Patients

Frequently Asked Questions

 
 
 

CPAPs

1. How does PAP or "CPAP" therapy work?
CPAP (Continuous Positive Airway Pressure) treats OSA by providing a gentle flow of positive-pressure air through a facial mask to keep the airway open during sleep. As a result:

  • Breathing becomes regular during sleep
  • Snoring stops
  • Restful sleep is restored
  • Quality of life is improved
  • Risk for high blood pressure, heart disease, heart attack, stroke, and motor vehicle and work accidents is reduced

2. What are the benefits of regular usage of PAP therapy?
Most PAP users who remain committed to treatment enjoy:

  • Increased energy and attentiveness
  • Fewer morning headaches
  • Reduced irritability
  • Improved memory
  • Increased ability to exercise
  • Lower blood pressure
  • Decreased risk of strokes and heart attacks
  • Increased effectiveness at home and at work
  • Improved overall quality of life

3. My eyes are sore, dry, irritated or swollen. What should I do?
The mask may be leaking into your eyes. Try pulling the mask away from your face and repositioning it. The mask may be too tight so try readjusting your headgear straps.

4. How can I tell when my mask is worn out?
Because masks are disposable, periodic replacement is needed when the mask shows signs of wear and tear. Inspect your mask for stiffness, cracks, or tears. Also check with your homecare provider regarding replacement options through your insurance policy.

5. My mask seems to be leaking. What should I do?
Check all the connections. If your mask has a forehead arm or adjustment feature, try readjusting that first to correct the leak. If there is no improvement with the above steps, readjust the headgear straps. The mask should be as loose as possible while still creating a seal. A mask that is too tight against the face can cause leaks to occur by creating folds in the material. Talk to the homecare provider about trying another mask size or type if necessary.

6. How do you know when you should replace your mask?
Replacing your equipment is an important part of being successful with your sleep therapy. There are several factors you need to watch for related to replacing your mask: seal deterioration in the mask, an improperly fitting mask, and a mask damaged by improper cleaning.

 

OXYGEN

1. What is a portable oxygen concentrator machine and how do they work?
Portable oxygen concentrators (or POC's) are a portable device used to provide oxygen therapy to a patient at substantially higher concentrations than the levels of ambient air. It is very similar to a home oxygen concentrator, but it smaller in size and more mobile. The portable oxygen concentrator makes it easy for patients to travel freely; they are small enough to fit in a car and most of the major concentrators are now FAA-approved.

2. Will insurance or Medicare pay for a portable oxygen concentrator machine?
Yes and No. The complete answer is lengthy. Medicare and insurance do have billable codes for POC's however the supplier or oxygen provider is the one you have to convince. DME companies or oxygen suppliers are not required to give Medicare beneficiaries a POC only what is necessary to maintain the patient on oxygen and abide by the 21 Medicare standards. Now if you have a private insurance company or Medicare replacement plan I would certainly recommend calling them and asking if they would pay for one.

3. How hard is it to operate one of these?
Most of the machines are relatively easy to operate. We strive to provide a seamless understanding for you by providing instruction when you open the box. In addition, most of the manufacturers provide an instructional video that comes with all of our rental and purchases. We also have video's for most of the POC's on the product specific page. Basically, you need to know how to turn it on, set your liter flow, how to change the battery, how to charge the unit and what to do if you have an alarm. Most of the time the alarms patients here with POC's is due to the patient not breathing through their nose and therefore the POC is telling you that "hey your not doing this correctly" which is a good thing. Most patients get use to their portable oxygen concentrator and understand how it likes to operate.

4. Can I sleep with my machine?
Yes you can, but you do need to speak with your physician prior to rental to determine your nocturnal needs. Most patients on oxygen are on a continuous flow when sleeping at home. However, sometimes the physician may say it is ok for you to sleep with the conserver for a week or so. You must consult your physician on this as we cannot be responsible for you making the wrong choice but will help to guide you as much as possible.

5. Can portable oxygen concentrators be used with CPAP or BiPAP devices?
Yes. Oxygen Concentrators that offer continuous flow can be used with sleep apnea devices.

 

PHOTOTHERAPY

1. Does blue light provide any additional benefit for lowering bilirubin levels?
Because bilirubin is a yellow pigment, the bilirubin molecule is only capable of absorbing the photons of violet, blue, and some green. When broad-spectrum white light is used, only a fraction of the light affects the bilirubin. Blue light at approximately 450 nm is better absorbed than green light but green light (because of its longer wavelength) penetrates the skin better. The most effective lights for phototherapy are those with high-energy output near the maximum absorption peak of bilirubin (450 to 460 nm). Special blue lamps with a peak output at 425 to 475 nm are the most efficient for phototherapy and these do not emit harmful ultraviolet (UV) rays. Blue-green light may interfere with the monitoring of cyanosis. In addition, blue light causes nausea, giddiness and headache to the staff working in nursery. Green light causes erythema and s ubsequent tanning of skin. A combination of alternating four blue and two white tube lights (20 W each) are sufficient to provide adequate irradiance of 20-30 w/ cm2 / nm in the wavelength range of 425-475 nm.

2. What are the advantages and limitations of double surface phototherapy?
By using double surface phototherapy more irradiance can be provided to a jaundiced baby which will result in faster decline of serum bilirubin. Unfortunately, the surface on which the baby has to lie is not comfortable for the baby in locally fabricated units available in India. A convenient way of providing double surface phototherapy is using conventional blue light and undersurface fibre-optic biliblanket phototherapy.

3. What are relative contraindications of using phototherapy?

  • As an isolated therapy when exchange transfusion is indicated for removal of antibodies in the presence of rapidly rising bilirubin.
  • In presence of direct hyperbilirubinemia.
  • Porphyria.
  • Concurrent therapy with tin proto-porphyrin.

