THE IRISH SLEEP APNOEA TRUST
FREQUENTLY ASKED QUESTIONS (FAQ's)
Disclaimer: The information provided by isat.ie is not
intended to be medical advice. If you suspect that you have a sleep disorder you
should consult with a physician or other qualified professional for advice.
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does not endorse any products or services.
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A layman’s definition of Sleep Apnoea is ‘the cessation of
breathing during sleep’. When breathing stops the levels of oxygen
in the blood begin to drop. After a short time the lack of oxygen
causes a reflex response. This response forces open the airway with
a loud snort, maybe gasping breaths and loud snoring. There may also
be kicking and flailing of the arms.
- There are three different types of sleep apnoea:
- obstructive
- central
- mixed
Obstructive Sleep Apnoea (OSA) is the most common;
Central Sleep Apnoea and Mixed Apnoea are rare.
Obstructive Sleep Apnoea
Obstructive sleep apnea is caused by the obstruction and/or collapse of
the upper airway (back of throat), usually accompanied by a reduction in
blood oxygen saturation, and then an awakening (arousal) to activate
breathing again. This is called an apnoea event.
Why?
There are a number of factors:
Extra or loose tissue in the back of the throat, such as large
tonsils, large uvula, large tongue or long/floppy soft palate.
There may also be an obstruction/obstructions at the base of the tongue,
turbinate problems or nasal blockages.
A decrease in the tone of the muscles holding the airway open.
Central Sleep Apnoea
Central Sleep Apnoea is defined as a neurological condition where there
is a cessation of all respiratory effort during sleep (the brain
forgets to instruct the body to breathe), usually with decreases in
blood oxygen saturation levels. The person is aroused from sleep by
an automatic breathing reflex, so may end up getting very little sleep at
all. Note that Central Sleep Apnoea, which is a neurological
disorder, is very different in cause than OSA, which is a physical
blockage - though the symptoms are very similar.
Mixed Apnoea
Mixed Sleep Apnoea, as the name suggests, is a combination
of Obstructive and Central Sleep Apnoeas’.
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For any type of apnoea to be considered important it must
last at least 10 seconds in duration or longer. Clinicians usually
consider 5 or more of such apnoeas per hour to be of possible clinical
significance (less than 5 per hour is normal). However, another
important factor is whether the person is excessively tired during the
day.
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One of the best people to help you answer this question is
your spouse/partner. People with sleep Apnoea generally have the
following symptoms: -
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Loud, frequent and irregular snoring: The pattern of
snoring is associated with episodes of silence that may last from 10
seconds to as long as a minute or more. The end of an apnoea
episode is often associated with loud snores, gasps, moans, and
mumblings. Not everyone who snores has apnoea, by any means,
and not everyone with apnoea necessarily snores (though most do).
This is probably the best and most obvious indicator.
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Your spouse/partner indicates that you periodically
stop breathing or appear to be choking during your sleep, or gasp
for breath (witnessed apnoeas).
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Excessive daytime sleepiness: Falling asleep
when you don't intend to. This could be almost anytime you are
sitting down, such as during a lecture, while watching TV, while sitting
at a desk, and even while
driving a vehicle. You may have sleep
apnoea or another sleep disorder. Even if you don't literally fall
asleep,
excessive fatigue/tiredness could be a positive indicator.
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Body movements often accompany the awakenings at
the end of each apnoea episode, and this, together with the loud
snoring, will disrupt the spouse/partner’s sleep and often cause her/him
to move to a separate bed or room.
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Forgetfulness, that is, effecting the short term
memory, also a difficulty in concentrating, focusing and
completing repetitive tasks. Bouts of irritability and
depression are common. If working, a disimprovement in
performance over a period of time.
Would I not be aware of all these symptoms myself ?
Probably not. Most people with sleep apnea do not
realize that they are awakening to breathe many times during the night.
The arousal is slight, and people become accustomed to this, but it is
enough to disrupt the pattern of sleep so that they get very little deep
sleep or
REM sleep, and awaken feeling sleepy. A great many apnoea
sufferers go through a large part (or ALL) of their lives unaware of
their condition.
Likewise regarding daytime sleepiness: people with sleep
apnoea often are not aware of feeling tired or unusually sleepy.
The disorder develops over a number of years, and they are not aware of
the increasing symptoms and believe they feel "normal". Only after
treatment do they realize how much more alert and energetic "normal"
feels!
