The Complete CPAP Buyer's Guide.

CPAP Buyer’s Guide

How Do We Breathe?

When we breathe, respiratory muscles contract to expand the chest cavity. This expansion creates slightly negative pressure relative to ambient pressure. Fresh air fills the negative pressure in our lungs. To exhale, the muscles relax and air comes out of our lung. Obstructive sleep apnea occurs when soft tissues block the airway and prevent air from entering the lungs.

How we breathe.

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The Importance of Sleep and Dangers of Sleep Apnea:

Sleep is an essential part of your health; sleep accounts for a quarter up to a third of your life. Sleep is a time when your body recharges and prepares for the next day. Without proper sleep, it is difficult for the mind and body to function at full capacity.

Obstructive sleep apnea prevents you from entering deep restful sleep. There are two parts of your sleep cycle: non REM and REM sleep. Healthy sleep will have four or five sleep cycles.

Circadian Rhythm - a cycle of 8 hours of sleep.

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Non REM sleep has three stages. Stage 1 is the lightest and easiest stage to arouse from. During Stage 3 or the “deep sleep” stage, your brain waves are much slower. REM (rapid eye movement) happens every 60-90 minutes in the sleep cycle. The brain is very active and your body is relatively immobile.

Sleep apnea causes you to temporarily stop breathing, and your brain sends a signal in response (called an arousal). Normal breathing vs. Obstructive sleep apnea.

You might not remember because sometimes you don’t fully wake up. Instead, you could move up to a lighter sleep stage in the sleep cycle.

When you suffer from sleep apnea your brain continually arouses you and prevents a restful night’s sleep.

According to Dr. Samuel Becker, Director of Rhinology at the Becker ENT Center.

When this happens, our heart works harder than usual to deliver blood to our end organs which need oxygen to function. While the heart is designed to function at higher capacity on occasion, doing this on a regular, prolonged basis can lead to negative consequences both for the heart and for the organs to which it pumps blood. ​

Treating sleep apnea properly, with a CPAP machine and mask, will alleviate most side effects and symptoms and also supports breathing patterns for a full night of uninterrupted sleep.

Effects of Sleep Apnea include:

Sleep is an essential part of your health according to Dr. Becker. Sleep is a time when the body recharges and prepares for the next day. Without proper sleep it is difficult for the mind and body to function at full capacity. Poor sleep impacts everything from focus and cognition to blood pressure and metabolism.

Obstructive sleep apnea prevents you from entering deep restful sleep. When sleep apnea temporarily halts breathing, your brain signals your body to wake up. When you suffer from sleep apnea, you continually fall asleep and wake up. In addition to feeling tired, sleep apnea has been associated with increased risk of serious health conditions such as:

  • Overweight
  • High blood pressure
  • Depression
  • Diabetes
  • Heart failure that may lead to heart attacks
  • Constant headaches
  • Alzheimers

How CPAP Therapy Works

To understand how CPAP helps you breathe and sleep, remember that air has weight. Air pressure presses against everything it touches; we just don’t feel it because the pressure is evenly distributed around our body.

CPAP is Continuous Positive Airway Pressure.  It requires a small machine to deliver the pressure through a hose into a tight-fitting mask worn by the patient during sleep. Treating sleep apnea properly, with a CPAP machine and mask, will alleviate most side effects and symptoms. The CPAP reduces the number of apneas, allowing you to experience full, restful sleep.

In obstructive sleep apnea, the airway is blocked when tissues of the face and neck collapse and interfere with the flow of air. CPAP keeps the airway open by delivering air under increased pressure.

Ambient Air Pressure

To better understand the pressure required, consider the ambient air pressure around as 0. This allows us to use simpler numbers to understand airway pressure during breathing With CPAP, your breathing doesn’t change, but you’re breathing at a pressure above ambient or room pressure. If we set ambient pressure to 0 as a reference, we create a negative pressure of 3 cm H20 to inhale (I). When we exhale (E) the pressure is slightly above ambient, at +3 cm H20.

