CPAP tips

As someone who’s used CPAP/BiPAP successfully for years (and credits it with saving my life), I pass along this advice to new CPAP users.

  • It can take a while to get used to CPAP treatment. Don’t give up. Good sleep is *very* important to health, and not just how you feel the next day. This is worth doing.
  • All kinds of people use CPAP/BiPAP. Some people get to reduce their pressure, or even stop using it (commonly after weight loss), ya never know. But even if you use it the rest of your life it’s s small price to pay for the health, and energy level, it will give back to you.
  • It’s common for beginners to rip the mask off during the night, and not even remember doing that… this will stop over time, especially if you get the right mask.
  • Using a CPAP can make your mouth dry (see mouth leak below), which is hard on the teeth and oral health, so be sure to brush/floss well before bed especially. I use a sonic toothbrush (the Aquasense, a great toothbrush), a Waterpik Water Flosser, and a tongue scraper. We’re only just now finding out the relationship between oral health and overall health; it pays big time to keep your mouth in as good a shape as possible.
  • If your headgear uses a headband made of real or synthetic cloth, you will find that it loosens up as the night goes on, resulting in mask slippage. I have mine kind of tight at bedtime to account for this. But you don’t want a mask to be too tight, as this can cause a bad fit and air leaking.
  • CPAP looks goofy, no doubt about it. My sleep improved so much with it, though, that I was able to go bed after my spouse, and wake up before her, thus sparing her the site of sleeping with a scuba diver. :-) But chances are they’ll be so happy you’re no longer snoring like a freight train that they’ll welcome the device.
  • CPAPs tend to lead people to sleep on their backs, or turn less often. If you are a side-sleeper, get a mask that is built for that (such as a nasal pillow mask the doesn’t have anything on the sides, just runs right up the middle of your face). I got a memory foam mattress which has been *fantastic*, as it sort of “melts” due to pressure and body heat, so you end up laying in a mold of your own body, which means no pressure points and a reduction in the need to turn. Note that even memory foam mattresses are only memory foam in the top few inches, so you might do just as well getting a memory foam topper for your existing mattress. You may also find a different/thinner/no pillow to be a consideration as well. They also make CPAP bed pillows that may be helpful.
  • Given the importance of CPAP therapy: I keep a spare mask/hose/water chamber in storage, just in case. I did this by asking for those things when offered when I didn’t really need them, and now when I get a new mask, I store that one and use the backup one (to make sure the backup one doesn’t get super old, as even when unused things can break down and not work as well).
  • My initial BiPAP pressure was pretty high (18/14), but after some weight loss I was finding I was able to reduce the pressure and have it be more comfortable with less leaking. Normally you’d need another sleep study to justify this, and then your DME would adjust it, but you might be able to find the instructions online for adjusting it yourself in the device’s menu system… just be really careful doing this, may adjust a point or two at a time and check yourself for continued CPAP effectiveness (fatigue level, reports/recording of snoring, etc.)
  • Masks:
    • There are many masks out there, for good reason: many people have to try multiple masks before they find the one that works best. I tried many of them, and ended up with nasal pillows (nose-only) mask. Your DME (durable medical equipment) supplier should be willing to help with that process.
    • New masks may not provide a good seal. When I get a new mask I put a very light coat of KY (or other water-based latex-friendly substance) on the parts that contact my face, just once, and it does the job.
    • If you find the initial pressure of the air coming out of the mask to be off-putting, check if your CPAP has a Ramp function, which will start the pressure out lower and slowly increase it to the full pressure.
    • Mouth leak: If you use a nose-only mask, you may find that your mouth opens while you sleep and the pressurized air rushes out of it, defeating the purpose of CPAP and feeling weird. You will likely eventually teach yourself to keep your moth closed, but you may also benefit from a chin strap (to complete the awesome look of using a CPAP, ha), or “taping”, where you tape your mouth closed. Taping: use a wide medical tape, and be sure to make a folded-over pull tab on one or both ends for quick removal (for sneezing, waking up in a panic, etc.).
    • If your DME wants to switch masks, and you’re using one that works for you: dispute that. You shouldn’t have to try a new mask just because they get a better price on another one. Or consider buying the mask or the replaceable part that touches your face yourself when needed, it may be no more expensive than with your insurance’s copay/deductible.
  • Moisture:
    • You’ll find that using heated, humidified air is best for comfort and respiratory health. Make sure your system offers that.
    • Although all the documentation says to use distilled water (which is the best), I use filtered water. I do get some mineral residue building up, but a vinegar wash every week or two takes care of that. Just soak half water half white vinegar inside it for 5-20 minutes, then swish it around good and rinse it out. (Vinegar never leaves a smell after it dries.) The metal plate in the water chamber that does the heat transfer may need a bit of finger/toothbrush scrubbing.
    • When you wake up, empty the water our of your water chamber. Every day. And set it up so that it dries: turn it upside down at an angle, so gravity and airflow help it dry out. You will end up throwing out some water each day, but don’t give in to the idea of saving water/making things simpler by just leaving it in there: you’ll get biofilm growth. Remember: the water you put *in* may be distilled/clean, but the water acts as a filter for air passing over it, even if your device already has a filter; and any water you let sit can grow its own garden of organisms, even if you can’t see it. I used to leave a folded hand towel next to my CPAP and just leaned the water chamber and lid against the CPAP with the bottom edges on the towel… now my bedside table is a black wire shelf, and I just turn the chamber and lid upside down on that.
    • If you keep a jug of water at bedside, make sure it’s not in direct sunlight.
    • You may experience “rain out”, when the heated humidified air causes condensation in the tube, leading to a buildup of water and weird bubbling (and excess moisture in the tube, which should be dry when not in use). The cure for that: a hose cover. I have a microfleece hose cover that not only stops rain out, but also make the tube much more comfortable to accidentally touch at night, and less noisy when it hots the wall or headboard.
  • Cleaning:
    • If you keep your hose dry and your water chamber emptied and dry, you may not have to clean things often; your mileage may vary.
    • Your DME will probably offer routine replacements, which will cost money (including your copay/deductible), so it’s in your best interest to keep things clean and dry.
    • I will occasionally take my headgear in the shower and give a good wash, with Ivory bath bar soap (or similar gentle soap with no moisturizers or fragrance), then shake it as dry as possible and hang it to dry, preferably in front of a fan.
    • Be sure and clean your reusable filter as well, with the same safe soap, and let it dry before use. I have allergies, but never found much benefit from the disposable allergy filters that go behind the regular filter, so I stopped getting those.
  • Travel:
    • When I travel with my CPAP, my morning routine is: empty the water chamber, put everything back together, and run the CPAP for 20 minutes or so with no water and the water heater turned to zero, with hose and mask and everything, to dry it out. Don’t forget to turn the water temp back up when done or before next real use. Keep the CPAP stuff tidy, or even put away, if you don’t want the cleaning staff to touch it during room cleaning.
    • You never know if a hotel room is going to have a power outlet within reach. I carry a 10-foot extension cable in my CPAP kit just in case.
    • Airlines allow your CPAP to be a carry-on for free, this is a federal law thing. Make sure you have/get a carrying case or backpack to make it easy. Don’t pack anything non-CPAP related in the case or it could be deemed regular luggage. If your CPAP gets sampled by the TSA, you can request a fresh swab be used (because: ewww).
    • Filtered/distilled water is easily obtainable when you get to your destination, don’t bother carrying it when you travel. Your hotel may provide distilled water upon request, they’ve probably dealt with CPAP users before.

