Sleep Apnea CPAP/APAP Knowledge Thread

BBC3

Member
10+ Year Member
CPAP TIPS FOR NEWBIES...: (I have been with CPAP for a good 10 years now so let me share..)

1. If you check out any CPAP Forums, you will quickly find THEY ARE LITTERED WITH MANUFACTURER AGENTS giving misleading, incomplete, and just poor information. I heard the expression "we are not the D.M.E." as they defended some stupid position/agrument in posts with folks enough to last me a lifetime in just a day or two around one of those places/ (E.G. IWEs - Idiots With Egos). Don't expect the rest of the world to have the mental capacity of us Mesoians.. LOL:eek::D:)
2. Use Nasal Pillow style mask(like I show below). The others are all too heavy, bulky, and disruptive to normal physiology. You can't even see around them well. Don't panic if you just got your setup as most of the equipment sellers will allow you to swap out the mask once for free on your first experience.
3. To help get used to it... At first take time and just chill in bed during waking periods (surfing or watching TV) to get used to wearing it. You soon won't even know you are wearing it. In fact, there will come a day when you don't even want to be laying down without it on. It does become a crutch...!
4. DO NOT try to tweak your own pressure up and get it "breathing for you" or whatever craziness you may be conjuring, because you lungs won't clear all the air. While on paper the claim to be, the mechanics of these systems are simply not this sophisticated. The KEY is to get high enough inhalation support to breath, but STILL ALLOWING lungs to completely deflate and clear all CO2, etc... This could subtly really get ya down. Your CPAP doc is taught to set you up on a low a pressure as possible anyway, just know that most have no real clue as to why.
5. DO NOT USE the RAMP Feature.. This is the feature which makes the machine start out around 4 and slowly work up to max pressure over a 30-45 min period. I don't have any idea why someone would contrive this claiming it helps. It does the exact opposite and makes you feel like you can't get enough air thru-put while you are still wide awake and breathing normally. If anything a new patient would want more pressure when they are just getting in bed so as not to feel air-constricted in any way.
6. Clean water reservoir for humidifier once a week with cleaning vinegar you can get at places like Walmart for 3 bucks a gallon. You can go longer when the reservoir is new depending on the air quality going thru the machine. Don't worry about hearsay about must use distilled water bullshit / BUT DO USE DECENT BOTTLED WATER. I found that it does not matter how distilled the water is, the machine pull room air across the water which deposits whatever is in the air in the water tank anyway. I got pissed once when I had to use a local hard water which had calcium and limestone in it which left massive deposits on bottom on humid tank thinking it was ruined and amazingly vinegar got the stuff off without even scrubbing. However, to get out the bacterial SLIME which will develop every week or two, you will have to scrub/wipe with a solid paper towel and vinegar . THE BIGGEST PROBLEM with using unclean water is that over evaporation cycles it will cause whatever is in the water to buildup on the bottom hot plate in the humidifier water box which is not a huge issue till you water runs dry one day and you are cooking it and its going up your nose like a rancid bong hit of whatever is stuck to the bottom of it.!
7. If you want to goof around and tweak your machine you can always HOLD DOWN the SETUP & POWER BUTTONS for 5 seconds will give you access to the machine's full SETTINGS which the equipment seller specs it will per docs orders. Its not rocket science short of knowing not to jack up your air and cause the issue I mentioned above. There is however at least one instance in which I am an advocate of turning up the air pressure by a couple of points. If you have a temporary cold/respiratory illness, this can be a life saver for a stuffed up nose. Also, you tweak your humidity setting if not using a sensing type hose, as well as turn off the Auto-Ramp. Be sure and take note of the Medical Equipment Seller's(DME's) settings which should have been given to them from Doc. Which brings to point that you can now check and be sure it did get set as doc recommended. It should be noted that a lot of these machines are cellularly monitored and can be adjusted by DME's while in use at your home. You can't even tell any more as there is no supplemental hardware visible or to be purchased (on the Resmeds anyway). You can opt out of this at the time of machine purchase if you tell them you don't want this. They won't ever take the time to review you and fuk with it regardless in my experience. And don't worry if you feel you goofed it up just take it back to them and let them check settings. No big deal.

On masks, I don't have any idea how anyone can sleep with any type "hard mask" on the face. Pillow style is the only way to go. The only reason to use anything other than a nasal pillow style is if your pressure is up over 10-12. The top mask will work up to a pressure setting of 14, I would imagine, if not more. The bottom picture is probably best 10 or below as it will tend to leak more at higher pressures due to comfort design.

