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Advice from a Sleep Doctor With Sleep Apnea

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My name is Dr. Amie Stringfellow, and I’m a board-certified physician in Sleep Medicine, Internal Medicine, and Pediatrics. I operate a practice called Milepost Medical which provides provides affordable direct primary care and sleep medicine services outside of insurance. Like many of you, I have Sleep Apnea, and in this article, I’ll share the story of my treatment journey in the hope that you may learn from some of the experiences I’ve had.

How I was Diagnosed with Obstructive Sleep Apnea

I was actually 15 when I was diagnosed with Sleep Apnea. I was starting to snore at night, got really tired and cranky during the day, and was struggling to stay awake in school. My parents took me to my ENT (Ear, Nose and Throat) doctor. Initially, they tried to do an at-home oxygen test, to monitor my oxygen levels at night while I was sleeping. These tests actually came back normal, so the ENT told me I was fine. I was still tired and snoring though, so my parents said – “no, this isn’t normal”. I ended up having a full in-lab sleep study done. While my oxygen level was fairly normal, we didn’t catch the apneas until I had the in-lab sleep study and not just the oxygen reading. From there, my doctor ordered me a CPAP.

My Struggles with Sleep Apnea

Initially, the struggle with Sleep Apnea was just simply getting the diagnosis. That took… months. I was really having a hard time being tired and struggling at school – this had not happened before.

When I got the CPAP machine, I did pretty well with it. Right away, I noticed that when I wore it, I felt better during the day. I felt a difference very quickly.

This isn’t to say it was all roses. I struggled to fall asleep with the CPAP on. I did it every night – I knew I would feel better for it, but it was tough. I remember putting on the equipment and being very conscious of my breathing and trying to regulate it. The CPAP makes you very aware of how you’re breathing, so I would just lay in bed thinking about breathing in and out. I had to find ways to distract myself so it wouldn’t bother me. I really had to consciously not think about my breathing. Which is hard. If someone tells you not to think about a cat. What do you do? You think about a cat.

Once I fell asleep, I was totally fine. But it probably took me a whole year to put the mask on without thinking of my breathing. It got progressively better over that time, but it wasn’t easy.

I was highly motivated to get it right for the rest. And I did.

My Best Sleep Apnea Treatment Advice

You must have realistic expectations with CPAP therapy. If you think, I am going to hate it, you will. If you think, this is going to be immediately awesome – you will likely be disappointed. Everyone has an adjustment period when they first start using their CPAP. Some people adjust quickly and others take months. Just realizing that it is a process is helpful. When that process becomes tedious, I find working with someone who is knowledgeable about sleep apnea treatment is helpful.

When I started using CPAP, there weren’t nearly as many mask options out there, but I am pretty sure I tried every mask that was available at that time before I was able to find one that worked. No idea how many. I tried a lot. It was over several different days of course. I’d try one at home, it wouldn’t work, and I’d go back and try more.

It takes time. It takes being diligent and working through problems. You have to stick with it. Eventually, you will find the right combination of things that will work for you.

The CPAP Equipment that Works Best for Me

Currently, I use a Respironics DreamStation APAP, and it is what I usually recommend to my patients. There are other machines like BiPAPs and ASVs – but strictly for CPAP – I like this Respironics machine. Respironics makes a good machine and their data reporting is really helpful. As a physician, it gives me a lot of good insight. I can look at the data and make recommendations. I can have a meaningful visit with my patients, say, “I am seeing this, so we should try this other thing”. Many other machines don’t have the same advanced data, and so I am less helpful because I only get half the story.

A little more on the machine type: An APAP is just a fancy CPAP that can adjust pressure itself. I like the flexibility of an APAP. There is flexibility if patients gain or lose weight or if they don’t feel as good. I can open the pressure range up and let them re-titrate at home. That’s very useful and more helpful at managing the patient’s Sleep Apnea over the long term.