Just some advice from a medical business administrator. I work for a private practice, but know the tricks hospitals, insurance agencies and office managers use.

For the effed-up US system, anyway.

In case the above goes away:

Do you often receive bills claiming you owe a hospital tens of thousands of dollars?

Never, EVER, assume you owe that. This is a tactic used by hospitals to try to have patients overpay them.

Here’s the best way I can explain it: Hospitals are allowed to say that the cost of using a needle to draw blood is $400 a pop. Not only is this untrue, but insurance companies say the maximum allowable amount is more like $10. So, a hospital can charge insurance $400 and they say ‘fuck that, the real price is $10’ insurance usually will pay $8 and then the remaining $2 is adjusted off. Now if you don’t have insurance, there is no agency performing the checks and balances to ensure you aren’t overpaying. Hospitals are not allowed to charge ANYONE above the maximum allowable amount, but for non-insured patients they will send a bill for all their jacked up prices and most people have no idea that this is not the amount they truly owe.

So what should you do? First, ask to speak with financial aid at the hospital. Usually, they will bring your bill down by 75% simply by having a conversation with them and filling out one form. The hospital billing department will not tell you about this. See financial aid before you leave the hospital. They can often find charitable organizations that pay medical bills, especially in cancer cases, they can retroactively procure you Medicaid or Medicare. They can get you the maximum discount for your bill. Second, mention you are aware of the laws for maximum allowable amounts. Third, if you are uninsured pre-scheduled surgery, ask to speak with the financial advisor of the surgeon’s office. Usually the surgeon has a relationship with a hospital and anesthesiologist that will provide you with an all-inclusive one-time payment covering the surgery, anesthesia and hospital bills. If the office manager refuses to speak with you, ask to speak with the doctor directly.

