During our time in business we have learned that many of our clients are unfamiliar with sleep apnea and oxygen therapy and have questions about what to expect. For your convenience we have collected some of the questions we hear most often from our clients and provided the answers. Click on any of the listed headings to jump directly to that section. Have a question that is not addressed here? Contact our office for more information.
What is home oxygen therapy?
Home oxygen therapy is the process of administering supplemental oxygen through various oxygen supply systems in your place of residence. Oxygen is a drug and is usually prescribed by a physician or a nurse practitioner. Specific tests are conducted to determine if home oxygen therapy is appropriate for each individual client and if funding is available. Supplemental oxygen is prescribed for various chronic respiratory and cardiac conditions and for clients with terminal illnesses. The goal of this treatment is to not only improve blood oxygen levels, but to improve our clients’ overall quality of life. Other benefits may also include decreased stress on the cardiovascular system, decreased shortness of breath, decreased hospital visitations and increased mobility.
How would I know if I meet the Assistive Devices Program (ADP) eligibility criteria?
ADP has specific medical eligibility criteria to determine whether funding is available. ADP requires that the applicant’s medical status is stable, with optimization of their treatment regimen. Optimal treatment prior to the initiation of supplemental oxygen therapy includes smoking cessation.
Your family physician may send a referral to Breathe Easy in order to make arrangements for an oxygen assessment at our office or in your home. This assessment will determine if supplemental oxygen may be beneficial and if you meet the Home Oxygen Program’s (HOP) eligibility criteria for funding. Clients requiring End of Life Care may be eligible for 90 days of funding without testing.
During the assessment, oxygen levels will be checked on room air at rest, with exertion and/or at night. Depending on the outcome of the assessment, you may be further referred for Arterial Blood Gases or a Sleep Lab by your family physician. In the event that the ADP medical eligibility criteria are not met, alternative funding will be investigated. This may include private insurance, self-pay, WSIB, Veterans Affairs, etc.
After an assessment, if a funding source is available, what’s next?
Oxygen must be ordered or prescribed by a physician, informed consent must be obtained from the client or their substitute decision maker, and the client must be properly identified prior to set-up. Depending on the blood gas results, Breathe Easy may inform the client that an immediate set-up is preferred to initiate oxygen therapy sooner than later, provided there is a valid medical order. Set-ups for clients in private homes are generally based on the client’s availability and at their convenience. Flowrates will be based on the valid medical orders from the prescribing physician. Registered staff may collaborate with the physician, facility staff and/or client or substitute decision maker, to discuss what is in the best interests of the client prior to initiation of therapy. A risk assessment will also be performed to ensure patient safety, with a follow-up visit scheduled within 7 days.
How frequently are oxygen users seen and reports sent?
Clients in long term care homes including retirement residences are seen on a weekly basis with weekly progress documented in the resident’s chart after each visit. A separate chart is also kept on the client outside of the facility and in the care of Breathe Easy. Clients residing in private homes will be seen monthly or more frequently, and will have a chart kept in the care of Breathe Easy. Progress reports will be forwarded to the client’s physician each month or more frequently when required.
What do our Regulated Health Professionals do during their weekly/monthly visit?
During routine scheduled visits, registered staff are to assess the client’s medical condition, address any questions or concerns they may have, change all necessary soft goods (cannula, tubing, etc.), check equipment, monitor hours used, clean or replace filters if required, provide extra supplies to the client and/or facility, and discuss any pertinent issues with the client, substitute decision makers, caregivers, or facility staff.
What about the delivery of cylinders?
Our Medical Service Driver will have a set schedule for deliveries. Convenient days and times for delivery will be discussed upon initiation of oxygen either in person or by phone. In some instances routine delivery may not be immediately set until the client’s portable needs are determined, or may be based on scheduled service to that particular area.
What about after-hours calls?
In the event of a life-threatening emergency, call 911.
Breathe Easy forwards calls to an answering service which will dispatch ALL calls to On-Call personnel. Our answering service is NOT automated and you will speak to a live person. Breathe Easy staff are to immediately respond to all calls initially by phone as some problems may be verbally resolved with some assistance over the phone. Employees must physically respond to a call as soon as possible if not resolved by phone. If the client is residing at a facility, emergency and backup equipment will be available. Facility staff may be verbally directed over the phone or may refer to the P&P manual left at each facility.