Now, having said that, APAPs are a little more expensive. The CPAP is also a good option and I do also like the DreamStation CPAP. ResMed is the other big player here – the AirSense line. They also make a really good machine. I just happen to like the data from Respironics a bit more. But if a patient comes to me on a ResMed machine, that’s good as well.

Now for masks… they are the marker of if a patient will be successful or not. I get asked a lot: “What is the best mask?” It’s like being asked what color is the best? It’s a personal preference. One person might like green, one person might like red. Masks are the same – some like nasal masks, some like full faces.

I personally use a nasal pillow, the Respironics DreamWear nasal pillow. I like it very much, but will it work for everyone? Absolutely not. It’s really an individual choice.

In general, the less surface area that a mask needs to seal, then the less likely it is to leak and to stay in place. Nasal pillows have a very small surface area.

The nasal mask also has a relatively small surface area, but definitely more than nasal pillows.

Then there are full face masks, which tend to be the most likely to leak, but if you can’t comfortably breathe through your nose, or sleep with your mouth open – you will need this. It just all depends on the person!

Hideen cpap supplies

Lastly, I don’t usually recommend CPAP accessories right off the bat. I like to let patients try their therapy, see how they do, then based on what problems they may encounter – seek out solutions. A few products I recommend for each problem:

For rain out the SnuggleHose is great

For face marks or pressure from mask headgear the Pad-a-Cheek strap wraps are good

Also good for skin irritation or leaks are the mask liners

Again, there’s no one thing I recommend all the time, it really depends on the individual. I really like to address the problems only as they present themselves.

Ways Having Sleep Apnea Has Helped Me Be a Better Doctor

I’m not afraid to talk about my personal medical experience with patients, so I think it helps patients relate to me and what I am educating them on. It allows me to be more thorough and hopefully be seen as more reliable. Me saying “Go do this and good luck” isn’t as helpful as saying “I know this can be annoying, but you can work through it.” I get to strike a good balance between commiserating with them and helping them do what it takes to realize the benefit of treating their sleep apnea. Being able to say “been there, done that” helps the patients better fight through whatever complications they are trying to solve.

And, I want to emphasize, I don’t necessarily think everyone with Sleep Apnea needs to see a sleep doctor. Whether it’s a pulmonologist, neurologist or even a primary care doctor with a lot of sleep education – you can likely get the help you need. However, if you’re having a hard time adjusting to CPAP therapy, it’s important to find someone who is knowledgeable about all the options available, to help you walk through those rough patches, and help you troubleshoot any issues.

Here in the office, we’ve seen quite a few patients who were diagnosed with sleep apnea, say 10 years ago, and never liked the CPAP. They never used it regularly and are now just completely miserable and want to know what to do. So realistically if they had someone work with them 10 years ago to understand their options – well they might have been better off ten years ago. Don’t wait until you’re desperate – find someone who has the knowledge and can work with you to find a solution that works for you.

  • Dr. Amie Stringfellow

    Dr. Amie Stringfellow is a board-certified physician in Sleep Medicine, Internal Medicine, and Pediatrics. She operates a medical practice called "Milepost Medical" which provides affordable direct primary care and sleep medicine services outside of insurance. She's a graduate of the University of Texas Health Science Center at Houston and completed her residency at Baylor University College of Medicine in Houston. 

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49 Responses

    1. I whole heartedly concur with Dr. Stringfellow. I was diagnosed with sleep apnea in 1993, and by 1995 had tried a lot of therapies, but only CPAP worked to correct snoring as well as breathing interruptions. I quickly settled on nasal pillows. Since then there has hardly been a night that i didn’t use the CPAP–you get to the point where you can’t sleep without it (my RX is 11 cm). In the last year or so I’ve had medicare pop for the the DreamStation Auto and associated heated tubing–its great and effective. But for travel I had and continue to use the Transcend. I wish i had the $ to upgrade to a Transcend Auto, but the regular one is just fine. One factor with that is that i have a couple of batteries that are specific to the Transcend, and i don’t want the extra expense of replacing them, too.