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As with most medical questions, if you have any doubt, the
best thing to do is see your doctor. Unfortunately, many doctors are
not very knowledgeable about sleep disorders. Our website contains a
list of
recognised sleep centres where proper treatment is available.
A referral from your doctor will be required. If you think that you
have a sleep disorder (are aware of a number of symptoms) do not be afraid
to tell your doctor that you want a referral to a sleep clinic.
The only definite way to diagnose Obstructive Sleep
Apnoea is to spend a night in a sleep lab undergoing a "polysomnogram."
This is probably what your sleep specialist (consultant) will
recommend. You may also be advised to lose some weight (if
overweight) and limit or abstain from alcohol before sleeping, while
awaiting treatment, as they can aggravate the symptoms of Sleep Apnoea.
Your doctor should refer you to a sleep disorders expert. On rare
occasions, a doctor may not take apnoea seriously enough. It has
been reported that some people have to actively prod their doctors a bit.
If your doctor seems inclined to pass the potential of apnoea off as
relatively unimportant, you may want to consider getting a second
opinion.
It's possible, but not definite. Some people snore
who do not have OSA. It's even possible, though extremely rare,
for someone who has OSA not to snore. (However, if the person has
excessive daytime sleepiness, he/she may have another type of sleep
disordered breathing, such as upper airway resistance syndrome,
or a different type of sleep disorder). Pay attention to the sound
and pattern of snoring: is it a steady, regular snoring, or is it
loud, frequent, and occurring in periodic bursts punctuated by periods
of silence, normal breathing, and/or gasping for air? The latter
is a very good indicator of OSA.
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There are thousands of "cures" for snoring. Most
of them are old wife’s tales that vary from ridiculous to dangerous or
both. Few of them are effective. Be aware that there
doesn't appear to be any guaranteed, safe "quick fix". However,
if you've been through a PSG (in a Sleep Disorders Laboratory) and
have been diagnosed as not having sleep apnoea, there are a few
things you can try:
-
If you're overweight, lose weight. Excess weight
on the throat can contribute to snoring (and, of course, is unhealthy
in general)
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Quit smoking. Again, this is a good idea in
general, needless to say, but the decreased lung capacity could
possibly have an effect on snoring, too.
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If you sleep on your back, try sleeping on your
stomach.
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The new procedure Laser-assisted
Uvulopalatopharyngoplasty (LAUP) could be helpful under
some circumstances. Be sure to read the section below concerning
LAUP.
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Absolutely! In rare cases, apnoea can be
fatal. Think about it! It is something that makes you
stop breathing something you consider not to be dangerous? It
has also been linked to high blood pressure and to increased chances of
heart disease, stroke, and irregular heart rhythms (arrhythmias).
Unfortunately, not all of the long-term effects of untreated sleep apnoea
are known, but specialists generally agree that the effects are harmful.
If nothing else, the continual lack of quality sleep can affect your life
in many ways including depression, irritability, loss of memory, lack of
energy, a high risk of auto and workplace accidents, and many other
problems. Medical Research indicates that people with untreated
Sleep Apnoea are more likely to die ‘before their time'.
This is not something to ignore or trifle with. While it isn't
usually immediately dangerous, don't take it lightly. If you
think it will go away by itself - don't - It won't.
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There are only a few effective treatments for OSA.
They fall into several categories: weight loss, surgery, dental appliances,
and a breathing-assistance device. The most popular and most effective
is the latter one, the use of a device which delivers air under slight
pressure to the airway by way of a nasal mask. There are several types
of positive airway pressure devices including, CPAP, Bi-level positive
airway pressure, and responsive and ‘smart’ airway pressure devices.
They are all variations on Continuous Positive Airway Pressure, or CPAP.
There is no guaranteed, permanent, device-free "cure"
for apnoea!
The type of treatment prescribed will depend on the type and
location of airway obstruction and on the person's overall health.
Obstructions can occur anywhere from the nose (deviated septum; swollen
nasal passages from allergies), the upper pharynx (enlarged adenoids; long
soft palate; large uvula; large tonsils), or the lower pharynx (tongue that
is large or situated far back; short jaw; short, wide neck with narrow
airway). The location of obstructions varies between individuals, and
an individual may have more than one obstruction.
Breathing-assistance devices
Continuous Positive Airway Pressure (CPAP)
"Nasal CPAP" is the treatment of choice for most people with
obstructive and mixed apnoea. It is the most reliable and effective
treatment in most cases. Hundreds of thousands of CPAP devices are now in
use treating obstructive sleep apnoea worldwide. An added advantage
with this treatment is the elimination of snoring.