Are there any safety concerns?
Oxygen is not flammable, but supports combustion and can cause other materials that burn to ignite more easily and rapidly. Fire involving oxygen can appear explosive-like.
Can oxygen be toxic and are there any side effects?
Oxygen is not toxic under usual conditions and is required to support life. Liquid oxygen or cold gas will freeze tissues leading to severe burns. Proper personal protective equipment should be used when necessary, and all safety protocols are to be followed. Some clients however, may suffer from hypoxic drive due to too much oxygen. Normally, our body tends to respond to high levels of carbon dioxide (CO²) in the blood by breathing. Excess CO² is then removed through exhalation. In other words, your body is usually stimulated to breathe when the levels of CO² increase or are too high. In some clients with chronic conditions such as Chronic Obstructive Pulmonary Disease (COPD), their body builds up a tolerance and no longer responds to the high blood carbon dioxide level. With this adjustment made by the body, it now uses low blood oxygen levels to help stimulate it to breathe instead of the high CO². Oxygen users who suffer from chronic CO² levels (CO² retention) may risk suffering from inadequate breathing patterns or rates (also known as oxygen-induced hypoventilation) caused by too much oxygen. Since the body no longer responds to high levels of CO² and prefers to be stimulated to breathe by lower oxygen levels, you won’t have the urge to breathe if you are receiving too much oxygen. Ideally, the PaO² or arterial blood oxygen levels should be 50-60mmHg (SaO² at 88-92%). These levels will allow for the maintenance of adequate tissue oxygenation while minimizing the chances of oxygen-induced hypoventilation. The most accurate method of determining if a client is retaining CO² is by obtaining arterial blood gases. Blood gases are generally drawn prior to initiation of oxygen therapy to determine if the client meets the Home Oxygen Program (HOP) criteria and qualifies for funding. Oxygen-induced hypoventilation may be monitored by routine oximetry testing during monthly or weekly visits. Further blood gases may be required to determine accurate levels of CO² and O².
Can oxygen be used with Continuous Positive Airway Pressure (CPAP) or a compressor?
Yes, oxygen may be used with CPAP, BiPAP, and AutoPAP if nocturnal (night time) oxygen is prescribed. Oxygen may also be used with a compressor while receiving aerosolized treatments as the nasal cannula can stay in place while using an aerosol mask. Oxygen is a drug and a valid medical order is required by a physician.
What is sleep apnea?
Sleep apnea (Obstructive Sleep Apnea-OSA) is a disorder characterized by abnormal pauses (apneas) in breathing during sleep. Symptoms of OSA include excessive daytime sleepiness, poor concentration, poor memory, depression and irritability. OSA is diagnosed by polysomnogram “sleep study” and is treated with Continuous Positive Airway Pressure (CPAP).
What is CPAP?
CPAP stands for Continuous Positive Airway Pressure. This pressure is used to maintain positive pressure in airways in order to prevent obstruction, which causes apneas.
How is CPAP different than BiPAP or AutoPAP?
CPAP is a set continuous pressure that does not change. BiPAP or bi-level has two set pressures, one for inhalation and one for exhalation. AutoPAP automatically adjusts the pressure required to keep airways open by sensing breathing patterns.
How do I know if I have sleep apnea?
Physicians may request a preliminary night study to be performed by Breathe Easy. An oximeter capable of performing night studies will then be provided to the client for a period of 1 or 2 nights. The outcome of the night study will be assessed with a report forwarded to the prescribing physician. If the night study indicates possible sleep apnea or nocturnal desaturation (low oxygen levels at night), the physician may refer you to a sleep clinic for a further assessment.
I was referred to a Sleep Lab, now what?
Once is a valid prescription is obtained, contact Breathe Easy at 519-439-1166 to set-up an appointment with one of our Registered Staff.
How does your free one-month trial work?
Clients are set-up on the prescribed unit and pressure and are fitted with the base mask. Should the base mask not be sufficient due to inadequate fit, client preference or the need for a full face mask, other masks will be properly fitted. Clients will be educated on the proper use, care and maintenance of the unit as well as their responsibility towards the unit while it is in their possession. Clients will be contacted within 7 - 10 days after being set-up as a courtesy follow-up to address any questions or concerns. During this time, clients are encouraged to contact their insurance provider (if not done so prior to set-up) to determine if any third-party funding is available if applicable.