  1. I was diagnosed 1996. I’m actually addicted to my machine now. I hit a out of pocket with insurance 2 years back and got a really nice machine now. Will be 65 10/20 and machine should last till then. Hope Medicare will cover because I can’t sleep without it now, even naps, I use..

    1. Donald Lackey did you pay out of pocket because the insurance wanted to only cover for a certain machine??

  2. I would like,to know what Dr. Stringfellow recommends for cleaning CPAP mask and machine. Any of the systems out there worth it?

    1. Hey Phyllis,

      I will be sending you an e-mail shortly with the standard cleaning instructions for CPAP supplies (masks, hoses, water chambers, filters) the machines themselves do not require cleaning as long as you are changing the filters and cleaning/replacing the parts on schedule. Additionally, we sell a machine called Lumin which uses UV light to sanitize your supplies. Here is a link to the Lumin for your reference. https://www.cpap.com/productpage/3B-medical-lumin-uv-cpap-sanitizer, please feel free to reach us at 1-800-356-5221 if there is anything else we can assist you with.

    2. I LOVE having a SoClean. Really makes the mask smell fresh, and so easy to use. Worth it. I’m bad about cleaning regularly so this gives me some feeling that I’m killing off germs. I also use CPAP wipes to keep the mask clean.

  3. what is the danger in allowing apnea patients to adjust their own CPAP pressure? I lost weight (100 pounds) and needed to do a split-night study ($800 out of pocket) to get it adjusted. Now my knees are bad and I can’t run so much so I’ve gained a little weight back. I have an older autopap machine. I know that the initial pressure is not enough. When the machine catches up it’s OK. I don’t want to pay out of pocket money for another study. I have a data card in my machine. Can’t they just look at that and make an adjustment or tell me the secret to opening the CPAP for adjustment? I think I can easily adjust it up until it is comfortable..

    1. Hey Richard,

      We always suggest that you speak with your doctor before making changing to your pressure settings, but if you would like to contact us with the name of your machine, we will be happy to assist you with adjusting your pressure settings over the phone, or we can e-mail to you the clinical manual and you can adjust the pressure on your own. We can be reached at 1-800-356-5221, or you can e-mail us with the name of your machine at cpap@cpap.com and we will send you the clinical manual.

  4. I am glad to know from the article that I am on a good CPAP machine and mask. It only took a week to get used to it and now it is my security blanket. My problem was no one knew how to clean it. I became very sick with bad bacteria and possible Aerophagia. I bought an expensive machine advertised on internet which seems to be helping but does not clean hose which is a hassle. I also reduced the amount of hours that I use the machine at night. Need a good recommendation on best way to clean the machine. Thanks

      1. Hi Jana, yes there is a cleaner called So Clean, but we do not currently sell this machine. We do however, have a cleaner called Lumin. This is a machine that uses UV light to sanitize your mask, water chamber and other household itmes. Please make note that the Lumin does not sanitize your hose. Please see the link below to find more information on the cleaner that we have available.


        Please let us know if we can be of further assistance.

    1. We use hydrogen peroxide to clean our CPAP supplies. It’s inexpensive and does not leave any odor. Does a great job.

  5. I thank You for Your time & the information on Sleep apnea. I’ve just been diagnosed w/severe S.A. and appreciate your dedication to helping minimize My anxiety.

    1. Hey Dr. Glenn Calabrese,

      Since we do not accept, or work with any insurance, we try to keep our prices as low as possible for our CPAP supplies and machines. Even though our customers pay out of pocket for their equipment they are able to avoid rental fees that the insurance companies charge in most cases and pay for the equipment out right at a reasonable price. If you are interested in getting pricing on our equipment, please contact us at 1-800-356-5221 and we will be happy to go over the costs with you.

  6. where is the practice? I live in Dallas, but still fly to El Paso for sleep follow up. would like someone closer.

