Sleep Apnoea

A message for Sleep Service patients from the Aberdeen Sleep Team during the coronavirus / COVID-19 pandemic

  • Please be aware that, like other Sleep services up and down the country, we no longer can support face to face hospital appointments due to the Coronavirus outbreak.
  • However, we are still doing our booked telephone appointments and we are currently in the process of changing our face to face appointments into telephone appointments. So instead of coming into hospital you may receive a call from one of the team.
  • Our existing patients can also contact our helplines CPAP 01224 550962 or NIV 01224 558808 if you are experiencing problems or need new mask or tubing etc posted to you.
  • While it is our aim to continue to provide the best service we can, our senior sleep nurse is trained in NIV ventilation and will be helping at times on the respiratory wards to support the increasing number of patients needing specialist care which means there will be a staff shortage . I know this is not ideal but I hope you understand this was not a easy decision to make.
  • Finally, please be patient with us. I hope you appreciate this is a difficult, anxious time not only for you but the staff too. We are working under conditions that many staff have not experienced before but patient care is still our priority.

Regards,

Aberdeen Sleep Team

More information (thanks to Dr Sonya Craig and Dr Sophie West with the OSA Alliance (incorporating British Thoracic Society, British Sleep Society, Association for Respiratory Technology and Physiology, Sleep Apnoea Trust Association)

  • People with OSA should continue to use their CPAP at home as normal.
  • There is no evidence that using CPAP makes you more likely to catch COVID-19, and nothing to suggest that CPAP will make you more unwell if you do catch it.
  • If a CPAP user becomes unwell with symptoms suggestive of COVID-19 (new cough and fever > 37.8 C), please follow government guidance regarding self and household isolation.
  • We do not know whether CPAP makes virus spread worse within a household. This will be something you will need to consider when deciding whether or not to continue using CPAP if you are self-isolating with symptoms of COVID-19.
  • You may wish to distance yourself from vulnerable household members by changing bedrooms or stopping CPAP for a short time.
  • Any respiratory infection, particularly with a blocked nose, can make it more difficult to use CPAP. Try and persist, but if wearing CPAP makes you feel worse (e.g. by increasing coughing and disturbing sleep), then stop using it until your respiratory symptoms improve.
  • Sleeping more upright, avoiding alcohol and using a mandibular advancement spilt if you have one, may help as alternatives to CPAP in reducing OSA a little in this period.
  • Your OSA symptoms are likely to worsen over the week, but will resolve when you restart CPAP.
  • Routine hygiene is adequate for infection control: changing machine filters routinely, cleaning surfaces, cleaning mask and tubing with hand-hot soapy water (washing up liquid) and washing hands regularly.
  • Masks and machines should not be shared.
  • Please use the telephone number/email address provided by your sleep centre for urgent issues with your equipment or sleep/OSA related symptoms. Do not attend in person unless instructed to do so.
  • Please be aware the team may not be able to respond quickly, as staff may have been moved to Emergency Services. • Please look after masks and tubing carefully as there may be a temporary shortage in the future. •
  • A reminder that DVLA says anyone with excessive sleepiness having or likely to have an adverse effect on driving must not drive.

What if I get admitted with COVID-19 / coronavirus and have a CPAP machine?

  • Bring your CPAP machine into hospital with you.
  • DO NOT USE YOUR CPAP UNLESS INSTRUCTED BY STAFF: you may be asked not to use CPAP for OSA on an open ward if you have suspected COVID-19, until COVID-19 screening results are back.
  • If you use CPAP for Obesity Hypoventilation Syndrome (OSA, obesity plus respiratory failure) requiring CPAP to maintain ventilation, this should be continued but will need an isolation area (such as side room or negative pressure area), so please be guided by medical staff caring for you.
  • To decrease any risks of infection from CPAP whilst you are in hospital: your usual mask, which has a vent to allow you to breathe out, may be changed. The new temporary mask will not have this vent, but a bacterial/viral filter can also be added along with an exhalation port in the tubing.
  • DO NOT USE your humidifier with your CPAP machine in hospital due to increased droplet spread.
  • Click here if you want a great link to the British Lung Foundation website with many pages devoted to Sleep Apoea, including advice about driving. There is also a useful Government leaflet called "Tiredness Can Kill" which is worth reading.

British Lung Foundation information on Sleep Apnoea (also called Obstructive Sleep Apnoea, or OSA)

  • Click here if you want a great link to the British Lung Foundation website with many pages devoted to Sleep Apoea, including advice about driving. There is also a useful Government leaflet called "Tiredness Can Kill" which is worth reading.

The Importance of Sleep

What is obstructive sleep apnoea (OSA)?

