5 [little known], bizarre facts about PAP therapy, to make it safer and more effective (2019)

5 [little known], bizarre facts about PAP therapy, to make it safer and more effective (2019)

Snorer.com
Rated 5/5 based on 16 customer reviews

In the old and grainy image above, I’m learning about Positive Airway Pressure (PAP) therapy. Indeed, there’s so much to learn it can feel overwhelming, and when you’ve just been prescribed a life-long therapy, it can feel like a curse and not the blessing it really is.

So, these 5 little known, bizarre and seemingly counter-intuitive facts about PAP therapy for obstructive sleep apnoea / apnea, aim to help and inform you. Help you avoid some of the common mistakes and make PAP easier to live with, more comfortable, safer and ultimately more effective.

Quick side note: I use the ‘PAP’ acronym to encompass both CPAP and APAP

If you or someone you know uses PAP, then you need to read this…

Adrian Zacher MBA

Adrian Zacher MBA

Author, Snoring and Sleep Apnoea Care Navigator

I teach UK dentists to help their patients stop snoring; sleep and breathe at the same time. Many of my customers find their work so rewarding they devote their practice to it. I’m a sleep-industry insider with a quarter of a century of sleep medicine experience.

Google Scholar

Bizarre Fact 1:

For a Better Fit LOOSEN the Headgear 

When your PAP mask leaks, it seems completely logical to tighten the headgear straps.

WRONG!

Full-face PAP mask sleep apnoea

Yes, I know it seems insane, and I’ve even witnessed experienced sleep professionals, over-tighten headgear straps… So, you’re in good company if you’ve done this…

 

How loosening PAP headgear straps improves fit

PAP masks or ‘interfaces’ are made of a soft and highly flexible material that inflates a bit like a hovercraft cushion ↗, and in so doing, adapts to the contours of your face. 

If you over-tighten the straps, you ‘crush’ this cushion and push the hard plastic frame into your face. Ouch! This makes it leak even more…

Getting the fit of your mask right is a moving target. You should adjust the straps when you are lying down and the PAP machine is blowing air.

PAP exhaust in your partner's face

Bizarre Fact 2:

Exhaust in your partner’s face

The Truth

PAP therapy exhaust is vented from the front of the mask straight at your sleeping partner. This venting is essential to prevent CO2 building up for when you breathe in (inhale).

While this might be fine in the Tropics… in Blighty at 2am, it can be less than desirable. Perhaps, if not a rocket exhaust, it’s a flow of air into your partner’s face which makes them turn over and move away from you #nice Other than a mask redesign, not a lot you can do about it.

This is something some sleep professionals and businesses may shy away from discussing…

Why?

Perhaps because it might discourage you from using what is already an arduous therapy.

I disagree. Education informs choice. And who are they to judge what you should know?!

Choice is what drives manufacturers to produce better products. Today, the noise from the a PAP mask exhaust is a design target. Perhaps tomorrow directing the exhaust will be.

 

Bizarre Fact 3:

Adjust Your Mask Straps – Once Again

Back to those darn straps….

Once you’ve got the tension of the straps about right by LOOSENING them – Fact 1 above (I found I had to pretty much have it falling off my face before turning on the machine…) leave it a week or so, and you’ll find you need to adjust the straps once more

This is because the headgear fabric stretches. As I said above, its a moving target. Quite literally.

Leave it a week or so, and you’ll find you need to adjust the straps once more…

Its a moving target

WAKE UP! Bizarre facts about PAP for sleep apnoea

Bizarre Fact 4:

WAKE UP!

This is for the sneaky, cheeky partner of a PAP user. And who knows, they may take some sort of insane ‘pleasure’ in this 😉

Should the partner suddenly hear an increase in air hissing from the mask while the PAP user sleeps, they have full licence to WAKE THEM UP! and get them to restore their mask ‘fit’.

This is because the pressurised air is escaping (that’s what’s making the hissing noise) and not keeping the user’s airway open.

They are not treated. Go ahead and wake ’em up!

Bizarre Fact 5:

Don’t put petroleum jelly up your nose

PAP therapy can make the inside of your nose sore. Really sore. 

The WRONG thing to do is to shove petroleum jelly up your nose in an attempt to soothe and protect the broken skin.

The RIGHT thing to do is to consult your sleep unit and discuss humidification.

Why is this?

Small particles of petroleum based products may enter your lungs as you breathe, over time this may cause chemical pneumonia (more correctly termed ‘chemical pneumonitis’).

Don't put petroleum jelly up your nose

Summary

PAP therapy is awesome. But it’s a bit like riding a bike. You need to learn how to use it, you will fall off at first and you will probably get cheesed off with it.

