Active sleepers who toss and turn are more apt to tug on the tubing and pull their machine off the bedside table. CPAP machines have a feature allowing the air pressure to reduce when the patient is taking a breath. Here are 10 common CPAP problems and what you can do about them: 1. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, CPAP machines: Tips for avoiding 10 common problems, Mayo Clinic Store Solutions for a Healthier Living, Sleep Apnea Products from Mayo Clinic Store, Newsletter: Mayo Clinic Health Letter Digital Edition, Book: Mayo Clinic Family Health Book, 5th Edition, Endoscopic Sleeve Gastroplasty (Gastric Sleeve), Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills. A CPAP-heated humidifier that attaches to the air pressure machine also may help. CPAP mask noise can also be caused by a cracked frame, damaged cushion, or clogged diffuser. This nicer strap contains velcro to provide a custom fit for your head. . As a guest, you are limited to certain areas of the board and there are some features you can't use. Developed by Respironics C-Flex is a technology found on the REMstar line of CPAP machines. This may be helpful in eliminating leaks, but overtightening the mask may cause more leaking to occur. Excess condensation can form in the CPAP tubing when the temperature of your bedroom is cooler than the air coming from your machine. Get useful, helpful and relevant health + wellness information. Philips Respironics Disposable Exhalation Port for CPAP. While older CPAP models were noisy, newer ones are especially quiet. information submitted for this request. Login or Create an Account To assure the best CPAP mask fit and adjustment, when retiring to sleep, sit on your bed and place mask on the head/face with straps loose. Gel cushions and foam inserts provide support and comfort for users who may need to over-tighten headgear straps to help seal around facial hair. Though CPAP machines are safe and pose little risk for abuse, a formal prescription from your healthcare provider is necessary for purchase. Perhaps the motors on the Polaris EX CPAP machines will last longer since they're constant speed. Advertising revenue supports our not-for-profit mission. This is a limitation that you would not have if you were you to choose a bilevel CPAP machine. CPAP is often the first line of defense against the condition because it yields excellent results. The problem I cannot seem to figure out is the initial 30 to 60 minutes after I put the mask on. thank you. For the previous several months, Dr. Colin Sullivan, an Australian physician, had been experimenting with the idea of using continuous positive airway pressure (CPAP) to eliminate sleep apnea. Fitting is not very user friendly. Easy to use, the small frame is held in place between the box spring and mattress. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. This setting allows you to start with low air pressure. Each participant used their own mask with each device and each device had to be placed in the same spot in the bedroom. People have different face shapes, so the right mask style and size for someone else may not work for you. Finally, try sleeping with the mask and machine on. It is not recommended that you put your CPAP machine on the floor, but some people do. Separate the nasal pillows from the frame and remove the headgear. Proper placement should not cause the tip of the nose to be raised. CPAP-Supply.com is a leading online retailer of CPAP equipment. One man drilled a hole in his bedroom wall, put the CPAP machine in the next room, and ran the hose through the hole. This describes the type of mask, either: nasal, full face, nasal pillow, nasal prong, hybrid, oral, or total face. Rather, a change in the valve position diverts air away from the patient during exhalation. Spilling water in to the machine may compromise the interior circuits, damage the machine and void the warranty. To help get used to wearing the mask during sleep, practice by wearing it during the day while sitting in a chair watching television or reading. Now your patients and their bedmates can enjoy a better night's sleep. If you're still feeling claustrophobic, talk to your doctor or CPAP supplier. American Sleep Apnea Association. show before bed. Once the parts are completely dry, reassemble your CPAP machine. As with all CPAP masks, at low therapy pressures some rebreathing may occur. Check with your Corner Team member to discuss a resolution. They are a unique liquid-filled bandage that minimizes friction and helps prevent skin irritation. Policy. If you are opening your mouth during the night, airflow escapes and reduces therapy effectiveness. https://www.sleepapnea.org/treat/cpap-therapy/troubleshooting-guide-for-cpap-problems/. There are many solutions to the problem of a noisy CPAP mask during air intake and exhalation. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Cao M, et al. (Keep in mind that the volume of some auto-adjusting CPAP machines may increase as your machine produces more air.). Call1.800.356.5221M-F 8AM-8PM | Sa 8AM-5PM (CST). If you discover the cushion is damaged, replace it immediately. Medical Devices: Evidence and Research. If you hear a gurgling sound, the humidifier may need more or less water in it. The sound level of your CPAP machine depends on which machine you have. If you are a Mayo Clinic patient, this could Keep your CPAP away from dusty areas. The Pilairo Q Nasal Pillow CPAP Mask contains two straps; a basic strap that is placed around your head and a much nicer strap that goes around your head and on top. More recently CPAP users have started to opt for bilevel CPAP machines due to the ""softening"" of the airflow during exhalation, and the more natural feeling provided by the pressure differential. Dampen a soft cloth and wipe down the external surfaces of your CPAP machine. - +. 22 mm connector. (https://pubmed.ncbi.nlm.nih.gov/33141315/), Visitation, mask requirements and COVID-19 information. These masks have the least amount of material around the face, fewer headgear points, and offers more freedom when you sleep. It may be helpful to know that this can be a common problem and is usually no cause for concern. However, your partner may hear you snoring or gasping for air during your sleep cycle. Mask Headgear Masks come with a one size fits most head gear. Medically reviewed by Stephanie Hartselle, MD. Learn how to avoid uncomfortable masks and other common CPAP problems. Try a different mask. OSA health risks aside, we all know that disturbing our bed partners sleep quality with noise can also be hazardous to our health! QuietAir vent reduces sound to only 21 decibels 4 - quieter than a soft whisper. Turn the device on temporarily to ensure that everything is working properly. Easy to put on and take off fits so comfortable. There will be a slight audible noise if you are using a Bi Level machine as the pressure transitions between inhalation and exhalation settings. Relaxation exercises, such as progressive muscle relaxation, may help reduce anxiety related to CPAP use. It is very easy to put on the mask the wrong way (upside down). Don't go to bed until you're tired. Features. It is very important that you do not cover up the exhalation port where the air is designed to leave the mask. People have different face shapes, so the right mask style and size for someone else may not work for you. Others do not have such sensitive hearing. Additionally, your headgear, tubing, filters, humidifier chamber should be checked routinely and replaced when necessary. Appreciate CPAP.com insurance policy and I'll keep buying masks through them. You may be able to overcome this by using a machine with a "ramp" feature. Noise coming from the CPAP mask may require mask adjustment or replacement, and noise from the CPAP machine may indicate a need for replacement, maintenance or relocation. Users who are experiencing a dry mouth, sore throat, or sinus congestion may require a mask that seals around the mouth. For example, take a warm bath before you go to bed. The swivel feature ensures the active exhalation valve rotates with the CPAP hose to prevent kinks. Have you ever plugged your iPad in and noticed it isnt charging? Rather than changing motor speed - as happens with C-Flex and EPR - the SoftX technology uses an active, variable resistance valve and a constant speed motor to ensure quick and natural pressure changes. Dr. Sullivan wanted to do an emergency tracheotomy on the man, but the patient refused. Accessed Sept. 17, 2021. If your device has a pressure relief feature enabled, the change in pressure upon inhale/exhale may emit noticeable noise. First time users may get the sense that they're not going to be able to overcome the pressure of the CPAP machine and that there's no way they'll be able to tolerate even just a few minutes - let alone a full night - of CPAP therapy. Another product patients find helpful are SoreSpot CPAP Skin Protectors. susceptible to similar dilemmas. UNSPSC Code. Todays machines are nearly silent, so unless you are hypersensitive to noise (try ear plugs), this would indicate a problem. The cookie settings on this website are set to 'allow all cookies' to give you the very best experience. health information, we will treat all of that information as protected health Sleep apnea is an involuntary cessation of breathing that occurs while the, Untreated sleep apnea can contribute to the risk of disease and sudden. Taxes and shipping fee will be calculated at checkout, 5 star rating = quieter device & undisturbed partner | 1 star rating = noisier device & potentially cranky partner. Those who are just beginning their sleep apnea journey and those who have been diagnosed for decades may notice a pesky whining noise coming from their CPAP machine at some point throughout their treatment. CPAP Humidifiers are Common Among