9/10 doctors have no idea about their billing processes and I guarantee you that most are willing to work with you. For instance, my doctor only requires a payment of $1 a month to ensure a patient’s account will not go to collections. He gives discounts to patients that have no insurance to the tune of 75% sometimes. And most of the time, the patient told him they can’t pay and the doctor tells me and we work out a payment plan this works and is discounted.

Basically, just know your rights. Don’t be afraid to speak up and mention to the doctor your financial concerns. Appeal any insurance payment decision you feel is unjust. And please, please appeal any insurance denial you receive. I can’t tell you how many times insurance denied a claim, simply because they didn’t have recent medical records or a wrong DX code. Don’t mistake an EOB (explanation of benefits) for a bill. Call your doctor’s office and make sure prior authorizations (PAs) are made before radiology testing and surgery. If you have a deductible YOU do not have to pay it before having surgery. If an office manager tries to make you, simply explain you will wait until the claim has been filed before paying. Say you’d be happy to put some money down, but you’re not comfortable paying your full deductible without knowing if you truly owe the entire amount for the procedure. And lastly if you need any help, like disputing a bill, filing an appeal, trying to understand an explanation of benefits, etc. don’t hesitate to message me. I’ll do all I can to help. Front page edit: Wow was not expecting this to go anywhere. Glad I could help spread information to you guys. I’m hoping to work my way up to a hospital administrator and put an end to this type of billing, designed to scare people and confuse those, who don’t understand EOBs or allowable amounts. Another tip, if you have ACA insurance and your insurance keeps rejecting claims, it may be because you have not assigned a primary care provider to your plan. Some require a PCP for hospital bills to be covered.

Farewell Badger, by Tesa Silvestre

“It tells the story of an old Badger who knows he will be dying soon, and worries about how his friends Mole, Frog, Fox, and Rabbit will cope with his departure after he goes down “the Long Tunnel.” The rest of this beautifully illustrated book revolves around the touching and creative ways in which Badger’s friends end up cherishing his legacy, and working through their loss.”

Experiencing Musical “Chills”

There are parts of some songs that give me goosebumps, or get me choked up.

Everything is Alive - excellent podcast

An “unscripted” interview show, in which all of the subjects are inanimate objects.

The best shave ever

I heard good stuff about shaving oils, and tried a few, but I finally tried Shave Secret (as found at my local Meijer store), and I can give up trying others, because this is the stuff!

It’s almost magical in how well it works, especially since it feels like it really shouldn’t work: to use it, you wet your face well, then rub just three drops of this stuff between your hands, and apply it to your face… and it feels like you didn’t even put anything on your hands, and there’s no way this is going to work… and then you get the smoothest, closest shave ever, and your skin feels super smooth all day from it. I’ve always had trouble with my neck especially, because my neck hair grows flat and sideways, but with this stuff on the job, no problem.

Because there’s no mass of soapy emulsifier like with other products, it’s harder to rinse the razor during shaving, I have to tap it on the side of the sink, and when I’m done I use an old toothbrush to really clean out the blades before I dry it and put it away (I use this method to get months out of each Schick Slim Twin disposable:

If you get irritated skin from shaving, or want a closer shave, I recommend trying this.


Climate vs. Weather - Science Rap Academy - YouTube

What's the difference between weather and climate? Learn in this science-ified version of "Better Now" by Post Malone, written and produced by 7th graders from the Nueva School.

What's next when you're the one who cheated on your partner

What I think of commercials (47-second humorous video)

I gave up cable TV, and listen to commercial free music… and I do not miss commercials.

Forgetting the correct word

Comforting (to know that others do it) and hilarious (I laughed out loud, often), this also leads to some interesting observations about how ideas become words in our head.

Pet hair removal by dishwashing gloves

Follow-up pro-tip: I’d read that dish gloves were good at removing hair from upholstery and clothing, and big yes! I bought these:

And was able to easily brush off the armrests of my microfiber couch, and a sweatshirt that was on its way to becoming a fuzzy sweater. It’s jut like crumbing a countertop, except the hair stays together in a nice easy-to-pick-up line.

Weird City - Ep 1 "The One" - YouTube

This kind of thing may get me to pay for YouTube Premium. Although the second one (also free) is not quite as good, in my opinion.

Cat Slicker Brush

Fellow cat owners: I bought this after seeing a good review of it, and wow, does it work well! You have to brush carefully (if you have an old cat like I do), but it really gets out the undercoat and loose hair. And then when you’re done, jut push the button to retract the tines and the hair falls right into the trash. I might grow my hair out so I can use it on me too.

Psychological Placebos – Science-Based Medicine   

"A thorough understanding of placebo effects is critical to the science of medicine, and to understanding how objectively worthless interventions can become so popular. A recent presents a series of experiments that take a look at psychological placebos, where the intervention is not medical, but purely psychological. The results are not surprising, but they are instructive for both practitioners and researchers."