Sleep Apnea can be debilitating for people suffering from it. There are a ton of side effects from a lack of sleep and even more from long term Sleep Apnea. In this blog we are going to discuss the signs of Sleep Apnea, side effects, and issues that arise from long-term Sleep Apnea.

What exactly is Sleep Apnea?

Sleep Apnea is when your airway closes off and you stop breathing while you sleep. When you sleep your muscles relax allowing your airway to close off momentarily. For it to be considered Apnea the breathing must stop for at least 10 seconds. Of course, when you stop breathing your oxygen levels drop and your body forces you to wake up or at least partially wake up. This means that not only are you stressing your heart and body from low oxygen, but you are not getting proper sleep. There are a ton of issues that can arise from Sleep Apnea.

Are there different types of Sleep Apnea?

There are different types of Sleep Apnea. The main form of Sleep Apnea is Obstructive Sleep Apnea. There is also a type of Sleep Apnea known as Central Sleep Apnea which we can explain later. Sleep Apnea is gauged by your AHI (Apnea Hypopnea Index) which is the amount of Apnea you have per hour on average. That is averaged by totaling all of your Apneas and your Hypopneas and dividing that total by the number or hours you slept.

Types of Sleep Apnea:

• Obstructive Apnea– This is when you stop breathing for at least 10 seconds before resuming.
• Hypopneas– This is a partial restriction of your breathing with the addition of your oxygen levels dropping at the same time
• Central Apnea– This is when you stop breathing, but it is because your brain isn’t telling you to breath. This type of apnea is very serious and needs to be treated with particular therapies that your doctor would set up.

Does everyone have Sleep Apnea?

We are asked this question by a TON of customers here. To answer this question, I will offer some statistical info as well as some personal experience. We coordinate a bunch of Home Sleep Testing with a few Board-Certified Sleep Physicians. When we receive the results back, we note whether the person has Sleep Apnea or not. You must keep in mind that people testing with us have one of two reasons for that: they think that they have Sleep Apnea personally, or someone else thinks that they have Sleep Apnea. Out of this predisposed group of people we have seen a 60/40 split on most months. 60% have Sleep Apnea and 40% don’t. Additionally, my wife and I both tested for Sleep Apnea. I came back in the normal range, and she came back with Mild Sleep Apnea. So, the answer is no. But how would you know if you do?

What are the symptoms of Sleep Apnea?

The symptoms of Sleep Apnea are very wide ranging. That is because restful sleep and breathing are both very important parts to a healthy life. If you have Sleep Apnea you stop breathing and get terrible sleep. So those two issues can show up in a number of ways.

Signs of Sleep Apnea:

• Being tired during the day
• Falling asleep during normal daytime activities
• Snoring while sleeping
• Noticeable pause of more than 10 seconds while asleep
• Poor blood test results
• Tossing and turning in your sleep
• Grinding your teeth while sleeping
• Dry Mouth in the morning

What happens if you don’t treat Sleep Apnea?

This question can also have very wide-ranging results. Again, if you deprive your body of oxygen and continually miss out on sleep, your body will suffer. These issues can also snowball leading to other problems. For instance: not sleeping can lead to weight gain and weight gain can lead to all sorts of problems. There have been so many studies linking Sleep Apnea to all sorts of other diagnosis and comorbidities that we could not scratch the surface listing them here. However, there are some big issues that jump out.

Top issues from untreated Sleep Apnea:

• High Blood Pressure
• Kidney Disease
• Lung Disease
• Stroke and Heart Failure
• Weight gain from metabolic issues

Personal Experience with treating Sleep Apnea:

I am a pretty skeptical in regard to pretty much everything. I really just have to experience something myself before I will get behind it. So, my wife and I decided to try our process for ourselves. My wife, Caitlin, and I took home our Sleep Apnea Tests and went through the process. I tested negative and had really consistent heart rate and blood oxygen through the night. She showed mild Sleep Apnea and her heart rate and oxygen were very inconsistent. The doctor interpreting the results recommended that she try CPAP therapy. She was not convinced and decided not to do that (even though tons of our customers use and love CPAP). After about 6 months she finally gave CPAP a try. She started with a nasal mask and only got about 3 hours of sleep on the CPAP before taking it off. Even with that little usage she was a different person that morning. She progressed to using a full-face mask and wearing the CPAP through the entire night over about 2 weeks of acclimation. She noticed quite a few positive things, and now will not even travel without taking her CPAP along to use while sleeping.

