Successful CPAP involves educating patients about the CPAP machine, but education should also extend to the many CPAP supplies. These supplies can enhance compliance for both CPAP and bilevel system patients. It is important to know exactly what supplies patients may need before setting up the system. A good place to start is the sleep study report and the patient interview.

Many times, sleep study reports may indicate mask type, brand, whether the mask was nasal or full face, or if a chin strap or humidifier was used. How do you determine which supplies a patient may need? Even before showing patients what a CPAP/bilevel device looks like, it is crucial that you interview them. Ask if they have any questions pertaining to obstructive sleep apnea. Ask patients about the sleep study. Did they sleep well? What did they like or not like? A majority of patients have bad experiences for many reasons: because they were not at home; it was not their bed; the wires and leads were annoying; they had to sleep on their back; they are continually disturbed; the mask was too tight; and so on.

At Med Mart, we put our patients in a positive frame of mind. We tell them that now they will be sleeping in their bed, in their home, on their pillow, but with a different CPAP machine with no wires or leads to worry about—and they can sleep on their back or on their side. We want to know how patients sleep, breathe, and react to allergens, and whether their nose or mouth is dry when they wake up. By the end of the interview, we have an idea as to what type of CPAP supplies we need.

CPAP Masks
If your patient knows the type of mask used in the sleep study and they slept well, use the same if available. If it is not available, provide a mask that fits snug but not tight. Use features such as the forehead adjustment to keep the mask from applying too much pressure at the bridge of the nose. This is a sensitive area, because it is just skin and cartilage. Too much pressure may lead to discomfort and even ulcers.

If your patient suffers from allergies and complains that his nose is congested when he sleeps, this brings up a red flag. This patient most likely breathes with his mouth open. In this case, consider using a full face mask so that the patient will receive the prescribed pressure even if he opens his mouth.

If your patient is claustrophobic and does not like to have anything over his nose, consider an interface that just occludes the nostrils. Be cautious using this type of mask on patients with high pressures such as 14 cm H20 and above. Patients may complain of soreness and dryness in their nostrils due to having the air pressure blowing directly in their nostrils. In this case, even a humidifier may not be sufficient to keep the nasal mucosa moist enough.

If mask air pressure is high, the tendency for a mask to leak is greater unless you tighten the mask and stop the leak. Many times, the mask may be too tight and uncomfortable for the patient to tolerate due to the pressure exerted on the face for an extended period of time. If this is the case, patients may not be compliant due to an uncomfortable mask.

There is a mask that has a cushion-like effect, and as it is placed close to the face, it appears to want to grab hold of your nose. I have found that you do not need to adjust this mask as tightly as most others to prevent an air leak. This type of mask exerts less pressure on the patient’s face, even at high CPAP pressures.

Make sure patients know where the exhalation port is and its purpose. Let them know that the air leaking out of it is normal and does not need to be occluded. This will prevent calls about the supposedly leaky mask.

Educate patients on how to keep their masks clean through methods such as wiping the mask cushion daily with a warm damp cloth to remove facial oils and keep the mask soft. Instruct also to wash and disinfect on a weekly basis.

Chin Strap
How can you tell if a patient needs a chin strap? Ask your patient if he sleeps with his mouth open. If he does not know, ask his spouse if available. If the patient does sleep with his mouth open, chances are that he may need a chin strap to keep the air pressure from leaking out of his mouth.
If the patient is unsure if he sleeps with his mouth open, ask if his mouth is dry when he wakes up. Note that I did not say dry or sore throat. If it is just dry mouth, this indicates that he sleeps with his mouth open. Once again, consider a chin strap. If the chin strap fails to keep a patient’s mouth closed or an air leak from occurring, you may have to resort to a full face mask.
How will a patient know that the chin strap is not keeping his mouth closed or an air leak from occurring? The patient most likely will wake up with a dry mouth and probably feel tired since he did not receive the prescribed pressure due to the pressure leak.

Humidifiers: Heated Vs NonHeated
CPAP delivers an extra amount of air pressure through the nose that the nose is not used to. Most likely, the nose may not be able to humidify and warm the added airflow, leading to dryness in the nose and throat. The nasal mucosa may even get dry enough to crack and cause bleeding as well as a sore throat. This, of course, will be uncomfortable and may lead to noncompliance. It is our job to provide the patient with the supplies necessary to increase the chances of compliance. In my experience, compliance is enhanced with a CPAP humidifier.

The heated humidifier assists the nose in warming and heating the air pressure delivered by the CPAP or bilevel machine. Although it is more expensive, the heated humidifier is the best option. Patients can also regulate the amount of humidity that best suits their nose and throat.

The nonheated humidifier (or passover humidifier) is cooler, less humid, and lacks the ability to regulate the amount of humidity. Many patients do well using a passover humidifier, though not many. Depending on the insurance, patients may not have a choice between heated and nonheated.

CPAP Tubing
The most common CPAP tubing length is two meters, although there is a three-meter tube if your patient should ask for a longer one. The CPAP tubing can be delicate, and you should instruct your patient how to remove the tubing from the soft rubber ends. Attempting to pull the tubing from the area where the rings are may stretch the tubing and tear it.

CPAP Filter
Show your patient where the CPAP filter is and how to remove and clean it. Make sure patients know how often to clean the filter, how to place it back in the CPAP, and how often they should replace the unit. Stress the importance of keeping the filter clean so as not to impede the airflow into the CPAP. Instruct patients not to cover the area of the CPAP filter.

The more you know about your patients, the greater the chance of providing them with the equipment and supplies best suited for them. Notify patients when they are eligible for another set of CPAP supplies so they know when to call you back. This simple reminder may keep patients from using a mask that is not functional because they did not know when they could get replacement supplies. Effectively sharing your knowledge and paying attention to clues in the sleep study and patient interview are ultimately the keys to successful CPAP.

Chris Solitaire, RRT, RCT, is clinical services manager at Med Mart, San Antonio. He can be reached via email: jramon79@aol.com.