This is seen in the figure below.  Ambient pressure is zero, and when we breathe in the pressure in our throat drops slightly, here shown as a drop of 3 cm H2O, or minus 3.  When we exhale the pressure in our throat is slightly above ambient, here shown as plus 3.

Normal breathing pressure curve.

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CPAP raises this pressure to always be above ambient, so the throat now stays open during breathing.

CPAP pressure curve

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As a result, CPAP reduces the amount of apneas, allowing you to experience better sleep.

Stacy at CPAP Babes was sick for many years. She tried everything from special diets to medications, but she was constantly tired. She could sleep for sixteen hours a day and still feel fatigued. Finally, after fifteen years of misdiagnoses, a doctor ordered a sleep study.

She had severe sleep apnea.  She got a CPAP right away and started feeling relief after the third night of using it:

One of my favorite moments was the Sunday after I got my machine. I went into the office, where my husband was working and said “Dave! It’s 4pm on a Sunday…do you notice anything different about me?” “Yes!” He said. “You’re not asleep!”

Though it might be uncomfortable at first, a CPAP machine can allow you to sleep all night long without the risk of dangerous pauses in breathing. The result: experience better sleep for a more productive day!

Doctor writing a CPAP prescription

Getting a Prescription

  • A prescription is required for all machines, complete mask systems and humidifiers. Your prescription details the proper pressure setting that your machine needs to be set at for efficient sleep therapy. A prescription can be used multiple times through the year, and your supplier will generally call your physician and obtain the prescription for you. If you’d rather submit your prescription, you can fax or email your script to the DME supplier that you are getting your supplies from. Many websites also offer a submission form where you can submit your prescription information online!
  • What doesn’t require a mask? Other sleep therapy items like filters, tubing and cushions for your mask do not require a prescription, and you can order those at any time online.
  • Who can write my CPAP prescription? Your physician, psychiatrist, Doctor of Osteopathy, Nurse Practitioner, Dentist or Naturopathic Physician can all write a prescription for a CPAP. These prescriptions are generally for a lifetime and do not need to be refilled. If your script has a set expiration date, you will need to visit your doctor for a refill.  

Taking the Sleep Study

  • Home Sleep Study: For those who don’t have a doctor’s referral to a sleep specialist or prefer to pay for a sleep study out-of-pocket, it is possible to do a sleep study at home. We work with a selection of qualified sleep clinicians who can determine what kind of home sleep test is most appropriate for you and help you read the results to get the proper treatment plan in place to best meet your needs. The home sleep study is usually a good option for someone who knows for certain that they are suffering from sleep apnea symptoms.
  • Overnight Oximetry Test: Pulse oximetry measures the oxygen level of the blood by comparing the absorption of red and infrared light by the blood. When a patient has an “apneic” event, they stop breathing for a short period of time. When this occurs, delivery of oxygen is slowed, and the oxygen saturation level – monitored by the oximeter – drops. It is through this relationship, that pulse oximetry may be used to detect sleep apnea.
  • Sleep Lab: Preparing for a sleep study in the lab is an important step — you should have everything you need to sleep comfortably, as well as a few extra items to ensure you have a nice experience. Overall, be sure to bring your comfortable pajamas, a toothbrush and some light reading material. It’s also helpful to go through your daily routine as usual so you’re tired enough to go to sleep in the lab.
  • Titration Study: If your sleep study confirms that a CPAP is the best course of treatment, you might need to take a follow-up sleep titration study. Sometimes, the titration study can be done the same night as your sleep study. The titration study determines the exact pressure settings and type of CPAP mask you need in order to get the best treatment plan. During the visit, you try on several different CPAP masks with various machine types that are calibrated to the pressure setting necessary to clear your airway blockage most efficiently.

What type of CPAP will I need?

There are several types of CPAP machines. Depending on the severity of your sleep apnea and your doctor’s recommendation, you’ll most likely know which machine is best for you.

