Difficulty Tolerating CPAP Pressure | 50 % have no problem,
30% some problem,
20% significant problem understand the health benefits. | A. Return to Sleep Center or vendor to ensure blower is set appropriately
B. Activate CPAP ramp feature
C. Have patient wear CPAP device while awake
D. Lower pressure by 1-2 cm H2O with or without adjunctive measures (eg, sleeping on side).
E. Return to sleep center to auto-adjust CPAP |
Masks Air Leaks | Poor fit | A. Ensure that mask and pillows are fitted appropriately
B. Return to vendor for resizing |
Intolerance of interface (Discomfort, nasal skin breakdown) | Usually due to poor face-machine interface fit or adjustment | A. Loosen mask slightly
B. Ensure that mask and pillows are fitted appropriately (Wear snug but not tight)
C. You may have to try a variety of mask or pillows to find one that is right.
D. A full face mask should only be used as a last resort |
Nasal Congestion | | A. Increase CPAP humidity
B. Administer nasal steroid spray (Flonase nasal spray, 2 sprays each nostril qd)
C. Administer histamine blocker spray (Atrovent nasal spray 0.03% 2 sprays each nostril tid) (takes 2 wks to work)
D. Return to vendor to fit patient for oro-nasal mask or oral interface. |
Claustrophobic response | | A. Wear CPAP device while awake
B. Desensitization/relaxation
C. Check fit of face device
D. Return to vendor for nasal pillows or provide a sleeker mask
* (Refer to the bottom of page for Tx Plan) |
Difficulty with initiation sleep with CPAP | | A. Wear CPAP while awake
B. Reinforce good sleep hygiene |
Dry mouth/nasal stuffiness | | A. Increase humidity
B. Have vendor fit patient for oronasal mask
C. Add chin strap
D. Tighten chin strap |
Taking off CPAP unintentionally during sleep | | A. Reassure patient that this is common
B. Assess all other areas of headgear
C. Assess for nasal interface problems, especially nasal congestion
D. Increase humidity
E. Add chin strap
F. Have patient repeat 15 times before going to sleep; I will leave CPAP mask/pillows on.
G. Have partner notify you to put mask back on |
Mouth opens and air rushes out | | A. Wear chin strap
B. Wear chin strap at an angle from the posterior high point of the head to the chin.
C. Push the chin portion of the chin strap forward to “push” the lower lip up |
CPAP induced drying and nasal congestion | The mouth generally opens if there is an obstruction in the posterior oropharynx. | A. Make sure CPAP pressure is appropriate, the obstruction could be the problem
B. Increase heat and humidity |
I have to much gas (Gastric insufflations) | Uncommon 1-2% of CPAP users | A. Increase Humidity
B. Lowering CPAP pressure
C. Switch to full time auto-CPAP unit
D. Switch to BiPap
E. Encourage the removal of the mask if the patient yawns or swallows (if awake). |
Ears hurt and cannot pop them | | A. Increase heat and humidity
B. Remove mask when the swallow or yawn
C. Antihistamines may help (Eustachian tube dysfunction of this nature usually precludes CPAP therapy) |
Cold or infection | | A. Continue to wear CPAP
B. Turn up the humidity as high as it will go until you feel better |
Can’t sleep with CPAP on | This suggests the presence of co-morbid insomnia | A. Try a period, on CPAP, of gentle sleep restriction.
B. Need for sleep may actually decrease on CPAP
C. Sleep becomes more efficient
D. No more than 6 hours in bed for a few days
E. Set the wake time for patients desired wake time
F. Then set bed time for 6 hours before wake time
G. Wear CPAP entire time
H. Call patient every 2 days.
I. Gradually lengthen sleep time (15-30 min q 2 days) until satisfactory length is achieved
J. Or embark on a full program of CBTI. |