It involves using a small air blower device connected via a hose to a nose
mask you wear while you sleep - much like a regular oxygen mask, with
straps to keep it in place. Essentially, this devices blows air into
your nose to keep your airway from collapsing and creating an obstruction
by increasing the air pressure in your airways. It isn't as
unpleasant as it sounds - most people get used to the sensation fairly
quickly.
Admittedly, having to wear a face mask to bed isn't the most attractive
thing in the universe. Most bed partners are usually happy to live
with that rather than snoring! And it is infinitely preferable to the
effects of apnoea, both the fatigue and the other physical effects
(additional strain on the heart). The exact results vary, but a
great many people report significant changes in their lives when they
start using CPAP - they feel more awake, more alive - "like a whole
different person", in some cases.
Bi-Level Positive Airway Pressure
Bi-level positive airway pressure is a variation on CPAP.
Instead of providing air at a constant, fixed pressure all night, the
machine "senses" how much air a person needs, based on inspiration and
expiration, and varies its level of pressure accordingly. On
inspiration, a higher pressure is needed to prevent Apnoeas, hypoapnoeas,
or snoring. But on expiration the patient typically requires several
centimetres less of pressure.
What is the purpose of this? Well, some people find that they simply
cannot sleep with regular CPAP due to the constant air pressure.
Bi-level pressure helps this problem by providing less pressure when you
are breathing out (exhaling) , and more when you are breathing in
(inspiring).
Bi-level pressure devices are significantly more
expensive than regular CPAP.
Responsive and "smart" airway pressure devices
In the belief that the reduction of total airway flow would provide
greater comfort to the patient and encourage patients to use the airway
pressure treatment on a regular basis, several manufacturers have begun to
offer a new generation of treatment devices. These devices incorporate
flow and pressure sensors and automatic regulation systems. There are
three basic approaches. One approach tries to keep overall pressure
requirements low by using high pressure only when there is a specific
problem, but this requires a very rapid increase in pressure when a
problem is detected. The second approach varies the pressure delivered,
providing less when problems are absent, and raising the pressure
gradually when problems appear. The third approach gradually raises and
lowers the pressure as conditions require, but also changes the pressure
within a specific breath if an emerging problem is detected.
Compared to CPAP, 'smart' devices may offer greater patient comfort
insofar as the overall pressure is reduced, providing that the changes in
pressure reduce or eliminate apnea, snoring, or flow limitation, and also
provided that the changing pressures are tolerated by the patient. They
may be used for patients whose pressure requirements may vary during the
course of a night, from night-to-night, and over longer periods of time.
As professionals in the field of sleep disorders gain experience with
these devices and their appropriate applications, they may provide an
additional path to relief for selected patients. As with any new form of
treatment, physicians and patients may need to review studies of each
device before selecting the one most appropriate to the needs of the
specific patient.
Responsive and "smart" airway pressure devices
In the belief that the reduction of total airway flow would provide
greater comfort to the patient and encourage patients to use the airway
pressure treatment on a regular basis, several manufacturers have begun to
offer a new generation of treatment devices. These devices
incorporate flow and pressure sensors and automatic regulation systems.
There are three basic approaches.
One approach tries to keep overall pressure requirements low by using high
pressure only when there is a specific problem, but this requires a very
rapid increase in pressure when a problem is detected.
The second approach varies the pressure delivered, providing less when
problems are absent, and raising the pressure gradually when problems
appear.
The third approach gradually raises and lowers the pressure as conditions
require, but also changes the pressure within a specific breath if an
emerging problem is detected.
Compared to CPAP, 'smart' devices may offer greater patient comfort
insofar as the overall pressure is reduced, providing that the changes in
pressure reduce or eliminate apnea, snoring, or flow limitation, and also
provided that the changing pressures are tolerated by the patient.
They may be used for patients whose pressure requirements may vary during
the course of a night, from night-to-night, and over longer periods of
time.
As professionals in the field of sleep disorders gain experience with
these devices and their appropriate applications, they may provide an
additional path to relief for selected patients. As with any new
form of treatment, physicians and patients may need to review studies of
each device before selecting the one most appropriate to the needs of the
specific patient.
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Dental Devices
Tongue-Restraining Devices (TRDs)
This is a suction cup that is gripped with the teeth and which sucks
the tongue forward, thus opening the airway behind the tongue.
People who snore only when lying on their back, and whose tongue is the
main source of obstruction, sometimes find this device helpful.
