As of April 27, 2010, CPAPMeister’s Blog will be moved to Sleep Well Canada.
Follow us at www.sleepwellcanada.com
As of April 27, 2010, CPAPMeister’s Blog will be moved to Sleep Well Canada.
Follow us at www.sleepwellcanada.com
Date: April 30, May 1 & 2, 2010
Location: The Vancouver Convention and Exhibition Center, 999 Canada Place
OVER 100 seminars, demonstrations, workshops and 250+ exhibitors… reflecting the most up-to-date information on wellness and healthy living.
Attend presentations at the Seminar Stage, learn more about yoga, pilates and meditation at the Demonstration Stage, learn from top BC chefs and cookbook authors at the Cooking Stage, listen to celebrity speakers such as Mariel Hemingway. There will also be food samples, area for kids, wellness for pets and of course tonnes of resources you can gather from a wide range of exhibitors to help find balance in your life.
Tickets: Adults $12.50; Students/Seniors $10; Children (6-15) $5; Kids under 5 Free; 3 day pass $27.
Clinical Sleep Solutions will have a booth that showcases the latest CPAP equipment. We will also have lots of pamplets and brochures to educate the public about Sleep Apnea. We are also offering FREE SLEEP APNEA RISK ASSESSMENT.
We would love to see you this weekend. Come say hello at our booth.
For more information go to www.thewellnessshow.com
by Cox Tan-Ngo, RRT, Clinical Sleep Solutions
Pros: Easy to fit; large selection of inner seal sizes; soft materials used for the seal and forehead spacer
Cons: May be difficult to put back together after cleaning for some users; no quick release for the headgear; some whistling noise from the exhalation port at higher CPAP pressures.
Overall: Despite the unique design concept, the technologies are effective in improving the user experience and comfort.
The EasyLife mask from Philips Respironics (click to see product) has been around for a number of months here in Canada and recently I was able to test it out for one week. According to Philips Respironics, this mask was intended to make fitting a mask “automatic” through their Auto Seal Technology and should fit a large population group who uses a standard nasal mask for their CPAP therapy.
At first glance, this mask almost looks like the Comfort Classic from the front in its overall size and shape (for those familiar with the older masks from Respironics). When you flip the mask over, the new technologies are revealed with new materials, shape, and the dual-cushion design of the mask. Visually, the dual-cushions look unorthodox because it can be confusing to distinguish which part of the mask is actually making the seal to the nose. When I first saw a picture of this mask, I actually thought that both seals are doing a similar function but this is actually not the case. The inner seal creates the seal to maintain the pressure from the CPAP and the outer seal maintains stability of the mask.
The inner seal comes in Small, Medium, Medium-Wide, and Large. The way this mask is fitted is not the conventional manner which is typically measured from the top of the bridge of the nose to a point below the base of the nose. Instead the reference point is slightly below the bridge of the nose similar to another of their earlier masks called the Simplicity or even the simple cushion of the Comfort-Lite mask. The outer seal only comes in one size but this part of the mask gives a visual perception that the mask seal is bigger than it actually is. Once you put it on, however, it does not feel as large on the face because the materials used for the seals are soft and lightweight. In fact the mask itself as a whole is relatively light which is a bonus for any standard nasal mask design.
The main performance feature for this product is the Auto Seal Technology that is intended to make fitting the mask easier and eliminate over-tightening of the mask headgear. Though I was skeptical at first, this features does work well; the dual seal system improved the seal even on side-to side movement in bed where your cheeks may compress on the pillow. The outer seal does add to the overall balance of the mask at a different point of the face instead of depending on a single seal to try to do all the work to conform to the contours of the face.
For the first time that I can recall in any mask, the materials used for the for the forehead spacer is the same as the one used for the seal around the nose. This to me was one of the primary benefits of the outer seal; it was just more comfortable than the rigid silicone material typically used in other masks of this style. The soft materials used on both the inner and outer seal are also an advantage to reduce pressure points on the nose and I found it to be very comfortable to the face even after using it for an average of 6.5 hours continuously for a number of days. The mask is quiet at low pressure but the new exhalation port design tended to emit a slight “whistle” on CPAP pressures of 15 cmH2O and above which can be a problem for some people.