  • CPAP: Continuous Positive Airway Pressure. The treatment works by using mild pressurized air, delivered at a constant pressure, to keep the airway open during the night. The air intake portion of the machine features an air filter that purifies the air delivered to the user.
  • APAP: Auto-Titrating Positive Airway Pressure. An APAP machine is another non-invasive type of therapy that delivers pressurized air to treat obstructions in the airway during sleep. The APAP machine uses a specific algorithm that best determines what pressure settings match your treatment needs and can suit your needs as they change throughout the night. Jason’s favorite APAP machines are Respironics, ResMed, and Fisher Paykel.
  • BiPAP: Bi-Level Positive Airway Pressure. Similar to a CPAP machine, the BiPAP is designed for users who need a higher pressure setting or have previously been unable to use a CPAP.
  • ASV: ASV or Adaptive Servo-Ventilation is a form of noninvasive ventilation used for sleep apnea when all other methods fail. ASV machines are prescribed when patients aren’t responding well to BiPAP therapy.
    They help patients who have irregular breathing habits when their respiratory patterns become too complicated for other devices to manage. Along with providing steady breathing patterns, ASV machines also automatically adjust blood oxygen levels to help maintain a healthy balance as levels should never dip below 30.

Purchasing Your CPAP vs. Qualifying through Insurance

  • Qualify through Aeroflow:  Aeroflow Healthcare can process your order so your CPAP Supplies are covered by your insurance provider. Qualify through your insurance for CPAP supplies by filling out the simple online form, which sends your information to a CPAP specialist who can process your claim and help you find the best CPAP setup for your health needs and your lifestyle.
  • Purchasing Your CPAP on You can purchase your CPAP machine and mask just like any normal online purchase, the only catch being that you need a prescription to complete your order. When you visit the online store, any item that requires a prescription will be clearly marked. You can upload your prescription through the website, email us a copy, or fax a copy to our office. If you do not have your script on hand, we can also request a copy directly from your sleep doctor.
  • Affirm: We offer a financing program through Affirm to help you manage the cost of a CPAP machine and mask. Affirm is a financial company based in San Francisco that offers easy, transparent loans with no hidden payments or surprises. All you need to do is select the Affirm Monthly Payment option at checkout and provide some basic information. Affirm provides a real-time loan decision and helps you manage payments based on what works best for you.

CPAP Machine Manufacturers, What Brand to Choose

Choosing the right brand and style of CPAP mask and machine can be difficult when you are just starting out. Our team is here to help make the transition into sleep therapy as smooth as possible. We offer products that are tried and tested to ensure that you receive a CPAP that goes beyond expectation and provides you with the comfort needed for a good night of sleep.

  • ResMed: ResMed offers a full range of CPAP masks and provides the most effective sleep therapy possible to users. ResMed CPAP masks are comfortable, lightweight and engineered to feel as if they are barely there. For over 25 years ResMed has been a leading pioneer of innovative treatments for sleep-disordered breathing. Browse our selection of CPAP machines to find a CPAP mask that works for you.

“If not for the fact the mask was on my face I would not know this machine was in the room. I went from having 47 events an hour to 2 in a matter of months. This CPAP literally not only saved my life but gave me back my life!”

  • Philips Respironics: Philips Respironics has been in the business since 1976 and creates innovative products for sleep apnea management. Respironics manufactures CPAP machines and mask interfaces that are designed based on patient interviews to develop CPAP systems that meet the needs of real life users.
    Depending on your needs, Respironics has a match for you. One popular option is the Dreamstation CPAP machine. The Dreamstation is packed with features, making it a great mask for those getting acclimated to sleep therapy: Bluetooth is standard on every Dreamstation device, and most machines include a humidifier for ultimate comfort.

“It’s amazing how far CPAP machines have come. Wow!”

  • Fisher & Paykel: Fisher & Paykel design many sleek CPAP Machines that offer effective humidification. Patients need not worry about dry mouth, dry eyes, inflamed sinuses and more when using Fisher & Paykel CPAP Machines.

Choosing a CPAP Mask

Research masks before you select one and review other CPAP users’ reviews. Many sleep techs just have you wear a mask that works in the sleep lab for them to successfully titrate you.  This doesn’t mean that mask is going to work for you long term. Visit several sleep forums and ask people there.  Check out YouTube for videos and reviews on different masks.  Even then you are likely going to try several masks before you find one that is perfect for you.