Mandibular Advancement Devices (MADs)
These are specialized dental devices (must be fitted by a dental
surgeon) which clamp on your teeth and jaw joint to ‘pull forward’ the
jaw to allow more space for breathing. They are only worn at night
(removable) and initial research show a certain amount of success,
however side effects include excess salivation and joint pain (soreness)
in some cases. They must be worn all night, every night.
While a relatively new way of managing Sleep Apnoea, further design
modifications are continually coming on stream making dental procedure
worth considering.
Surgeries
General
Surgery (of any type) where anaesthesia is used, poses a very real
danger to people suffering from Sleep Apnoea. In all cases your
surgeon and anaesthetist should be informed (in advance) if you suffer
from Sleep Apnoea. You also need to inform your sleep specialist
of any impending surgery, as they may need to send medical data to your
surgeon. If using CPAP you will probably be advised to bring your
CPAP machine to hospital and possibly to the operating theatre. It
may be required during the post operative recovery period.
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Surgery for Sleep Apnoea
The goal of surgery is to enlarge the airway and prevent
snoring and airway collapse. Surgery is site specific (to enlarge
a specific portion of the airway). Due to the risks associated
with anaesthesia or an operation, surgery should not be considered as
a first option. There is also a risk that surgery may cure
snoring, but if the patient has Sleep Apnoea, one of the primary
symptoms (snoring) will be removed while the Sleep Apnoea remains and
may go undiagnosed while further damage is being done to the respiratory
and cardiovascular systems possibly leading to a stroke (which may have
been avoided).
We are unable to source reliable figures for
success/failure with surgery. In general, with the exception
of a tracheostomy (see below) surgery for ‘curing’ Sleep Apnoea is not
successful and is quite painful. In Europe surgery is seldom used
to treat/cure Sleep Apnoea. In America an increasing number of ENT
(Ear Nose and Throat) surgeons continue to pioneer this method of
treatment and now offer a ‘cocktail’ of surgical procedures over a
period of two to four years. In some cases ‘success’ has been
claimed, however they are usually short lived as symptoms of Sleep
Apnoea start to reappear within a short space of time. There are
no ‘quick fixes’ for Sleep Apnoea.
The following is a list of all known surgical procedures
currently in use to treat/cure Sleep Apnoea. There are no reliable
figures available for the success or failure of any one procedure.
The best estimates for UPPP surgery is ‘a 50% improvement in 50% of
cases’. Unfortunately for anyone with mild to severe Sleep Apnoea
this means that CPAP must still be used after the operation.
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Types of surgery
Nasal Surgery
Septoplasty
The septum is the divider between the two nasal passages. A
deviated (crooked) septum may obstruct the nasal airway. A Septoplasty
is performed through the nostrils. The cartilage and bone of the
septum is straightened.
Turbinate Reduction
The turbinates within the nose are made of bone surrounded by soft
tissue whose function are to warm and moisten the air as you breath.
There are three turbinates in each nostril (lowest, middle and upper).
Reduction of the size of an enlarged turbinate can improve the size of
the nasal airway. Turbinate reduction may be performed with surgical
instruments, lasers. radio frequency energy or cauterised.
Removal of Polyps
Nasal polyps can obstruct the nasal airway. Removal of polyps can
‘free up’ the airway.
Sinus Surgery
Sinus infections can contribute to nasal obstruction and surgery
may be necessary.
Upper Airway Surgery
Uvulopalatopharyngoplasty (UPPP) surgery
This surgery removes the uvula, the lower edge of the soft palate
trimmed. If present, the tonsils are generally removed and
tissues around the tonsils trimmed. It can be done separately or
in conjunction with other treatments, depending on where in the airway
the obstructions occur. There are the usual surgical risks
involved with this surgery. Notable ones are general anaesthetic
(depresses breathing reflex and can be risky in people with breathing
problems like sleep apnoea), swelling of the airway, need for pre-and
post-operative medications (may depress the breathing reflex),
bleeding, and significant pain lasting up to several weeks.
Is it effective?
Will it free me from having to wear a CPAP machine for life?
This surgery seems to have a history of being about 50% effective
in about 50% of patients who have it. In other words, many of
the people who have UPPP will end up having to use CPAP anyway.
It is almost never a "cure-all." The risks and side effects of
the surgery are usually not worth it. This is a decision that
each person has to make, but you should give it a great deal of
thought beforehand. Surgery is not something to be undergone on
a whim, and certainly not for the sole reason of ridding yourself of
the need for CPAP. The vast majority of people who have
undergone UPPP for the treatment of Obstructive Sleep Apnoea do have
to continue using CPAP.
