CPAP devices: Tips for avoiding 10 common problems

CPAP is an important treatment for sleep apnea, but it's not without its frustrations. Learn how to avoid uncomfortable masks and other common CPAP problems.

CPAP (continuous positive airway pressure) therapy is a common treatment for sleep apnea. CPAP includes a small machine that supplies a constant and steady air pressure, a hose, and a mask or nose piece. Common problems with CPAP include a leaky mask, trouble falling asleep, and a dry mouth or nose. If you are experiencing these or other issues, you're not alone — two out of every three people using CPAP devices will experience such problems.

The good news is that if one CPAP mask or device doesn't work for you, you have other options. And most CPAP masks are adjustable, to help make them more comfortable for you. Here are 10 common CPAP problems and what you can do about them.

The wrong size or style CPAP mask

Work closely with your doctor and CPAP supplier to make sure you have a CPAP mask that suits your needs and fits you. Everyone has different needs and face shapes, so the right style and size mask for someone else may not work for you.

• Many mask styles available. A range of CPAP masks are available. For example, some feature full face masks that cover your mouth and nose, with straps that stretch across your forehead and cheeks. These may make some people feel claustrophobic, but they work well at providing a stable fit if you move around a lot in your sleep. Other masks feature nasal pillows that fit under your nose and straps that cover less of your face. These can feel less cumbersome. And they may work well if you wear glasses or read with the mask on, because some nasal pillow masks obstruct vision less than do full face masks. However, they may not work if you move around a lot in your sleep or sleep on your side.
• Size important. Most masks come in different sizes. Just because you're a certain size in one mask doesn't mean you'll be the same size in another. CPAP masks are usually adjustable. Ask your doctor or CPAP supplier to show you how to adjust your mask to get the best fit. Manufacturer product instructions also can help show you how to do this.

Trouble getting used to wearing the CPAP device

It may help to start by practicing wearing just the CPAP mask for short periods of time while you're awake, for example while watching TV. Then try wearing the mask and hose with the air pressure on, still during the daytime while you're awake. Once you become accustomed to how that feels, shift to using the CPAP device every time you sleep — at night and during naps. Inconsistently wearing the CPAP device may delay getting used to it. Stick with it for several weeks or more to see if the mask and pressure settings you have will work for you.

Difficulty tolerating forced air

You may be able to overcome this by using a "ramp" feature on the machine. This feature allows you to start with low air pressure, followed by an automatic, gradual increase in the pressure to your prescribed setting as you fall asleep. For example, the pressure can be increased over 10, 15 or 20 minutes. The rate of this ramp feature can be adjusted by your doctor.

If this doesn't help, talk with your doctor about changing to a different type of device that automatically adjusts the pressure while you're sleeping. For example, units that supply bi-level positive airway pressure (BiPAP) are available. These provide more pressure when you inhale and less when you exhale.

Dry, stuffy nose

A CPAP device that features a heated humidifier, which attaches to the air pressure machine, can help. The level of humidification is adjustable. Using a nasal saline spray at bedtime also can help. Your doctor may prescribe a nasal steroid spray if your dryness doesn't respond to heated humidity. It's also important that your mask fit well. A leaky mask can dry out your nose.

Feeling claustrophobic

While you're awake, practice by first just holding the mask up to your face without any of the other parts. Once you're comfortable with that, try wearing the mask with the straps. Next, try holding on the mask and hose, without the straps, with the hose attached to the CPAP machine at a low pressure setting (turn the ramp feature on). And, finally, wear the mask with the straps and with the air pressure machine turned on while awake. After you're comfortable with that, try sleeping with it on.

Relaxation exercises, such as progressive muscle relaxation, also may help reduce your anxiety. If you're still feeling claustrophobic, talk to your doctor or CPAP supplier. It may help to get a different size mask or try a different style, such as one that uses nasal pillows.

