Dr. Helene A. Emsellem
Yes, most insurance policies cover CPAP. CPAP is considered to be durable medical equipment, and you can call your insurer to find out the specifics of your coverage. Deductibles and copayments for medical equipment may be different than what you pay for office visits or prescriptions. Medicaid does cover CPAP equipment, but it will need authorization. Supplies are covered separately, and the amount of coverage varies by state. Deductibles and copayments may apply depending on whether or not you have a secondary insurance.
Nasal pillow systems, nasal masks and full face masks are available in all sizes, shapes and styles from a variety of vendors. They are all effective. The delivery system selection is very personal. On the night of a CPAP titration study (similar to the sleep study), we encourage patients to try on a variety of different types, guided by our experienced technologists. We ask patients to choose a first and second choice and to let us know if they are uncomfortable during the night so they can make a change. We find that even with maximal attention to mask/pillow fit prior to the first night, about 10-15% of the time patients may have an issue with irritation, air leaks or discomfort and may need to make a change over the first few weeks to optimize adaptation.
Humidification of the air in your CPAP system can be extremely helpful in managing both dry mouth as well as a runny nose. Most current CPAP setups include humidification chambers. Studies have shown improved comfort and compliance when the humidity is used. The humidity setting may need to be adjusted, with a higher setting required in cold climates during the heating season. A persistently runny nose can be a problem and sometimes this is due to an allergy to the mask materials. Changing masks and brands is sometimes helpful. We have had to send some patients to see an allergist when a runny nose persists despite humidity and multiple mask changes.
Difficulty breathing with CPAP can be due to the newness of the experience or pressure problems. High prescribed pressures may be uncomfortable initially and low settings, such as 4 cm, may create a sensation of being “air starved.” Contact your homecare provider to check the accuracy of your equipment and discuss the problem with your sleep specialist so they can determine if a pressure adjustment is required.
You should receive specific cleaning/maintenance instructions from the homecare company that delivers your equipment. We recommend taking the mask, tubing and headgear in the shower with you once a week, rinsing it with a mild dish soap (odorless or with a smell you can tolerate), hanging it over the showerhead to dry and remembering to hook it back up the next night. Filters should generally be checked once a month, more often if the environment is dusty. The humidifier chamber should be rinsed daily, and the use of distilled water will keep it clean and free of mineral deposits.
Studies show that at least 6 hours of CPAP usage per night is needed to reduce the long-term health risks of obstructive sleep apnea. We encourage our patients to put the CPAP on at lights out each night and to make every attempt to put it back on after nighttime awakenings. If there are frequent awakenings or if you are finding the mask on the floor in the morning, then pressure adjustment or a mask refitting may be necessary.
For technical problems with the equipment, check in with the homecare company. Your doctor/sleep lab should also provide troubleshooting services if the problem has to do with mask fit or pressure adjustments rather than the workings of the equipment itself.
The short answer here is that it is important to make an appointment to see your sleep doctor and go over the possible explanations. Persistent sleepiness may occur in a small percentage of patients with sleep apnea despite nightly use of the device for at least 7 hours. If sleepiness has not resolved after you have been fully adapted to the device for 4 to 6 weeks, then there are several possible explanations:
Dr. Helene A. Emsellem, director of the Center for Sleep and Wake Disorders in Chevy Chase, MD.