4. Why does bronze baby syndrome occur?
Bronze baby syndrome occurs when phototherapy is used in the presence of hepatic dysfunction and cholestasis leading to high serum porphyrins and copper. Bilirubin photo-products sensitize copper porphyrins to form brown photo-products that bronze the skin. Phototherapy with a direct bilirubin >2mg/dl indicating cholestasis may result in bronzing in susceptible infants.

5. Is there a way to decrease the intensity of blue light experienced by personnel to offset adverse symptoms perceived by them?
Yellow or amber-tinted transparent plastic curtain fastened as a skirt around phototherapy are found to decrease the symptoms of nursery staff. Alternatively, one of the blue lamps may be replaced with a gold or white fluorescent bulb. The light will compromise the efficacy to some extent.

6. When should phototherapy be stopped?
Phototherapy may be discontinued in a term baby when the serum bilirubin level falls below 14 to 15 mg/dl. (if the phototherapy is commenced for bilirubin > 15 mg/dl) or the bilirubin level is below phototherapy line on the jaundice graph. After discontinuation baby should be observed for another 24 hours for rebound, especially for hemolytic settings. Discharge from the hospital need not be delayed in order to observe for rebound especially in non-hemolytic jaundice. If phototherapy is initiated early and discontinued before the infant is 3 to 4 days old, follow up of baby may be necessary for assessment of jaundice.

 

WALKER

1. How do I use my non-wheeled walker safely?

Preparing to Stand Up:

  1. Move forward and sit as close to the edge of the chair as you feel comfortable.
  2. Keep your feet as far under you as possible. Aim to place your toes directly below the edge of the chair.
  3. Place both hands on the arms/seat of your chair OR one hand on the chair and one hand in the center of the walker frame. Do not tip the walker by placing too much weight on one side of the walker as you stand.
  4. Lean forward until you feel some of your weight on your feet.
  5. Use your legs to stand as much as possible – your arms should only lift what your legs cannot. Use your arms mostly to help keep your balance.

Preparing to Sit Down:

  1. Stand directly in front of the chair, facing away from it. The back of your legs should be almost touching the chair.
  2. Move the walker a little away from you so that you can bend slightly forward as you sit down.
  3. Reach behind for the chair with both hands (preferred) or with one hand and one hand on the walker.
  4. Slowly lower yourself using your legs as much as you can.

Walking with a Non-Wheeled Walker:

  1. Place your walker ahead of you, giving yourself enough room to take steps.
  2. Do not take any steps while you are holding your walker off the ground.
  3. Move your walker forward after taking one step with each leg.

Turning:

  1. Place the walker towards the direction you wish to go. Do not take any steps while you are moving the walker.
  2. Step your feet around until you are facing your walker.
  3. Repeat the process until you are facing the direction you wish to walk.
  4. Do not twist through your back when turning as this may cause you to lose balance.

2. How do I use my wheeled walker (rollator) safely?

Preparing to Stand Up:

  1. Engage the brakes. Move forward and sit as close to the edge of the chair as you feel comfortable.
  2. Keep your feet as far under you as possible. Aim to place your toes directly below the edge of the chair.
  3. Place both hands on the arms/seat of your chair or one hand on the chair and one hand on the walker.
  4. Lean forward until you feel some of your weight on your feet.
  5. Use your legs to stand as much as possible – your arms should only lift what your legs cannot. Use your arms mostly to help keep your balance as you stand.
  6. Do not walk forward until you have tested your balance and you feel strong enough to walk.

Preparing to Sit Down:

  1. Stand directly in front of the chair, facing away from it. The back of your legs should be almost touching the chair. Do not start to sit until you are balanced and standing still.
  2. Move the walker a little away from you so that you can bend slightly forward as you sit down.
  3. Engage the brakes.
  4. Reach behind for the chair with both hands (preferred) or with one hand and one hand on the walker. Do not tip the walker by placing too much weight one side as you sit.
  5. Slowly lower yourself using your legs as much as you can.

Walking with a Wheeled Walker:

  1. Place your walker ahead of you before you take any steps.
  2. Gently roll the walker ahead of you as you walk. Keep the walker close enough to you that it is supportive.
  3. If your steps are uneven, its best to shorten your longer step rather than work to lengthen your shorter step. The shorter step is usually the step where you have less balance.
  4. To turn around: stay within the width of the walker even if you are slightly behind. Roll the walker around you without twisting your back.

 

NEBULIZER

1. What is a nebulizer machine and what does it do?
These machines are typically used to treat the symptoms of asthma. The nebulizer is the mechanism used to deliver the medication in mist form to help alleviate these symptoms. The medication comes in liquid form which, when installed into the nebulizer machine, is converted into a mist which makes it easy to inhale. Sometimes referred to as a breathing treatment, is effective in infants and small children who need medication or anyone who struggles with asthma.

2. How do you clean nebulizer machines?
Like any other piece of medical equipment, it is important to clean and disinfect after each use. Cleaning is simple and should be done with plain soapy warm water. Refrain from using strong or harsh detergents especially those with a scent. Simply disconnect the mask and tubing from the nebulizer. The mask, if not disposable, should be washed and let air dried. It is not necessary to clean the tubing daily. However, cleaning on a weekly basis is recommended. If you prefer to disinfect your nebulizer mask, use a 1/3 ratio of vinegar to water. Let the mask soak for 10 minutes and rinse well so not residue remains. Allow to air dry. Remember that having a proper cleaning regiment help to stave off any types of infection.

3. What do you put in nebulizers?
Medication prescribed by your doctor will be converted into a mist in order to inhale from the nebulizer. Two types of medication, Albuterol or Alupent, are used to relieve asthma attacks quickly by opening up the airways. These start to act immediately and last for up to four hours.