UPPP is seldom, if ever, used for treating OSAS in Ireland or England.
Laser-Assisted Uvulopalatopharyngoplasty (LAUP)
LAUP is a relatively new laser surgery on the uvula and soft
palate that is reported to diminish snoring, but no controlled studies
have been done to show that it reduces sleep apnoea. Because it
is less extensive than UPPP, it is unlikely to be any more effective
than UPPP in treating obstructive apnoea. It is usually done in
several steps, and is an outpatient procedure. For that reason
it is less risky than UPPP.
While the procedure may sometimes be effective in
helping people who snore but do not have apnoea, the main
danger from LAUP is that people may eliminate their snoring and assume
that their problems are solved, when in fact they may still have
untreated sleep apnoea which may continue to get worse but be
ignored because its primary alarm signal (snoring) has been silenced.
Potential patients should be careful that they don't see an ad in
the paper, call the doctor, and rush into an LAUP procedure without
research and consideration.
Somnoplasty (Radio-frequency Tissue Ablation of the Palate)
Deliverance of Radio-frequency waves by a needle electrode to the
underside of the soft palate to cause contraction of excessive tissues
that cause snoring. This procedure involves a progressive
shrinkage of the soft palate and uvula. Usually patients require
up to four treatment sessions of 15/20 minutes, under local
anaesthesia. The procedure is relatively painless.
Tonsillectomy and Adenoidectomy
Tonsils are tissues on the sides of the upper throat and if
enlarged may narrow the width of the upper airway. Adenoids are
at the back of the nose and can obstruct the nasal airway. This
surgery is most common with children as Adenoids usually shrink with
age.
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Lower Airway Surgery
Genioglossus Advancement
The Genioglossus muscle attaches from the back of the tongue to a
spot on the back of the chin. This surgery attempts to pull the
back of the tongue forward in an effort to enlarge the air space
behind the tongue. The procedure pulls forward a rectangular or
circular segment of chin bone (below the front four teeth) and holds
it in place with a plate or screw. A minimal change in the
appearance of the chin results (millimeters).
Hyoid Advancement
The Hyoid bone is just above the Adam’s apple. The Hyoid
bone is moved forward and either attached to the Adam’s apple or jaw
bone. The purpose is to enlarge the air space behind the tongue.
Midline Glossectomy, Lingualplasty, and Lingual Tonsillectomy
Midline Glossectomy involves a reduction in the size of the tongue
(if enlarged). The back of the tongue is reduced in size by
excising a V shaped portion of the centre part of the tongue.
Lingualplasty is a more aggressive resection with additional removal
of side wedges. Lingual Tonsillectomy involves the removal of
tonsil like tissue on the back part of the tongue, it may also be
removed with a laser. A temporary tracheostomy is usually
performed with these procedures to avoid breathing difficulty that
might result from temporary swelling. The purpose is to reduce the
size of the tongue thereby increasing the air space behind the tongue.
Bimaxillary Advancement (Lafort 1 Maxillary Osteotomy with
Bilateral Sagittal Split Mandibular Osteotomy)
The upper and lower jaw bones are moved forward along with all
teeth in an effort to pull soft tissue structures forward and make
more room for the tongue. Metal plates and screws are used to
hold the realigned jaw bones in place. Orthodontic work prior to
or following the procedure may be necessary to maintain proper
alignment of the teeth. Change in facial appearance relates to
the extent of the advancement.
Tongue Suspension Suture (Repose)
The tongue is pulled forward by way of a permanent stitch attached
to a screw which has been placed through the back of the tongue.
This is to prevent the tongue falling back during sleep and
obstructing the airway.
Surgical Bypass of the Airway
Tracheostomy
An opening is made at the front of the neck to the
windpipe and a plastic or metal pipe is inserted. During sleep the
patient breathes through the tube, while during the day the tube is
covered to allow normal speech and breathing. There are considerable
hygiene problems with this procedure.
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It is wiser and safer to get professional treatment.
You can use the techniques below, in consultation with your sleep
specialist/doctor, while your treatment progresses. Sleep Apnoea is
a disorder and as such cannot be cured, it can however be managed
efficiently. There are several things doctors suggest you do that
can greatly alleviate it:
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Weight loss
If you're overweight, loose it! Excess weight
contributes to obstructive sleep apnoea in two ways:
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Fat deposits in the neck tissue compress the airway
and make it more likely to collapse.
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Excess weight in the abdomen makes the breathing
muscles operate inefficiently, which contributes to breathing
difficulty when sleeping.