    1. Hey Walter, I am not certain if your question is specifically for Dr. Stringfellow, but I thought I’d chime in. A lot of people that have difficulty with keeping their mouth closed during their sleep enjoy the benefits of the chinstrap. Here are a couple of my favorites, https://www.cpap.com/productpage/ruby-style-adjustable-chinstrap-extension-strap, and https://www.cpap.com/productpage/breathewear-halo-chinstrap.

      I hope you find this information useful, enjoy your day!

  7. Thank you very much for the helpful articles, Dr. Amie! I really appreciate hearing from a Dr with sleep apnea. I found the article about the difference between all of the Pap machines very useful!

  8. Thank You!
    Very informative and helpful.
    My problem: power outages in New Engkand storms, camping where there is no electric,
    Wanting to pull off to rest area for nap with machine.
    I am told with severe sleep apnea that it is life and death.
    Insurances do not covert very expensive battery packs.
    I am on bipap variable pressure.
    Patients need thievbatteriesvas a medical necessity.
    There needs to be a way for insurance to help
    Patients with this. Power outages, snow, ice, blizzards.
    As patients we need Board Certified Physicians to lobby and advocate .
    CPap batteries not compatible with bipap.
    So no camping . Tried battery that stopped working after 5 hours. Had to go home alone while family camped.
    I am an RN. Insurance does not see severe obstructive sleep apnea as life and death. Doctors say it is. I give up.
    May have to buy generator for storms .

    1. For Pippa
      I have been on a CPAP for ten years. I live out west and have been able to enjoyed the outdoors and camping trips number of times over the years. I use regular RV type batteries. One trip to Canada was for 10 days..Took two batteries plus generator as back up to recharge if needed. Can get about a week on one charge. Do not use the humidifier, just only the air pump part. I have used a riding lawn mower type battery couple of times — good for two days. A guy from same town I live in use to go backpacking into the wilderness for days. carried battery and solar charger with him. Just hung solar charger on out side of his pack while hiking.As for power outages — I just hookup to the battery for the night. Remember, you can not use the humidifier. It will suck the juice right out oft the battery quickly. . Hope this will work with your bipap and help you enjoy camping with your family. .

  9. I am also addicted to my machine which I have been on since 2002. It was hard to get diagnosed hated machine (did not use for 10 years) because the mask was deforming my face. Started using nasal pillows which was a lot better. Just bought a SO-CLEAN machine to clean daily pleased so far with that purchase. I use a humidifier.

  10. When I started with my CPAP in 2004, I struggled with the Ramp setting because I felt like I was smothering. My doctor changed setting to No-Ramp, and I was able to fall asleep very quickly. Couldn’t sleep without it now.

  11. For Rich
    Thank you for the battery information.
    Guessing RV batteries are heavy.
    We tent camp and often carry gear.
    Will check into small portable generators.

    Thank you,

  12. I have just aquired my AirMini Machnine from Resmed. I have learnt alot from this article and from other contributors. I live in Kenya Africa and my problem is compounded by the distance and availability.

  13. After a couple of years of doing fine with apap, I have developed a problem: I have a run of 5 -6 nights that are great—extremely low AHI’s, feel great next day. Then, with no change in position, settings, leakage, weight, etc, suddenly the AHI shoots up dramatically for several nights—to the point that it’s worse than with no cpap at all. I am a physician and have trouble functioning at work after such nights. The leakage is no different than on the good nights (very low). At this point, I am actually afraid to use the equipment (I have gone through a few rounds of this). My sleep medicine doc is stumped. Have you run into anything like this?

    1. Hi Dr. Shoshana, I am not certain if you are asking specifically of Dr. Stringfellow but thought I’d chime in. Has your sleep doctor looked into the possibility that you are having a Central Sleep Apnea Event? Some machines may record this for you such as the DreamStation Auto and the AirSense 10 Auto, off the top of my head.