Durability and Cleaning
Although we don’t have ability to predict the longevity of the mask, the quality of the materials used appear to be durable. Unless the seal or frame is mishandled, I do not think that there are any obvious parts that are prone to breakage or tearing (unlike the earlier versions of the comfort gel with the frame easily breaking at the ball-and-socket joint). The mask is easy to pull apart but if you have dexterity problems, it may not be as easy to put the mask back together; I can see some people having problems aligning the inner seal and outer seal properly after cleaning.
This may finally be the mask that can replace the Comfort Classic which continues to be used by long-time CPAP users because of some its simple but unique fitting characteristics. The EasiLife is a simple mask to use despite the unique visual design concept. The technologies that Philips Respironics has put into this mask is not only “for show”, but it actually enhances the user experience. If you are having problems with irritations to the bridge of the nose or if you need a wider base opening to accommodate you nose shape, this mask should be one of the ones to consider. If I had one wish for this mask, however, it would be to have a quick release system for the headgear like 99% of the standard nasal masks in the market have nowadays.
Obstructive sleep apnea, a condition in which breathing stops intermittently during sleep – is associated with an increased risk of stroke in middle-aged or older Americans, especially in men, according to a new study out of the American Journal of Respiratory and Critical Care Medicine. And that’s a scary statistic, since, according to the National Sleep Foundation, 18 million people in the U.S. suffer from sleep apnea and many of them don’t know it.
Researchers compiled data from the famous Sleep Heart Health Study and looked at stroke risk in 5,422 participants aged 40 years and older without a history of stroke. At the start of the study, participants performed a standard at-home sleep test that determined whether they had sleep apnea and, if so, the severity of the sleep apnea. Participants were followed for an average of nine years. During that period, a total of 193 participants had a stroke – 85 men (of 2,462 men enrolled) and 108 women (out of 2,960 enrolled).
Study investigators found that the increased risk of stroke appeared in men with mild sleep apnea. Their risk of stroke rose if the apnea was more severe. Men with moderate to severe sleep apnea were nearly three times more likely to have a stroke than men without sleep apnea or with mild sleep apnea. But in women it was different. The increased risk of stroke in females was significant only with severe levels of sleep apnea. The increased risk of stroke from sleep apnea depended on other risk factors the women had such as weight issues, smoking, race, diabetes and high blood pressure.
People who have sleep apnea can have one or more pauses in breathing or shallow breaths while they sleep. It can also be accompanied with loud snoring, or snorting. The pauses often occur five to 30 times an hour. Many times the sleeper is disrupted during the night, because of odd breathing habits, which can result in excessive daytime sleepiness. The erratic sleeping/breathing pattern can also put serious stress on the heart, because the pauses cause the flow of oxygen to the vital organs to slow or even stop for a few seconds, which makes the heart pump harder.
“And what’s even more alarming, is that the body becomes used to these erratic patterns, even if we are not sleeping,” says Michael J. Twery, Ph.D., director of the NIH National Center on Sleep Disorders Research “And when that happens you have stress on the heart all the time. The effects from sleep apnea start to erode your health and that can eventually lead to stroke.”
Researchers believed that because men are more prone to have sleep apnea earlier in life, the risks of stroke are much higher than in women, who usually suffer from sleep apnea when they are pregnant, overweight or are already going through menopause.
“So it suggests, that the longer you have sleep apnea, the more at risk you are,” notes Twery. “And men just seem to develop it at an earlier age.”
“Our findings provide compelling evidence that obstructive sleep apnea is a risk factor for stroke, especially in men,” said Susan Redline, M.D., M.P.H., professor of medicine, pediatrics, and epidemiology and biostatistics, at Case Western Reserve University in Cleveland, Ohio, and lead author of the paper. “Overall, the increased risk of stroke in men with sleep apnea is comparable to adding 10 years to a man’s age. Importantly, we found that increased stroke risk in men occurs even with relatively mild levels of sleep apnea.”
Because sleep apnea symptoms happen at night, when the patient is asleep, many don’t realize they are affected and can go years, even a lifetime, suffering from the condition and not knowing it.
