VA Sierra Pacific Network (VISN 21)

VISN 21 Sleep Clinical Resource Hub (CRH)

On this page
What is VISN 21 Sleep CRH
Services Provided
Common Positive Airway Pressure (PAP) Issues
Cleaning and Caring for Your Device
Fitting and Adjusting Mask
Managing Air Leaks
Other Issues
Options for Ordering Supplies
Resources

What is VISN 21 Sleep CRH

The Sleep Clinical Resource Hub (CRH) provides care to Veterans at their local VA Health care facilities through telehealth technology or in-person visits. When paired with telehealth technology, CRHs allow Veterans to connect with their providers to improve access to health care.

Contact Information
Phone: 415-379-5554
Fax: 415-379-5539
MyHealtheVet Secure Messaging: V21 CRH SLEEP@

The Sleep CRH currently provides sleep services to the following facilities:

VISN 21
Central California VA Health Care System (Fresno, CA)
San Francisco VA Health Care System (San Francisco, CA)
VA Northern California Health Care System (Mather, CA)
VA Pacific Islands Health Care System (Honolulu, HI)
VA Sierra Nevada Health Care System (Reno, NV)
VA Southern Nevada Healthcare System (N. Las Vegas, NV)

VISN 19
VA Sheridan Health Care (Sheridan, WY)
VA Western Colorado Health Care (Grand Junction, CO)

Services Provided

— Sleep Disordered Breathing (SDB) evaluation and management
— Obstructive Sleep Apnea (OSA) management and therapies:

Positive Airway Pressure (PAP) Therapy
Oral Appliance Therapy (OAT)
BongoRX
eXciteOSA
Positional Therapy (i.e., Philips NightBalance and Zzoma)
Inspire Surgery

— Behavioral Sleep Medicine
Cognitive Behavioral Therapy for Insomnia
PAP Desensitization

— Management of the following:
Chronic respiratory failure requiring non-invasive ventilation (NIV)
Movement disorders of sleep such as restless leg syndrome and periodic limb movement disorder
Disorders of hypersomnolence such as narcolepsy and idiopathic hypersomnia
Circadian rhythm disorders
Parasomnias (RBD, Nightmares)

Common Positive Airway Pressure (PAP) Issues

**If you attempt to troubleshoot the following issues without success, please call Sleep CRH or send a secure message via MyHealtheVet for assistance.**

You’ve received your CPAP device and would like to get started as soon as possible but the next available appointment is several weeks out. How can you get started on your own?

The first step is to ensure your device has been remotely set to your prescribed pressure. You can send a secure message to V21 CRH Sleep@ or call 415-379-5554 to confirm. Once the pressure setting is confirmed, you can watch YouTube videos to help guide you. Here are a few short videos that may be helpful:

For set-up on Resmed Airsense 11:
ResMed AirSense 11: Get to know your sleep therapy device - YouTube



For set-up on Resmed Airsense 10:
How to set up & use your new AirSense™ 10 CPAP machine from ResMed - YouTube

For set-up on Philips Respironics Dreamstation 2:
Philips DreamStation 2 CPAP Setup and Use - YouTube

Cleaning and Caring for Your Device

For Airsense 11/Airsense 10:
ResMed AirSense 11: Cleaning and caring for your device - YouTube

For Philips Respironics Dreamstation 2:
Philips DreamStation 2 CPAP Cleaning and Maintenance - YouTube

ITEM	DAILY	WEEKLY
MASK: (FULL FACE, NASAL, NASAL PILLOW, ORAL INTERFACE)	WIPE CUSHION WITH WARM DAMP WASH CLOTH OR ALCOHOL-FREE BABY WIPE	HAND WASH THE ENTIRE MASK INCLUDING HEADGEAR WITH MILD SOAP AND WATER. LET AIR DRY, OUT OF DIRECT SUNLIGHT.
CPAP TUBING	N/A	HAND WASH THE ENTIRE MASK INCLUDING HEADGEAR WITH MILD SOAP AND WATER. LET AIR DRY, OUT OF DIRECT SUNLIGHT.
FULL FACE CUSHION	WIPE CUSHION WITH WARM DAMP WASH CLOTH OR ALCOHOL-FREE BABY WIPE	HAND WASH WITH MILD SOAP AND WATER. LET AIR DRY, OUT OF DIRECT SUNLIGHT.
NASAL CUSHION	WIPE CUSHION WITH WARM DAMP WASH CLOTH OR ALCOHOL-FREE BABY WIPE	HAND WASH WITH MILD SOAP AND WATER. LET AIR DRY, OUT OF DIRECT SUNLIGHT.
RESMED FILTERS	N/A	CHECK THE CONDITION OF THE FILTER AND FLICK ANY DUST OFF
PHILIPS RESPIRONICS FILTERS (DREAMSTATION- SYSTEM ONE)	N/A	LIGHT BLUE/ WHITE - CHECK CONDITION DARK BLUE/ BLACK SPONGE- WASH WITH SOAP AND WATER. ALLOW FILTER TO DRY COMPLETELY BEFORE PUTTING BACK INTO THE MACHINE
HUMIDIFIER TANK	FILL TANK BEFORE USE WITH DISTILLED WATER. EMPTY WATER DAILY AND REFILL.	OPEN THE TANK; HAND WASH INSIDE/OUTSIDE WITH SOFT BRUSH/SPONGE WITH GENTLE SOAP AND WATER.
CHINSTRAP	N/A	N/A

To disinfect CPAP supplies follow directions above, then soak for 30 minutes in a solution of one part distilled white vinegar and three parts water. Rinse supplies well in warm water.

Periodically wipe down to prevent dust/debris build up on outside of machine and dust surface around the machine.