During the 30-day trial, clients may be fitted with multiple masks to ensure that a comfortable mask is provided at the end of their trial should they opt to purchase the unit. All paperwork and relevant payment will be finalized at the end of the 30-day trial; however clients will be asked to sign the paperwork at the beginning of their trial and may be asked to provide a credit card for security purposes.
Clients are encouraged to contact Breathe Easy during business hours should they have any questions or concerns during and after the 30-day trial.
Why do I need to use my CPAP/PAP therapy equipment and for how long?
PAP therapy was prescribed by your physician and is to be used every night and during naps. CPAP equipment is portable, light weight and may be taken on vacations and business trips. If you find it difficult to wear your CPAP at first, try to wear it as long as you can tolerate it; 4 hours is considered therapeutic. Try to work up to the entire night as it may take time to adjust using your CPAP.
Will I feel different with PAP therapy?
Some of our clients notice an immediate improvement from the first night. Improvements experienced by our clients include: dreaming, improved memory, more energy, weight loss, improved focus, being more efficient at work, having the ability to work out, taking fewer or no naps, not feeling tired anymore, and so on.
Why am I dreaming more now that I am using my CPAP?
Frequently, with Sleep Disordered Breathing (SDB) such as Obstructive Sleep Apnea (OSA), your sleep is disrupted to the point that you are unable to get into a deep sleep. This prevents dreaming or only allows fragmented dreams. When you start using your CPAP, you are able to get to the deep level of sleep required to dream. You may experience a lot of dreams at first, and then taper down to a normal amount. This occurs due to the body getting used to deep sleep again. Once you are used to "normal sleep" again, dreams should be more normal in frequency.
I feel much better after using my CPAP for a few weeks. Can I stop using my CPAP now that I am better?
SDB is usually a lifelong challenge. Feeling better with PAP therapy is a good thing as you are treating your SDB with the required therapy. Stopping therapy will likely cause symptoms to return, including increased fatigue and the inability to sleep. Some people overcome their SDB though diet, surgery or dental appliances, but most will require PAP therapy for an indefinite duration.
I feel very claustrophobic when I wear my CPAP mask. What can be done about it?
Sometimes a smaller mask with minimal headgear may assist. Many clients are choosing a direct nasal mask that fits directly in the nares/nostrils. Another option is to use a full face mask to give you the ability to breathe through your mouth and nose.
Proper mask fit and the right humidifier settings are two key factors in helping you feel comfortable when using your PAP therapy equipment.
A high humidity setting may make it feel very hot and/or uncomfortable. Try turning down the humidifier setting to minimize heat and humidity. An improper mask fit may also make you uncomfortable. Clients are to ensure the mask is not too tight. Try loosening the straps of the mask and tighten the headgear, just enough to prevent leaks. Start with the bottom straps first and then tighten the top straps.
Why do I still snore while using my CPAP?
If you are opening your mouth while you're asleep, you aren't treating your SDB. Your pressure setting may need to be increased or you may need a full face mask. A full face mask will give you the freedom to breathe with your mouth and nose. If the problem has not been resolved with the use of a full face mask, your pressure may need to be increased.
Our registered staff will check your prescription to determine if there is a range allowing for an increase without having to consult your sleep specialist. For instance, if the current pressure setting is at 8 cmH²0 and your prescription reads: 8 cmH²0 +/- 1-2cmH²0, it would allow our staff to adjust the pressure between 6 and 10 cmH²0. If your current prescription does not allow for a pressure adjustment, you sleep physician will have to be consulted.
You may or may not have to make an appointment with the sleep clinic, depending on the date of your last visit.
Why do I sometimes remove my mask when I sleep?
It can take some time to adjust in using a CPAP mask. You may take the mask off in your sleep due to being unaccustomed to having a mask on your face. This happens to a frequent number of clients. Most adjust in time, generally within a month. Should the problem continue, clients are encouraged to contact Breathe Easy to make an appointment for another mask trial. Another possible solution is to ensure the humidifier is not set too high, as it could possibly lead to the feeling of smothering or suffocation. In this instance, clients are to turn down their humidity settings.
Why do I feel bloated and burp in the mornings?
