Your Appointment for PAP Set-Up
Once you have been diagnosed with obstructive sleep apnea, and a decision has been made to use PAP therapy, your physician or provider will order the treatment and send the necessary clinical and sleep study information to Ultreia Health. You will be contacted by a staff member of Ultreia Health to set up an appointment to receive, and be shown how to use your PAP device and to answer any questions you may have. Prior to your appointment, the billing staff at Ultreia Health will contact your health insurance company to verify benefits and to obtain pre-authorization for treatment with PAP. During the appointment for initial PAP set up, an Ultreia Health Billing Specialist will typically meet with you to review your health insurance benefits related to the use of PAP and to discuss your financial responsibility for the treatment. They will also review payment options for the services, equipment, and supplies that have been prescribed for you. Though Ultreia staff will assist you in navigating the process of determining your benefits and your portion of the costs of the treatment, it is your responsibility to understand your insurance benefits and what amounts your insurance will cover for services that are provided.
Preparing For Your PAP Set-Up Appointment
Having someone available to be with you for the PAP set up appointment is valuable and is recommended, though Ultreia staff understand that this may not always be possible. Ultreia Health uses a PAP buddy system to provide accountability and encouragement during the time period a patient is acclimating to the use of the treatment. It is recommended that a first time user of PAP therapy identify someone who they know well and trust and who is willing to engage with them in the treatment process. This is frequently a spouse, family member, or friend, and having them present at the set up appointment can be helpful in later remembering information provided during the set up as well as asking questions during the appointment.
As part of the process of getting to know you, and better understand how obstructive sleep apnea may be affecting you, and any barriers you have to the use of the treatment, a link will be provided for online completion of several questionnaires. It is recommended that these questionnaires be completed prior to the set up appointment. If unable to complete the questionnaire prior to your appointment, the questionnaire can be made available to you when you arrive for your set-up appointment. Anticipate 10-15 minutes to complete the questionnaires before your set up appointment in planning your arrival time to Ultreia Health’s offices. Ultreia Health does not provide in-home PAP set up services.
What to Expect During the Set-Up Appointment
Once you have arrived at the Ultreia Health office, you will check in with the receptionist, and complete a number of forms necessary to provide treatment to you. You will also meet with an Ultreia Health Billing Specialist to answer any questions that you may have regarding insurance coverage of treatment, and your financial responsibility related to equipment and services you will be receiving. Please make sure to bring your health insurance card, and a method of payment for any amounts that may be due.
During the PAP set up appointment, you will meet with a respiratory therapist who is trained in the use of PAP equipment, and who will show you how to use and care for your PAP device. Plan for 30-60 minutes of time during which you will be shown a variety of masks that can be used with the therapy and will have an opportunity to use the PAP device with pressure settings prescribed by your treating physician or health care provider before leaving the office. A variety of topics will be reviewed by the respiratory therapist regarding the proper use and care of the PAP device. You will also be given information to take with you that relates to treatment and use of PAP therapy. You will be provided a carrying case to transport the device and supplies to your home, and that can be used any time you travel with the PAP machine.
Setting Up Your PAP Device at Home
During the PAP set up appointment, you will be given some helpful tips on setting up your device at home. For most patients, the device will be set up in their bedroom either on a bedside table, or on the floor. What side of the bed the PAP machine is placed will be a function of what side of the bed you typically sleep on, though individuals will often find that it is easier to sleep on the side of the bed that is closest to the device when they are positioned on their side and facing the PAP machine. Where electrical outlets are located may also dictate where the device needs to be located.
Many individuals will have some anxiety or apprehension about sleeping with a PAP device. If this is you, relax, as nearly all individuals can acclimate to PAP therapy if willing to be consistent with use and persist through the period of getting used to sleeping with the treatment. One useful technique for acclimating to the therapy is to implement a desensitization routine that can be used to help you become more comfortable with the treatment. This involves setting up the PAP equipment next to a comfortable chair or couch, in the room where you generally relax, and then sitting down, putting the mask on, and starting the machine with no intention of sleeping. During this time, you can watch TV, read, or listen to music, etc. and this distraction can be helpful in the initial acclimation process. Short trials of the device running and holding the mask to the face without the headgear on the head can be used if the pressure is bothersome and claustrophobia is being experienced. As the acclimation process progresses, the trials can be lengthened, and eventually the headgear put on the head. You may find that you fall asleep with it on inadvertently. Using a desensitization process like this can relieve anxiety that you may feel about losing sleep while trying to get used to the device, and being more comfortable with the therapy may reduce tossing and turning in bed, and concerns that you are keeping your bed partner awake. The length of time this process may take will vary among individuals, but it would be appropriate to call your physician or DME provider if after one week of desensitization, you are not able to use the PAP device in your room for sleep. Sleeping medications can be used during the acclimation period, though the risks and benefits of this intervention should be discussed with your sleep or primary care physician. Anxiety related to the use of the therapy can also be addressed with medication, or other interventions, including cognitive behavioral therapy. Once you are more comfortable with the treatment, or falling asleep while using the therapy, the device can then be set up in the bedroom and sleep in bed attempted.