What did Caitlin Experience?

• Stopped grinding her teeth while Sleeping– This really affected me as much as her, but she noticed a lot less jaw pain during the day because of that.
• No more snoring– She didn’t snore bad enough to wake me up, but I always tried to get asleep before her to avoid hearing it.
• More morning energy– She has always been more of a night owl and definitely not a morning person. That changed significantly when she started CPAP. She had much more alertness in the morning and went to bed much earlier. She says that she even falls asleep much faster when wearing the CPAP.

What can I do to help my Sleep Apnea?

The truth about Sleep Apnea is that in most cases it is due to being overweight. That means that the first and most effective thing that you can do is lose weight. However, that can be tough to do when you aren’t sleeping. We have all seen that move with the fat guy saying, “I eat because I’m unhappy, and I’m unhappy because I eat”. Well, dealing with Sleep Apnea can be a lot like that. You might be saying, “I don’t exercise because I’m so tired”. Well, there is some truth to that. If you’re not sleeping, your metabolism suffers, which leads to more weight gain and a MUCH tougher time losing weight. In some cases, we have had customers start CPAP therapy, and then be able to stop using CPAP after losing a lot of weight.

Things to help reduce Sleep Apnea:

• No alcohol before bedtime
• Weight loss
• Avoiding sedatives around bedtime
• Exercising
• Sitting up in bed while sleeping

What is Heated Tubing for CPAP?

Heated Tubing for CPAP machines in a fairly common addition to CPAP Therapy. Heated Tubes are designed to keep a stable temperature and humidity level from the outlet of the CPAP to your airway. It does this using heated coils that are powered by a connection to the CPAP machine. In most cases the Heated Tube will connect to the CPAP via a small electric plug. You can adjust the temperature of your CPAP tube to reduce condensation and to keep the air you are breathing comfortably humidified.

Do I need Heated Tubing for my CPAP?

Whether or not to add a Heated Tube to your CPAP is usually a pretty clear choice. For most CPAP users it is important to strike a comfortable balance of humidity in the air that you are breathing. As you adjust the humidity setting up on your CPAP you may encounter rain-out or excess condensation. That is because the CPAP is adding more humidity than your rooms ambient temperature can hold. It literally rains in your tube because the air cools as it travels through the tube to your airway. To remedy this, a heated tube will keep a constant temperature the whole way through so that the rainout doesn’t happen.

Why did I receive Heated CPAP Tubing with my order?

In many cases a heated tube is a standard part of a CPAP order. That is because it allows the CPAP user to add more humidity than would normally be possible in your ambient room conditions. In many cases this will help a new CPAP user to acclimate more easily to CPAP therapy. In other cases, you may receive heated tubing because it pays more. Whether you are purchasing with cash or using insurance heated tubing costs more. So be careful. If you do not need heated tubing, then you may want to look into standard CPAP tubing in an effort to reduce long term cost of your CPAP therapy.

Can I switch to Standard CPAP Tubing from Heated Tubing?

Yes, you can. You might even save some money! The biggest question that you need to answer related to that switch is whether or not you will get enough humidity with a standard CPAP tube. The only way to know is to try. You can substitute the standard CPAP tube for your heated tube. Then adjust the humidity to your comfort and see if you have condensation issues. Much of that issue can be related to your location in the world as well as the time of year. Some areas and sometimes of the year may be drier or more humid as well as colder or warmer. Your needs can change seasonally as well as where you are located.

What are the downsides to Heated CPAP Tubing?

Heated tubing for a CPAP can be very helpful, but is it always a better option? Let’s look at the downsides.

