CPAP Comfort Features

This is an excerpt from my forthcoming book, The 7 Day Sleep Apnea Solution: Get the sleep you need and the life you want. Please feel free to make comments and suggestions. If I select and implement your suggestions, I’ll acknowledge you in my book.
Although the basics of CPAP therapy hasn’t really changed dramatically over the past 30 years, various comfort features have been developed which can make a difference. 
In early years of CPAP, humidification was only an option. Now it’s generally a must. This is one of the most important aspects of helping to use your CPAP machine, but is also the one feature that creates so many problems and headaches. As you can imagine, regular cleaning of the water chamber can be a challenge for many people.
For many new CPAP users, it’s difficult to fall asleep with a mask attached to your face and with forced air blowing in. Most machines will have a ramp feature, where the pressure is gradually raised to reach your set pressure over a predefined timeframe. One problem with using this feature is that any mask leaks may not show up until you’ve reached your optimal pressure. To solve this potential problem, another solution is to perform the mask fit test, where a button press can give you 10 seconds of a relatively high pressure, so you can tell instantly if you’re having a leak.
One complaint about CPAP is that it’s hard to exhale, even at low pressures. Before moving on to a more expensive bilevel device, a new feature that tackles this problem is to provide a slight lowering of the pressure at the beginning of exhalation. It’s not a sudden, flat lowering like with bilevel devices, but a brief lowering that comes back up to the prescribed pressure very quickly. The magnitude of this pressure relief can be manually adjusted by the user. Some trade names for this function include EPR (ResMed), and C-Flex or BiFlex (Phillips-Respironics). 
Although I’ve had lots of patients tell me that they like the expiatory pressure relief feature, research studies have reported conflicting objective findings on the benefits of this feature.
Another common problem with CPAP uses is what’s called rain-out. Since the air being forced through the tube is humidified, and if the room air temperature is cool, water vapor inside the tube can condense, forming drops of water. This will lead to a gush of water coming out of your mask at times. There are a number of ways of dealing with this issue (which we’ll talk about in more detail in Chapter x) but one option to to maximize humidification or to upgrade to heated hosing. Manufacturers now use sophisticated algorithms along with heated tubing to minimize rainout. You’ll find various names attached to this technology, including Climate Control (ResMed), System One Humidity Control (Phillips-Respironics), Ambient Tracking (Fischer & Paykel), and ThermoSmart (Fisher & Paykel).
Fisher Paykel has a new feature called Sense Awake. It detects when you wake up completely at night and instantly lowers the pressure, so it won’t prevent you from falling back asleep. Not being able to fall back asleep again while using CPAP is a very commonly reported problem.
This next option isn’t really a comfort feature, but the machines are getting smaller and smaller. Some of the newer models don’t even look like a medical device. One model in particular (Fisher Paykel) looks like an alarm clock.
With all these new “comfort” features, it’s difficult to predict of you will be able to sleep better overall if you have any or all of these options. Some people tell me that it does help, but others tell me that it doesn’t make any difference. Everyone has different preferences, and so you can’t say that one manufacturer is better than another. 

Next: Basics of CPAP Masks

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One thought on “CPAP Comfort Features

  1. my BiPAP had a feature that had to do with the sensitivity of the device detecting my inspiration, to know when to give me the breath. I had it on the most sensitive setting and still I noticed it not sensing some of my breaths. then my smartcard data would show a lot of centrals, but I knew it was just because the device wasn’t sensing my breathing. so while you said in a different section that you thought the auto devices could replace a titration, I don’t think they are sensitive enough for some people. maybe for someone with hypoxic OSA with obvious airway collapse, but maybe not for someone with UARS who has more subtle breathing abnormalities that are hard to detect even in the most sensitive sleep studies. using an autoCPAP the machine gave me an average pressure of 7. Stanford titrated me to 12-13. this makes you wonder about people who do not tolerate CPAP; could it be they are just not getting the pressure they really need, they rip the mask off because it adds to their sense of suffocation. this might be happening with auto devices or people whose titrations are inadequate because not all their nasal flow limitations are corrected.