Choice Cair provides the finest in Sleep Medicine products and services because we know the value of sleep. Sleep Apnea brutally afflicts individual physical and mental well being, because as we all know sleep is the fundamental key to personal health and success. Sleep disorders adversely affect health, mood, and energy levels. Continuous Positive Airway Pressure(CPAP) devices maintain open airways in patients suffering from obstructive sleep apnea by providing airflow at prescribed pressures during sleep.

Most patients receiving CPAP report better quality sleep, more energy, increased alertness, and improved cognitive function. In order for treatment modalities to be effective, patients must be compliant with their prescription. The trained professional staff at Choice Cair maximizes compliance through careful instruction and follow-up monitoring. With an experienced and clinically trained staff, Choice Cair employs the finest in CPAP and Bi-Level therapy available on the market today.

Rest assured with Sleep products from Choice Cair!

10 Most Frequently Asked Questions

1. What is CPAP?
CPAP stands for "Continuous Positive Airway Pressure". It is the most widely accepted form of treatment for Obstructive Sleep Apnea, a condition that occurs during sleep, resulting in the partial or complete blockage of the airway by soft tissues in the throat. CPAP is the application of a nasal mask or interface that allows the pressure to be delivered to your airway.

2. What is Bilevel?
Some patients have difficulty adjusting to, or tolerating CPAP because they can't exhale against the positive pressure required to correct their condition. These patients are indicated for "Bilevel" therapy, in which separate inspiratory and expiratory pressures are delivered, allowing a lower and more tolerable pressure upon exhalation.

3. Does insurance cover the cost of CPAP and Bilevel equipment?
Most insurance companies, including Medicare, cover the costs of the equipment necessary to treat sleep apnea. Medicare and private insurance companies have specific guidelines for the provision and reimbursement of the equipment and supplies. All cases are unique. Keep in mind individual insurance plans are subject to deductibles and co-pays.

4. Do I need a prescription for CPAP/Bilevel, and/or supplies?
Absolutely! A physician must order your therapy. Masks and headgear are "legend" items and are regulated by the Department of Health Services. A physician must prescribe all legend items. Any items to be considered for re-imbursement through your insurance requires a prescription. You can buy filters and tubing without a prescription.

5. What are the symptoms of Obstructive Sleep Apnea and how do I find out if I have the condition?
The most common symptoms of Obstructive Sleep Apnea include snoring, daytime fatigue, poor cognitive function, in-ability to remain mentally focused, agitation, insomnia, and depression to name a few. You should see a doctor as soon as possible to have an overnight sleep test scheduled and performed. This sleep study will document if you have Obstructive Sleep Apnea.

6. Who can use CPAP or Bilevel?
Most patients can use CPAP/Bilevel therapy, but there are areas of concern. Age is not an issue. Some patients have poor tolerance to a device on their head or face with straps, etc. when they are sleeping, and this leads to non-compliance. Patients with range-of-motion disabilities may have difficulty putting the interface on properly and should have a caregiver available to help them.

7. Can I be tested at home?
It is possible to be tested at home but Medicare will not pay for it. Private insurance will sometimes authorize a home study but the level of testing is not as good as a sleep laboratory for several reasons. Some of those reasons are that most home studies are not attended by a sleep technologist, and those studies cannot isolate additional problems that may occur during sleep that can mimic the same symptoms as Obstructive Sleep Apnea. Limb movements, hypoventilation, and sleep staging are generally invisible during a home sleep study.

8. How do I get my equipment once I am diagnosed?
Your sleep study, report, and recommendations are sent to your physician from the sleep lab. Your doctor will then write a prescription for the appropriate therapy. This can then be taken to the CPAP Provider of your choice (i.e. AirCare Home Medical), or one that is contracted with your insurance company. Your sleep test is then evaluated for qualifying based on the requirements of your insurance carrier, and once qualified, you will be contacted by the CPAP Provider to schedule an appointment.

9. How long does it take for the therapy to work?
For some patients, as soon as overnight. Obstructive Sleep Apnea interrupts and fragments consolidated and restorative sleep. CPAP and Bilevel therapies correct this problem by maintaining a patent airway, eliminating sleep fragmentation due to repeated awakenings during the night to breathe.

10. What surgical options are available and do they work?
There are several surgical options available and you should speak with your physician about them. In general, surgical procedures (except in rare cases) have limited success. CPAP and Bilevel therapies work if you use it.

CPAP & BiPAP Cleaning Instructions

CAUTION: DO NOT clean any parts of the system with alcohol or cleaning solutions containing alcohol.

DO NOT clean the system by steam autoclave or gas sterilization methods. These cleaning processes may harden or deform the flexible plastic parts of the system and adversely affect their function.

A . You should check the mask or nasal pillows after each cleaning. Although silicone is not susceptible to hardening, it can tear. The actual life of the nasal mask or pillows can vary greatly, depending upon use. Replace the mask every 6-12 months or when it leaks air excessively, there is a tear in the cushion, or it becomes uncomfortable to wear.