    2. HI Shoshana,..
      Just wanted to comment here but I bet you’ve already figured out your issue by now.
      I was struggling along with extremely high AHIs, like you, and finally, someone thought to check for Central Apnea, and sure enough I have both types as well…OSA and CSA. Once I found a good person to work with me, I was switched to an Auto SV device; we worked with all types of masks and I’ve had single digit AHIs since.(~6yrs) I love seeing 1.9 AHI when I check it in the mornings!! It made a real difference. Hope you get sorted out. When you do, you’ll never want to be without it for sleep. Best of Luck,

  14. Background:
    This message is for Dr Stringfellow and I can am relating to customer comment of Dr. Shoshana. I am a retired dentist recently (last 2 years), 63 now and use BiPAP machine by ResMed. I collapsed two years ago from Atrial Fibrillation, Congestive Heart Failure. Extremely healthy lifestyle (runner, vegetarian, no alcohol,ect), no prior medical problems, rarely saw doctor. After 3 Ablation surgeries and finally a sleep study and BiPAP machine, my last surgery finally worked. I believe machine saved my life for I was having 41 Apnea’s per hour and Cardiac problem not resolving. It has been a journey. Doing well for 9 months with Apnea’s averaging 5-7 per night, feel great and strong. Walking 5-7 miles per day, functioning all day. Have been using Oxygen Concentrater with flow of 3 liters per minute for more than 6 months because followup showed 50% of my apnea’s were Central Nervous System and could not reduce apnea’s below 21 per hour until oxygen bleed into cannula.
    My Point:
    Recently my Apnea’s increased from 5-7 range to 10 to 14 range and I am starting to feel the difference and through process of elimination (cleaning, etc) trying to find the cause. Is it possible that as my heart and lungs get stronger, could my body be adapting to the 5/9 pressure and maybe not require quite as much
    pressure? Originally my doctor had to dramatically lower the pressure they were using to drop the Apneas
    I was experiencing, saying the high pressure was causing Central Nervous Apnea’s.

  15. Estimada dra mi nombre es alex tengo apnea de sueno utlizo bipap y tengo 2 años de usar la maquina pero lo mas que tolero la maquina son 4 horas por noche.
    Y tengo fugas en la maquina constantemente uso agua deslitada y quisiera saber si la apnea es una enfermedad curable y si uno puede dejar de usar la maquina algun dia mi problema es obesidad pero estoy en el proceso de cirugia bariatica cuantas horas tengo que usar la maquina vipap y como evito fugas.
    atte Alex bendiciones.

    1. Hola Alex, lamento que solo toleres tu máquina CPAP durante 4 horas cada noche.

      Usted habla de tener fugas en su máquina. Es posible que la fuga provenga de tu máscara. ¿Ha cambiado recientemente su colchón de máscara / máscara?

      Le deseamos lo mejor y una pronta recuperación de su cirugía, pero no podemos decir con certeza que la pérdida de peso pueda curar la apnea del sueño. Sin embargo, en individuos obesos o con sobrepeso, perder peso puede tener un efecto sobre su apnea del sueño y las necesidades de presión para la máquina de CPAP. Comer una dieta saludable combinada con ejercicio, puede promover la pérdida de peso y con la pérdida de peso puede llevar a la necesidad de una menor presión en la máquina CPAP.

      Lo alentamos a que hable con su médico sobre sus preocupaciones con la pérdida de peso y el efecto que pueda tener en su terapia de CPAP.

      Espero que esto ayude, ¡disfruta tu día!

  16. hi i just diagnosed to have Sleep Apnea, i have a curious question, the using of CPAP machine will make the patient addict to the machine? is patient will rely on the machine for whole life? sorry anyone can help me?

    1. Hi Lucas, with using your CPAP machine on a daily basis, you get in the habit of using it and in a sense you may become dependent upon your machine. With the CPAP Therapy, this is a excellent habit to have as you should be using your machine each day unless your doctor states otherwise.

      In regards to your question about must you rely on the machine forever, the short answer for most people with sleep apnea is that CPAP is the most effective treatment that currently exists. This doesn’t necessarily mean that it is forever. In some instances making some life changes can help decrease your need for using a CPAP machine. I would recommend you speaking with your doctor, or sleep specialist to gain more knowledge about if and what ways you may be able to decrease the use of a CPAP machine.

