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 questions to expand and see the section. Have a question that is not addressed here? Contact our office for more information.

Oxygen Therapy

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.

Contact Breathe Easy at 519-439-1166 for more information, or visit the Ontario Ministry of Health and Long-Term Care website.

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. Flow rates 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.

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.

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.

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.

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.

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.

  1. Never smoke while using oxygen. Visitors must be informed smoking is not allowed around any oxygen equipment or when oxygen is in use. NO SMOKING signs are to be posted where they can be visually seen.
  2. Oxygen should not be used nor stored around open flames such as candles or fireplaces, nor around excessive temperatures such as radiators or other sources of heat.
  3. Always ensure that all electrical outlets used with concentrators are safe and up to Canadian standards. Never use extension cords.
  4. Turn the cylinder or concentrator off when not in use and always unplug prior to cleaning. Only clean the outer shell of the concentrator by wiping it down.
  5. Keep flammable products such as cleaning fluids, paint thinners, or aerosol sprays away from oxygen equipment.
  6. Use water-based lubricants on lips, body, or hands. DO NOT use oil-based products such as petroleum jelly, or other petroleum based creams or lotions.
  7. Never lubricate oxygen equipment.
  8. DO NOT allow untrained individuals to handle or operate any oxygen equipment.
  9. Store oxygen in a dry, cool and well-ventilated area. DO NOT store cylinders or concentrator units in confined areas such as closets. Store concentrators and cylinders in an upright position.
  10. Ensure cylinders are properly transported while travelling in a vehicle. DO NOT store cylinders in a car or the trunk under extreme heat (52C or 125F).
  11. Never drop cylinders, drag, slide, or violently strike them. Always properly secure cylinders when transporting or storing them.
  12. In the event of a fire YOUR SAFETY COMES FIRST. Turn off source of oxygen and fight like a conventional fire with a dry chemical ABC or BC extinguisher, if trained and safe to do so. If unsafe, turn off source of oxygen, close all doors on your way out to the exit, and immediately leave.

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.

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.

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.

Sleep Therapy

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).

CPAP stands for Continuous Positive Airway Pressure. This pressure is used to maintain positive pressure in the airways to prevent obstruction, which causes apneas.

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.

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.

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.

PAP therapy was prescribed by your physician and is to be used every night and during naps. CPAP equipment is portable, lightweight 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.

Some of our clients notice an immediate improvement from the first night. Improvements experienced may 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.

If a client has a valid health card, has obtained a prescription from a registered Ontario 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.

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.

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. CPAP units, only when unplugged, may be wiped down with a damp cloth. Headgear may be cleaned weekly.
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.

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.

Water used in the humidifier should be changed daily to prevent bacterial growth. The humidifier is to be cleaned daily with warm soapy water. Rinse well. Only use distilled water in the humidifier chamber (refer to your manufacturer’s user manual for more information).

As most manufacturers have suggested, the average life of a mask is six (6) months depending on use 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 a replacement include masks, mask parts, hose, humidifier chamber and filters.

Yes, our infection control procedures consist of an initial soap and water cleaning, followed by high-level disinfection (HLD). The HLD used at Breathe Easy is Accel HLD5 which contains 2% hydrogen peroxide. HLD5 is 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 between clients.

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.

Your humidity settings may be too low and may need to be increased (refer to the manual on how to adjust humidity settings). 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 regarding possibly prescribing a nasal spray to help decrease nasal inflammation/stuffy nose.

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 obstructive sleep apnea. 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. If using a nasal mask, you may need to wear a chin strap or switch to a full-face mask.

Initially, this is common with the use of PAP therapy but typically resolves itself in time.  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 regarding 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 mouths closed during the night. A chin strap in conjunction with a nasal mask or the use of a full-face mask may help alleviate this problem.

It can take some time to adjust to 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 to discuss mask options. Another possible solution is to ensure the humidifier setting is adequate.

If you are opening your mouth while you’re asleep, you aren’t treating your sleep apnea. Your pressure setting may need to be adjusted or you may need a full-face mask.
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, your sleep physician will have to be consulted.
You may require a referral from your primary care physician to the sleep clinic if it has been more than a year since your last sleep clinic appointment.

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 tightening the headgear, just enough to prevent leaks. Start with the bottom straps first and then tighten the top straps.

Sleep apnea is usually a lifelong challenge. Feeling better with PAP therapy is a good thing as you are treating your sleep apnea with the required therapy. Stopping therapy will likely cause symptoms to return, including increased fatigue and the inability to sleep. Some people overcome their sleep apnea through diet, surgery or dental appliances, but most will require PAP therapy for an indefinite duration.

With 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 can 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.

There may be a crack in your humidifier chamber and the chamber will have to be replaced. Humidifier chambers must be properly put back together when taken apart to clean to ensure there is a good seal to minimize the possibility of leaks.

Your humidifier setting may be too high and may need to be turned down. Mask leaks and mouth breathing may lead to more water being used as more airflow will be going through the humidifier chamber (see the section on mask leaks and mouth breathing).

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 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.

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.

Clients are encouraged to contact Breathe Easy to set up an appointment for a pressure adjustment. A copy of your prescription will be required, along with a valid health card.

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.

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:

Yes, many of our clients have travelled all over the world for business and leisure. Our current line of PAP therapy units adjusts 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 travelling and to directly contact the airline should you intend on using your PAP therapy equipment in flight.

If distilled water is not available, use bottled water or cooled boiled water. Never transport your humidifier with water. Always make sure it is empty prior to transport.

Our staff may be contacted by phone at 519-439-1166, toll free at 1-800-267-3279 or by email at breatheeasyresp@gmail.com. We strongly 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.