B. Cleaning procedure: Items included are: Mask or nasal pillows, swivels, connectors, and tubing.

• Step 1. Remove the headgear from your mask or nasal pillow shell. Disconnect the mask or shell, swivel or Whisper Swivel from the tubing. NOTE: You do not have to remove the support ring, spacer, or rotating connector from the mask before cleaning it, but you may want to do so to clean the parts more thoroughly.
• Step 2. With a soft cloth (or a disinfectant cloth), gently wash (or wipe) all the parts of the mask, the shell and pillows, the swivels in a solution of warm water and mild unscented shampoo or unscented dish detergent. DO NOT use any cleaners containing fragrance, conditioners or moisturizers as these will leave a residue. Be sure to thoroughly clean the mask cushion flaps or the nasal pillow.
• Step 3. Rinse thoroughly. If any part or parts still seem to be oily, wash them again.
• Step 4. If desired, you can disinfect the tubing, mask parts, the shell and pillows, the swivels in a cold sterilizing solution, such as Control III, Cidex, or Sonacide, following the manufacturer's directions closely. You can use a white vinegar and distilled water solution, mixing 1 part white vinegar and three parts distilled water. Allow all items to soak for 20 minutes. Make sure you thoroughly rinse the items after disinfecting them. Any residue left on the parts may shorten their useful life and/or irritate your skin.
• Step 5. Let every thing dry completely before using them again. To make sure all parts of the system are completely dry, put the system together and run the unit for about 30 minutes before using.

C. Cleaning the Headgear, Chin Strap, Shell Retainer Strap: These items should be cleaned a minimum of once each month.

• Step 1. To maximize the life of the soft goods (headgear, chin strap, comfort strap, shell retainer strap) hand washing with a standard laundry detergent is recommended. NEVER USE BLEACH. Before washing, remove the soft goods from the hard goods (mask, shell, swivels, etc.). Fasten all hook tabs to the pile straps to protect other garments in the laundry. DO NOT take the headgear apart.
• Step 2. Air dry or machine dry WITHOUT HEAT. Machine drying with heat may cause wrinkles or render the elasticity useless. NEVER IRON ANY SOFT GOODS.

D. Cleaning the Heated Humidifier:

• Step 1 . Always use distilled water in your humidifier
• Step 2 . The humidification chamber should be cleaned daily or after each use. After the heater plate has cooled, disconnect the tubes from the top of the humidification chamber and remove it from the heater base.
• Step 3 . Discard any water remaining in the humidification chamber if you are not using distilled water.
• Step 4 . Wash the chamber top, base, deflector, and supply tubing in mild dish washing detergent. Rinse thoroughly and air dry. Disinfect chamber top, base, deflector, and tubing weekly in a solution of Control III. Follow label directions. Rinse thoroughly after disinfecting.
• Step 5 . Inspect the chamber, base, deflector, and tubing to ensure no residue remains after cleaning and sterilizing.

CPAP/Bilevel Troubleshooting Questions

1) Why do I have a dry mouth and sore throat in the morning after using CPAP/Bilevel therapy?
Most likely your mouth is open or leaking during the night. This causes de-pressurization and the rush of air out of your mouth is probably drying you out. You may benefit from a chinstrap to help correct this situation. Another cause could be that you are sensitive to the dry air and may benefit from a cool or heated humidifier.

2) Why do I develop a sore nose or blemishes on the bridge of my nose and forehead?
Chances are your mask is too tight or poorly fit, blocking small capillary blood flow to the tissues. Also, some patients have an aversion to gel-type masks that tend to cause this problem more often than silicone or foam-type interfaces. Always wash a new mask before using as there may be chemical residue from the manufacturing process that clogs your pores and creates pustule-type blemishes at the pressure points where the mask contacts your face.

3) I have a heated humidifier and every morning the tubing is full of water. What causes this?
Heat applied to water creates condensation (rain). The higher the heat applied, the higher the output of humidity that occurs (this is good), and the higher the output of rainout in the tubing (not good). As the temperature falls in the room at night, the heat and cool air results in increased condensation.

4) Does my CPAP/Bilevel machine need to be serviced?
Not unless you feel there is a problem, i.e. increased noise or an apparent pressure issue. If you feel the unit is not working properly, STOP USING IT AND CONTACT YOUR EQUIPMENT PROVIDER AS SOON AS POSSIBLE. Your device will need to go back to the manufacturer for evaluation and you will need to rent another machine until your unit comes back.

5) When and how do I clean my equipment and change filters?
We recommend that you disinfect your mask, tubing, and humidifier canister 3 times a week by soaking these devices in a 1:1 mixture of white vinegar and water for 30 minutes and rinse. This solution is only good for about 6 hours so you must dispose of it when done. Your non-disposable foam filter should be washed once per week in water only and must be dry prior to use. Medicare will get you a new foam filter every six months. Your small particle disposable filters should be checked weekly and changed about every 30 days or when dirty (black).

6) When can I get new supplies?
Private insurance generally will replace your supplies every 6 months.

Medicare schedule is as follows:

• Mask (1) Every 3 months
• Headgear (1) Every 6 months
• Tubing (1) Every 1 month
• Disposable Filter (1) Every 2 per month
• Non-Disposable Filter (1) per 6 months

7) I want to change my pressure and the manual doesn't tell me how to do it.
This procedure is to be performed by your Respiratory Therapist only. Your pressure is set via prescription from your doctor and should not be changed unless ordered by your MD.

8) My mask is broken and my insurance will not cover a new one until the next allowable time period. Can you fix it?
Many times we can fix a mask, depending on where it is broken. We can change parts on some masks. Most masks are backed up by the manufacturer for incidents of failure that may occur under normal handling conditions. If you broke your mask under other conditions (children, pets, mis-use), you will be required to obtain another prescription and pay cash for a new interface and headgear.

9) HELP!!! I'm in France and my machine is dead…
You didn't switch the unit over to 240 VAC and blew the fuses. Many units nowadays will handle 110-240 VAC. Older models need to be physically prepared for 240 VAC. Replace the fuses and be sure the voltage setting switch is in the correct position. If it still won't work, contact your Health Care Provider.