Obscure Problems and Gotchas

I have been using a CPAP now for about five or more years. It is a welcomed change in my life, and frankly I cannot imagine sleeping without one anymore. I have obstructive sleep apnea. This is mostly due to a rare lung disease that I have called intrinsic asthma. Essentially, any dramatic changes in temperature makes it hard for me to breath. It’s incredibly annoying as breathing is important. My nose, has also been severely obstructed, I have had two nose surgeries to fix it. My first sleep study revealed that I have an 87% oxygen saturation level which is incredibly low. Normal is 95%. Anyway, I have picked up several tips and tricks through experience that I would like to share with new users.

For the purpose of this article I am going to be using the term CPAP, but just understand that most models as of late are actually APAP. The difference being that CPAP are for a single pressure; whereas APAP automatically change the pressure depending on your breathing. Both types of units are still in use today, but colloquially speaking people generally just refer to both of them as CPAP. Much like people who call facial tissues Kleenex. Facial tissues is the generic term and Kleenex is a brand.

For argument’s sake I will be referring to the AirSense 10 by Resmed with this explanation. Follow your manufacturer’s guidelines for care and cleaning.

First a word of caution

You will quickly learn that getting your CPAP can be a pain in the ass. It requires a prescription from a doctor. Your doctor may recommend that you just get it through insurance, which for some may be the only option, but please do your research. Make sure that the company that is going to be supplying you with the machine and supplies isn’t over billing you and your insurance company. The supplier is going to call you periodically to make sure that you are going to your doctor appointments and to badger you about supplies. They don’t care about you, they care about maximizing profit. I have an entirely separate article about this here explaining why Lincare is a horrific company.

If you don’t like the treatment you are getting from your supplier, I recommend looking for alternative suppliers who aren’t going to harass you. This is not an endorsement, but I use https://www.directhomemedical.com/. I bought my machine from them and I buy my supplies at my own pace. I am in control, not the supplier.

The mask

First time users most of the time get the half mask. If you have facial hair you will hate this thing. I recommend switching to the pillows and be done with it. Unfortunately, the naming scheme for Resmed products is nothing short of confusing.

Talking

You aren’t going to do a lot of talking while this thing is on, so make sure you aren’t going to have an in depth discussion once you put this on. With the F30i no one can hear you. With the P30i you are stopping air from entering your nose so you can talk and it’s not comfortable.

Daily cleaning

It is very important that you wipe down your face mask and frame every day. Do it before going to sleep. You can use regular ol’ scent free baby wipes. Don’t let the supplier con you into buying special wipes, they are lying to you. The reason for doing this is that bacteria is collecting on your equipment every night. I know from experience if you don’t clean it you can get pimples around the sides of your face and a skin infection on your nostrils. Therefore, please just wipe down your equipment and your face before going to bed. You will thank me.

Weekly cleaning

This is not optional. You can stretch it out to two weeks, but I recommend you try to clean it at least once a week. At the minimum, empty out the water chamber, and refill it with clean water. If you neglect to clean your equipment you can get a respiratory infection. Avoid this preventable problem.

Why must you clean it?

Bacteria from your breath is circulating in and out of the machine. This will produce what is called “Bio-film” inside of the water chamber. When you look inside of the water chamber you will see crud floating in it. Congratulations, that’s your bacteria! This is why it’s critical that you use distilled water. Not using distilled water is dangerous because it could have bacteria in it already aside from sediment which will scale on the heating plate. The whole goal here is to not breath in an excess of bacteria.

Other gross things to clean out

It’s not only important to clean out your water chamber. It’s also important to clean everything else. Bacteria and Bio-film can begin collect or form on any surface where your breath is traveling.

General cleaning tips

• Don’t soak any of your equipment. Meaning, don’t just leave it in the water. Treat it like you would dishes you are hand washing. Wash them and set them aside to dry. Don’t just let them sit in a pool of water. Letting it sit gives the soap in the water a chance to start attaching itself to surfaces. You really don’t want that.
• If your frame has socks on them, don’t pull the socks off. Leave the socks on, it’s okay for them to get wet. If you remove the socks off, you won’t be able to get them back on. I learned this the hard way.
• Use scent free castile soap for cleaning. Doesn’t take a lot, just make the water somewhat soapy. If you use something with a scent you are going to regret it because the smell will stick and then you are breathing it in. It gets annoying.
• Always make sure to wash your sink thoroughly before cleaning.
• Don’t use hot water, use warm water for cleaning.
• Use cold water for rinsing before and after cleaning. You use cold water to rinse off any visible crud and afterwards to get the soap off.
• Let it air dry, don’t try to accelerate the drying.
• If you see anything growing in your hose, throw it away immediately. This has only happened to me one time, but I wasn’t taking chances so I opted to just get a new hose.

Special tip just for P30i nasal pillow users

One of the drawbacks of this part is that it has a exhaust filter on the front of it. Here is the photo again below so you don’t have to scroll back up:

Therefore, I recommend two very important things:

1. Do not wet this part! Pop it out before washing your gear. If you do not pop it out and you wet it, it will become black with mold. Then, if you ignore that black mold, you are breathing in black mold. Don’t do that. It will make you sick.
2. Once you see it is getting dingy, you can safely pop it out, put it into a glass container and soak it in isopropyl alcohol for at least one minute. This will give the alcohol enough time to lyse any bacteria that has built up into this filter. Dump out the alcohol into the sink, then rinse it with distilled water. Shake out the excess water and then let it sit to air dry somewhere safe.