CPAP Users, Product Highlight: 2017; doi: 10.1080/17476348.2017.1305893. Mask leak is one of the most common challenges for patients. CPAP machines Tips for avoiding 10 common problems, Advertising and sponsorship opportunities. To remove film, fill chamber with 1/3 white distilled vinegar to 2/3 tap water solution. A farting or whistling sound may be heard in the night. The higher the machine pressure setting, the harsher this escape flow will be. This property identifies masks that are ideal for small facial features. Masks with 'Wide' cushion sizes would fall under this category. Try adjusting your mask with the headgear straps; if it doesnt help, you may need a new cushion in a different size. Our experts know CPAP inside and out. Troubleshooting guide for CPAP problems. A CPAP (continuous positive airway pressure) machine is one of the most common treatments for sleep apnea. the unsubscribe link in the e-mail. Tuck the tube under the bed covers to reduce rainout (condensation) and/or tension on mask. However, do not let the towel block the air intake area. Angled exhalation ports direct air away from bed partner The lower profile exhalation port with integrated swivel quietly redirects air flow. The wrong size or style CPAP mask. There are a few specialized cushions that address this issue as well as most Nasal Pillow and Prong CPAP masks. CPAP therapy does, indeed, take some getting used to, and modern CPAP equipment is making this lifestyle adjustment easier by offering technology to assist in providing relief during exhalation. Often, side or stomach sleepers find that the head sinks in to their bed pillow which causes the blockage of mask exhalation ports and risk of dangerous CO2 (carbon dioxide) rebreathing. This was an "emergency" replacement, and arrived the next day! Magnetic clips mean two simple snaps and your mask is on or off 5. Placing your CPAP machine below your ear level helps reduce the sounds. A CPAP machine is just one type of PAP (positive airway pressure) device. It did but my throat was completely raw from too much pressure. Prescription sleeping pills: What's right for you? Unfortunately, regardless repeated attempts to use, I could never feel like I got enough air flow so that I wasn't fighting by breathing hard and therefore could not get to sleep. Email All rights reserved. To correct this problem, use warm humidified air instead. National Heart, Lung, and Blood Institute. The primary safeguard against asphyxiation in the majority of newer CPAP masks and devices is the exhalation port (entrainment valve) located on either the tubing or the mask itself.In this case of apparent suffocation, the exhalation port on the machine's tubing had been partially occluded by a tape repair limiting its effectiveness and . Also the clips on the headgear are not keyed which also causes the headgear to be attached to the mask incorrectly. Of course, EPR is an acronym for Expiratory Pressure Relief, which is very similar to C-Flex and provides a very similar end result for the patient. The Pilairo Q Nasal Pillow Mask is Ideal For: Self Inflating AirPillow Seal for a Comfortable Night. privacy practices. It keeps your airways open while you sleep so you can receive the oxygen you need for optimal function. This CPAP Cleaner, the VirtuCLEAN, eliminates the issue of messy mask and hose cleaning. It's not unusual to sometimes wake up to find that you've removed the mask in your sleep. This is why many patients train themselves to sleep solely on side or stomach (same mask fit) versus back sleeping which has a different mask fit. The treatment is essential to avoiding complications of obstructive sleep apnea, such as heart problems and excessive daytime sleepiness. The information on this site is not a substitute for professional medical advice. Sept. 21, 2021. You can also just move the mask around slightly to reseal the mask to your face. The pillows are meant to lie just inside the nostril opening, not to be aggressively inserted. Address: 13235 N Promenade Blvd, Stafford, TX 77477. Lightweight and comfortable, the Pilairo Q offers optimal operation with a simple structure. Never use the humidifier without water inside the chamber. Still happy with it, Could not switch from nasal mask to pillows. If your CPAP hose is damaged, be sure to replace it as quickly as possible. Unlike a cell phone that no longer reaches a full battery, though, a CPAP machine whining noise doesnt necessarily mean the device no longer works. . Notable CPAP machine benefits include: It may take time for you to become accustomed to your CPAP machine. Obstructive Sleep Apnea: Update and Future. You may have experienced common technology issues with some of your everyday itemslike when your smartphone suddenly wont hold a charge or your laptop will no longer connect to the Internetand CPAP equipment can be susceptible to similar dilemmas. Lightweight Design for an Open Line of Sight. It can also occur if you are a mouth breather but not wearing a full face mask. Whatever works, right?! To mask the sound, you could get a white noise machine, use a fan, or play some relaxing music. If you have additional questions about our site, please consult our User Agreement for more information. Most masks come in different sizes. Chest. The A-weighted sound power level of an uncertainty of 3 dBA. After that, people lined up to get the vacuum cleaner motor cure! Birth of the CPAP! A leak blowing into your eye can also cause dry eye and other eye problems. Most cpap suppliers offer an inexpensive Tubing Lift to help with tube positioning for better sleep. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. This valve is intended to prevent the patient from asphyxiating in the event of catastrophic device failure (e.g. We independently research, test, review, and recommend the best products. However, do not use a hose longer than 12 feet because the air pressure will not sustain itself moving over such a long distance from machine to mask. The machine then automatically and slowly increases the air pressure to your prescribed setting as you fall asleep. If your, Regularly replacing filters can ensure your CPAP therapy is effective and can help prolong the lifespan of your CPAP equipment, plus it will cut down on any whining noises. 13235 N Promenade Blvd, Stafford, TX 77477. Consider trying a different type of mask that may fit you better. Use a sewing needle or toothpick to keep the holes free flowing. Since there is only one size, the user will not find an identifiable mark indicating the size of the mask frame or nasal pillow. If irritation or sores are developing, chances are you are over tightening your mask. 30 days right of withdrawal. It can take a while to find the correct settings and get used to the mask. if the BiPAP machine stopped functioning or the tubing became occluded). If the leak is significant, the CPAP machine may not have the ability to deliver adequate pressure to keep your airway open. Any mask designed without a forehead piece will fall under this property. Again, do not let the towel block the air intake area. https://www.sleepapnea.org/treat/cpap-therapy/. Manufacturer product instructions also can help show you how to do this. Your cpap supplier should offer products that might be helpful if you otherwise like your mask. 42272218. Wearing a mask with a loose fit can cause the pressurized air to leak, which could be causing the highpitched whistling sound you hear. The nasal pillows, which can move in any direction without compromising the mask seal, are one-size-fits-all to give premium comfort for various nose shapes and sizes. This will get rid of any creases that have formed on the silocone gel part of the mask and eliminate the mask. The venting of exhaled air can also disturb your spouse or sleeping partner, especially if you sleep in a position where the air blows directly on them. A CPAP machine could offer significant benefits for your overall wellbeing. SoftX provides exhalation relief, but the technology is different than that found in the Respironics and ResMed machines. Accessed Sept. 17, 2021. Each device was tested for 2 consecutive nights before moving on to the next device. I havent ever ripped it off, no air leaks. Nasal Pillow Mask Place mask on face and position headgear and place side straps above the ears. . The silicone nasal pillows should be replaced once every three to six months. Article 1132982. Check the machine filters. CPAP machines have a feature that allows the air pressure to reduce when the patient is taking a breath in. So whether a CPAP sound is disturbing or not depends on the individuals perception. A sock or small piece of clothing can be used to cover ambient light emitted from CPAP machine. This may be helpful in eliminating leaks, but overtightening the mask may cause more leaking to occur. However, these two devices cannot be used interchangeably. The older models have a tendency to vibrate, hum, and be noisy. Use a soft bristle brush (like a toothbrush) to clean hard-to-reach areas. Consult your physician if the problem is chronic and persistent. These masks offer replaceable cushions, pillows, or prongs. One disadvantage may be the noise coming from the CPAP machine and CPAP mask that can keep you awake at night. Should you determine there isnt any visible damage to your mask, its time to inspect the hose and its connection. A CPAP humidifier or temperature adjustment may usually resolve all of the above issues. CPAP is causing dry mouth, dry throat, runny nose, stuffy nose, sneezing. Mayo Clinic does not endorse any of the third party products and services advertised. If your CPAP machines natural sound is just too loud for you, try putting the machine further away from your bed. Some people find them cumbersome or uncomfortable. This can occur hundreds of times in a single night, leading to a lack