• Weight– Heated tubes are quite a bit heavier than standard tubing. That means that if you move around a lot in your bed, you will be pulling a considerably heavier tube with you.
• Flexibility– Standard CPAP tubing is much thinner and in turn much more flexible. That gives you a little more freedom of movement in bed while using your CPAP.
• Cost– Heated tubing is at least 4 times more expensive than standard tubing. For instance, standard tubing runs less than $10 per tube while heated tubing can be as much as $49. Even if you are operating through insurance the cost difference is significant. To determine the difference in insurance cost you would compare the A4604 (heated tube) procedure code to the A7037 (standard tube) procedure code.

How do I get the right Heated Tube for my CPAP?

Every CPAP that has a heated tubing option must use a specific type designed for that particular CPAP. For instance, the AirSense 10 CPAP from ResMed must use the ClimateLine Air Heated Tube. Because these tubes connect in a very particular way to the CPAP, they are not universal. With that being said, not all CPAPs have a heated tubing option. An example of that would be the AirMini Travel CPAP from ResMed. You can only use the standard non-heated tubing that is designed for the AirMini with that particular device. If you require heated tubing, you should certainly do some homework to make sure that your new CPAP has that option.

Can I use oxygen with my Heated Tube?

You can use oxygen with the heated tube. However, you will need to place your oxygen adapter at the junction of the CPAP mask and tubing instead of at the air outlet on the CPAP. You may also be able to purcahse a specific heated tube with oxygen adapter. Such as the ClimatelineAirOxy tube. Additionally, we have a great video that goes over How to Connect your CPAP to Oxygen that you can watch here. 

Downloading your iBreeze CPAP Data

The iBreeze CPAP machine is extremely new to the CPAP world here in the US. Because of that, not only are customers reaching out about compliance downloads, but so are our competitors. So, we figured it would be best to put out a full tutorial to explain how to use the iBreeze Compliance system. Currently, there are two versions of the iBreeze CPAP. The first is the standard SD card version which will only allow you to upload data via the SD card. The other version has a WIFI option, and it will allow you to link your iBreeze CPAP your home WIFI. The WIFI option will automatically upload your data so that your CPAP provider or doctor can view the data remotely.

What Software do I use to download the iBreeze CPAP?

There are two ways to produce a compliance and therapy report on your iBreeze CPAP machine. The first is via the local software option. That software is called the iMatrix Compliance system. We will explain that in detail below. The next and better option is to use the cloud-based version of that software which is called ResAssist. We will go into detail on that option below as well.

iMatrix Software for the iBreeze:

The first step to using the iMatrix software is to download and install it on your computer. It is a pretty large file. So, you may need to use the Zip tool to perform the download. A link to the iMatrix software can be found in the Product Specifications section of the iBreeze CPAP listing on our site. Once you have downloaded the software to your computer, you can then open it up and get started. Once you open the software you can add yourself as a patient and enter your iBreeze CPAP serial number. Then you will be able to use the Download function to pull the data from your SD card. Once you have that information uploaded to the software you can pull compliance and therapy reports for any time frame you need.

ResAssist Cloud software for iBreeze:

The cloud-based software for the iBreeze is called ResAssist. You can access that via the website; however, you will need login credentials. Those credentials should come from your CPAP supplier. Here at CPAPmyway we give you access with a username of your patient ID number and password of CPAPmyway. Then you can change those credentials on your own after logging in. We also preemptively load your iBreeze CPAP information into the cloud so that you have immediate access for downloading your data. If you are using a WIFI enabled unit you will be able to see the data, there and can produce reports. If you are using the SD version of the iBreeze then you will be able to use the “Upload Data” function to upload your CPAP data via the SD card. When you click the Upload Data button, then you will select the SD card on your computer and the data will populate.

Creating the Compliance and Therapy Report on iBreeze software:

Producing the report is pretty simple in the software. You can simply hit the “Create Report” button on the right side of the screen. Then you will see a preview report. Next you will select the appropriate Report Date Range for your needs. Once you get the right range, just hit print. You will be able to print a nice clean PDF that will show you everything that you or your doctor need. Your Compliance Percentage will be found in the > 4 hours days section.  

  Whether you call it APAP, Auto CPAP or Auto-Titrating CPAP you get the same result. For the sake of the article, we will call it Auto CPAP. Auto CPAP is a form of Positive Airway Pressure therapy. In the Auto mode the CPAP machine will adjust to the best pressure for your needs every night. This therapy is by far the most widely used at this point. Very few CPAP users are going the route of a Lab Study, Titration, and fixed pressure CPAP therapy.