Perseverance, help and advice will see you using PAP therapy and appreciating the benefits. Grab our free PAP guide and if you or your loved one are struggling with PAP therapy consult your sleep unit immediately for help.

There are also fantastic support groups who offer online and even 1-2-1 phone support (read the free PAP guide – they’re listed at the end).

Don’t give up = fit some stabilisers! Just like you did as a kid 😉

How to choose PAP therapy information guide

Related

Check out related independent reviews and how-to’s:

Dental Appliances for Sleep Apnoea | Snorer.com

Dental appliances for sleep apnoea are an appealing option. But how do you know if they will work without buying one? This post explores how predictor or titration dental appliances for sleep apnoea came to be and the vital role they may play building trust between medical and dental sleep professionals.

© Snorer.com 2019. All rights reserved.
Created by Adrian Zacher | Page last updated 10th Sept 2019

Do Anti Snore Pillows work? (Sleep-Expert Review 2019)

Do Anti Snore Pillows work? (Sleep-Expert Review 2019)

Snorer.com
Rated 5/5 based on 16 customer reviews

Anti snore pillows: Do they work?

Anti snore pillows seem ideal: an easy and comfy way to return peace and quiet to your bedroom…

But:

Do they really stop you snoring? 

If you’re thinking of buying an anti snore pillow, then read this independent (no advertisements or affiliate links!) sleep-industry expert review.

I examine:

  • How anti snore pillows claim to work
  • What the clinical evidence tells us 
  • What the experts say
Adrian Zacher MBA

Adrian Zacher MBA

Author, Snoring and Sleep Apnoea Care Navigator

I teach UK dentists to help their patients stop snoring; sleep and breathe at the same time. Many of my customers find their work so rewarding they devote their practice to it. I’m a sleep-industry insider with a quarter of a century of sleep medicine experience.

Google Scholar

Tired of the sleepiness and the snoring?

Then read our free, definitive step-by-step how to stop snoring Guide.

This comprehensive Guide walks you through self-help, signposting, screening, professional assessment and diagnosis, the three categories of prescription treatment, follow-up and rounds off with a substantial FAQ.

CAUTION: Snoring may be a symptom of Obstructive Sleep Apnoea / Apnea (OSA)

Without first being screened for obstructive sleep apnoea (OSA) your purchase of an anti-snore pillow could be delaying your diagnosis and effective treatment (should your snoring be a symptom of OSA.)

A treatment that will prolong your healthy life!

Get signposted to the most appropriate professional (it’s free!)

The professional will screen you for OSA and decide if you’re ‘just’ a snorer or if your snoring needs investigating.

Your GP may be able to help you. Or if you live the UK, you can also find sleep-trained dentists who can screen you and recognise Obstructive Sleep Apnoea/Apnea (OSA) symptoms. These dentists can also provide you with a custom-made anti-snoring device.

Anti snore pillows (How they claim to work)

Various anti snore pillows are available, yet they share design similarities:

They’re either ‘door-wedge’ shaped or double-curved with the hollow being where you place your head.

In this independent review, I look past the marketing ‘hype’ and examine the science (if there is any) behind their claims:

sleep on your side Encouraging you to sleep on your side
better breathing by supporting your head and neck Encouraging better breathing by supporting your head and neck
better body alignment Encouraging better body alignment (whatever that is)

 

So we have 3 claims to review:

Anti Snore Pillows (What I'm not including in this review)

There’s another type of anti snore pillow that I’m not including in this review.

They’re the expensive (circa 300 USD) ‘high tech nudge’ pillows that don’t treat your snoring – they merely disturb your sleep in some way when a snore is detected. They wake you up enough to regain muscle tone in your throat.

Some manufacturers claim that after a while you will get used to this pillow movement and regain tone in your throat without waking up.

The jury is out on this.

No. 1. Anti Snore Pillows make you sleep on your side

Why? Why is sleeping on your side an aim? And how does that help stop snoring?

Think First Aid.

Are you familiar with the ‘Recovery Position’? Perhaps you should be!

This is when the unconscious individual is moved by a first-aider off their back into a semi-prone position known as the ‘Recovery Position’ to help them breathe.

We’ll come back to how this relates to snoring and anti snore pillows, later in this post (it’s called positional therapy).

Check out the video below about the Recovery Position by the St John’s Ambulance. It’s all about ensuring you can breathe when unconscious.

Here’s an authentic and less than favourable review of an anti snore pillow in the Huffington Post

The Recovery Position (YouTube video) by the St John’s Ambulance.