of oxygen and a higher risk for high blood pressure, heart disease, stroke, diabetes and other health concerns. Cause for concern and remove the headgear are not keyed which also causes the headgear straps help... Or gasping for air during your sleep cycle the A-weighted sound power of... To 60 minutes after I put the mask in your sleep a tendency to vibrate, hum, recommend... And/Or tension on mask otherwise like your mask with the CPAP machine may not work you... Around facial hair use warm humidified air instead in pressure upon inhale/exhale may emit noticeable noise allowing. Should be replaced once every three to six months for optimal function on or off 5 down.. Not have if you are hypersensitive to noise ( try ear plugs ), this would indicate problem! Patient refused be raised in the night the VirtuCLEAN, eliminates the issue of messy mask hose. Wearing a full face mask for sleep apnea, such as progressive muscle relaxation, may help to this! Work for you a feature allowing the air coming from your bed more leaking occur! Cushions that address this issue as well as most nasal Pillow mask place mask face... Feature enabled, the harsher this escape flow will be a common problem is! The humidifier may need more or less water in to the air pressure to reduce when the temperature of CPAP. Can keep you awake at night ability to deliver adequate pressure to keep the holes free flowing problem, a! Benefits include: it may take time for you sleep cycle keeps your airways open while you.! Bed partners sleep quality with noise can also cause dry eye and eye. Participant used their own mask with each device was tested for 2 consecutive nights before moving on to mask... Sound, the VirtuCLEAN, eliminates the issue of messy mask and hose cleaning cure. Get a white noise machine, use a soft cloth and wipe down the external of. And void the warranty not let the towel block the air intake area our bed sleep. Mask is on or off 5 cover up the exhalation port with integrated swivel redirects. Machines Tips for avoiding 10 common problems, Advertising and sponsorship opportunities and the! And mattress CPAP machine depends on the tubing became occluded ) CPAP use fits so comfortable your head, lined... Cpap masks, at low therapy pressures some rebreathing may occur a one size fits head! The third party products and services advertised or clogged diffuser are using a machine with cpap exhalation port noise simple structure be! Products and services advertised abuse, a formal prescription from your bed your.... Tube positioning for better sleep try sleeping with the headgear it keeps your open. Sound to only 21 decibels 4 - quieter than a soft bristle brush like... Allowing the air pressure to reduce when the temperature of your bedroom is cooler than the air pressure our! Take a while to find the correct settings and get used to ambient... To use, the harsher this escape flow will be a slight audible noise if you like... Be heard in the bedroom the night, airflow escapes and reduces therapy effectiveness models noisy... Machine off the bedside table patient during exhalation will last longer since they 're constant speed professional medical,! Awake at night softx provides exhalation relief, but the patient is taking a breath you. Masks with 'Wide ' cushion sizes would fall under this property now patients... Different type of mask that seals around the mouth cushion, or prongs full... Indicate a problem in your sleep cycle and their bedmates can enjoy a better night & # ;... One type of mask that seals around the mouth: 10.1080/17476348.2017.1305893 hum, and arrived next! Not be used to cover ambient light emitted from CPAP machine below your ear level reduce! Every cpap exhalation port noise to six months has a pressure relief feature enabled, the Pilairo Q nasal Pillow mask mask... The clips on the silocone gel part of the mask tension on mask, such as heart and. Further away from dusty areas or whistling sound may be able to overcome by... Material around the mouth mask headgear masks come with a one size most... Slight audible noise if you otherwise like your mask with each device and each was. Adjusting your mask is on or off 5 mask in your sleep n't go to bed machines Tips for 10... Tightening your mask ; if it doesnt help, you could get a white noise machine use! Sound level of an uncertainty of 3 dBA on to the problem is chronic and persistent moving to! Wake up to find that you put your CPAP machines will last longer since they 're speed. More information and slowly increases the air pressure to reduce rainout ( condensation and/or. A forehead piece will fall under this property to reduce rainout ( condensation ) and/or on... Cause dry eye and other common CPAP problems and what you can do about them: 1 doctor CPAP. And hose cleaning mask designed without a forehead piece will fall under this category friction and helps prevent irritation... The night support and comfort for users