Why is Auto CPAP the best Choice?

You always should consult with your doctor to determine what therapy option is best for you and your Sleep Apnea needs. With that being said almost all of the Sleep doctors that we work with are ordering Auto CPAP instead of Fixed Pressure CPAP. This is because of a few different factors:

1. Insurance Authorizations for Sleep Studies– In many cases your insurance carrier will not authorize a Lab Sleep Study. This is where you spend the night in a lab. These are very expensive, and the Home Sleep Test options have become much more accurate and cheaper. If you do a Home Sleep Test, then you must use an Auto CPAP due to the fact that you cannot be titrated for Fixed Pressure CPAP in the lab.
2. It actually works– Not only does Auto-CPAP allow you to titrate in your own home, but it actually will report on how well it is working. You can follow up with your doctor after using Auto CPAP for a few weeks and they will be able to tell you how well your therapy is working for you. If it isn’t then you can work with that doctor to take next steps.
3. Things Change– Whether you have gained or lost weight, drank alcohol before bed, or started new medications, your sleep can change with time. The nice thing about Auto CPAP is that it will change with you. So, if you lose weight and need less pressure or got sloshed on Busch light and need more pressure, the Auto CPAP will make the adjustment.

How does Auto CPAP work?

All Auto CPAPs have their own proprietary algorithm that monitors your breathing and adjusts the pressure accordingly to account for Apnea. To simplify that all the way down, as you stop breathing (Apnea) the pressure increases slightly until your airways are opened. The differences between Auto models usually have to do with how quickly the unit adjusts and by how much. Some models adjust up and down slowly so that you can adjust more easily. These models are great for first time users. Other models are more aggressive and will adjust more dramatically. These models are great for Severe Sleep Apnea and those that are already accustomed to CPAP therapy. Many models allow you to select a more aggressive or less aggressive algorithm to help you find a more comfortable CPAP therapy.

What is the difference between CPAP and Auto CPAP?

CPAP is usually referring to a Fixed pressure CPAP. This means that when you turn on the CPAP it will go to one pressure and stay there at all times. That pressure is usually determined by a Sleep Lab Titration Study. Auto CPAP is a CPAP that Automatically adjusts to the best pressure for you on a nightly basis. This means that no matter what you night is like, your Auto CPAP will work to provide the most suitable pressure for your therapy needs.

What is the downside to Auto CPAP?

While there are a lot of great things to love about Auto CPAP therapy, there are downsides:

1. It takes time– The first issue is that it takes a little time to adjust itself to your best pressure. For many long-term CPAP users this can be a big problem. If you are accustomed to a certain pressure on your old CPAP, and you switch to Auto CPAP it will take time to adjust. More than likely, it will get to a comfortable pressure over the first week or two.
2. New CPAP users give up– Another issue with a delay in proper therapy pressure is new users giving up before they get proper therapy. If you are starting CPAP and wake up feeling the exact same, it can be frustrating. So, when new users begin on Auto CPAP and do not get past those initial few days out of frustration they may quit.
3. Maybe you need more than a CPAP– For some people suffering from Severe Sleep Apnea you may need more than just a CPAP. This would be easily determined in a Lab Study but may not be if you did a Home Sleep Test and started Auto CPAP at home. That is why it is important to keep a close eye on your Therapy Data from your Auto CPAP report to make sure that you get a proper reduction in your Sleep Apnea.

How do I know if Auto CPAP is working for me?

The most important thing is to treat the Sleep Apnea. Luckily, almost all of the newer Auto CPAP models record and report on your therapy in detail. These detailed reports will allow you and your doctor to monitor your Usage and Therapy to determine how well it is working. You will see things like AHI, Mask Leak, Hours of Use, and more. You and your doctor can use this information to make certain that you are receiving benefit from you Auto CPAP. If you are not, your doctor can help you move to a therapy more suitable to your needs.  