No.2. Anti Snore Pillows support your neck

According to the NHS ↗, the most common cause of neck pain is when your neck has become locked in an awkward position while sleeping.

But what’s neck pain got to do with snoring?

Allow me to explain:

If your pillow inadequately supports your neck while you sleep, and your head is on your shoulder. Then the airway in your twisted neck may become restricted.

And you guessed it:

You snore.

Anti snore pillow neck ache
So, there is merit in supporting your neck while you sleep:
  • From both a neck pain perspective
  • And if your current pillow could be improved upon, it seems reasonable it could improve your breathing while you sleep

But unless your pillow is truly terrible and you routinely wake-up with neck pain from a strange sleeping position;

I would not expect it to stop you snoring.

But what do the experts say?

What do the experts say about anti snore pillows?

Clinical experts research products or theories to establish if it does or doesn’t work. You can think of it as proof or as close as possible to ‘fact’.

There is good evidence that positional therapy i.e. training the individual NOT to sleep on their back (No. 1 in this review) can help stop snoring1.

What do the experts say about anti snore pillows?

No. 3. Anti Snore Pillows stop snoring by encouraging 'Better Body Alignment'

Encouraging better ‘body alignment’ (as in sleeping with your head and body straight and your neck not bent) would on the face of it seem reasonable.

Perhaps if you were to sleep with your neck at an acute angle (as I mentioned in my review of claim No. 2) then yes the airway in your throat would be restricted and it could make you snore.

However, marketing a pillow with a supposed anti snore feature being improved ‘body alignment’, is I think reaching a little.

Anti snore pillows are they the most effective positional therapy device?

The Real Question

So if positional therapy has some validity as a way to stop snoring, the real question is:

Are anti snore pillows the most effective positional therapy device?

And to answer that I will:

  • Look a little closer at positional therapy
  • Provide a rough cost/benefit analysis
  • Review what the experts advise

Unless your pillow is truly terrible, I would not expect a new one to stop you snoring.

Adrian Zacher MBA

Snoring & Sleep Apnoea Care Navigator

Positional therapy for snoring and sleep apnoea

Turn over you're snoring!

Positional therapy for snoring is ‘as old as the hills‘. Think tennis ball in the breast pocket of a t-shirt worn back to front.

Position dependent snoring1 is the technical name for when snoring either stops or lessens in different (not on your back) sleep positions.

Fortunately things have moved on some from tennis balls and anti snore pillows.

I’m not going to review the various high tech ways to or my experience of them here.

Suffice to say positional therapy may be useful IN ADDITION to:

  • A prescription, custom-made anti-snoring device
  • Positive Airway Pressure therapy

To get either of these you’ll need to know what you’re trying to ‘fix’. As in not self-diagnose yourself.

Keep reading:

Sleeping prone or on your front with an anti snore pillow

My personal experience of an anti snore pillow

When I rolled over and tried to sleep prone (on my front) my wife reported that the part of the pillow designed to support my neck when I slept on my side, pushed against my throat.

It appeared to be collapsing my airway!

She said I was making some very strange noises…

However, I continue to use an orthopaedic neck support pillow (remarkably similar shape!) and wouldn’t used anything else. I’ve learnt not to sleep quite so flat on my face!

Are they worth the money?

Anti Snore Pillows (Cost/Benefit Analysis)

Are anti snore pillows worth the money?

From a financial perspective its hard to beat the tennis ball in the pocket of the t-shirt.

With anti snore pillows on the market from 5 GBP they may be worth a punt.

However, you need to be aware of these limitations:

  • The tennis ball or anti snore pillow might not be enough to stop the snorer sleeping on their back (they just ignore it)
  • You have no evidence of effect throughout the night (other than the lack of a partner’s elbow in the ribs!)

Anti Snore Pillow: Costs

Anti snore pillow prices online and in the shops range from as little as 5 GBP to 25 GBP.

As a first-line and relatively harmless way to stop snoring they probably make financial sense.

However (and it’s a big HOWEVER) if they don’t stop the snoring problem then you need to seek the advice of a professional.

Pretty much everything is going to cost more than a tennis ball or a stop snoring pillow, but if you’re serious about no longer snoring, then consult a professional. There are considerable drawbacks to self-diagnosis.

  • If you have mild to moderate obstructive sleep apnoea (OSA) and you’re using an oral appliance then some data to show you turned over and your sleep has improved might be worthwhile.
  • If you’re on an auto-titrating PAP then getting off your back may reduce pressure and make PAP more tolerable.

Are you trying to ‘cure the snore?‘ (Before you know what’s wrong?)

Trying to ‘cure the snore’ before you know why you snore – is like driving a car before you’ve passed your test.