  • Nasal pillows: a nasal pillow mask uses two soft silicone pillows that are inserted into the nostril: these are generally very small and lightweight and are preferred by many CPAP users over a full face mask.

Diagram of a nasal pillow mask

  • Nasal mask: the nasal mask is a triangular mask that fits entirely over the nose. The silicone cushion makes the fit more comfortable. Stacy was excited to try the nasal pillow, but she quickly identified it didn’t provide enough air.

Diagram of a nasal mask.

  • Full face: this is the best type of mask for mouth breathers as it covers the nose and mouth. This type of mask is usually made with gel or silicone cushions to provide optimal comfort.

Diagram of a full face mask.

  • Oral: the oral mask only delivers air through the mouth. An oval cushion seals around the mouth and delivers air through two small inlets in the mask. This mask is a good choice for people who have seasonal allergies or suffer with nasal congestion.

Each manufacturer has its own sizes. A medium in one manufacturer might be the equivalent in a large in another.

The Best CPAP Masks

ResMed Airfit 30

The AirFit F30 is lightweight, designed to prevent red marks and allows you to wear glasses with your mask. Because the AirFit F30 sits lower on your face, it doesn’t impede your field of vision. Plus, the smaller seal makes less contact on your skin for more freedom and less claustrophobia.ResMed Airfit 30

The AirFit F30’s simple design includes the ResMed QuietAir elbow with multiple vents in the mask to disperse airflow for an incredibly quiet mask. This almost silent CPAP mask won’t wake you or your partner to provide more peaceful sleep.

The soft, flexible, one-size-fits-all headgear is easy to quickly slip on and adjust for the perfect fit. Its magnetic clips allow you to snap your mask in place or remove it, for ease of use. A recent study proved that the AirFit F30 provides an accurate first-time fit for 93% of sleep apnea patients.

Respironics Dreamwear

The Philips Respironics DreamWear Full Face Mask connects at the top of the mask instead of at the nose bridge, to provide freeing comfort that allows you to sleep without becoming entangled in your hose.Respironics DreamwearHave more freedom as you sleep with the lightweight and ultra comfortable DreamWear Full Face Mask. This mask has a new, innovative air tube connection at the top of the head so you can rest without getting tangled in tubing all night. The unique in-frame airflow creates a soft, weightless feel so you can quickly and easily drift to dreamland every single night.

This CPAP mask was developed by Philips Respironics to provide extreme comfort by eliminating the discomfort and hassle of having a tube connect at the nose bridge. As a result, this freeing design prevents both irritation and red marks to make your CPAP treatment feel like a dream.

CPAP Features to Consider

  • Mask Fit and Style
  • Noise
  • Air Filter
  • Exhalation Pressure Relief
  • Humidifier
  • Portability
  • Heated Tubing
  • Leak Compensation
  • Data Capability and Compatibility – Jason, a Registered Polysomnographic Technologist, stressed data capability and compatibility with SleepyHead. SleepyHead CPAP software is designed for reviewing and exploring the data produced by your CPAP machine.

A man cleaning his CPAP mask

Replacing & Cleaning CPAP Parts

  • Overall Recommendations: One of the most important things that you can do is regularly clean your CPAP supplies. Since your CPAP mask is in direct contact with your nose and mouth and delivers air, there are many opportunities for bacteria to grow. Cleaning your CPAP setup isn’t difficult, and usually only requires some hot water, soap and a safe place to dry.
  • How to Identify Worn/Dirty Parts: Worn out tubing generally starts showing air leaks and exterior scuffs/damage.
  • How to Clean Machine + Mask, SoClean option: The dirtiest part of the CPAP is the CPAP mask because it touches your skin every night. The plastic is designed to feel comfortable on your skin and to create a good seal. The thin design of the cushion leads to break down over time.

One of the easiest ways to clean your CPAP is a SoClean, an automated CPAP cleaner and sanitizer. It kills 99.9% of the germs left behind in your mask, hose, and reservoir.