• DO NOT allow water to enter your CPAP/BIPAP machine by transporting it with water in the chamber.
• DO NOT attempt any repairs to the CPAP/BIPAP machine. Call CRH sleep at (415) 379-5554
• The use of ozone or UV light cleaners is PROHIBITED, this could void the manufacturer’s warranty and can be hazardous to your health.

REMEMBER: CLEAN AND WELL MAINTAINED CPAP EQUIPMENT WORKS BETTER, IS MORE COMFORTABLE AND WILL LAST LONGER

Fitting and Adjusting Mask

Fisher & Paykel Eson 2 Nasal Mask
https://www.youtube.com/watch?v=7tNKf37LCq8



Fisher & Paykel Evora Nasal Mask
https://www.youtube.com/watch?v=t47ybn9fIgI



Fisher & Paykel Simplus and Vitera Full Face Mask
F&P Simplus™ - Fitting Your Mask - YouTube
Fitting your F&P Vitera™ Full Face Mask - YouTube



Philips Respironics DreamWear Nasal Mask
https://www.youtube.com/watch?v=_mxRqW9Etf4



Philips Respironics Wisp Nasal Mask
https://www.youtube.com/watch?v=3gbFo3IjzT0



ResMed AirFit P10 Nasal Pillow Mask
https://www.youtube.com/watch?v=Gs4v1Lk3FyM



ResMed AirFit F20/AirTouch F20 Full Face Mask
AirFit F20 Full Face mask: How to fit your mask - YouTube
How to fit your AirTouch F20 full face mask - YouTube



ResMed N20 and Airtouch Nasal Mask
https://www.youtube.com/watch?v=J_kTSko5Vak
https://www.youtube.com/shorts/kKAya9m3oXA



ResMed N30i Nasal Mask
https://www.youtube.com/shorts/LUpcey8DN8I




ResMed P30i Nasal Pillow Mask
https://www.youtube.com/shorts/4joojnbqaIc

Managing Air Leaks

For ResMed AirFit F30i and DreamWear Full Face Mask
ResMed AirFit F30i: Managing leaks for a full face CPAP mask - YouTube
DreamWear Full Face | Adjusting for Leaks | Philips - YouTube



For Dreamwisp Nasal Mask
Adjusting the DreamWisp minimal contact nasal mask for leaks | Philips | Sleep and Respiratory Care - YouTube

Other Issues

Experiencing oral dryness or nasal congestion indicates that more moisture and humidification are needed. Please click the respective link for a short video on adjusting this setting.

Philips DreamStation 2
https://www.youtube.com/watch?v=vR_g_rPDj1M

Philips Respironics DreamStation 1
Adjusting humidification on the DreamStation | Philips | Sleep therapy system - YouTube

ResMed Airsense 11
ResMed AirSense 11: Maximize your comfort with humidification - YouTube
https://www.youtube.com/watch?v=RzCskdfN46k&t=15s

Adjusting ramp for comfort.
ResMed AirSense 11: Maximize your comfort with Ramp control - YouTube

CPAP Troubleshooting: Humidification, quick disconnect to use the restroom at night, noise bothering your bed partner, and desensitizing to therapy.
CPAP Troubleshooting - YouTube

Condensation is collecting inside tubing (also known as “rain-out”) causing gurgling or dripping into the mask.
If you have a heated tubing/climate control tubing, you can increase the tube temperature to resolve rain-out. If you have maxed out the tube temperature and are still experiencing rain-out you will need to decrease humidity level.

You received a new mask but it doesn't connect to your tubing.
When this happens the most common problem is that the quick disconnect adapter from your old mask is still inside the tubing. It may look like this:



You will need to connect your tubing back to your old mask to get some leverage and then wiggle the tubing off the adapter to get it out. Another option is to stick your finger inside the adapter and wiggle the tubing off the adapter. Once the adapter is out, your new mask will connect to the tubing.

Options for Ordering Supplies

Item	Package Size	Replacement Schedule
Full Face Mask/Nasal Mask/ Nasal Pillow/Oral Interface	Each	1 per 3 months (up to 4 per year)
Replacement Cushions (Full Face)	Each	1 per 1 month (up to 12 per year)
Replacement Cushions (Nasal)	Each	1 per 1 month (up to 12 per year)
Replacement Pillow (Nasal)	Each	2 per 1 month (up to 24 per year)
Replacement Chin Strap	Each	1 per 6 months (up to 2 per year)
PAP Tubing	Each	1 per 3 months (up to 4 per year)
Disposable Filter	Each	2 per 1 month (up to 24 per year)
Disposable Filter	Each	2 per 1 month (up to 24 per year)
Non-disposable Filters	Each	1 per 6 months (up to 2 per year)
Water Chamber	Each	1 per 6 months (up to 2 per year)

Veteran Resupply Ordering Options

ONLINE REQUEST AT VA.GOV
Resupply items can be ordered 24 hours a day, 7 days a week using theon-line application located at https://www.va.gov under the 'Health -Manage My Health' link. You may need to create an account through VA.GOV prior to placing your first order.

EMAIL REQUEST
When it is time for a resupply of your items, submit your resupply request via email to dalccss@va.gov Please ensure you provide your full name.

MAIL-IN REORDER CARD
When it is time for a resupply of your items, simply complete the VA request form included with all orders and drop it in the mail.

CUSTOMER SUPPORT
Contact our Customer Service Support telephone system at (303) 273-6200, and select option '2' for our customer assistance center. Agents are available 0815 - 1715 EST M-F

Resources

Path to Better Sleep
SleepEZ - Veteran Training (va.gov)

Philips Respironics CPAP and BiPAP Recall
Philips CPAP and BiLevel PAP Recall - VHA National Center for Patient Safety (va.gov)

Treatment Options for Patients
Sleep Apnea - Treatments - Veteran Training (va.gov)