DreamStation 2 Foam Update

We have had a ton of customers asking us about the new DreamStation 2 CPAP Foam. As distributors of Philps Respironics products, we do our best to provide information to our customers as we receive it. This means that we are passing along the information from Philps Respironics and the FDA. We understand that many have reservations trusting these sources. That is certainly understandable. However, we must move forward with the information that we have at hand. So here we go.

Did the Dreamstation 2 Foam fail an FDA inspection?

According to Philips, the FDA did inspect their manufacturing plant and tested some of the devices there to ensure that they passed required metrics. During that inspection there was a device that failed the VOC (volatile organic compounds) limits. Many people read that FDA inspection and assumed that the device that failed was a DreamStation 2 CPAP. Using that assumption, many theorized that the DreamStation 2 CPAP would be recalled next. Fortunately, that was not the case. Philips Respironics announced that the device that failed inspection was not a DreamStation 2 CPAP. The device was an unreleased version of an A-Series Bipap. They also reiterated that the DreamStation 2 Foam as well as the foam used in the repair kits have passed all necessary inspections and are safe.

What kind of foam is in the Dreamstation 2 CPAP?

Obviously, you would not want to use the same foam in the DreamStation 2 CPAP as the DreamStation original version. Luckily, Philips went with a completely different version. The original foam found in the DreamStation 1 was a PE-PUR (Polyester based polyurethane) Foam. This original foam produced VOC (Volatile Organic Compounds) that could be harmful to people breathing them in. The Foam found in the new DreamStation 2 CPAP is a Silicone based foam. This new silicone-based foam has been inspected by the FDA and has been approved for use in the DreamStation 2 CPAP.

Can ozone hurt my DreamStation 2 CPAP?

One of the largest contributors to the foam breakdown (according to Philips) was use of Ozone on the CPAP. The long-term use of Ozone can be harmful over time. Ozone is Ionized Oxygen, and that is certainly a corrosive element. This means that over time it can break down metals and plastics. That will obviously cause early breakdowns of your CPAP. That is obviously something that you should consider. For many CPAP users a cleaner like the SoClean has been a great option for them and has been really beneficial. So, you would need to weigh out the consequences of using Ozone on your CPAP verses the benefit of the integrated Cleaners. Additionally, both ResMed and Philips have issued statements that they do not recommend using Ozone to clean their CPAPs. They have even stated that it may void your warranty.

What other options do I have for Cleaning my DreamStation 2 CPAP?

Philips recommends that you use a soap and water mix for cleaning the washable portions of your CPAP. They do not recommend any cleaning of the CPAP device itself, outside of wiping it down. Check out our DreamStation 2 Maintenance video here. With that being said, there are ozone options that do not intrude into your DreamStation 2 foam. Those cleaners use a separate bag and clean the cleanable parts separately from the CPAP machine. This keeps the ozone outside of your CPAP. One great option for this is the Sleep8 CPAP Cleaner. You can also use UV Cleaners such as the Liviliti CPAP Cleaner.

The most recent update for the DreamStation Recall

It has been a long 6-7 months in the CPAP world. Most of that due to the unprecedented recall from Philips Respironics. With that being said, there are some relevant updates. Here is what you need to know.

Recent FDA Inspection Findings for DreamStation Recall:

Philips has received a lot of questions regarding the FDA’s published Form 483 report. That is because in that report the FDA documented that a Philips Respironics unit failed the VOC (Volatile Organic Compound) test. That was extremely concerning, because that was the major reason for the initial recall. Many people assumed that the VOC test failure was on the DreamStation 2 CPAP. Fortunately, it was not. The unit that failed was an unreleased design for a specific A-Series Bipap. Thankfully, the DreamStation 2 CPAP as well as the repair kits for DreamStation 1 CPAPs are all still approved as safe and effective.

Updated Recall Patient Recommendations:

When Philips initially announced the recall back in June 2021, the notice said, “Stop using your device immediately”. That was a pretty big shock to DreamStation CPAP users. It was also a pretty scary thing to say. Since that announcement the FDA and Philips have worked together and decided to change that recommendation. Now the recommendation says to “Consult with your Physician”. See the FDA recommendations here. That is a big change for DreamStation users. This means that they believe the risk of something bad happening because of an affected device may not be as potentially harmful as not treating your Sleep Apnea. Of course, you should consult with your Physician to make that decision. For the latest updates and recommendations check out the Philips Recall Website. 