Your First Night Sleeping with PAP
Getting adjusted to sleeping with PAP and being successful with the therapy is a process. Do not be discouraged if you do not sleep through the night initially with the PAP machine. The use of PAP therapy can feel ackward and overwhelming initially though this improves with time and use of the device. You may only last a portion of the night at first before needing to take the mask off. It is important to use the device daily, however, because with regular use, the therapy becomes easier to use over time. You will find that as you use your device regularly, you will make progress with being able to use it for longer periods of time. If you are not making progress with the use of the therapy, contact Ultreia Health for assistance with the treatment. Make note of the specific problems you are having and be prepared to share these with the Ultreia staff. The staff may direct you to questionnaires that help identify barriers if you are having difficulty identifying specific problems with the treatment.
The PAP equipment should be very quiet and typically will not bother your spouse or bedpartner. When the treatment is working effectively, you should not snore when the PAP device is being worn. If your mask is leaking, or if your mouth comes open when wearing a nasal mask, you may make noises that will awaken your spouse or bedpartner. These issues can be addressed and resolved readily, and occur less frequently as you acclimate to the treatment and get more proficient with using the therapy.
Once awake and ready to get out of bed, remove the mask and headgear, and turn the PAP device off. It is recommended that the mask be disconnected from the long tubing, and the mask surface that touches the skin be wiped off. Instructions vary among mask types, and your Ultreia Health treatment specialist can help to clarify care instructions if you have questions. Disconnecting the long tubing, and allowing it to dry (typically hung up in the bathroom) will keep the tubing fresh smelling, and avoid any tendency for mold. Though some users may not empty the humidifier water reservoir, and only add to it, emptying the reservoir daily (recommended), or at least several times weekly is prudent. The reservoir for most PAP humidifier units can be washed in a dishwasher periodically, but check the manufacturer’s instruction booklet to make certain this is recommended for your unit.
Managing Your Treatment
Follow-up for PAP treatment is extremely important in the successful use of the therapy. Though a minority of individuals have little difficulty adapting to the treatment, the majority of initial PAP users will experience some problems, which if addressed promptly and appropriately, can be resolved, with success in PAP use. There is wide variability, however, in the extent, and intensity of follow-up provided by sleep medicine practices, sleep laboratories, and primary care providers who may prescribe PAP therapy. With this in mind, CPAPu, a self help resource developed by Ultreia Health has been designed to provide the tools you need to succeed with PAP treatment in addition to that furnished by your Ultreia Health treatment specialist.
The first 3-4 weeks of PAP treatment is thought to be the most important time period in which to address problems that arise with treatment, and to intervene with solutions. During this time period in particular, an initial PAP user should be very proactive in seeking help for issues they are having with the treatment. Some health insurers require a limited number of follow-up visits to document use of the PAP therapy, and improvement in symptoms. Once treatment has been successfully implemented, and PAP is being used consistently for most of, or optimally, all of the sleep period, and with effective control of symptoms, the frequency of follow-up can be reduced to once yearly. However, if problems with the therapy remain, including residual symptoms, or the PAP treatment is not being used consistently, or for adequate hours, setting up a visit with the prescribing physician, or physician extender is important to address the issues, or to consider alternative treatment interventions.
The Importance of Taking Control of Your PAP Therapy
Treatment of sleep apnea is important to one’s long term health, as well as to quality of life. Often patients prescribed PAP therapy experience difficulty acclimating to the treatment and using it consistently during the night. Ultreia Health has been developed to provide you with the resources needed to be successful with treatment, but ultimately success with PAP treatment requires that you take control of your therapy by using your PAP device consistently, using Ultreia Health staff for help and support, and taking advantage of the PAP buddy you have identified to keep you accountable to using the treatment that has been prescribed and that you need. For some, the use of PAP therapy is not bothersome and consistent use is easier. For others, using their PAP device effectively is a significant challenge that requires determination and persistence. The benefits of treatment are the same for both groups. Take control of your PAP therapy and sleep better, feel better, and live a healthier life.