Leaky mask, skin irritation or pressure sores

A leaky or ill-fitting mask means you're not getting the full air pressure you need, and you may be irritating your skin. It can also release air into your eyes, causing them to become dry or teary. Try adjusting pads and straps to get a better fit. If the device fits over your nose, make sure it doesn't sit too high on the bridge of your nose, which can direct air into your eyes. Washing the mask daily with warm, soapy water and washing your face at night can help ensure a better, less irritating seal to your skin. If your mask comes with instructions on how to use and clean it, review them before using the mask and again, later, if you have problems.

You may need to ask your supplier to help you find a different size mask, particularly if your weight changes markedly, or try a different style device such as a nasal pillow. If you develop skin deterioration or sores, such as on your nose, tell your doctor promptly.

Difficulty falling asleep

This is a normal, temporary problem. Wearing the mask alone for some time during the day may help you get accustomed to how it feels. Using the ramp feature, which provides an automatic, gradual increase in the air pressure to your prescribed pressure setting as you fall asleep also may help. And practice good general sleep habits — exercise regularly, avoid caffeine and alcohol before bedtime, and try to relax. For example, take a warm bath before you go to bed. Avoid going to bed until you're tired.

Dry mouth

If you breathe through your mouth at night or sleep with your mouth open, some CPAP devices may worsen dry mouth. A chin strap may help keep your mouth closed and reduce the air leak if you wear a nasal mask. A full-face-mask-style device that covers your mouth and nose may also work well for you. A CPAP-heated humidifier that attaches to the air pressure machine also may help.

Unintentionally removing the CPAP device during the night

It's normal to sometimes wake up to find you've removed the mask in your sleep. If you move a lot in your sleep, you may find that a full face mask will stay on your face better. You may be pulling off the mask because your nose is congested. If so, ensuring a good mask fit and adding a CPAP-heated humidifier may help. A chin strap also may help keep the device on your face. If this is a consistent problem, consider setting an alarm for sometime in the night, to check whether the device is still on. You could progressively set the alarm for later in the night if you find you're keeping the device on longer.

Annoyed by the noise

Most new models of CPAP devices are almost silent, but if you find a device's noise is bothersome, first check to make sure the device air filter is clean and unblocked. Something in its way may be contributing to noise. If this doesn't help, have your doctor or CPAP supplier check the device to ensure it's working properly. If the device is working correctly and the noise still bothers you, try wearing earplugs or using a white-noise sound machine to mask the noise.

Time and patience key to success

Using a CPAP device can be frustrating as you try to get used to it, but it's important you stick with it. The treatment is essential to avoiding sleep apnea-related complications such as heart problems and daytime fatigue. Work with your doctor and CPAP supplier to ensure the best fit and device for you, and try making adjustments if you're experiencing some of the common CPAP problems. It may take several months to find the correct settings for you and to adapt to the mask. With time and patience, CPAP can positively affect your quality of life and health.

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Depression and anxiety: Exercise eases symptoms

Exercise can improve symptoms of depression and anxiety. Even a little exercise helps. Use these realistic tips and goals to get started and stick with it.

If you have depression or anxiety, you might find your doctor or mental health provider prescribing a regular dose of exercise in addition to medication or psychotherapy. Exercise isn't a cure for depression or anxiety. But its psychological and physical benefits can improve your symptoms.

"It's not a magic bullet, but increasing physical activity is a positive and active strategy to help manage depression and anxiety," says Kristin Vickers-Douglas, Ph.D., a psychologist at Mayo Clinic, Rochester, Minn.

When you have depression or anxiety, exercising may be the last thing you think you can do. But you can overcome the inertia. See how exercise can ease depression symptoms and anxiety symptoms. Plus, get realistic tips to get started and stick with exercising.

How exercise helps depression and anxiety

Exercise has long been touted as a way to maintain physical fitness and help prevent high blood pressure, diabetes and other diseases. A growing volume of research shows that exercise can also help improve symptoms of certain mental health conditions, including depression and anxiety. Exercise may also help prevent a relapse after treatment for depression or anxiety.