Wrong

You might think you can drive – but you could be on the wrong side of the road!

Treatment (the ‘cure’ for the snore) follows diagnosis i.e. find out if your snoring is more than just anti-social before trying to ‘cure’ it – for this you need signposting.

What about anti-snoring devices?

If anti snore pillows aren’t helping then you might wonder what else is available. Enter anti snoring devices.

Anti-snoring devices are commonly oral appliances you wear in your mouth at night.

They work by holding your lower jaw in a more forward position. This keeps your tongue away from the back of your throat so you don’t snore.

What’s the best anti-snoring device?

Example of an anti-snoring device

Example of an anti-snoring device. Image courtesy of SomnoMed and used with permission.

What about surgery?

A long way from an anti snore pillow…

Surgery for snoring is divided into whether hard and soft tissue is involved.

Soft tissue surgery is intended to improve the effect of an anti-snoring device or PAP therapy (more about what PAP is in a moment).

Whereas hard tissue surgery (that changes the way you look) is intended to eliminate the need for any other treatment.

Learn more:

Radio-frequency ablation for snoring

Image representing a soft tissue operation: radio-frequency palatal surgery.

Image representing a hard tissue operation: bi-maxillary osteotomy (both jaws operated on).

What about CPAP?

There are pillows especially designed for PAP users. Keep reading:

CPAP stands for Continuous Positive Airway Pressure therapy. Today, it is referred to as just PAP.

PAP works by providing low pressure air (through a mask worn over your nose and sometimes both your nose and mouth) to the airway in your throat. This pneumatically holds open your airway.

While an arduous therapy, it is highly effective if snoring is actually a symptom of obstructive sleep apnoea (OSA).

Learn more:

Example of a full face PAP mask

Do’s

Don’ts

  • Don’t self-diagnose yourself as ‘just’ snoring
  • Don’t buy over-the-counter stop snoring gadgets
  • Don’t ignore drowsiness or sleepiness during your normal awake time (consult your GP)
  • Signposting to the right professional

    When self-help and pillows aren’t helping it’s time to get serious.

    Signposting is when you’re directed to the most appropriate expert to help you stop snoring.

    The expert professional (your GP, additionally if you’re in the UK a sleep-trained dentist2) will screen you for sleep apnoea and decide if you need further investigation i.e. a sleep study.

    If you don’t need a sleep study a custom-made anti-snoring device (available from the sleep-trained dentist) is the first way to stop snoring and treat mild to moderate OSA3.

    Oh and signposting is free.

    Signposting to the right professional to stop snoring

    Summary

    My final verdict is that anti snore pillows are a relatively low-cost way to try to stop snoring. But don’t get your hopes up.

    You need to be comfortable to sleep well, so find a pillow that helps you sleep comfortably on your side and supports your neck. Consider orthopaedic pillows in addition to the big headline grabbing brands.

    When snoring is a problem consult a professional. If you’re in the UK you can get signposted to the right type.

    Otherwise consult your primary care physician. They have your medical history and want you to be well (they’re not trying to sell you something!)

    A final note about high tech anti snore ‘nudge pillows’:

    I’d like to see the impact this type of anti snore pillow has on the individual’s sleep quality.

    They appear to me to be fragmenting sleep and preventing deep restorative sleep from occurring. I consider the onus upon the pillow manufacturers to substantiate their marketing claim.

    And I come back to the fact that this is a ‘treatment’ before knowing why you snore: there has been no prior assessment or screening for sleep apnoea.

    Reviews

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    If you are looking for impartial advice about snoring from an expert in the field, the highly respected Adrian Zacher should be your go to. We applaud Adrian’s work, to raise awareness about the health implications of snoring, and the importance of custom-made devices for long-term success.

    Lucie Ash Director Somnowell How to choose the best anti-snoring device September 7, 2018

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    Let others know what you think.

    1 - 5 out of 5, where 5/5 is the best and 1/5 is the worst


    Here are some more high quality, independent sleep-expert reviews of anti-snoring devices, snoring and sleep apnoea / apnea products, cures and aids!

    Glossary

    Anti-Snoring Device – generally considered a product worn in your mouth to stop you snoring.

    Custom-made – a bespoke device made specifically for you by a registered dental technician, working to prescription, using CE marked materials. In Europe working to the Medical Devices Directive  administered in the UK by the Medicines and Healthcare Products Regulatory Authority (MHRA)

    OSA Obstructive Sleep Apnoea – (also spelt apnea) When an individual is unable to sleep and breathe at the same time. Visually, a repetitive pattern of breathing interruptions (apnoeas) occurring while the individual sleeps, due to a physical obstruction in the airway.

