Northumbria HealthcareNHS Foundation Trust

Sleep Apnoea and CPAP treatment

Issued by Lung Function Department

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What is sleep apnoea? People with Obstructive Sleep Apnoea (OSA) experiencerepetitive episodes of complete, or partial obstruction of the upperairway during sleep, preventing air from entering the lungs untilthe obstruction is overcome. These periods of obstruction of theairway (apnoeas), only become clinically significant if they last formore than 10 seconds each time, and occur more than 10 timesevery hour. The lower airways (windpipe and airways leading into each lung),are held open by cartilage, the upper airway is fleshy and relieson muscle tone to keep it clear. When you are awake you havesufficient muscle tone to keep the upper airway open, howevermuscle tone is reduced when you fall asleep.

Various things can increase the risk of the upper airway collapsingduring sleep: l Obesityl Narrowed airway (recessed lower jaw, large tongue or tonsils)l Reduced muscle tone (due to drugs, including sleeping tablets

and antidepressants, or alcohol)l Blocked/partially blocked nose, making it harder to draw air into

the chest.

When the airway collapses your body makes ever increasingefforts to overcome the obstruction until it succeeds, typically witha loud snort. These efforts tend to waken you partially orcompletely. You are usually unaware of these awakenings as theytend to be very brief. In people with OSA these episodes occurmany times throughout the night, preventing them from gettingenough deep restful sleep. As a consequence they tend to feelvery sleepy during the day, which affects all aspects of daily life.Untreated severe sleep apnoea is associated with high bloodpressure, type II diabetes, increased risk of cardiovascular eventsand stroke.

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How do I know I have sleep apnoea?People with sleep apnoea may complain of excessive daytimesleepiness often with irritability or restlessness, but it is normallythe bed partner, family or friends, who notice the symptoms first.

Sufferers may experience some of the following:l Loud heavy snoring, often interrupted by pauses and gasps. l Excessive daytime sleepiness, e.g. falling asleep at work,

whilst driving, during conversation or when watching TV. (Thisshould not be confused with excessive tiredness with which weall suffer from time to time).

l Not refreshed after sleep.l Irritability, short temper. l Morning headaches. l Forgetfulness. l Changes in mood or behaviour. l Anxiety or depression. l Decreased interest in sex.l Passing water overnight.

Remember, not everyone who has these symptoms willnecessarily have sleep apnoea. There are many causes ofdisturbed sleep, and all people may experience some of thesesymptoms from time to time. People with sleep apnoea suffersome or all of these symptoms most of the time.

To determine whether you are suffering from sleep apnoea youmust first undergo a 'sleep study'. This will usually involve taking apiece of equipment home to set up and wear overnight, which willrecord your breathing and oxygen levels during sleep.

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You will be shown how to set it up when you attend the lungfunction department.

The recordings that are made are:l chest and abdomen movements l nose airflow and snore l pulse oximetry - heart rate and blood oxygen level monitoring l body position.

Treating sleep apnoeaLife-style changes, including weight loss and avoiding alcohol, areimportant but usually do not completely control OSA except if thecondition is mild or the weight loss marked.

If the sleep study confirms you suffer from sleep apnoea you willusually be given a trial of Continuous Positive Airway Pressure(CPAP) therapy. This is the “gold standard” treatment for OSA.

A CPAP machine is a pump which blows air through tubing,connected to a mask that you wear over your nose or your noseand mouth. The air is blown at just enough pressure to splint yourupper airway open, preventing it from collapsing during sleep.This is similar to inflating a bicycle tyre; when the tyre is flat youcan easily pinch the side walls together, but this becomes verydifficult once the tyre is inflated.

Benefits of CPAPOnce the airway is prevented from collapsing by CPAP you willachieve deep restful sleep. Your symptoms, including snoring andexcessive sleepiness, should be controlled. Most patients tolerateCPAP and the response is often dramatic. In others it can takesome time to get used to wearing the mask, however it is usuallywell worth the effort.

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Care and maintenance of CPAP and maskEvery day: Mask cushions need to be wiped to remove sweatand grease which can accumulate and affect the seal. We wouldrecommend a non-moisturising soap (washingbaby wipes and skin cleansing wipes are not recommended).

Every week: The complete mask needs to be thoroughly cleaned,the headgear needs to be washed (hand wash or machine 30ºC),

to be rinsed and hung to dry. Wipe the CPAPdamp cloth.