So how do you know if you have sleep apnea, or just a snoring problem? Sleep experts recommend that if you have a partner who notices you are snoring heavily and gasping for breath as you sleep, or you wake up in the morning and find you can’t function during the day, because you a sleepy, it’s best to talk to you doctor. Prior studies have shown that sleep apnea can be a precursor to hypertension, weight gain, diabetes, as well as heart disease and stroke. It is also linked to excessive daytime sleepiness, which lowers performance in the workplace and at school, and increases the risk of injuries and death from drowsy driving and other accidents.
“It’s really up to the patient to make the first move, to go to the doctor and ask to be tested.” explains Twery, “There are a lot of treatments out there that can help. And people need to follow them. Because sleep apnea has no pain with it, many people think it can’t hurt them. But research shows, that sleep apnea can and will hurt your body, especially if it goes undetected.”
The next step for this project? Researchers will start clinical trial studies that can help scientists determine if treating sleep apnea can lower a person’s risk of stroke and other diseases.
Pros: Stable even with movement; lightweight; perception that there’s less bulk on the face; minimal leaks due to nasal pillow design
Cons: No “over-the-head” interface; possible discoloration of the headgear.
Overall: One of the most superior nasal pillow masks I’ve ever used; I hope it will be the same for all my patients!
The Swift FX is the newest installment to the Swift series of nasal pillow masks. The enhancements to the design features of this new mask is based on the idea that “less is more”. This mask was intended to make you feel as if your wearing as little as possible on your face and yet have the confidence that it not leak or displace in the middle of the night.
My first impression of the mask was that it was very light and it really has the streamline design that ResMed was trying to acheive. At first, I was slightly skeptical about the silicone material they used for the headgear which the call the soft wrap but was impressed by how stable it was when I put it on. The clear silicone also gives the visual perception that you have less on your face. I’ve used a nasal pillow style mask for a long time starting with the Breeze Sleepgear from Puritan Bennett, the Opus masks from Fisher and Paykel , and the full line of Swift masks; I have to say this has to be one of the most comfortable masks I ever used.
Let me break down a few of the points that makes this mask work so well for me; Going back to the stability of the mask, the silicone headgear has a locking mechanism on the top similar to a “zip-tie” which reduces movement unlike the buckle system used on the previous Swift models. The material also plays a role with the increased feeling of recoil and a slight “grip” to the face that minimizes sliding especially when I rolled my cheeks onto the pillow. Although I was left with some markings on the face in the morning, it quickly went away. For those who may have a problem with that particular side-effect, the mask comes with fleece wraps similar to those found on the Swift LT for Her. I have to let you know that using this accessory negates some of the benefits of “grip” that I mentioned above. The strap that wraps behind the head to add stability also had a minor improvement but addresses a lot of my patients’ complaints from the previous models. They eliminated the buckle on the back of the head and moved the velcro to the side of the mask (above the ear). I believe this will improve comfort significantly by eliminating the “bump” at the back of the head if one is sleeping on his/her back.
Another improved feature is with the tubing; the tube was designed like a “slinky” which absorbs the opposite forces that occur when the weight and position of the tube from the CPAP pulls one direction and the individual move the other direction. Normally sudden movements pull the nasal pillows away from the nostrils, especially when the position of the tube is just hanging on one side of the bed (unlike the Swift II and Swift LT, the tubing has no fastener to place it on the top of your head). I was amazed how well this design works; ifn fact I think they should design CPAP tubing that way altogether!
The pillow design is similar to the Swift LT but with less volume. The flatter design actually helps to minimize leaks because it seems to wrap around the base of the nose better. It’s also what adds to the streamline feeling when wearing the mask.
Cleaning of the mask is simple. Everything can be pulled apart without fear of breaking it. The only concern I might have is related to the possible discoloration of the silicone over time due to the increased surface area contact with the face or the hair. The nasal pillows are replaceable just like in previous models.
As I mentioned earlier, this is really a well designed mask. Since I started wearing it, I still have not found any reason that has made me reconsider some of my early impressions about the mask. I would’ve loved to see an adaptor or attachment that will allow the tubing to come from above the head. Though it may be more of a personal preference, it would’ve been a nice option. If you are a nasal pillow user, this is definitely one mask you should try.
