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Thoracic Medicine

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Sleep Medicine

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Long the stuff of science fiction, the disembodied 'brain in a jar' is providing science fact for researchers, who by studying the whole brains of fruit flies are discovering the inner mechanisms of jet lag.  Researchers present the first real-time imaging of intact circadian neural networks and demonstrate how light shifts disrupt biological clocks.


Popular non-prescription and prescription medications, including the active ingredient in Benadryl, have been linked to increased risk of developing dementia by a study published in a top-tier medical journal.


“WHEN SLEEP IS SOUND, HEALTH AND HAPPINESS ABOUND” is the slogan for World Sleep Day 2015 taking place worldwide on March 13th, 2015. Sound sleep is a treasured function and one of the pillars of health, along with a balanced diet and adequate exercise. When sleep fails, health declines. Poor sleep and bad health decrease the quality of life and take happiness away.


TSGQ registered nurse and polysomnographic technician Travis Bell joined 612 ABC radio presenter Kelly Higgins-Devine to discuss sleep disorders on 2nd February 2015.


Scientists have found that that activation of cholinergic neurons - those that release the neurotransmitter acetylcholine -- in two brain stem structures can induce REM sleep in an animal model. Better understanding of mechanisms that control different sleep states is essential to improved treatment of sleep disorders.


Going to bed early could help individuals avoid repetitive negative thinking, according to a recent study. According to the authors, repetitive negative thinking is "defined as an abstract, perseverative, negative focus on one's problems and experiences that is difficult to control."


Help with your CPAP

Beginning on CPAP can sometimes be a challenging adjustment however it does get easier and you will soon enjoy the benefits of better sleep.

The important thing to know is that initial obstacles are NORMAL, COMMON & FIXABLE

Get Plenty of Supportphoto_mask

 The support of your wife/husband/bed partner/friend is vital for therapy success. Ask around - Most people are interested to find they already know someone who is on CPAP therapy.  By talking to others who are going through treatments themselves, you will discover new approaches that will help you overcome the challenges of CPAP therapy and be encouraged by their success.

Your CPAP machine user manual is also a great resource for you.

Some Common Side Effects of CPAP

Nasal discomfort

Nasal stuffiness or congestion is the most common side effect of PAP therapy and is often a nasal reaction to airflow from the PAP device. More than half of patients experience some increased nasal stuffiness when they first begin PAP treatment. The symptoms often disappear within a month of use.

CPAP users may also report nasal itching, runny nose, nosebleeds and nose dryness as other frequent nasal problems. In general, PAP-related nasal symptoms are treated with the techniques given below:

Applying a few sprays of nasal saline solution (a combination of salt and water) in each nostril before using PAP eases nasal symptoms. This solution is available at a pharmacy without prescription. Oral antihistamines may also be useful to control PAP-related nasal discomfort. Nozoil (a nasal lubricant oil spray) has been shown to be of some assistance with nasal discomfort.

Prescription antihistamines are also available. Consult your healthcare professional before using any prescription or non-prescription medication for PAP problems.

CPAP/BPAP/AutoPAP devices can be connected to specially designed humidifiers that will greatly reduce nasal symptoms. Humidifiers add moisture to the pressurized air PAP devices use. All humidifiers can add cool moisture and some can add heated moisture. If a cool air humidifier fails to relieve your nasal symptoms, consider trying a heated humidifier, available on all modern devices. PAP humidifiers will need to be prescribed by a healthcare provider and should be carefully maintained according to the manufacturer’s instructions to avoid nasal and sinus infections.

Several prescription medications can be used to combat PAP-related nasal discomforts. Anti-allergic nasal sprays may be of help, particularly if you have nasal allergies. Atrovent® or a nasal spray can be used to combat nasal problems and runny nose not caused by allergies. Nasal discomforts from PAP devices are usually simple to control with one or more of the suggestions above. If symptoms persist contact you healthcare professional.

Mouth discomfort

PAP devices may cause dryness and pain the throat. Often the discomfort is caused by air blowing through an open mouth. A chinstrap to keep the mouth closed or a mask that covers the nose and mouth can eliminate this complaint. Humidifiers for PAP machines can also help control discomforts.