Research suggests that it may take at least 30 minutes of exercise a day for at least three to five days a week to significantly improve depression symptoms. But smaller amounts of activity — as little as 10 to 15 minutes at a time — can improve mood in the short term. "Small bouts of exercise may be a great way to get started if it's initially too hard to do more," Dr. Vickers-Douglas says.

Just how exercise reduces symptoms of depression and anxiety isn't fully understood. Some evidence suggests that exercise raises the levels of certain mood-enhancing neurotransmitters in the brain. Exercise may also boost feel-good endorphins, release muscle tension, help you sleep better, and reduce levels of the stress hormone cortisol. It also increases body temperature, which may have calming effects. All of these changes in your mind and body can improve such symptoms as sadness, anxiety, irritability, stress, fatigue, anger, self-doubt and hopelessness.

If you exercise regularly but depression or anxiety symptoms still interfere with your daily living, seek professional help. Exercise isn't meant to replace medical treatment of depression or anxiety

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Sleep apnea

Definition

Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. You may have sleep apnea if you snore loudly and you feel tired even after a full night's sleep?

Sleep apnea occurs in two main types: obstructive sleep apnea, the more common form that occurs when throat muscles relax, and central sleep apnea, which occurs when your brain doesn't send proper signals to the muscles that control breathing. Additionally, some people have complex sleep apnea, which is a combination of both.

If you think you might have sleep apnea, see your doctor. Treatment is necessary to avoid heart problems and other complications.

Symptoms

The signs and symptoms of obstructive and central sleep apneas overlap, sometimes making the type of sleep apnea more difficult to determine. The most common signs and symptoms of obstructive and central sleep apneas include:

• Excessive daytime sleepiness (hypersomnia)
• Loud snoring, which is usually more prominent in obstructive sleep apnea
• Observed episodes of breathing cessation during sleep
• Abrupt awakenings accompanied by shortness of breath, which more likely indicates central sleep apnea
• Awakening with a dry mouth or sore throat
• Morning headache
• Difficulty staying asleep (insomnia)

When to see a doctor
Consult a medical professional if you experience, or if your partner observes, the following:

• Snoring loud enough to disturb the sleep of others or yourself
• Shortness of breath that awakens you from sleep
• Intermittent pauses in your breathing during sleep
• Excessive daytime drowsiness, which may cause you to fall asleep while you're working, watching television or even driving

Many people don't think of snoring as a sign of something potentially serious, and not everyone who has sleep apnea snores. But be sure to talk to your doctor if you experience loud snoring, especially snoring that's punctuated by periods of silence.

Ask your doctor about any sleep problem that leaves you chronically fatigued, sleepy and irritable. Excessive daytime drowsiness (hypersomnia) may be due to other disorders, such as narcolepsy.

Causes

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Sleep apnea

Causes of obstructive sleep apnea
Obstructive sleep apnea occurs when the muscles in the back of your throat relax. These muscles support the soft palate, the triangular piece of tissue hanging from the soft palate (uvula), the tonsils and the tongue.

When the muscles relax, your airway narrows or closes as you breathe in, and breathing momentarily stops. This may lower the level of oxygen in your blood. Your brain senses this inability to breathe and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don't remember it.

You can awaken with a transient shortness of breath that corrects itself quickly, within one or two deep breaths, although this is rare. You may make a snorting, choking or gasping sound. This pattern can repeat itself five to 30 times or more each hour, all night long. These disruptions impair your ability to reach the desired deep, restful phases of sleep, and you'll probably feel sleepy during your waking hours.

People with obstructive sleep apnea may not be aware that their sleep was interrupted. In fact, many people with this type of sleep apnea think they sleep well all night.

Causes of central sleep apnea
Central sleep apnea, which is far less common, occurs when your brain fails to transmit signals to your breathing muscles. You may awaken with shortness of breath or have a difficult time getting or staying asleep. Like obstructive sleep apnea, snoring and daytime sleepiness can occur. The most common cause of central sleep apnea is heart disease, and less commonly, stroke. People with central sleep apnea may be more likely to remember awakening than people with obstructive sleep apnea are.