Replacing the filter

Even after cleaning this filter with alcohol, eventually it gets gross, and it can smell weird. Throw it away and pop in a new filter if you have extra nose pillows of different sizes you aren’t using. What I mean by this, is sometimes when you buy an all-in-one pack that includes the frame, headgear, fittings, and three different pillow sizes of small, medium, and large. You are only going to use one of those sizes. Take the filters from the other two as extra filters as they are compatible.

Learn from my mistakes and experience, I didn’t realize that this filter had a build up of mold in it, and it was making me sick! Once I realized what was going on, I started to experiment on how to clean these things.

Distilled water

Most people when they start will automatically just assume they are going to the grocery store to buy distilled water. Very quickly, you will learn you are competing with other people for distilled water. Most notably people with infants. I recommend you exit this losing race as soon as you can by making your own distilled water.

I strongly recommend you pick up one of these, which ever one you want, and just make it a habit to make your own water about once a month. I make three to four gallons per month. It takes a single day to do this, and like I said you aren’t going to stand there to watch it drip into the collection container. Just set it and forget it. You know it’s done when the fan turns off.

How does it work?

When the distiller kicks on, it is boiling the water in what is appropriately named “The boiler”. That water turns into steam, and the steam enters a radiator like coil of tube that has heat fins surrounding them. There is a fan at the top that cools down the steam as it is traveling through the tube. The steam condensates and turns back into water that has zero minerals or sediment in it. It will eventually make its way down the tube into the collection container.

Cleaning the boiler

Cleaning the boiler is really easy. What happens is, the water you put into the boiler – filtered or not – will leave behind an incredible mess of sediment. Some of that sediment burns too and smells terrible. This sediment grips onto the steel surface and crystallizes. Whatever you do, do not scrape it off. There is a much easier way to do this using simple chemistry.

1. Rinse out the boiler to remove any loose sediment.
2. Included with your distiller should be citric acid crystals. You are going to put four scoops of this into your boiler.
3. Add water to the fill line of the boiler.
4. Stir the boiler with a wooden spoon to avoid scratching the steel surface.
5. Allow your boiler to sit for about two hours or longer.
6. Stir the boiler to see if the contents are dissolving.
7. Once you can see all of the build up has dislodged, you can dump it all into the sink.
8. Rinse the boiler.
9. Set the boiler down to let it dry. You are done.

You can buy more citric acid when you run out. It’s readily available and it’s food safe.

Frequency

I only clean my boiler like every other session. Meaning I make about six gallons of water before I decide to clean it. If you don’t clean it, it’s just going to make the water smell bad, and the sediment build up makes the whole process less efficient. These distillers are like 99% efficient, so it does count to clean it. The efficiency refers to the water you put in, at least 99% comes out distilled. Very little is lost in the process.

Overuse

Don’t overuse the distiller. Meaning let it rest a little between sessions. I learned the hard way if you just keep operating it before it’s ready the bottom starts to warp and the feet begin to suck inwards causing your water to spill every where except into the collection container. This was not a happy surprise for me. In other words it can get too hot.

Water containment and dispensing

Notice I said I make about three to four gallons a month. Well I have to keep all of that water somewhere. I put it in a food safe water container. Then I bought a water dispenser to make it really easy for me to fill up my water chamber every night.

I keep this water container on my night stand right next to my CPAP. The dispenser is battery operated and that sits on top of the blue cap shown on the top of the container. The container has an air-inlet which is where I feed the silicone tube into. Because this is distilled water, the container hardly gets dirty. Dust does enter the container, but it’s not enough to cause a problem. I just keep an eye on it to make sure it’s not getting gross.

Traveling with your CPAP

• Good news, your CPAP is not considered a carry-on. Therefore, you are allowed to bring your CPAP on the plane with you and no one can tell you anything.
• Always remember to plan where you are getting your distilled water from during a trip!
  • If you are flying, try to figure out where you are getting your distilled water from. Remember you are competing with people with babies. Most stores have it, but they do run out too. Mind the time! Are the stores open when you arrrive? In rare instances some drug stores have it locked up in a display case just for CPAP users. I have only seen this once!
    • Worst case scenario you can use bottled drinking water, but this is absolutely the last thing you should do. One night won’t cause your machine to malfunction.
  • If you are going on a road trip, just bring it with you.

Power outages

I know for a fact that the power supply for the AirSense 10 has an excellent protective feature for when there are power outages. I am just writing this here to tell you, if your power goes out several times in quick succession, the power supply will shut itself off. This protects your machine from damage. So don’t panic, just unplug the power supply, wait like 10 seconds, and plug it back in. That will bring it back.

I have considered putting my CPAP on a UPS, but I haven’t done so yet because I am still trying to understand what kind of UPS I would need. From what I have read, you want to make sure you get a true sine UPS and those are expensive. Also if the power goes out for more than like 15 minutes it’s not going to help you in that situation. This is why I haven’t bothered personally.

I will say it’s very unsettling when the power goes out and then all of sudden you are woken up because the airflow has cut off. That sucks.

If you are without access to your CPAP, sleep at an incline, this is much safer. Most of the danger is when you are lying on your back, the weight of your chest is what makes it harder for you to breath. Especially if you are a heavy set person.

Negative talk about CPAPs

I just want to take a moment to say, anyone who says the following phrase or something like it is a giant fucking asshole, “CPAPs aren’t sexy.” If you know someone who has said this, tell them I told them to shut the fuck up. A CPAP will SAVE YOUR LIFE. Three times in my life I have nearly died in my sleep because I stopped breathing. I am just lucky that my brain made one last effort each time to wake me up. Gasping for air in the middle of sleep is a HORRIFIC feeling. Making brushes with death like this is absolutely preventable. Therefore, anyone who is fixated on “looks” probably doesn’t have your best interests at heart.

Vein people need to shut the fuck up about what a CPAP looks like. No one fucking asked you asshole.