Mask Air Leaks

Symptoms of mask air lead are red eyes, loss of beneficial effects of PAP and return of snoring or apnoea. Air leaks are most often the result of a poorly fitting mask. Sometimes a different mask or a mask of a different size is needed. If you continue to experience significant air leaks despite using a chin strap consider a mask designed to fit inside your nostrils (nasal pillows). A mask that moulds to your face may be another option. Remember, if your mask and PAP therapy worked well for you in the beginning you should check to see whether your mask is worn out or torn. Contact your PAP equipment supplier and ask for help.

noise from the machine or mask vents

Newer PAP machines are much quieter than older models, but all make some sound. Placing the machine under the bed or on the floor may solve this problem. Again, the PAP supplier can provide advice and assistance.

sore, dry or red eyes

These problems can result from an air leak from your mask. Try reapplying the mask and readjusting the headgear. If the problem continues, contact your PAP supplier to determine whether you need to try to different mask size, nasal pillows or different headgear.

skin redness or irritation

If you develop reddened areas or sores on or above the bridge of your nose or on your forehead, first check to see whether your mask is pressed too tightly to your face. Your mask needs to be fitted and adjusted to eliminate air leaks without putting excessive pressure on your skin. Sometimes spacers and air cushions can help ease the pressure points. If you need to loosen your mask so much that leaks develop, ask your PAP supplier whether your mask is the right type and size and is properly adjusted.

If redness occurs wherever the mask touches your skin, loosen the headgear slightly, but not so much as to cause an air leak. If you think you might be allergic to a mask, try applying a paper tape over areas where the mask touches your skin. If that eliminates the problem, contact your PAP supplier to find out whether a different mask or nasal pillows might be beneficial. Fortunately, modern PAP masks are made of materials designed to minimise allergic responses.

too much air

Especially when first using PAP some people complain that the pressure of air through the nose seems too high. If this sensation makes it difficult for you to fall asleep, try using your PAP for short periods during the day or while watching TV to get used to it. If that fails try using a pressure ramp. Most PAP machines have ramp capability. The ramp starts the machine at a very low pressure and gradually raises it to the right amount over a period of minutes. Using lower pressures at the beginning may help you fall asleep more easily.

Most PAP machines will allow you to adjust your ramp time.

Many people find they prefer longer ramp times (10 to 20 minutes) when they first start using PAP. As you get used to PAP, or if the air pressure doesn’t bother you, set your ramp to shorter times so you get the full benefits of the correct PAP pressure from the beginning.

What do I need to know about my PAP machine?

Cleaning cpap devices

Regular cleaning is essential to assure proper function and safety of PAP devices. The method and schedule for cleaning hoses and masks and for changing filters may be different for each PAP device, so you should refer to the manufacture’s instruction manual for details about the maintenance of your PAP equipment. Improper care of PAP devices, filters, mask and hoses can lead to nasal and sinus problems (congestion, infection etc).

For more information on cleaning your CPAP machine click here.

“Regular cleaning is essential to assure proper function and safety of PAP devices”

Travelling with your cpap machine

Most PAP machines available today come equipped with transformers that allow them to be used with 12 and 240 voltages when you travel to foreign countries. Current PAP models are lightweight and portable. A travel case for the device and accessories often comes with the machine or can be purchased from the manufacturer. A battery power option is also available for those who camp.

Many airlines have tested and approved PAP machines for use on overnight/international flights, these airlines can make special arrangements for you to use your PAP machine whilst flying. The majority of current model PAP machines can be used on aeroplanes but you should contact your airline and PAP supplier before making your travel plans.

Airport x-ray devices do not harm PAP machines. You should consult your healthcare professional or PAP supplier if your travel plans call for sleep at altitudes much higher or lower than those at home.

Other concerns about using PAP machines

Cold nose

The air cools as it moves through the PAP hose tubing. To reduce heat loss, try repositioning the tubing so that it runs under your bed or bed coverings, or use a specifically designed tube-cosy. Some more advanced PAP Machines are developing new ingenious ways to keep warmth in the air you are breathing, if you would like to know more about these new model PAP Machines you should contact your supplier to discuss this.


Some people with dentures find that if they sleep without their upper dentures, the PAP mask does not fit properly and air leads develop. Try sleeping with your upper dentures in to eliminate this infrequent but difficult problem. If you have no upper teeth consider trying a mask that fits inside or just under the nose.