If you have issues with your stomach valve, pressure from your PAP therapy equipment may push air into the stomach. It is best to speak with your physician in regards to this matter. Another cause is mouth breathing with a nasal mask leading to the swallowing of air. Clients may opt to try and train themselves in keeping their mouth closed during the night. A chin strap in conjunction with a nasal mask or the use of a full face mask may helpalleviate this problem.
Why do I wake up with a dry mouth in the morning?
A dry mouth signifies that you have opened your mouth at night while using your PAP therapy equipment. This will let the pressure escape out of your mouth and hence prevent you from properly treating your SDB. The dryness is caused by the pressure blowing through your mouth. If you use a full face mask, your humidity setting may need to be increased a bit. If using a nasal mask, you may need to wear a chin strap or switch to a full face mask.
Why do I wake up with a dry or stuffy nose in the morning?
Your humidity settings may be too low and may need to be increased a bit. Make sure your equipment is being cleaned regularly as un-cleaned or contaminated equipment may lead to sinus infections. Should you suffer from allergies, you may need to consult your physician in regards to possibly prescribing a nasal spray to help decrease nasal inflammation/stuffy nose.
I keep getting air leaks with my mask. What should I do?
Over-tightening your headgear can lead to mask leaks. Tightening the top straps too much can cause leaks at the mouth while tightening the bottom straps too much can cause blowing at the eyes. Clients are to loosen off their headgear and slowly re-tighten the straps just until the leak stops. Another cause of leaks is a worn out mask or mask part that may need to be replaced.
How often should I replace my mask and other PAP therapy accessories?
As most manufacturers have suggested, the average life of a mask is between 6 to 12 months depending on use and care. Some clients have kept their masks for a longer duration due to proper usage and care. Most masks will have parts that can be replaced to help keep costs down. PAP system filter replacements will also vary on usage, unit placement, home environment, the presence of pets, etc. Check your manufacturer's guidelines for recommended filter changes. Most filters will need to be changed between 3 to 6 months.
Contact your insurance provider if applicable, to determine the frequency your mask and/or mask parts as well as other accessories may be replaced. Accessories that will eventually need replacement include: masks, mask parts, hose, humidifier chamber and filters.
What if I don't like my current mask and want something new?
Breathe Easy offers free 7-day trials on masks. Clients are encouraged to contact Breathe Easy to set-up an appointment for their free mask trial.
Do you disinfect loaner masks and units in-between clients?
Yes, our infection control procedures consist of an initial soap and water cleaning, followed by a high level disinfection (HLD). The HLD used at Breathe Easy is Virox's Accel HLD5 which contains 2% hydrogen peroxide. HLD5 is a sporicidal, virucidal, fungicidal, bactericidal and tuberculocidal when used according to the manufacturer's directions. Various low level and high level disinfectants are also used to clean PAP therapy systems in between clients, including vinegar. Mask and PAP therapy unit filters are also changed in between clients.
Why do I have to clean my PAP therapy equipment?
Proper and effective cleaning of your equipment will help prevent bacteria from growing, help minimize infections, and will also help prolong the life of your equipment. Over-cleaning is not recommended as it may shorten the life of your equipment.
How do I clean my own PAP therapy equipment at home?
We recommend clients clean their equipment daily according to the manufacturer's guidelines as noted in the instruction manuals for all PAP therapy systems and masks. Clients are to clean their mask parts and hose with mild soap and warm water, followed by a rinse with warm water. Allow all parts to air dry. For clients using a Fisher & Paykel mask that has a gray foam cushion, separate the foam cushion and wipe clean with a damp cloth. Do not submerse the foam cushion in water. CPAP units, only when unplugged, may be wiped down with a damp cloth. Headgear may be cleaned weekly.
A high level disinfectant is not necessary as the equipment is solely used by you. It is also not recommended as the replacement of mask parts will be greatly facilitated with its use.
It is best to clean your equipment first thing in the morning or after you wake up (for clients working shifts) to allow for it to properly air dry before its next use. Clients need to take all necessary precautions to ensure their safety when drying their PAP therapy equipment. Water may drip from accessories leading to spills and the possibility of slips and falls. We recommend that PAP therapy hosing is hung and dried in a clean sink or tub to avoid this possibility. Tip: Attach CPAP hose to CPAP unit (ensure humidifier is empty) and run the unit. The air from the unit will help expel the water and dry the hose.