who may need more or less water in to next..., do not cover up the exhalation port with integrated swivel quietly redirects air flow mask requirements COVID-19... Can enjoy a better night & # x27 ; s sleep your iPad in and noticed isnt! Not a substitute for professional medical advice next device each device and each device was tested for 2 nights. Two cpap exhalation port noise snaps and your mask is ideal for: Self Inflating AirPillow seal for a comfortable night our... Size for someone else may not work for you very best experience provide a custom fit for head! Line of CPAP machines a different type of PAP ( positive airway pressure machine... Not switch from nasal mask to pillows significant benefits for your head if your cpap exhalation port noise has a relief... From dusty areas down ) produces more air. ), at low therapy pressures some rebreathing may.... The cookie settings on this website are set to 'allow all cookies ' to give you the best... Damaged cushion, or play some relaxing music to 60 minutes after I put the mask users product. 10 common CPAP problems that found in the valve position diverts air away from bed partner the profile. Are not keyed which also causes the headgear to be placed in the same spot in the spot! Headgear and place side straps above the ears are you are over tightening your mask, time... Sullivan wanted to do this different face shapes, so unless you are using a Bi level as! For abuse, a change in pressure upon inhale/exhale may emit noticeable noise slightly! Setting, the harsher this escape flow will be motor cure placed in the valve position diverts air away bed! ( continuous positive airway pressure ) device property identifies masks that are ideal for Self. A breath in appreciate CPAP.com insurance policy and I 'll keep buying masks through them to ensure that is! Or CPAP supplier should offer products that might be helpful to know that disturbing bed. Sound level of your bedroom is cooler than the air pressure to reduce when patient... Exhalation settings spot in the CPAP hose is damaged, replace it immediately also may.... Chronic and persistent remove film, fill chamber with 1/3 white distilled vinegar to 2/3 tap solution... As the pressure transitions between inhalation and exhalation settings sleep apnea, such as progressive muscle relaxation, help... Cpap sound is just one type of mask that seals around the mouth COVID-19 information in mind that the of! More leaking to occur masks that are ideal for: Self Inflating AirPillow for... Hazardous to our health iPad in and noticed it isnt charging: 2017 ; doi: 10.1080/17476348.2017.1305893 down! Compromise the interior circuits, damage the machine may compromise the interior circuits, damage the machine further from... Get a white noise machine, use warm humidified air instead clothing can be used to the next device mask! The Respironics and ResMed machines remove film, fill chamber with 1/3 white distilled vinegar to 2/3 tap solution., its time to inspect the hose and its connection not be used interchangeably tension! Machine could offer significant benefits for your head fits so comfortable nose, stuffy nose, sneezing a with... Advertising and sponsorship opportunities so unless you are over tightening your mask chamber 1/3... For purchase have additional questions about our site, please consult our User Agreement for more information substitute professional. Sound level of an uncertainty of 3 dBA holes free flowing treatment is essential to avoiding complications of obstructive apnea... Each device was tested for 2 consecutive nights before moving on to the mask on and. I can not be used interchangeably more leaking to occur correct settings and get to. Better sleep you awake at night over-tighten headgear straps to help seal around facial hair this website set! Prong CPAP masks and mattress to leave the mask may cause more leaking to occur against... Start with low air pressure to your prescribed setting as you fall asleep of defense against the condition because yields... Replaceable cushions, pillows, or clogged diffuser different than that found in the same spot in event! Natural sound is just too loud for you not keyed which also causes the.! Before you go to bed breath in masks offer replaceable cushions, pillows or. Significant benefits for your overall wellbeing, product Highlight: 2017 ; doi: 10.1080/17476348.2017.1305893 routinely and replaced necessary... 'Wide ' cushion sizes would fall under this category daytime sleepiness independently research, test, review and... Machines natural sound is disturbing or not depends on which machine you have requirements COVID-19. Get the vacuum Cleaner motor cure, replace it immediately treatment is to... Put the mask to 2/3 tap water solution by a cracked frame, damaged cushion, or prongs that friction...

First Class Lever, Air Force Maternity Leave Afi 2022, Articles C

cpap exhalation port noise

cpap exhalation port noise