Review by Cox Tan-Ngo, Chief Therapist at Clinical Sleep Solutions
Pros: Lightweight and simple design; fit most facial profiles with ease; improved materials for durability.
Cons: Minor sensation of airflow from the vents; needs a better forehead pad design
Overall: One of the best satandard nasal masks; positive imporvements from the FlexiFit series it replaces.
For a number of years, the FlexiFit series of masks from Fisher & Paykel has been one of our most successful standard nasal mask. The Zest mask is their newest installment to replace the FlexiFit line and it comes in 3 forms; the Zest, Zest Plus, and Zest Petite. Since it was released in the latter part of 2009, it has taken over where the FlexiFit series left off.
One of the reasons why the the FlexiFit and Zest have been so successful is due to its lightweight and streamline design. The biggest problem with most standard nasal masks is that they are built too bulky and as a result they feel quite heavy to the face. When one puts a standard nasal mask on for a few minutes, they generally feel comfortable and tolerable. However, since a CPAP is intended to be used between 4-8 hours during the night, it often causes irritations to pressure points on the face such as the bridge of the nose and on the cheeks. Movement also become a problem because the displacement of the mask is more likely with a heavier mask.
The Zest mask frame is not as hefty as other masks but it remains durable and we’ve had no noticeable problems with breakage. Fisher & Paykel has also designed it to be more proportionate to the face The diffused exhalation ports have been moved to the top part of the frame and is intended to reduce condensations build-up on the mask. By avoiding the immediate contact of the varying air temperature (temperature difference between the CPAP and the exhaled air from our nose) this minimizes the potential for condensation inside the mask.
The major change they made to the mask is in the materials they used on the silicone seal and foam seal. The most common complaint patients had in the past was that the silicone seal was easy to remove but difficult to align properly to the frame on the FlexiFit line. The new silicone seal is now reinforced with a plastic ring. Initially, I had concerns that it would be a source of problems due to possible cracking or breaking. Fortunately the plastic they used seems to be very durable and the problem has not come up from normal use. Another change to the silicone is that they have now used a dual density silicone design wherein they made the different parts of the seal softer or harder depending on the requirement for structural integrity. The bridge of the nose was designed to be very soft and should benefit people who are proned to irritations to that part of the nose.
Another concern from the FlexiFit line that Fisher & Paykel improved on the Zest was in regards to the foam seal that is placed inside the silicone seal. The old design was problematic because is had a tendency to absorb a lot of moisture, causing it to expand almost 30% compare to its original size. Depending on a person’s humidity requirements and settings on the CPAP, this deterioration can occur within 3-4 months of consistent use. The new foam seal now has a different coating which repels most of the moisture and should last longer. They’ve also changed the shape of the seal (a design philosophy taken from their Forma full face mask) that they say is intended to distribute pressure points more appropriately and minimize leaks.
If you are using a standard nasal mask, the Zest line is certainly one to consider. Once again the streamline design and lightweight characteristics really improve your chances to achieve a comfortable and effective therapy. When using the mask for a 3 week period, I would rate the mask leaks to be minimum to none on most nights. The diffused exhalation port of mask is also quiet but because it is positioned closer to the nose, I can feel the movement of air a bit more through the holes. I would like to see a redesign of the forehead pads because it needs a more even distribution of pressure on that part of the face. The 360 degree swivel where the hose connects to the mask seems to be smooth (at least in the mask that I tried) and it did not have a tendency to “squeek” which sometimes happened with the FlexiFit 407 I previously used.
Still one of the best standard nasal masks in the market. Make sure you get the right model. It comes in the Zest which is for standard noses; Zest Plus for patients with a taller nose bridge or wider nose base; and the Zest Petite for the patients with a small or “button” nose. Though I use a pillow style mask on a regular basis, I use this mask as my “relief” mask in case I want a break from wearing a mask that goes directly into the nostril. When looking for a standard nasal mask, this mask certainly has most of the attributes that one looks for and that is why I highly recommend it.