This is the Go-To in decent comfort for all nasal pillows - IMHO..
Swift FX | ResMed
View attachment 96254

The mask (below) is the best I have ever found. Be sure and buy extra nose pieces cause they wear out and can tear due to how soft they are. Optimally, a pillow every three months. Might be able to make a year on just two pillows total if you are careful, but be sure and have a replacement on hand in case it tears so you will have something.. (and make sure and put it on correctly so you are not one of the idiots complaining that it dont work).

*** This one is also kinda wild because it has super thin sleeves (they don't really show in pics) that slip barely up in nostrils and the outside blows up with air grabbing the outside of the nose via air pressure. Works pretty good actually. It also comes with a really light strap (not shown) option that works well up to 8-10. NOTE: be careful when buying as if you see advertised under $80-$100, it may not have any straps in the package.
View attachment 96255
https://www.cpap.com/productpage/fp-pilairo-q-nasal-pillow-cpap-mask.html (CPAP.com - Pilairo Q Nasal Pillow CPAP Mask with Headgear)

Finally, I recommend the RESMED Brand entirely over the Phillips Respironics systems. I had issue after issue with Phillips which were insidious inclusive of main board defects which caused the machine to seditiously shut off on me in the middle of the night multiple times. Phillips won't even formally acknowledge the issue. But they did get busted for shitty equipment (ventilators) in hospital application which actually was a forces recall. They claim no one died, but that's pretty pathetic. IT IS JUST SO HARD TO KNOW WHAT TO BUY when you consider that your selling medical equipment provider will have a political preference so you take what they tell you. Plus once you start one brand its a scary proposition to change. Finally, all the CPAP type forums have some many company spooks and ignorant assholes giving poor information you can't tell which way is up. The factors that made me decide to use RESMED were determined over years of research, reading, and listening.

RESMED vs. Phillips Respironics (This is the big game I don't have other experience)
- First, It was apparently RESMED that came up with the original mechanical operating computer coding algorithms for a successful CPAP. I have also heard that Phillips copied or uses Resmed's coding anyways.
- Phillips just seems to not give a shit about product quality, IMHO. I won't even get into the implications of them putting out a mainstream machine that turns off on the user in the middle of the night and not formally addressing. And their website forum spooks WILL delete or shutdown any posts inquiring about equipment issues.
- The newest Resmed is COMPLETELY SILENT. This is an issue you find nothing but lies and bullshit at CPAP Forums claim who's is quietest. You can literally put you ear on the AirSense and not hear it. The Phillips System One is pretty noisy and gets noisier as time goes by. I have not seen or tries Phillips latest machine as their counter to Resmed Airsense, but fuk-em I hate their asses for all the trouble I went thru.
- With a years experience with Resmed now, I DO believe the algorithmic routine works better with Resmed. There were too many times I woke up in the morning with the Phillips just to marvel at how low the pressure had dropped thinking "neat". But this was probably the reason I woke in retrospect. When wearing the Resmed you truly don't know you are breathing on air pressue at any time its pretty astute. But when you consider these AUTOPAPS are supposed to make constant adjustments throughout the night and long term, any hint of improper operation can't be a good thing.
- The old Phillips System One was poorly designed physically speaking, as it is flat on top. I believe the latest Phillips is like this too. The problem is that dumbasses like me will tend to put things like BEERS on top of them from time to time which then causes water condensation to collect on top near the buttons and will enter the machine and damage the board (yes happend to me once):confused::(;). The Respironics has a smaller footprint on the nightstand and sits a little taller.
- Splitting hairs, I don't like that fact that none of the manufacturers seem to make a stainless steel humidified water tank. They are all plastic which with heated at least indirectly and brings to mind potential BPA and Plasticizer Chemical contamination concerns. Especially when you spend so much time using it. All seem to be aluminum when the heat meets as hotplate-to-water. The Phillips System One tank had a soft black o-ring which separated the aluminum from the hard plastic walls and top of the tank. I did not like this as my understanding is the softer the plastic, the more likely to emit BPA, etc under duress such as heat. I am not sure how the aluminum meets the plastic on my current ResMed machine as I dont see anything like that. I have not looked well I just hope it's not some funky glue but so far I have never smelled anything noteworthy when it has run out of water while heating away at the dry aluminum tank bottom so not sure on that. But I prefer not seeing that rubber ring for whatever reason.
- Finally, and the icing on the cake in my decision to switch to ResMed was seeing so many people saying that they were replacing their ResMed CPAPS simply because, "it was 10 years old now and thought they should", or that "they wanted to update to newer model". I NEVER HAD A PHILLIPS UNIT LAST TWO YEARS..!!! As minimally they start getting noisy as shit even if there are no other major known problems. I will also say that every time I replaced my Respironics with another Phillips and same machine it the new one always performed notably better, which indicates to me that they start to function improperly over time. Not good. Actually, the place I but mine switched their store brand which they sell. I was actually so scare to switch I thought about going elsewhere. Glad I did not.

