CPAP Blog

I was asked recently whether I thought the Comfort Curve mask I use is suitable for a side sleeper. People who sleep on their sides for most of the night tend to find that conventional nasal cushion CPAP masks dig in to the pillow, being pushed side ways causing leaks or added pressure on the opposite side which may cause skin irritation and red marks on the face.

Whilst I sleep mostly on my back I do think the Comfort Curve is a decent option for side sleepers. I’ve tried it myself and the extra pressure caused by the contact with the pillow does not cause major interference with how the mask sits. Depending on the pillow type you have, the cheek pad resting on the side of your face can make your cheeks slightly sore. Therefor, I don’t think the Respironics Comfort Curve mask is the best option for someone sleeping on his or her side.

I have no experience with ‘nasal pillows’ myself but have heard great feedback from side sleepers. Unlike a conventional CPAP mask with a cushion that sits around your nose, a nasal pillow literally plugs into your nostrils (or nares as they say in the US) therefor not touching your face at all. No material goes to the side of the nose so you are free to lay on your pillow on your side. With a medium firm pillow that doesn’t cause your face to sink in it completely (like some feature and down pillows) the pillow’s surface won’t get near enough to your nose to disrupt the way the nasal pillow mask is worn.

This image illustrates the point. This man may be lying on his back there but as you can see, nothing would stop him from sleeping on his side. Minimal contact with the most sensitive parts of the face is made so red marks and skin irritation is likely to be avoided with a mask interface like this. Like with wearing a hat or cap, most people don’t get any skin rashes, marks or itching at the forehead.

This examples is a Respironics Comfort Lite 2 but it’s not the only one like this. In the UK you can also get the ResMed Mirage Swift II though with the tube sticking out on one end, this may only be suitable for side sleepers who know which side they sleep on consistently. Puritan Bennett does the Breeze SleepGear CPAP nasal pillow interface and UK/E.U. readers can order it here. Like the Comfort Lite 2, the sides of the face are completely free to be flat on the pillow, making this a great solution for side sleeping CPAP users. Unfortunately, because these types of masks plug into the nose only, they are not suitable for mouth breathers (if you are, keep reading though, solution to follow).

Similar designs, suitable for side-sleepers: Snapp-X by VIASYS and Fisher & Paykel’s Opus.

Having spoken of the various CPAP mask options for side sleepers, did you know you can also change your pillow to accommodate your mask, instead of the other way around?

This clever design features a cut-out where the mask and tube sits, making room for this gear so it doesn’t dig into the pillow, putting pressure on the face. The pillow is called the CPAP Sleep Aid and you can read more about it on the manufacturer’s website here.

So to sum this post up, if you suffer from marks on your face, skin irritation or just generally prefer to sleep on your side you have two options. Go for a ‘nasal pillow’ mask interface or opt to change the actual pillow you sleep on.

Via the people I got my CPAP machine and masks from, I got in touch with Clare Jeffries who runs a Nutritional Therapy Practice in Surrey called Healthy Influence. We all know dietary choices have an effect on our body and sleep apnoea condition so it helps to know the do’s and don’t when it comes to food intake. Clare kindly agreed to be interviewed about how nutrition influences disorders such as OSA. Our forum members also pitched in with a few questions.

Coincidentally, yesterday I was watching The Truth About Food on the BBC in which the volunteers dropped an average of 23% in their cholesterol levels after eating raw fruit and veg only for just 10 days. Many reported weight loss and increased energy so it clearly illustrates how making the right food choices can help sleep apnoea sufferers with very quick results.

Interview with Nutritional Therapist Clare Jeffries:

JMcM: How long have you been a Nutritional Therapist for?

CJ: Studying for 4 years and practising for 1 year.

JMcM: How did you first learn about OSA?

CJ: It came up in my reading on obesity as something many overweight people suffer from.

JMcM: As you know a lot about the human anatomy, can you summarize the effects of sleep apnoea on an otherwise healthy body?

CJ: Because sleep apnoea restricts, sometimes severely, the amount of oxygen being delivered around the body whilst sleeping, cells are not able to get rid of wastes to keep them healthy and this can have many long term effects. Also, the brain registers this drop in oxygen and tells the heart to pump harder to deliver more blood faster. This can then lead to high blood pressure and over time sleep apnoea can cause other heart abnormalities. And of course, due to the lack of good sleep, sufferers will be excessively sleepy in the daytime and may get morning headaches.

JMcM: As we all know, untreated OSA affects blood oxygen levels. Is there anything nutrition-wise sufferers can do to improve the condition of the blood or to make sure the little oxygen in there gets used up best?