      I hope this information helps.

      I wish you the best!

  17. I recently got the airsense 10 and like it but when I use the humidifier at s level 5 I notice that my nightstand where the machine sits gets very hot under the humidifier.Is that normal? Any suggestions? For now I’ve turned off the humidifier! I’m afraid it will melt the varnish on my nightstand or cause a fire!.

    1. Hey Pat, it is normal for the nightstand to get hot with the humidifier setting being at 5. You may consider laying a towel under the machine, or lowering the heat. Another option is that you could pair the humidifier with a heated hose, if you are not using one and also lower the heat on your humidifier.

      I hope this helps, enjoy your day!

  18. Good recap. I had a very similar experience getting used to my vpap.
    My issue was, I developed AFib, and the origin was traced back to sleep apnea through testing.
    I know sleep like a baby and awaken feeling rested and energetic.
    This even allowed me to forgo coffee in the morning as I just don’t need the stimulus anymore.
    My advice to anyone who snores (horrifically) is get tested, as it may save you health issues down the road… and please listen to your spouse or significant other..if they think there is an issue – there probably is!

  19. Hello Dr Amie,

    Thanks for taking the time to read & respond to these questions.

    I’ve been a 10-year CPAP user (Fisher-Paykal Sleepstyle 5-series), and it’s worked great for the first set of years, however I started getting headaches when I woke up in the morning.

    Based upon research, most recommended to increase the humidification, and am currently on a setting of Fisher Paykal 3.5, . . . which sometimes encounters runout (even with tube cozie), but am waking up certain mornings with a sinus pressure headache, and moderate congestion (e.g., way up in my sinuses).

    I generally do a NeilMed Sinus Rinse upon awaking, and that seems to get the congestion moving (and reduced headache pressure), but would greatly appreciate your inputs?

    Could it be possible that I am over-humidifying?

    Many thanks,


    1. Hey Bud, I know that you directed your question to Dr. Amie, but I have a little bit of experience with your concern. In the interest of getting you some relief, I would encourage you to speak with your doctor to have them confirm that your machine is still set at the optimal pressure setting for you.

      Also, please see the link below for additional information regarding waking up with headaches.


      I hope this helps even a little bit and we wish you the best!

  20. It has been mine and my wife’s experience that the full face mask seals better that nasal cushions. So I did agree with the doctor’s statement that the full face mask leaks more.

  21. I’m on a cpap and there taking the machine from me for the 2nd time I am having trouble keeping it on I have the mask any suggestions on what to do

    1. Hi Sabra, I am sorry to hear that your machine is being taken from you. I am not certain as to what your circumstances are, but you may come out better if you purchase your own machine.

      Whereas there are some machine that may be very expensive, CPAP.com has an in-expensive selection of machines available for purchase. If you are interested, please feel free to reach us at: 1-800-356-5221, or visit our website at: cpap.com.

      Have a great day!

  22. I’ve been using A CPAP machine for about 3 years. Still makes me more tired than if I don’t use it. I wake with chest pains and very tired. So I’ll skip a day and will feel better. I spent 300 dollars to see a sleep expert. He arrived 45 minutes late and didn’t have time to talk. I saw a second sleep specialist Dr. and she said there’s no reason I should feel worse. Then she tried to sell me on a implant in my chest that would electronically open my throat but may not work. She then had my machine set incorrectly for a nasal mask instead of a full face mask. I sleep 5 to 6 hours at best. I’m scared to sleep knowing it’s taxing my system hard. Can’t find a doctor with knowledge of CPAP.

    1. Hi PK, my apologies for the delayed response. I am sorry that you are having problems getting answers to what may be causing you to wake up with chest pains and feeling really tired after using your CPAP machine.

      Perhaps, some setting adjustments may help you get better sleep. If you would like for us to see if we may be able to assist you with some troubleshooting and possible setting changes, please feel free to reach us at: 1-800-356-5221.

      Have a great day!

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