Every 3-6 months: Change the air filter, under the plastic cover atthe back of the machine. Some machines have washable filters

Every year: We will service your CPAP when you attend thesleep clinic for review, and replace mask parts as necessary.

If you use a humidifier:Every day: chambers must be emptied and refilled, filtered water is

cool water.

rinse with a mild white vinegar and water solution.

Warnings:If there is visible damage or wear to the mains cable returnimmediately for replacement.

Never move the CPAP with the humidifier chamber in situ, watercan cause serious damage to the CPAP unit.

up liquid is ideal,

some masks can be washed in a dishwasher up to 60ºC or cleanedin hot soapy water, .thoroughly check your mask information leaflet

The tubing also needsunit with a clean

check with the physiologist if you are not sure.

recommended if you have a water filter jug or use pre-boiledThe chamber should be rinsed with soapy water, if lime scale builds up

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Alternatives to CPAP If you cannot tolerate CPAP therapy you may wish to try wearinga “mandibular advance device/splint”. This is a gum shield thatholds the lower jaw forward, reducing the risk of the airwaycollapsing. These devices are best fitted by a dentist with relevantexperience and are more appropriate in mild to moderate OSA.

Some patients only suffer from OSA when they sleep on theirback. Patients can train themselves to avoid sleeping on theirback, which may avoid the need for CPAP therapy.

Common strategies include:

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2.

Using 'training golf balls' stitched to a vest to make it uncomfortable to roll onto your back.

Using sleep position training belts or vibrating sensors whichwe can advise you about if necessary.

RisksUp to one fifth of accidents on motorways and other monotonousroads and 10% of all accidents are caused by excessive sleepiness.

If you feel sleepy for any reason, or if your ability toconcentrate is impaired, you must not drive.

If you are diagnosed with OSA and start CPAP, or alternativetreatment, you will be able to drive once symptoms of unduesleepiness and poor concentration are controlled.

Most patients require CPAP; regular use of your mask system isimportant to maintain control of symptoms and to enable safe driving.

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The key DVLA guidelines are below

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ContactsLung Function Department 03 44 811 8111 extension 2657North Tyneside General HospitalRake Lane, North Shields NE29 8NH

Lung Function Department 03 44 811 8111 extension 33793Wansbeck HospitalWoodhorn LaneAshington, Northumberland NE63 9JJ

The Lung Function Departments are open Monday to Friday9.00am to 5.00pm

In the event of problems occuring outside of normal workinghours (Monday to Friday 9.00am-5.00pm), most patients will beable to manage for 1 or 2 nights without CPAP treatment, with nodetriment to their health. Please remember you must not drive if you are excessively tired.You will be seen at the earliest convenience when the departmentre-opens.

*Always phone before attending as staff will not be availableevery day.

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CPAP ‘out of hours’ service – for emergencies onlyAn “out of hours” service is available for emergencies only whenthe Lung Function department is closed.

Patients who have very severe Obstructive Sleep Apnoea (OSA),obesity hypoventilation, or a combination of lung disease andOSA, who feel they cannot manage without CPAP are the onlypatients who should use this service.

If you feel that you fit the criteria stated and that you need to seekemergency help regarding your CPAP; phone the switchboard on03 44 811 8111 and ask for the ‘on call electronics engineer.’

You will then be speaking to an electronics engineer about theproblem. If things cannot be fixed over the telephone, and theengineer thinks they need to see the equipment you will be askedto attend your nearest urgent care centre (Hexham, North Tynesideor Wansbeck).

The engineer will meet you there approximately 1 hour later,please take your CPAP and mask with you.

The engineer will be able to fix CPAP (compressor unit) problemsin the event of a failure and, in the event of mask problems, beable to provide a basic hospital mask for short term use only.

You will then need to make an appointment to attend the LungFunction Department where usual service will resume.

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Sleep apnoea websites British Lung Foundation www.lunguk.orgSleep Apnoea Trust www.sleep-apnoea-trust.orgBritish Snoring & Sleep Apnoea Association www.britishsnoring.co.ukBritish Sleep Society www.sleeping.org.ukDVLA www.dvla.gov.ukHealth and Safety Executive www.hse.gov.ukObstructive Sleep Apnoea Online www.osaonline.com

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PIN 427/V4

Review date: June 2019

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