Causes of complex sleep apnea
People with complex sleep apnea have upper airway obstruction just like those with obstructive sleep apnea, but they also have a problem with the rhythm of breathing and occasional lapses of breathing effort.

Treatments and drugs

For milder cases of sleep apnea, your doctor may recommend lifestyle changes such as losing weight or quitting smoking. If these measures don't improve your signs and symptoms or if your apnea is moderate to severe, a number of other treatments are available. Certain devices can help open up a blocked airway. In other cases, surgery may be necessary.

Treatments for obstructive sleep apnea may include:

Therapies

• Continuous positive airway pressure (CPAP). If you have moderate to severe sleep apnea, you may benefit from a machine that delivers air pressure through a mask placed over your nose while you sleep. With CPAP (SEE-pap), the air pressure is somewhat greater than that of the surrounding air, and is just enough to keep your upper airway passages open, preventing apnea and snoring.

  Although CPAP is a preferred method of treating sleep apnea, some people find it cumbersome or uncomfortable. With some practice, most people learn to adjust the tension of the straps to obtain a comfortable and secure fit. You may need to try more than one type of mask to find one that's comfortable. Some people benefit from also using a humidifier along with their CPAP system.

  Don't just stop using the CPAP machine if you experience problems. Check with your doctor to see what modifications can be made to make you more comfortable. Additionally, contact your doctor if you are still snoring despite treatment or begin snoring again. If your weight changes, the pressure settings may need to be adjusted.

• Adjustable airway pressure devices. If CPAP continues to be a problem for you, you may be able to use a different type of airway pressure device that automatically adjusts the pressure while you're sleeping. For example, units that supply bilevel positive airway pressure (BiPAP) are available. These provide more pressure when you inhale and less when you exhale.

• Oral appliances. Another option is wearing an oral appliance designed to keep your throat open. CPAP is more effective than oral appliances, but oral appliances may be easier for you to use. Some are designed to open your throat by bringing your jaw forward, which can sometimes relieve snoring and mild obstructive sleep apnea.

  A number of devices are available from your dentist. You may need to try different devices before finding one that works for you. Once you find the right fit, you'll still need to follow up with your dentist at least every six months during the first year and then at least once a year after that to ensure that the fit is still good and to reassess your signs and symptoms.

Surgery
The goal of surgery for sleep apnea is to remove excess tissue from your nose or throat that may be vibrating and causing you to snore, or that may be blocking your upper air passages and causing sleep apnea. Surgical options may include:

• Uvulopalatopharyngoplasty (UPPP). During this procedure, your doctor removes tissue from the rear of your mouth and top of your throat. Your tonsils and adenoids usually are removed as well. This type of surgery may be successful in stopping throat structures from vibrating and causing snoring. However, it may be less successful in treating sleep apnea because tissue farther down your throat may still block your air passage. UPPP usually is performed in a hospital and requires a general anesthetic.
• Maxillomandibular advancement. In this procedure, the upper and lower part of your jaw is moved forward from the remainder of your face bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely. This procedure may require the cooperation of an oral surgeon and an orthodontist, and at times may be combined with another procedure to improve the likelihood of success.
• Tracheostomy. You may need this form of surgery if other treatments have failed and you have severe, life-threatening sleep apnea. In this procedure, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe. You keep the opening covered during the day. But at night you uncover it to allow air to pass in and out of your lungs, bypassing the blocked air passage in your throat.

Removing tissues in the back of your throat with a laser (laser-assisted uvulopalatoplasty) or with radiofrequency energy (radiofrequency ablation) are procedures that doctors sometimes use to treat snoring. Although sometimes these procedures are combined with others, they aren't usually recommended as sole treatments for obstructive sleep apnea.

