9 ADVANCE FOR RESPIRATORY CARE & SLEEP MEDICINE VAEs JANUARY 2017 WHEN TO START The fit of the mask should be a priority for the patient as soon as treatment is considered. “When fitting a mask, the patient should be very involved,” said David Hambel, RRT, at Good Samaritan Hospital Medical Center, West Islip, N.Y. “When they go for the sleep study, they should be involved in the process with the sleep technologist. They should be educated on the proper fit. When they get equipment for their home, the durable medical equipment provider should provide information on proper fitting.” If a mask doesn’t properly fit a patient’s facial dimensions, they are less likely to use CPAP. As an obstructive event can occur up to hundreds of times per night depending on the severity, extreme exhaustion is a concern. It will also put the patient at risk for high blood pressure, congestive heart failure, depression, diabetes and insomnia. To choose the right mask for the patient, Jason Hudson, RPSGT, South Seminole Hospital in Longwood, Fla., starts by finding out if they are a mouth breather. If they are not, a full-face mask may not be necessary. After measurements are taken and the mask is fitted to the face, Hudson always takes one extra precaution: “The biggest thing is fitting them with the CPAP pressure on so that it actually fills out the mask,” he said. “This will show whether it’s too tight or there’s not enough pressure.” Overtightening of the CPAP mask is an issue that Hambel sees regularly from both patients and professionals. “The mask doesn’t need to be glued to the face. It should be snug, but comfortable,” he said. “Some have a bubble seal. You’re supposed to be able to lift it a little bit off your face and it creates an air cushion. If you’re tightening to the point where you’re not letting the silicone flap inside the mask make a proper seal, and it’s digging into your face, you’ll get pressure sores and other complications.” RESOLVING ISSUES If a patient or professional is tightening a mask because they are afraid of a leak, McCown urges them to pay attention for one type. “The area of leak that we focus on is around the eyes. That can cause dryness and eye problems with continued leakage,” he said. “Leaking down around the mouth … the machine does a very good job about compensating for a little bit of a leak.” Having a vocal patient is a key component to making sure the right mask, with the right fit, is found. Hudson believes that patients need to speak out in their care of sleep management. “If a mask isn’t working for them, they need to reach out and let someone know and not give up on the CPAP process,” he said. “It’s very important that they wear the mask and use CPAP, but a lot give up because a week or two down the road, they’re not comfortable with it anymore.” If there is some apprehension after trying a mask, McCown suggests “baby steps” toward regular use. Since the process can cause anxiety, he claims that the clinician needs to step up, find the root of the problem and work through it. Since it can take a considerable amount of time before they may become comfortable using the device, he suggests the patient put it on every night and try to keep it on as long as they can. If it becomes unbearable, take it off. If they wake up in the middle of the night, he advises that the patient should try again since they may be more relaxed. FOR SLEEP APNEA When fitting a mask, the patient should be very involved.” — David Hambel, RRT, Good Samaritan Hospital Medical Center RELATED CONTENT No Masking CPAP Discomfort Many patients give up on sleep therapy due to irritation.
Advance for Respiratory Care & Sleep Medicine • January 2017
To see the actual publication please follow the link above