    OTC – Over-the-Counter product sold over the pharmacy counter or on-line without prescription, medical or dental assessment and without a review of medical/dental history.

    Signposting – Is the medical term for directing people to the most appropriate professional to help them based upon their answers to some high-level questions.

    Sleep-trained Dentist – A dentist that has undergone special interest training in sleep. As such they are able to obtain professional indemnity insurance.

    References

    1. Benoist LB, Morong S, van Maanen JP, et al. Evaluation of position dependency in non-apneic snorers. Eur Arch Otohinolaryngol. 2013;271(1):189–94. https://link.springer.com/article/10.1007/s00405-013-2570-5  new window
    2. Stradling, J. and Dookun, R. 2009, Snoring and the role of the GDP: British Society of Dental Sleep Medicine (BSDSM) pre-treatment screening protocol, British Dental Journal, 206, 307 – 312. Available here: http://www.nature.com/bdj/journal/v206/n6/abs/sj.bdj.2009.214.html new window [accessed 12 April 2017]
    3. The American Academy of Sleep Medicine (AASM) has approved oral appliance therapy (OAT) as a first line treatment for patients diagnosed with mild to moderate OSA. https://www.sleepapnea.org/treat/sleep-apnea-treatment-options/ new window

    Created by Adrian Zacher | Page last updated 3rd June 2019

    Updated NICE Guidelines for Sleep Apnoea

    Updated NICE Guidelines for Sleep Apnoea

    In my view improving NHS provision and fast tracking certain individuals, at this time of austerity, has for any rational person to be considered at best, highly unrealistic.

    At Snorer.com we applaud the intent behind the 2015 updated NICE Guidelines for Obstructive Sleep Apnoea Syndrome (OSAS) new-window.
    empty pockets
    However, we feel duty bound to point out that the reality is sadly somewhat different to the aspirational view the Guidelines suggest.

    Fast tracking those in ‘hazardous roles’ is absolutely the right thing to do, but we have a new Conservative Government (new Parliamentary session commenced today 27th May 2015) and the prospect of a £30bn cuts programme to tackle the deficit. In my view improving NHS provision and fast tracking certain individuals, at this time of austerity, has for any rational person to be considered at best, highly unrealistic.

    Getting prompt help through the NHS (or for that matter any help at all with sleep apnoea) depends upon your success in obtaining at least two things:

    1) Your local Doctor recognising your symptoms and being able to do anything much about it. This requires more than just education. Your local Doctor is now in a quandary: They can no longer do much more than ‘paper screen’ (they may also be employed by a Private Provider who limits what they can and cannot do).

    They also know that their sleep unit (if there is one locally – see below) is bursting at the seams. So they cannot know with any degree of confidence if you need to be seen at specialist level…. Do they make the referral and add you to the already overstretched service?

    2) Capacity of your local sleep unit (that is if you are one of the lucky 15% of UK citizens that have access to appropriate treatment – see British Lung Foundation, OSA Health Economics Report 2014 PDF new-window).

    According to the BLF just 15% of those with OSA have access to treatment

    Here is the exact quote from the BLF, OSA Health Economics Report 2014 (see page 5):


    … the proportion of people with OSA that do not have access to the most appropriate treatment is still very high (up to 85%). Evidently there are difficulties in identifying patients and referring them to the right specialist, and in implementing NICE’s recommendation at the local level.

     

    In our view, several things, including the below, need to change:

      1. Local Doctors need education and funding so they may screen using something like the OSA50 questionnaire and an SpO2 recording device (at a minimum) to recognise symptoms of sleep apnoea and then make more informed referrals
      2. Diagnostic capacity and sleep apnoea treatment provision needs to be more widely available (both geographically and financially)
      3. Those employed in hazardous roles should be prioritised all the way from the local Doctor to diagnosis and in turn on to treatment (and not in effect stigmatised and financially penalised as they are at present)

    Until these things change the updated NICE Guidelines are just that: very ‘nice’, a step in the right direction perhaps or a ‘signal of intent’ but sadly completely out of touch with NHS financial reality.

    So then, as a Country, we need to consider the mismatch between our financial support of the NHS and our demands from it, which perhaps means we need to swallow the pill of Private Provider provision of services complementary to those offered by the NHS and/or subscribe to employer provided healthcare schemes. What do you think?

    Postscript: I consider OSAS therapy should include prescription, custom, adjustable oral appliance therapy through a sleep trained Dentist as well as PAP (available when medically necessary and not just ‘indicated’ and available to those who can pay). Perhaps that is even more unrealistic!

    Created by Adrian Zacher new-window | Page last updated 27 May 2015

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