Other types of surgery may help reduce snoring and contribute to the treatment of sleep apnea by clearing or enlarging air passages:

• Nasal surgery to remove polyps or straighten a crooked partition between your nostrils (deviated nasal septum)
• Surgery to remove enlarged tonsils or adenoids

Treatments for central and complex sleep apnea may include:

Therapies

• Treatment for associated medical problems. Possible causes of central sleep apnea include heart or neuromuscular disorders, and treating those conditions may help. For example, optimizing therapy for heart failure may eliminate central sleep apnea.
• Supplemental oxygen. Using supplemental oxygen while you sleep may help if you have central sleep apnea. Various forms of oxygen are available as well as different devices to deliver oxygen to your lungs.
• Continuous positive airway pressure. This method, also used in obstructive sleep apnea, involves wearing a pressurized mask over your nose while you sleep. The mask is attached to a small pump that forces air through your airway to keep it from collapsing. CPAP may eliminate snoring and prevent sleep apnea. As with obstructive sleep apnea, it's important that you use the device as directed. If your mask is uncomfortable or the pressure feels too strong, talk with your doctor so that adjustments can be made.
• Bilevel positive airway pressure (BiPAP). Unlike CPAP, which supplies steady, constant pressure to your upper airway as you breathe in and out, BiPAP builds to a higher pressure when you inhale and decreases to a lower pressure when you exhale. The goal of this treatment is to assist the weak breathing pattern of central sleep apnea. Some BiPAP devices can be set to automatically deliver a breath if the device detects you haven't taken one after so many seconds.
• Adaptive servo-ventilation (ASV). This more recently approved airflow device learns your normal breathing pattern and stores the information in a built-in computer. After you fall asleep, the machine uses pressure to normalize your breathing pattern and prevent pauses in your breathing. ASV may be more successful than CPAP at treating central sleep apnea. However, more study is needed.

Along with these treatments, you may read or hear about different treatments for sleep apnea, such as implants. Although a number of medical devices and procedures have received Food and Drug Administration clearance, there's limited published research regarding how useful they are, and they aren't generally recommended as sole therapies.

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Traveling for business? Work in a workout

When you're traveling, you can stick to your fitness routine — seriously! Use these simple tips to maintain your fitness program when you're away from home.

If your job keeps you on the road, you know how challenging it can be to maintain your fitness program. Hours of travel and back-to-back meetings may leave little room in your schedule for exercise. But it's not a lost cause. A little dedication and planning can help you stay in shape when you're traveling.

Pack for fitness

Before your trip, call your hotel and ask about on-site or nearby fitness facilities. Then pack accordingly. You may want to bring:

• Athletic shoes
• Exercise clothing
• Swimsuit
• Jump-rope
• Resistance tubing
• Tennis racket
• Music and headphones
• Exercise video or DVD

If you prefer a quicker pace, ask the hotel staff about renting in-line skates or a bicycle.

Start right away

Wear your walking shoes when you travel. If you're traveling by plane, store your carry-on bags in a locker and walk briskly through the terminal while you're waiting for your flight. Pump your arms to increase your heart rate. During your flight, get up once an hour to stretch and walk.

If you're traveling by train, walk through the cars occasionally. Walk outdoors when the train stops to let passengers on and off. If you're driving, take frequent breaks to get out and stretch. Even a short walk around a rest area can boost your mood and energy level.

Check out the facilities

When you arrive at your destination, check out the fitness facilities at your hotel or a nearby health club. Then schedule time for a workout. If the options seem limited, get creative:

• Use the halls. Walk up and down the hotel halls. Better yet, climb the stairs between hallway laps.
• Get wet. Swim laps in the hotel pool.
• Skip rope. Use a jump-rope in the hotel's fitness room or at the edge of the parking area.
• Do jumping jacks. Try a few sets right in your room.
• March in place. Pump your arms to increase your calorie-burning power.
• Try aerobics. Follow an aerobics program on TV, or play an exercise video or DVD from home.
• Use resistance tubing. These stretchy tubes offer weight-like resistance when you pull on them. You can use resistance tubing to build strength in nearly any muscle group.
• Take advantage of your own body weight. Try push-ups, abdominal crunches and leg squats.