Colds and congestion

You may find your PAP more difficult to use when you have a cold or severe congestion. You may need more humidity or decongestant. Contact your healthcare professional for recommendations if you find you cannot sleep with your PAP when you have a cold. If you develop nasal, sinus or ear pain when using your machine, this could be a sign of a developing infection. Contact your healthcare professional for further advice.


Some people experience feelings of claustrophobia, difficulty breathing, choking or suffocation when first using PAP. Let your healthcare professional, sleep technologist or PAP machine supplier know about these feelings. Spend some time practicing with your PAP machine during the day while awake and watching television or reading. You may need to start by wearing the PAP device for only a few minutes at a time and gradually increase the time you spend breathing with it until you feel comfortable. At first, some people fight the pressure and tend to hyperventilate. Practice regular breathing. If you don’t like the mask over your nose, try a mask that fits in or just under the nose. If you find the air pressure is too high, consider a longer ramp time or two-level or self-adjustable PAP. If these measures fail, consider learning a relaxation technique, either from a self-help book or a tape or from a professional trained in relaxation methods (eg. a psychologist). Some amount of discomfort during the initial therapy is not unusual. PAP can work for you if you give it a chance.

11 Tips to Help You Adjust to CPAP

  1. Begin using your CPAP for short periods of time during the day while you watch TV or read.
  2. Use the “ramp” setting on your unit so the air pressure increases slowly to the proper level.
  3. Use CPAP every night and for every nap.  Using it less often reduced the health benefits and makes it harder for your body to get used to it.
  4. Place your CPAP unit on the floor and move it slightly under your bed to dampen the sound.
  5. Make small adjustments to your mask, tubing, straps and headgear until you get the right fit.
  6. Use a saline nasal spray or Nozoil to ease mild nasal congestion
  7. Use a humidifier that fits your CPAP model if you have a fry mouth, throat or nose.
  8. Try a system that uses nasal pillows if traditional masks give you problems.
  9. Clean your mask, tubing and headgear once a week.
  10. Regularly check and replace the filters for your CPAP unit and humidifier (on average every four months).
  11. Work closely with your sleep doctor and your CPAP supplier to make sure that you have the machine, mask and air pressure setting that works best for you.

Ten keys to CPAP Success

Making CPAP Therapy a positive experience

Continuous positive airway pressure, or CPAP, is the most effective treatment of obstructive sleep apnea. A decision to use CPAP is a major step forward in the pursuit of a healthier life. The successful use of CPAP will help you breathe easier, sleep better and live healthier. Using CPAP can be a positive experience if you keep these key points in mind:


CPAP is not a quick fix for your problem. It involves a long term commitment to improve your sleep and your health.


Stay in close communication with both your sleep doctor and your CPAP supplier. Ask lots of questions and seek help when you need it.


Use CPAP all night, every night and for every nap. You will receive the maximum health benefits from CPAP when you use it every time that you sleep. This will also make it easier for your body to adjust to the treatment.


The first machine and mask that you try may not be the best ones for you. Work with your sleep doctor and your CPAP supplier to corrections to your equipment selection. Ask about trying a different type of machine or mask if you have ongoing problems.


Tell a family member or close friend to ask you each morning if your used your CPAP the previous night. Have someone to challenge you to give it your best effort.


Your adjustment to CPAP will be easier if you are able to connect with others who use the same treatment. As your sleep doctor is there is a support group in your area for people who have sleep apnea or look for one on the Internet.


Increase you level of comfort by using a saline spray, Nozoil or humidifier if CPAP irritates your nose, mouth or throat. Use your unit’s “ramp” setting to slowly get used to the air pressure level. Some machines also reduce pressure while you breathe out. See if there are soft pads you can buy that will fit over your mask straps.


Clean your mask, tubing and headgear on a regular basis. Put this time in your schedule so that you don’t forget to do it. Check and replace the filters for your CPAP unit and humidifier. C-flex or EPR may also aid in your comfort.


Although you are never finished with CPAP therapy, you should reward yourself by celebrating the completion of your first month of treatment. Expect this first month to be your hardest period of adjustment. It will involve some trial and error as you find the machine, mask and pressure settings that are right for you


After your first month of treatment, continue to make a daily commitment to use your CPAP all night, every night and for every nap.

Download CPAP Survival Guide.

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