Consider the Siesta Med Hurricane Driver, a favorite of Jason founder of Free CPAP Advice, “there are several methods for cleaning your mask and tubing, but getting it dry quickly is another issue entirely.  The Hurricane Dryer does this very well.”

  • Replacement Schedule: Following a replacement schedule ensures that you’re keeping your mask and parts as clean as possible in order to get the most our of your therapy (and avoid getting sick!). Your friends, internet forums might have suggestions about cleaning, but it’s always best to follow a physician-approved replacement schedule:
    • Once a month: replace the pillows or cushions and disposable filters.
    • Every 3 months: replace mask frames including full face, nasal and oral masks. Replace the tubing as well. (Tubing should be flushed more often than it is replaced. There are plenty of cleaning tools to help.)
    • Every six months: replace the CPAP headgear and the chinstraps, along with the non-disposable filters and the humidifier chamber.

Accessories & Supplies to Consider

  • Carrying Case
  • Backup Travel CPAP
  • Batteries
  • Snugglehose
  • SoClean
  • VirtuClean
  • Lumin

Getting Acclimated to CPAP

Like any new piece of equipment, it takes some time to get used to a CPAP machine. It takes patience and persistence to get acclimated to a CPAP machine. PAP can be delivered by a variety of machines and masks.

Breathing with CPAP/Bilevel is completely different than how you are used to breathing. It is going to feel different. Jason suggests practice breathing with your mask and machine during the day when there’s no pressure to sleep. Allow yourself to get used to the PAP machine when you’re not tired in order to avoid any panic. When you first start sleeping with the CPAP, gradually add the different accessories. Start with the mask. Attach the tube the next time, hook it the machine the night after that.

People new to CPAP often feel claustrophobic. Taking a piecemeal approach can help. Try experimenting with different size or styles of masks.

Using Multiple CPAP Machines

Stacy uses two different masks and different machines. She started with the Respironics Pico Nasal Mask, but recently switched to a ResMed N20 for Her Mask. The magnetic closurers are super convenient. Stacy uses the Phillips Respironics Dreamstation for regular use and a ResMed AirMini for travel and sometimes naps in the living room. I like them both!

If one systems doesn’t work, it is important to advocate for yourself. “You absolutely must bug your care and support team until [it is working]. It can get to the point where you feel annoying, but remember – you’re paying them for a service, they should provide excellent care for you,” Stacy at CPAP Babes.

CPAP and Your Health

Sleep deprivation and sleep apnea can lead to or exacerbate serious health conditions. Sleep apnea has been shown to contribute to headaches, memory loss, depression, anxiety, type 2 diabetes, Alzheimer’s, hearing loss, memory loss, and more.

Treating your sleep apnea can lead to a better quality of life. You’ll feel more restful and have more energy. After a good night’s sleep, you will be able to concentrate better and think clearer. It will be easier to loss weight because you’ll have the energy to exercise. Your blood pressure will improve.

While CPAP does treat sleep apnea, it does not cure it. As long as you suffer from sleep apnea, you will need to use a CPAP, but sleep apnea may enter remission or be cured. The factors that cause sleep apnea are different from person to person. There is a lot you can do to improve or even reverse your sleep apnea. Exercising, eating healthier, and cutting out nicotine and alcohol helps you shed excess weight and improve your health.

Side Effects

A CPAP or BiPAP machine is virtually 100% effective, but occasionally people experience some unwanted side effects. Some common CPAP side effects and solutions are:

CPAP Glossary of Terms

  • Apnea–hypopnea index: The measurement of severity of a case of sleep apnea. It’s measured by the number of apnea events that happen per hour.  
  • BiPAP/BiLevel Therapy: An alternative to CPAP therapy that utilizes two different pressure settings through a facial mask. The key difference between CPAP and BiPAP is that the BiPAP system uses two pressure settings: the inspiratory positive airway pressure (IPAP) is higher and supports breathing patterns, while the expiratory positive airway pressure setting (EPAP) is lower and supports exhalation.
  • Bruxism: Grinding of the teeth. Associated with sleep apnea.
  • Central Sleep Apnea: Sleep apnea occurs when the brain fails to signal the muscles to breathe.
  • Complex sleep apnea (CompSA): This is a serious condition in which sleep apnea symptoms persist during attempts to treat breathing with a CPAP machine or bilevel therapy.
  • Compliance: This term defines how well and how frequently you are sticking to your treatment plan. Compliance can also be used to verify insurance claims – if a CPAP user sticks to their treatment plan their insurance provider will generally continue to offer the benefit.
  • CPAP: Stands for Continuous Positive Airway Pressure. It is a therapy designed to treat sleep apnea using pressurized air that is delivered at a constant pressure to ensure there are no pauses in breathing during sleep.
  • CPAP Ramp Feature: Designed to allow the CPAP machine to start at a lower pressure and work up to the intended pressure over a set period of time. Starting with a lower pressure often allows the user to fall asleep easily. From there, the pressure gradually increases to the level necessary to keep the upper airway from collapsing. Not all machines have a ramp feature, but if you have trouble adjusting to the pressure you need, this might be a great feature to look for in your CPAP setup.
  • Epworth Sleepiness Scale: Questionnaire to give measure to the intensity of daytime sleepiness experienced by any given patient.
  • Expiration: Refers to breathing out, either manually or with the help of a therapy device such as a CPAP.
  • Hypertension: Commonly associated with sleep apnea because OSA is a recognized trigger for hypertension. Apnea episodes (pauses in breathing) cause a surge in systolic and diastolic pressure that elevate blood levels. In turn, people suffering from cardiovascular problems like high blood pressure have a high prevalence of apnea, so the two conditions are often thought to be connected in a cause-effect type manner. 
  • Hyponea: Less than 50% decrease in airflow for 10 seconds or greater with a decrease in oxygen saturation of less than 3%.
  • Hypoxemia: An abnormally low level of oxygen in the bloodstream. According to a study on the treatment of hypoxemia in OSA: “Usually, treatment is directed at correcting the apnea, which will, in turn, prevent hypoxemia.”
  • Inspiration: Refers to breathing in, usually in regard to inhaling with the support of a respiratory therapy device.
  • Leak: Refers to air leaking out of the CPAP mask, causing an interruption in therapy.
  • Mask Seal: The mask seal ensures that no air escapes from your mask during therapy.
  • Nocturnal Polysomnogram (NPSG): Sleep study
  • OSA: Stands for Obstructive Sleep Disorder, a breathing disorder that results in interrupted breathing patterns that can affect sleep patterns. OSA is a serious condition that affects about 18-30 million adults in America. Most cases remain undiagnosed.
  • Outgassing: Process by which plastic component parts of CPAP masks and other CPAP supplies give off a chemical odor after being manufactured until they have been exposed to the air for a sufficiently long period of time.
  • Oximeter: A device that indirectly monitors the oxygen saturation of a patient’s blood.
  • Oxygen Desaturation: An index that defines how many times per hour the blood oxygen levels drop below baseline. This is measured during a sleep study. The Division of Sleep Medicine at Harvard Medical School defines a normal blood oxygen level (saturation) at around 96 percent. Levels below 80 percent are considered severe.
  • Polysomnogram: The scientific term for a home sleep study. The test records brain waves, oxygen levels, heart rate and breathing to detect sleep disorders like sleep apnea.
  • Polysomnographic technologist (PSGT): Technician, typically registered, who administers a sleep study.
  • REM Sleep: Characterized by rapid eye movements, this sleep cycle works to occurs at intervals during the night.
  • REM: A sleep interval that occurs during the night and is defined by rapid eye movements, increased pulse rate and more frequent bodily movements.
  • Rainout: The accumulation of water due to moist air condensing inside the tubing as it travels from machine to mask.  
  • Titration: Refers to the study that determines the best pressure setting for your machine. During the study, you will also be fitted for a CPAP mask and matched to a machine that best suits your therapy needs. After you are set up with your mask and machine, you will be monitored overnight to ensure that the pressure setting works best throughout the night.
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