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Tai chi: Improved stress reduction, balance, agility for all

The ancient art of tai chi uses gentle flowing movements to reduce the stress of today's busy lifestyles and improve health. Find out how to get started.

The graceful images of people gliding through dance-like poses as they practice tai chi (TIE-chee) are compelling. Simply watching them is relaxing. Tai chi, in fact, is often described as "meditation in motion" because it promotes serenity through gentle movements — connecting the mind and body.

Originally developed in China as a form of self-defense, tai chi is a graceful form of exercise that has existed for some 2,000 years. Practiced regularly, tai chi can help you reduce stress and enjoy other health benefits.

Understanding tai chi

Tai chi, sometimes called tai chi chuan, is a noncompetitive, self-paced system of gentle physical exercise and stretching. To do tai chi, you perform a series of postures or movements in a slow, graceful manner. Each posture flows into the next without pausing.

Anyone, regardless of age or physical ability, can practice tai chi. It doesn't take physical prowess. Rather, tai chi emphasizes technique over strength.

Tai chi is used to:

• Reduce stress
• Increase flexibility
• Improve muscle strength and definition
• Increase energy, stamina and agility
• Increase feelings of well-being

Tai chi has more than 100 possible movements and positions. You can find several that you like and stick with those, or explore the full range. The intensity of tai chi varies somewhat depending on the form or style practiced. Some forms of tai chi are more fast-paced than others, for instance. However, most forms are gentle and suitable for everyone. And they all include rhythmic patterns of movement that are coordinated with breathing.

Although tai chi is generally safe, consider talking with your doctor before starting a new program. This is particularly important if you have any problems with your joints, spine or heart.

Stress reduction and other benefits of tai chi

Like other practices that bring mind and body together, tai chi can reduce stress. During tai chi, you focus on movement and breathing. This combination creates a state of relaxation and calm. Stress, anxiety and tension should melt away as you focus on the present, and the effects may last well after you stop your tai chi session.

Tai chi may also help your overall health, although it's not a substitute for traditional medical care. Tai chi is generally safe for people of all ages and levels of fitness. Older adults may especially find tai chi appealing because the movements are low impact and put minimal stress on muscles and joints. Tai chi may also be helpful if you have arthritis or are recovering from an injury.

Despite its ancient history, tai chi has been studied scientifically only in recent years. And that research is suggesting that tai chi may offer numerous other benefits beyond stress reduction, including:

• Reducing anxiety and depression
• Improving balance and coordination
• Reducing the number of falls
• Improving sleep quality, such as staying asleep longer at night and feeling more alert during the day
• Slowing bone loss in women after menopause
• Lowering blood pressure
• Improving cardiovascular fitness
• Relieving chronic pain
• Improving everyday physical functioning

Learning to do tai chi

Wondering how to get started in tai chi? You don't need any special clothing or equipment to do tai chi. To gain full benefits, however, it may be best to seek guidance from a qualified tai chi instructor.

A tai chi instructor can teach you specific positions and how to regulate your breathing. An instructor also can teach you how to practice tai chi safely, especially if you have injuries, chronic conditions, or balance or coordination problems. Although tai chi is slow and gentle, with virtually no negative side effects, injuries are possible if tai chi isn't done properly. It's possible you could strain yourself or overdo it when first learning. Or if you have balance problems, you could fall during tai chi.

You can find tai chi classes in many communities today. Contact your local senior center, YMCA or YWCA, health club, community education center or wellness facility for help finding qualified instructors.

During tai chi classes, the instructor can give you personal guidance and correct any errors in your style before they become habit. Eventually, you may feel confident enough to do tai chi on your own. But if you like the social element, consider sticking with group classes.

Putting tai chi into practice

To reap the greatest stress reduction benefits from tai chi, consider practicing it regularly. Many people find it helpful to practice tai chi in the same place and at the same time every day to develop a routine. But if your schedule is erratic, do tai chi whenever you have a few minutes.

You can even draw on the soothing concepts of tai chi without performing the actual movements if you get stuck in stressful situations — a traffic jam or a work conflict, for instance.

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