CJ: Ideally, you want the blood to be able to carry as much oxygen as it can and having adequate iron levels is required for this. When a person is anaemic, they have reduced capacity for carrying oxygen on their red blood cells. However, most men who eat a varied diet will be getting sufficient levels, unless they have a disorder of some kind that means they are losing blood, such as bowel disorders or haemorrhoids. Another factor that is important is to ensure you are well hydrated. When we don’t consume adequate levels of fluids, the blood becomes slightly ‘thicker’ and therefore harder for the heart to pump around the blood vessels. Think of it like sucking a McDonalds thickshake as opposed to orange juice through a straw! So, make sure you have at least 1.5 litres of water (herbal teas can count towards this) in addition to tea & coffee.

JMcM: A feeling of sleepiness is possibly what bugs us most. Are there any foods specifically full of energy, aiding staying awake and alert?

CJ: B vitamins and magnesium are crucial for energy production and are found in fish, wholegrains, brown rice, mushrooms, green vegetables, beans & pulses, some meats & eggs. It will also be helpful to keep your blood sugar balanced, by not eating too many refined carbohydrates such as white bread, cakes, biscuits, chocolate and sweets, and not leaving very long gaps between meals. When we do eat lots of these foods and leave long gaps (more than 4 hours) between eating, your blood sugar levels resemble a rollercoaster, with big peaks & troughs. In the ‘troughs’, you can feel very tired and lethargic. Aim to eat little and often and have foods that contain fibre (fruits, veg, wholegrains), as these keep the blood sugar on an even keel.

JMcM: What about the use of coffee or energy drinks in a desperate attempt to stay awake; good or bad?

CJ: Understandably, these must be appealing at times, but using them in the long run often disrupts your blood sugar balance as described above, because they push your body to churn out stress hormones like adrenalin & cortisol which can make you feel a bit ‘wired & fired’ but then comes the inevitable crash after they’ve worn off. If you do feel you can’t do without these though, coffee (good quality filter best) is better than energy drinks which are full of caffeine, chemicals & sugar.

JMcM: Many OSA sufferers often feel depressed or easily agitated. Can food help with controlling one’s mood?

CJ: Balanced blood sugar levels is also very important for this as the brain is very sensitive to drops in blood sugar, and one can feel low mood, irritable, angry, get headaches and generally feel under par when levels drop too low. Again B vitamins are important for producing ‘happy hormones’ in the brain and having good intake of essential fats (oily fish, nuts, seeds, olive oil, avocado are all good sources) has been found to reduce depression.

JMcM: With a CPAP machine and a mask on, it can be difficult falling asleep at times. What is the role of food in a good bedtime routine and for promoting a restful sleep?

CJ: Serotonin is needed to induce sleep and this is produced from something called tryptophan. This is a part of protein and is absorbed best from walnuts, milk, soy, eggs, bananas & fish. So eating fish or an omelette for your evening meal or having a snack including these foods 1/2 hour before bed can help you drop off easier. Obviously, its best to avoid coffee, tea or chocolate in the evening due to the caffeine levels and again if you have something very sugary in the evening, your blood sugar levels may drop off too steeply in the night which can then wake you up.

JMcM: Many of us are overweight, contributing to the causes of OSA. What are your best tips on weight management?

CJ: Sorry to be a bore, but keeping you blood sugar balanced, so that the body knows it has a steady supply of energy, encourages it to let go of excess weight, so simply not eating very much may be bad for losing weight in the long run. Eat 3 small meals per day and two healthy snacks. Eat plenty of vegetables & fruit as these are low calorie but high fibre, so keep you satisfied for longer than cakes & biscuits! As a general rule, try to avoid large portions of carbohydrate (bread, potatoes, rice, pasta) with your evening meal and have them at lunch time instead.

JMcM: I’ve been reading about light therapy possibly having a beneficial effect on sleep. Do you happen to know anything about this subject and if so, what are your views on this?

CJ: Light therapy does indeed have a positive impact on sleep. This is because it helps regulate the circadian rhythm, our ‘body clock’. Without adequate levels of light in the day, the body sometimes gets confused as to when it should be sleeping and sadly with modern living and long ours in offices with artificial light, exposure to full spectrum natural light is often inadequate. I certainly think it is something worth considering as part of our overall health.

JMcM: Finally, not necessarily related to OSA, what is your favourite nutrient-rich food and why?

CJ: That’s hard as there are so many, but certainly oily fish (salmon, mackerel, sardines, kippers, anchovies) cannot be underestimated. These oils help protect the heart from damage, be keeping the blood vessels supple, they protect the brain in a similar way. As heart attacks & stroke are more common in those with OSA, I think they are particularly important. But they do lots more not related to sleep apnoea, such as reduce inflammation so helpful in arthritis, they help the body balance weight and regulate hormones. A real super food!

JMcM: Our forum member katiemcewan asked the following question: “My husband doesn’t ever drink any water. I keep saying he should but he just can’t keep it up for longer than a few hours. I’ve heard drinking too little water can cause back trouble etc. but does it also add to the sleep apnoea symptoms he suffers from?”