- Disclaimer, I have only had ResMed about a year, but I can say I have never had an issue or even a reason to think about it. That was not the case at all with the other.

I don't endorse any site. I think I order masks from this place amongst other but not sure. I don't think this one dikkers with me over a fucking script to buy mask stuff. Don't recall for sure though. I think they will all hit ya for a script these days to buy a machine though/.

ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
https://www.cpap.com/productpage/resmed-airsense-10-autoset-humidair.html (AirSense™ 10 AutoSet™ CPAP Machine | Free Next Day Shipping | CPAP.com)
 
I will add pertaining to another thread and reported causes of sleep apnea (supposedly over 150 causes technically documented). I have come to believe that the majority of sleep apnea has to do primarily with lower mandible alignment and oral bite occlusion. In short our lower jaws grow forward, - and in order to make a proper bite during sleep, we must push our jaw back toward and into the airway. The bottom line is that even if you think you sleep mouth open, you will bite and clench during sleep, thus causing the issue if present. Most people simply dont fall asleep without securing their lower teeth behind the upper teeth as its not natural, and they don't fit together right like that. Walking around we don't realize this issue if present due to gravity and constant mouth use. The guy that invented the mouth positioner stuff is really on to something I think. However, to acknowledge that device would be to acknowledge this real issue which would have further $Rammification$.

To test, simply make a normal bite and do your teeth come together easily for a proper bite without straining to retract the lower jaw? Can you intentionally make your lower teeth go in front of the upper teeth as you can make them go behind with little effort? When standing is there a normal inclination for the tips for your front teeth to come together/clash? So, if you are one who's teeth tend to come together incisor to incisor (improperly) when relaxed this might be you. The final test is just lay there in bed and let those teeth come together touching on the bottoms tips of lower and upper front teeth(just tooth to tooth and not a full bite). NEXT, WHILE LAYING DOWN AND BREATHING NORMALLY, slightly pull your lower jaw back WHILE SLOWLY INHALING. You will quickly find it takes only about 1mm of rearward movement to totally cut off the air and not unlike some drunken Jar Head with his hands around your throat in you avg bar fight.. LOL

So if you are one who's lower jaw has grown forward ever so slightly over the years, unfortunately your body just won't sleep without locking jaws and attempting proper occlusion as soon and you fall asleep.

YES, steroid use and any type activity which promotes protein synthesis with regard to muscles and skeletal parts which we use will GROW. Steroid users also tend to engage in activities which encourage the natural production of GH. Yes the lower jaw, nose, etc, do grow OUT and FORWARD in the natural aging process FOR MOST. The lower jaw will logically grow out more than or prior to the upper JAW /maxilla (or top teeth whatever it's called), as it is fixed and does not move and get stressed as much. Body parts when stressed will get a natural GH dosing by the body as well and of course the more its used, the more... .. . I guess you could always start sucking your thumb again actually to get that upper moving out to match.:eek::p

So if the fix is that simple for many apnea sufferers, then why doesn't everyone just go and get the sleep apnea jaw splint to hold the jaw where it now sits per its current and natural tooth alignment? First Cpap docs aren't going to put themselves out of business. And if a simple oral splint would resolve, this might them be able to be handled by the likes of Dentists and regular docs. If you really want to consider adding some spice to the subject, the real fix is a considerable Mxlfacial surgery in which they will cut a couple of MMs of lower jaw out on both sides and remove the tooth above thus again resulting in proper bite/occlusion. Now you are talking a risky and pretty invasive surgery, jaws wired up for 8 weeks, and minimal braces hardware application. It would be interesting if someone could actually get a CPAP doc or physician of ANY TYPE to formally acknowledge this and get the surgery covered on insurance. You would be hard pressed as it only occurs in folks old enough that they are far beyond the "teeth straightening years", and we are talking 40-60k in medical expense. I don't think surgery is currently excluded for APNEA as they are more than happy to go in and MAIME your freggin throat which never works and makes things worse many times. Maxil guys make too much damn money to risk pissing of BC/BS short of an impact injury.. I will post up if I ever decide to risk the dime to buy that oral splint and give it a try.

Honestly thinking, there is one real caveat to using any type of oral splint or positioner, which is the risk of damage to the Temporal Mabible joint (TMJ disorder). The jaw joint appears to be able to sustain considerable rearward pressure and force during a bite. It does not work all that well biting while moving the lower jaw forward and strains the TMJ significantly. That's a bigger risk than it sounds like as a messed up TM Joint aint nothing to fuk with. They are not readily reparable (if at all), can be extremely painful, and long term misery just getting worse and worse once started. We are talking about our ability to eat peacefully. That's actually probably the reason I have not tried a splint yet.

 
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