  • Obstructive sleep apnoea occurs when your upper airway (the part between your nose and Adam’s apple), narrows and shuts during sleep.
  • This can result in apnoeas - when the airway closes completely, and hypopnoeas – when the airway partially closes.
  • Apnoeas and hypopnoeas can last as long as 45 seconds at a time and happen many times during the night resulting in very disturbed sleep.
  • People usually ask for medical help because of a partner’s concern or because they feel very sleepy at inappropriate times (for example when driving the car or during a meal).

What are the symptoms of OSA?

  • Loud snoring.
  • Pauses in breathing (confirmed by partner).
  • Restless sleep.
  • Feeling unrefreshed on awakening, headaches, loss of concentration.
  • Excessive daytime sleepiness.

What causes OSA?

  • In approximately 50% (about half) of people with OSA weight is a factor.
  • OSA is considered to be more common in men and in the over 50s.
  • For women the risk increases after the menopause.
  • Occasionally it may be due to a problem with the upper airway such as enlarged tonsils.

Can OSA be treated?

  • Yes. Continuous Positive Airways Pressure (CPAP) which involves using an air pump and a mask is the most effective way to treat OSA.
  • CPAP works by delivering pressure to your upper airway which pushes the airway open to prevent it collapsing.
  • It’s the best treatment for moderate to severe sleep apnoea.
  • For mild sleep apnoea devices which pull your lower jaw forward and take the tongue away from the back of your mouth can help. These are called mandibular repositioning devices are fitted over your teeth.

What does CPAP feel like?

When you use CPAP for the first time you will notice the pressure when breathing in and out and may feel you need to consciously push the air out. This is normal and as you get used to the therapy it will subside.

Tip: When you are just starting CPAP, try using it when you are distracted by something such as a TV programme. In this way you will gradually become used to the feeling of having a mask on your face with some pressure.

Modern CPAP machines are designed to adjust the pressure automatically so you get just the right amount to keep your airway open at any time.

Ramp - This is used to keep the pressure at minimum for a short period after you turn the machine on to give you time to fall asleep.

Humidification - Some people find CPAP makes their mouth and throat very dry. If it doesn’t settle down a humidifier can be added to the CPAP machine that puts some moisture into air before you breathe it in.

  • The CPAP machine you received today is the property of NHS Grampian.
  • We will ask you to sign a form to show that you understand and agree:
  • To take good and proper care of the equipment and maintain it in accordance with the instructions given.
  • Not to sell, assign, mortgage, charge, hire out or otherwise dispose of, or part possession with, the equipment other than to return it to the authorised clinic.
  • If you move to another health board area, to return the equipment to NHS Grampian.
  • To have the equipment checked regularly by the sleep clinic. If the equipment is faulty, let the clinic know immediately.
  • To make sure the equipment is covered by your household insurance. NHS Grampian cannot be held liable for any loss, theft or damage to the machine.
  • If you are travelling with the machine, you will need to make sure it is covered by your travel insurance.
  • If you are unsure of any of the above, please ask a member of staff.

How do I use the mask?

There are three types of mask commonly available.

Nasal masks: Fit over the end of the nose only. Good for people who are able to just breathe through their nose.

Pillows: Small and discreet, they fit under the nose. For nose breathers only.

Full face mask: Cover the nose and the mouth and are used for people who breathe through their mouth and nose. When you come for your set-up appointment you can try out the different masks so we find the best one for you.

Fitting the mask

  • Modern masks and CPAP machines are designed so the mask doesn’t have to be a tight fit.
  • A well-balanced comfortable fit that’s not too tight will still give a good seal.
  • Pulling the headgear straps too tight can cause sensitivity of the bridge of the nose or the upper lip, and occasionally irritate the skin.
  • A minor leak around the lower part of the face can be better than fitting the mask too tightly.
  • Don’t have any air leaks blowing towards your eyes as this may irritate them.
  • If you decide to use a nasal or pillows mask you will find that when the machine is on, opening your mouth will cause the air to rush out which can be uncomfortable.
  • If this disturbs your sleep, we can change you to a full face mask.
  • If you keep having a problem fitting the mask, contact the Sleep Service.
  • We can modify the cushion to improve the fit, or suggest another size or style of mask or headgear. Mask manufacturers also have videos on their websites and there will be fitting instructions with your mask.

Does CPAP have any side effects?

Common side effects

  • Nasal symptoms such as sneezing, a runny nose or nasal congestion.
  • Dryness of mouth, nose or throat.
  • These symptoms should settle in time but if they persist, contact the Sleep Service.
  • Skin irritation. This is usually because the mask is fitted too tightly or not washed properly every morning.

Less common side effects of CPAP

  • Headache.
  • Middle ear or sinus discomfort.
  • Chest pain.
  • Abdominal bloating.

Is there anything else I need to know?