CJ: As I mentioned above regarding helping the body deliver oxygen, being adequately hydrated is very important for the blood to flow easily, reducing the change of high blood pressure.

JMcM: Another member, aptly named JackTheSnorer, asked: “Not so much coffee, more Red Bull for me to perk me up. I know it’s full of caffeine so how exactly does it work with blood and the heart etc.?”

CJ: As discussed above regarding using stimulants to stay alert, caffeine makes the body produce more stress hormones (hence the jittery feeling some people experience with high levels of caffeine) which often makes the heart pump harder. Although this might seem like a good thing for delivering oxygen around the body, the heart is artificially being stimulated to work harder than is necessary. The occasional red bull is not a problem, but be aware that it contains a similar amount of sugar to coca-cola. There is a sugar free variety, but due to the possible dangers of artificial sweeteners to the health of your brain, I do not recommend having the diet variety.

JMcM: Thank you Clare, that has been some great advice I’m sure all readers can benefit from. Thanks for taking the time to answer them!

CJ: No Problem!

And of course, if you are curious about nutritional advice more tailored to your specific circumstances, you can contact Clare here to arrange a consultation.

Other helpful links related to this post:

• Guide to Lower High Blood Pressure
• Eat well, be well - Blood pressure
• Suitable foods for Diabetics
• BBC: What can diabetics eat?
• Fruits and Vegetables for Weight Loss
• Is Caffeine Your Friend or Foe?
• Energy Drinks and Insomnia

If you would like to discuss nutritional topics with fellow sleep apnoea patients, please visit the forums. You can also leave your feedback in a comment below.

On October 10th, the National Institute for Health and Clinical Excellence (N.I.C.E.) holds the second appraisal committee meeting. This is an important step in N.I.C.E.’s appraisal of Continuous Positive Airway Pressure (CPAP) and its use in the NHS around the country.

The Department of Health recognizes the growth in obstructive sleep apnoea / hypopnoea syndrome prevalence and is seeking advice from expert consultants in regards to the way forward. It is no secret that allocated funds don’t meet demand for sleep apnoea treatment in England and Wales with many patients complaining about the current ‘postcode-lottery’ system.

At the first meeting the appraisal committee considered the evidence submitted and views put forward by consultees other than the CPAP manufacturers, who in fact are on the committee’s list of sources of evidence. Based on this, preliminary recommendations on the use of CPAP as a treatment for OSA have been put together. This second meeting will allow for comments on the preliminary recommendations and re-consider evidence submitted.

The Final Appraisal Determination (FAD) is scheduled for early next year.

The current recommendations, still subject to change read:

1	Appraisal Committee’s preliminary recommendations
1.1	Continuous positive airways pressure (CPAP) is recommended as a treatment option for people with moderate and severe symptomatic obstructive sleep apnoea/hypopnoea syndrome.
1.2	Continuous positive airways pressure (CPAP) is also recommended as a treatment option for people with mild symptomatic obstructive sleep apnoea/hypopnoea syndrome if lifestyle advice and any other relevant treatment options have been considered and deemed inappropriate or unsuccessful.
1.3	The diagnosis of obstructive sleep apnoea/hypopnoea, the prescription of CPAP treatment and monitoring of the initial response should be carried out by specialists in sleep medicine.

Point 1.1 doesn’t seem to be a big change. CPAP was already the recognised form of treatment for OSA prior to these meetings. Points 1.2 and 1.3 will have a greater impact on the health care system and service patients may come to expect.

It looks like the NHS will start to recommend CPAP based on a lower symptoms threshold. Where previously you had to be diagnosed with severe sleep apnoea (breathing lapses of over 10 seconds many times every hour) it looks as if this requirement will be lowered to include those with milder forms of obstructive sleep apnoea, like those with shorter apnoea events or fewer. If this recommendation goes through, this could mean many more people being diagnosed and needing treatment so one would hope more funds will become available to pay for this increased demand.

Point 1.3 may have implications on the current bottleneck that is diagnosis. Where elsewhere in the world stakeholders have been discussing the appropriateness of in-home testing with portable diagnostics devices such as Respironics’ Stardust or ResMed’s ApneaLink, the NHS seems to favour clinical diagnosis. In-home testing could take the burden off busy sleep labs. By opening up CPAP treatment to more people we need more people diagnosed. Insisting on the conventional diagnosis route could mean a bigger bottleneck and reduced access to the actual therapy, considering a prescription is required. Some sleep labs charge over £1,000 for an overnight stay - an amount the average OSA patients is unable to stomach so waiting lists are bound to increase.

We will find out early 2008 whether these recommendations will make it into official Department of Health guidelines. I just hope they don’t make the problem bigger than it already is.

What do you think about these important developments? Leave a comment below or discuss in the forums.