Is there a quicker way to clean my CPAP equipment?
Breathe Easy offers a variety of CPAP cleaning products to help minimize cleaning times of masks and mask parts. These products are available for purchase at our office.
How often should I clean and change the water in my humidifier?
Water used in the humidifier should be changed daily to prevent bacterial growth. The humidifier is to be cleaned daily warm soapy water. Rinse well. Only use distilled water in the humidifier chamber. Once per week, your humidifier should be cleaned with one part water and 2 parts vinegar. Allow the vinegar solution to sit for a few minutes prior to rinsing it thoroughly.
What if I'm travelling and don't have access to distilled water?
If distilled water is not available, use boiled water, allowing it to cool before use. Never transport your humidifier with water. Always make sure it is empty prior to transport.
Why is there a white film at the bottom of my humidifier chamber?
A white film may be caused by a calcium build-up from tap water. Only distilled water is to be used with all PAP therapy humidifier chambers.
I am getting a lot of water in my CPAP hose. Why is this happening?
If you keep your house cool at night, the cool room may be causing the warm moist air from your PAP therapy humidifier chamber to cool, leading to condensation or water build-up in your tubing. To prevent this, you may consider the following options: purchasing a heated hose provided it is compatible with your PAP therapy unit; purchase a sleeve for your hose; sew a sleeve to go over the hose (but ensure it comes off in order to properly clean your hose); tuck your hose under your blankets to avoid exposure to the cold room; increase the temperature in your home; or decrease your PAP therapy humidifier setting as it may be set too high.
I am going through a lot of water in my humidifier at night. Sometimes I need to top it up half way through the night. Is this normal?
Your humidifier setting may be too high and may need to be turned down. Mask leaks and mouth breathing (without the use of a full face mask) may lead to more water being used as more air flow will be going through the humidifier chamber (see section on mask leaks and mouth breathing).
Why is my humidifier chamber leaking water?
There may be a crack in your humidifier chamber in which the chamber will have to be replaced. Humidifier chambers must be properly put back together when taken apart for the purposes of cleaning to ensure there is a good seal in order to minimize the possibility of leaks.
What do I do if my physician prescribes an increase in pressure?
Clients are encouraged to contact Breathe Easy to set-up an appointment to increase the pressure. A pressure adjustment generally does not take longer than 5 minutes. A copy of your prescription (if not already faxed to our office by your physician) and your health card will be required.
Can I travel with my PAP therapy equipment?
Yes, many of our clients have traveled all over the world for business and leisure. Our current line of PAP therapy units adjust to 100 - 240 volts (50 - 60 Hz). All that is required is an outlet adapter. Clients are encouraged to take their unit as part of their carry on to ensure it is not damaged. The X-ray machine will not damage your unit, but it may be inspected by security. It is best to carry a copy of your prescription when traveling and to directly contact the airline should you intend on using your PAP therapy equipment in flight.
Can I use a battery with my PAP therapy equipment?
Some clients have also taken their PAP therapy unit camping. Certain accessory equipment will be required. For clients using certain ResMed units, an inverter or converter will be required. For certain Fisher & Paykel units, a deep cycle battery/marine battery will be required. For more information, please refer to your manufacturer's manual or the following websites:
How do I contact your registered staff?
Our staff may be contacted by phone at 519-439-1166, toll free at 1-800-267-3279 or by email at firstname.lastname@example.org. We encourage our clients to book an appointment as our registered staff do visit oxygen clientele in the community and are not always available in office.
What about power surges and power outages?
In the event of a power outage, your PAP therapy system will not work. There are some options for an alternative power supply (see section on battery use). Clients are strongly encouraged to use a power surge protector in conjunction with their PAP therapy systems.
With ResMed systems, a power surge may damage the external power supply instead of the actual system. Your power system may need to be replaced in the event of damage.
With the Fisher & Paykel ICON series, the unit will shut itself down to protect its internal components. The next time the system is turned on, an error code (13.0 or 13.1) will be seen on the display unit. This is not a true error code, but an indicator that the unit shut down to protect itself from a power surge.
What about funding?
If a client has a valid health card, has been assessed by or seen at a sleep lab, and has been diagnosed with obstructive sleep apnea, that client may qualify for funding. For more information, contact Breathe Easy at 519-439-1166.