If you are admitted to hospital or are prescribed any other medical treatment

  • Always let the medical / nursing staff know that you are on CPAP treatment.
  • If you are having a general anaesthetic you must let the anaesthetist know that you are on CPAP treatment.
  • You must bring your CPAP machine into hospital with you and show nursing staff how to use it.

Oxygen and CPAP

  • If you need oxygen with your CPAP always make sure the CPAP machine is turned on and running before you turn on the oxygen.
  • Always turn the oxygen off before turning off the CPAP machine.
  • There is a small risk that oxygen building up in the machine could be a fire hazard. Upper airway infections If you have a respiratory tract, middle ear or sinus infection, contact the Sleep Service or your GP before continuing CPAP. You may be advised to stop CPAP treatment until your infection clears up.

Length of use

  • Studies have shown that people who use the CPAP machine for 6 to 8 hours get the most benefit from the treatment.
  • Even using it for 4 hours a night will make a difference.
  • Sometimes, for various reasons, people no longer use their CPAP machine.
  • If you stop using yours, please return it to the Sleep Service as soon as possible.

Holidays

  • Useful information on travelling with CPAP therapy can be found here.
  • If you are travelling by air or ship you may need a letter of conformity stating the type of machine you have and the reason you are using it. Check with your carrier and please give us at least two weeks’ notice if you need these documents.
  • To use a CPAP machine on a long haul flight, contact your airline to let them know and arrange a seat by a plug point.
  • Most CPAP machines can be used with different power supplies as long as the correct power adaptor is used. Tip: Take an extension lead with you as some hotel bedrooms do not have a plug point next to the bed.
  • Always take your CPAP machine on a flight as hand luggage.
  • The standard CPAP machine does not have an internal battery. If you need these, you can buy them from the machine provider e.g. ResMed, Dolby.
  • Check the lithium content of your battery before taking on a flight as there are regulations about the amount of lithium allowed.

Driving

  • It is your responsibility to let the DVLA know about your medical condition. For more information on your responsibilities go to: www.gov.uk/browse/driving/disability-health-condition.

How do I care for CPAP equipment?

  • Looking after your CPAP machine, mask and circuit will make sure it’s working at its best.

Mask

  • The mask should last for about a year.
  • Keeping the mask clean is the best way to keep your mask fitting well.
  • Your skin naturally produces sweat and oils which soften the mask cushion, make it floppy and affect how well it stays on your face.
  • Wash the cushion every day to keep it in good condition.
  • Dismantle and wash whole mask including the head straps every week using mild unperfumed and without disinfectant detergent (such as green Fairy Liquid).
  • Check for damage before you put it back together. You can get spare parts and headgear from the Sleep Service.

Circuit / hose

  • This should last for about a year.
  • Wash weekly with your mask and check for holes.

Machine

  • CPAP machines are designed to last 5 years or more.
  • They don’t need regular servicing.
  • Check the filter at least every month and change it when it gets discoloured. A clogged filter will significantly affect the performance of your machine.
  • Don’t keep your machine on the bedroom floor as it will suck up the dust under your bed. Clean the casing with a damp cloth.
  • Don’t spray anything directly onto the surface of the machine. If you don’t feel the machine is working properly then return it to the Sleep Service for inspection.

Monitoring your progress

  • We’ll arrange a review appointment with the consultant (hospital doctor) approximately 2 months after you start CPAP.
  • Modern CPAP machines can send information on your progress to a secure data location which Sleep Service staff can access.*
  • The advantages of this for you are:
  • We can monitor your progress and give you help and support without you needing to come to hospital.
  • We can access information about your treatment quickly which may be important if, for example, you’ve been advised not to drive until you can show that you’re receiving treatment.
  • If we need more information or feel that an appointment would help you, we would invite you to come to the Sleep Service clinic.
  • *Please note: NHS Grampian takes your data security very seriously and have undertaken extensive checks on the way this data is collected and stored. It is only accessible to the Sleep Service staff who have secure log-ins. In addition, you will be asked to consent (agree) to your data being used in this way. You can withdraw your consent at any time.

Useful contact details

Sleep Service

  • Clinic C, Aberdeen Royal Infirmary AB25 2ZN
  • 01224 550962 Please note: This is an answer phone and we will call you back or respond to your request as soon as possible.


The Scottish Association for Sleep Apnoea


CPAP manufacturers

  • The main manufacturers of CPAP and masks have their own websites with advice on using CPAP and the masks.
  • Please note that NHS Grampian is not responsible or liable for the quality of the information, resources or maintenance of external websites. Any advice on external websites is not intended to replace a consultation with an appropriately qualified medical practitioner.
  • ResMed UK Ltd
  • Phillips
  • Fisher Paykel