indication of CPAP?
Treatment of - obstructive sleep apnea (OSA) - Post-Op atelectasis CHF - severe hypoxia
what is snoring casued by
vibration of the wall of upper airway, preceded by flow limitation or partial obstruction of the airway
what is OSA?
when upper airway becomes severly limited or completely obstructed
CPAP responds to apnea by increasing the pressure
What happens during a central sleep apnea
- airway remain open but there is no flow
CPAP will not increase its pressure
What is the contraindication of CPAP?
- Central sleep apnea syndromes (because its not the airway thats causing the problem) - Pneumothorax • Large bullae • Low BP • Dehydration • Cerebrospinal fluid leak, - recent cranial surgery/trauma
what is the adverse effect of CPAP
Report to MD - Chest pain – pleural/ non-pleural – Severe headache – Increased breathlessness
treatable – Dry mucous membranes in upper airway – Nose bleed – Bloating – Ear/sinus discomfort – Eye irritation – Skin rashes – Claustrophobia
what is the circuit used in CPAP?
Single-circuit, interface over or in the nose
- exhale Co2 via exhalation port
what is the pressure available on CPAP
2.5 - 20 cmh2o
What are 2 adaption to CPAP
Cflex
APAP
what is the function of APAP?
auto-PAP
increase pressure(which is set early on) to meet inspiratiory needs of the patient during REM sleep
- need a standard normal CPAP before qualifying for a APAP
- the difference between REM AND non-rem has to be greater or at least 4 cmh2o to keep the saturation above 90 in the titration study
how to maintain CPAP?
- Change disposable inlet filter 1/mo
• Wash reusable inlet filter 1/mo
• Wash interface, tubing and headgear daily
• Wash humidifier daily, use only distilled
water for operation
What are the interfaces options
- Full face
- Nasal mask
- Nasal “prong” or “pillows”
- Total Full Face
what is a Properly Fitted Full Face Mask
a) Below lower lip
b) Corners of mouth
c) Bridge of nose
Advantages of Full Face Mask
- More effective for dyspneic patients
- for pt with nasal obstruction (better for mouth breathers)
- good for high pressure setting due to wider SA
Disadvantages of Full Face Mask
Claustrophobia Increased risk of aspiration Difficulty with speech Difficulty with secretion clearance Increased risk of facial pressure sores
Properly Fitted Nasal Mask
Sides of nose
Bridge of nose
Above the lip
Advantages of Nasal Mask
Less risk of aspiration Enhanced secretion clearance Less claustrophobia Easier speech - more nature airflow - optimum for use in high pressure
Disadvantages of Nasal Mask
Mouth leak
Less effectiveness with nasal obstruction
Nasal irritation and rhinorrhea
Mouth dryness
not suggested for ppl with allergies or cold
Advantages of Total Face Mask
Claustrophobia
Skin sensitivities
Need for visability
how to troubleshoot inadequate flow
- check power
- check device switch on/offf
- filter
how to troubleshoot airleak
- mouth open at night–>need a chin strap
- mask fit on the face
- connection are tight
precautions to CPAP
- Skin irritation/redness – try different interface
• Mask stiffens with age- replace
• Dry mouth – heated humidity
• Nasal problems e.g. congestion – nasal saline rinse,
heated humidity
• Stomach bloating/discomfort – see MD
• Air leaks – wash mask and face and use creams, adjust
mask/straps, accept small leak
• Difficulty breathing – Ramp or APAP or CFlex
• Mask removal – adjust mask, head/chin strap
• Noise - earplugs
How does the funding via the assistive device program
OSA pts with Level 1 Polysomnography
• Receive ADP package at a cost of $860.00
• ADP will fund a new unit after 5 years if the
current unit requires major repairs
• Most units have a minimum 3 year warranty
(1/3 the original cost then will replace the unit)
how does people qualify for ADP funding for CPAP
Dx OSA - presence of significant symptoms - or medical risk without treatment and absence of symptoms/risks with treatment
- Level 1 polysomnography showing evidence of
OSAS during sleep