Weight loss by itself is very difficult (as many of us
know). Sometimes people are only able, or much better able, to
lose their excess weight after treatment for sleep apnoea has begun,
they are able to be more awake and vigorous, and increase their energy
use.
Naturally, weight loss is just a generally very healthy thing (if you're
overweight - if your weight is normal, don't starve yourself!)
As with the loss of excess weight, this is, of course,
just a good idea in general. However, quitting might also help your
sleep apnoea in addition to its countless other health benefits, by
returning lung capacity to normal.
Eliminate alcohol in the evening. Alcohol
depresses your breathing reflexes and significantly worsens sleep
apnoea.
Apnoea sufferers should be very careful about excessive drunkenness.
It's possible that if you depress your reflexes enough, you might
not wake up at all. The same thing goes for sleeping pills, drugs,
or anything that might affect your breathing.
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Allergies and respiratory infections:
These cause nasal congestion, which narrows the airway
and contributes to apnoea. Consult your physician for medications to
treat these which will not interfere with sleep.
Many common medications interfere with either the
breathing reflex or sleep or both. Some of the most common are "sleeping
pills", tranquilizers, and short-acting beta blockers. Consult your
sleep specialist about seeking alternative medications.
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The answer to this varies, but generally there are things
you can do, depending on your individual situation:
This is probably the easiest and most effective thing
you can do: spend time learning how to adjust your headgear and
mask. Many people struggle with it and call it uncomfortable when
they haven't really tried to adjust it properly. It's especially
tough when you’re sleepy and fumbling with it in the dark.
Take some time. Sit down at the table during the day with
the headgear. Take it apart. See where all the straps,
buckles, and Velcro seams are. Figure out what each one does.
Generally familiarize yourself with it. Put it on.
Adjust it so it's the most comfortable, and note what each strap has to
be like to achieve this. Ask someone to help you, if necessary.
A lot of people mistakenly think that the solution to all problems with
air leakage is to adjust the straps more tightly. This
frequently increases the leak. Usually air leakage problems
are due to positioning, not pressure. Naturally, there has to be
enough pressure to keep a seal, but make sure you have everything
positioned just right before you start tightening the straps. It’s
a very personal thing. What works for one person may not work for
another.
Some people have found that putting a hook in the wall over the bed, and
hanging the hose over that helps to keep it from "tugging" on the mask
and headgear by removing the weight of the hose.
If you find the incoming air to be too dry, and your
sinuses are drying out, many manufacturers offer a humidifier as an
option. Essentially, this is a (rather expensive, for what it is)
piece of plastic which you fill with water and place in between the
machine and your mask. The air flows over the water and picks up
moisture, just like a regular house humidifier.
A heated humidifier used with CPAP can make a significant
difference in comfort. The water container sits on a hot plate
which ensures that the air you breath is both moist and warm. This
form of humidification is proving very popular.
Most CPAP machines are quite quiet. Most people
don't mind it, and some even find the soft "white noise" of rushing air
to be relaxing. Some, however, find the noise of the machine
disturbing. The only two things you can do are 1) block the noise
somehow, or 2) put the machine further away.
To block the noise, try putting the machine behind
something - a dresser or board, perhaps.
However, DO NOT PLACE ANYTHING
OVER THE CPAP UNIT OR BLOCK THE FLOW OF AIR IN ANY WAY!
Remember, this machine pumps air - if you cut off the air flow, you
could damage it or even start a fire. It must have plenty of space
around it so air can circulate.
Unfortunately, there's really nothing you can do about
this. Even if you bought Gucci or Armani headgear and mask,
there's no hiding the fact that you're wearing headgear and a mask.
If you think your bed partner doesn't like it, ask them if they find
snoring more attractive!
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Nasal pillows ("Adam circuit" is another name for the
same thing) refers to a different method of delivering air with a CPAP
machine. Basically, these are nose plugs that you use in place of a
traditional mask over your nose (you still connect it to the hose to
CPAP machine, like a mask). It is less bulky than a mask, and
there aren't as many problems with air leaking out, particularly at low
pressure.
There are several different manufacturers of CPAP
machines, each with different models. They all perform the same
function; the major differences are in price, weight, and options.
Some are "bare bones" while some have many options including such things
as voltage converters (handy for people who travel to foreign countries)
and even remote controls! In particular some machines make less noise
than others. Our Web Site at
http://www.isat.ie/services.htm contains a full list of
suppliers with contact details, or we can be emailed at
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