Recall Registration and Remediation Updates:

Philips states that it is working diligently to remediate the millions of devices that were affected by this recall. To date, there have been 4 million devices registered worldwide. Of those 10% have been completely remediated. This means that there is still lots of work still ahead. We have been advised that the recall is estimated to be completed by September of 2022.

Recall Prioritization Requests:

Philips Respironics has been involved in conversations with external parties regarding patient prioritization. As a manufacturer, they do not typically have the clinical background of the patient nor the direct interaction with them required to support the design of formal patient prioritization plans. However, upon request of the FDA, they will be collecting data on the patient registration web site to determine if a prioritization scale for the U.S. based on relevant patient health information from registrations would be a positive step. The scale is used in addition to several pre-requisites (e.g., the availability of a given device in stock). More details will be provided in due course.

What to expect in the first Quarter of 2022 for the Philips Recall:

Philips is still running around the clock in the recall and remediation efforts. They still expect to finalize the remediation of registered recall units by September of 2022. In addition to the massive number of units on the recall list, global supply chains are also disrupted. This means that while Philips does not expect any delays in their plan, things can change. They are ramping up continuously to accelerate the remediation efforts as much as possible.

Should I still be using my DreamStation 1 CPAP?

Continuing to use your DreamStation 1 CPAP is something that you will have to decide on in consultation with your Sleep doctor. This means that you will have to weigh out the risks of potential VOC (Volatile Organic Compounds) and foam degradation against not treating your Sleep Apnea. Philips has been inspecting old DreamStation 1 units pretty closely. Here is what they are saying about that.

Philips updated DreamStation 1 Inspection Statement:

“We are encouraged by the VOC test results to date for the first-generation Dreamstation devices, which we published in December 2021. The results indicate that VOCs do not exceed safe exposure thresholds specified in the applicable safety standards (e.g. ISO 18562). Using conservative health-protective exposure thresholds, the additional testing suggests no increased risk for adverse health effects in the general patient population nor the higher risk patient population as a result of VOC exposure. As we announced in December, it is important to note that the tested DreamStation devices were not exposed to ozone cleaning, as per the device instructions for use.”      

Accessing iBreeze CPAP Clinical Settings

The iBreeze CPAP is a great new option to the CPAP world. It has had great feedback so far but has only been widely available for a short time. This means that there isn’t a whole lot of information at hand to help CPAP users navigate the iBreeze. The information below will help you gain access to the Provider Clinical Menu on the iBreeze CPAP. This menu is designed to be accessed by your Provider or Clinician. So, it is not advised to make changes to your settings without first speaking with your Doctor.

How to access the Clinical Settings in your iBreeze:

The Provider Menu on the iBreeze is not difficult to access, but you do need the key. As with most CPAP models you have a series of buttons to hold down to gain that access. Below are the steps needed:

1. Make sure that your iBreeze CPAP is plugged in.
2. Press and hold the Ramp button on the top of the CPAP.
3. While holding that ramp button down also press and hold the round knob on the front of the iBreeze for about 5 seconds.
4. You will see the Prescription and Mode settings appear on the left side of the screen. You are now in the Provider Menu.
5. To Exit the Provider Menu simply repeat the steps to get in, by holding the Ramp Button and front round knob for about 5 seconds.

Navigating the iBreeze Provider Menu Clinical Settings:

It is once again worth noting that your Clinical Settings are prescribed and preset to your needs by your Doctor. Changes to these settings should only be made with supervision of your treating physician. Below is a list of the Settings that you will find in the Provider Menu:

• Mode Selection– This is found with one click to the left at the top of the screen. It will read APAP or CPAP. You can click and change that setting from Fixed Pressure “CPAP” to Auto CPAP “APAP”.
• Therapy Settings– Below the Mode Selection will be your APAP or CPAP settings. Highlight and select the setting to change it to the desired setting.
• R-Care Setting– This setting can be enabled or disabled. It will adjust the aggression of the iBreeze Auto CPAP algorithm.
• E-Comp Setting– This setting is only seen when in the CPAP mode. It can also be enabled or disabled to help with CPAP comfort.