic obstructive pulmonary diseases) also known as overlap syndrome. The focus of this blog is on overlap syndrome.

+750,000 Canadians have COPD which is a progressive lung diseases that make it difficult to breathe such as emphysema, chronic bronchitis and non-reversible asthma. Unfortunately at least 7 of 10 people with COPD don’t know they have it. COPD symptoms (e.g. shortness of breath, wheezing, and chronic coughing) often don’t appear until your lungs are significantly damaged. Both OSA and COPD are strongly linked to smoking (use and second hand) and also worsens when gastrointestinal reflux disease (GERD) is present.

Sleep is the period of greatest physiologic disturbance in COPD and the time of greatest danger to these individuals. Sleep aggravates their abnormalities of gas exchange and could cause secondary pulmonary hypertension and cardiac arrhythmias. A COPD patient has a 10% chance of developing sleep apnea and vice versa. On their own, both chronic conditions lower patients’ quality of life and are potentially fatal. But combined, they can be even worse than the sum of their symptoms, so treating both is critical.

Due to the breathing difficulties those with COPD commonly have low oxygen level at all hours of the day, those who have both COPD and OSA are at greater risk of prolonged oxygen desaturation at night than those with OSA but without COPD. Therefore, patients with overlap syndrome are particularly prone to the complications of chronic hypoxaemia (low oxygen levels in your blood), such as cor pulmonale and polycythaemia and also have higher risk of hospitalizations from acute exacerbations.

Using CPAP significantly reduces rates of intubation (inserting a tube into someone’s throat to assist breathing in COPD) and acute respiratory failure.  CPAP also can increase inspiratory capacity (ability to inhale) in patients with stable COPD, especially in those with emphysema.

Some COPD patients are on oxygen therapy and as well as CPAP therapy. If this is you contact your clinician at CanSleep to find out how to combine both therapies at night to get the optimal benefits.

By Bahareh Ezzati (RRT)

Restless Leg Syndrome & Periodic Limb Movement Disorder

Diagnosis  Restless legs syndrome, pills and stethoscope.


Did you know: 1 out of 10 adults has restless leg syndrome (RLS) or/and periodic limb movement disorder (PLMD)?  80% of those with RLS also have PLMD, meaning their limb movements make it hard to fall and stay asleep, however, those with PLMD are not more likely to have RLS? Both disorders occur more frequently in women and in people over 65? To learn more about these disorders and how to get diagnosed and treated, read this blog.

RLS is a neurological syndrome which causes a “creepy-crawly” feeling and sometimes painful sensations in the legs, resulting in the uncontrollable urge to move them. This usually occurs within 15 minutes of lying or sitting down, and can also affect the arms, torso or even a phantom (amputated) limb. As a result of restless leg syndrome, people have difficulties falling asleep. On the other hand, as a result of periodic limb movement disorder, people wake up repeatedly throughout the night. It causes an involuntary kicking or jerking movement of legs or arms while asleep. It also kicks people out of deep stages of sleep and they may not be aware of constant awakenings.

The primary cause of both disorders is unknown. However research suggests that some medications, such as antidepressants can cause PLMD. RLS may be genetic and it could develop or get worse during pregnancy. Both PLMD and RLS can be brought on by low levels of iron or sleep apnea.

RLS is not diagnosed through a specific test. PLMD is diagnosed by a polysomnogram (PSG), the same overnight sleep lab test that can diagnose sleep apnea and other sleep disorders by monitoring vital signs and movement while sleeping.

There is no cure for restless leg syndrome but treatment options to reduce or even eliminate its symptoms are: taking prescribed pain medication; cutting back on caffeine, alcohol and tobacco products; exercising; massaging legs and/or taking hot baths before bed may help reduce symptoms. Most importantly treating other medical conditions such as mineral deficiency; kidney, thyroid or Parkinson’s disease; neuropathy; sleep apnea; diabetes or varicose veins could relieve RLS symptoms. PLMD also has no cure but certain very powerful medications such as medications used to treat Parkinson’s disease is usually used to reduce the symptoms.

Keep in mind that certain medications may affect your sleep apnea symptoms. If your apneas (AHI) increase after taking an RLS or PLMD medication or any other drug/supplement, contact your clinician at Cansleep and physician right away.

By Bahareh Ezzati (RRT)