ResMed CPAP Masks - Nasal Mask Styles

Continuous Positive Airway Pressure can be delivered in multiple modes including CPAP, Bi-Level with and without back-up rate, and adaptive servo modes.  No matter which mode of pressure is administered, the air pressure has to be administered through a well-fitting interface.  Since everyone’s face is a little bit different, different styles of masks are needed.  Fortunately, ResMed not only makes positive airway pressure machines, but they also make a range of well-designed CPAP masks. 

CPAP interface masks have to deliver airflow effectively through the nose and/or mouth through the airway to the throat (pharynx) where it holds the soft palate, tongue, and other airway soft tissues out of the way, creating an open passage for breathing. 


Nasal Masks

For years the standard interface has been the nasal mask.  This triangle shaped mask style fits over the nose and makes a seal with silicone against the skin.  Nasal CPAP masks make a seal against the skin next to the nose, above the upper lip, and across the bridge of the nose.  This means that a nasal mask is positioned to make a secure seal over skin that lies over bone, which makes CPAP masks the most secure style of mask for many people. 


ResMed AirFit N20

ResMed makes several styles of nasal CPAP masks.  The ResMed AirFit N20 is an excellent standard nasal CPAP interface.  ResMed cites that the AirFit N20 fits 99.4% of faces worldwide.  Medical equipment suppliers find that fitting the AirFit N20 is often quite easy.  Patients find the AirFit N20 to be easy to use.  It fastens with a magnet at each side which permits quick positioning at bedtime.  It remains in place comfortably throughout the night, even with position changes turning from side to side. 


ResMed also makes several other nasal CPAP masks, including the AirFit N10, the precursor to the N20, the FX Nano, a streamlined, low profile nasal mask, the Mirage FX, a simple, lightweight nasal mask, the Mirage Activa LT, a mask with a compliant and soft cushion, and updated versions of their popular Mirage masks. 


ResMed AirFit N30i

The newest ResMed mask is an over the head interface or “tube up” design.  The tube attaches above the head instead of in front of the face allowing for greater freedom of movement.  The air is transmitted through both sides of the interface to a “curved nasal cradle cushion” which remains in position when turning from side to side. In fact, its low profile and the airflow through both sides of the mask allows for CPAP users to sleep on their stomachs, which can be difficult with many other styles of masks. 

I recently tried the AirFit N30i.  It connects to a standard CPAP tube which I looped over the top of my pillow.  The nasal cushion is positioned first and the headgear slips over the head.  Once in place the “SpringFit” frame holds it in place comfortably.  I slept well throughout the night.  By the next morning I had decided to make it my primary CPAP mask. 


CPAP mask fitting is an individual process and now there are many options for nasal masks available.  ResMed has multiple comfortable nasal masks available. 

BleepSleep DreamPort CPAP Interface

Obstructive sleep apnea is a common condition that affects 26% of adults aged 30-70.  The most effective treatment for sleep apnea is continuous positive airway pressure (CPAP).  Although CPAP treats nearly every case of sleep apnea, some people find available CPAP masks uncomfortable.  Air leaks can make noise and interfere with treatment effectiveness.  Frustrated, people discontinue their CPAP therapy, continuing to snore, stop breathing while they are asleep, and feel tired during the day.   

The Interface 

BleepSleep has a novel product that replaces ordinary CPAP masks.  Rather than a silicone mask BleepSleep’s DreamPort is an interface that does not use headgear.  Instead of a silicone mask, soft adhesive pads hold the interface to the nostrils, delivering airflow to the upper airway to prevent the airway collapse of obstructive sleep apnea.   

I met with founder and CEO of BleepSleep Stuart Heatherington demonstrated the DreamPort.  I was intrigued by the features and design of this product.  In some ways it is similar to a nasal pillows interface:  it interfaces directly with the nostrils rather than fitting over the face like a traditional CPAP mask.  The DreamPort differs from other CPAP interfaces by using adhesive pads rather than a headgear to keep itself in place.  The single use adhesive has been designed for comfortable connection to the nose, creating an airtight seal that delivers air pressure without leaks.  The device itself is designed to be light and flexible to allow for easy position changes throughout the night.   

The Test 

BleepSleep sent me a DreamPort for testing.  The demonstration unit came in well-designed packaging and contained instructions that clearly explained how to apply the DreamPort adhesives and connect it to a CPAP tube.  The first step is to clean the skin around the nose to remove excess skin oils and cells.  Then the DreamPort adhesives are applied one at a time to each nostril making sure create a good seal.  Next the DreamWay connector is attached to the adhesive ports and it is ready to be used.   

I applied the BleepSleep DreamPort adhesives, avoiding facial hair.  I found connecting the Dreamway connctor to the ports to be a bit challenging while in bed.  However, facing a mirror it was easy.  I connected the CPAP tube to the other end and the interface.  The first thing I noticed was that the fully connected DreamPort felt very light.  There was no pulling sensation from the weight of the tube or when turning my head. I turned on the CPAP and air pressure was easily transmitted.  I felt comfortable lying on my back and on my side.  I needed to secure one of the adhesives to stop a small leak, but I didn’t need to make any other adjustments.   

It must have worked well, because the next thing I knew was that it was morning.  The adhesives had remained in place through the night.  The BleepSleep team must have done a lot of research on the adhesive.  Even though the adhesives held through the night, removing them was easy.  The nose has relatively delicate skin, but the adhesive did not irritate or tear.  The adhesive is designed for single use which insures that a fresh set of ports is used daily.   

The DreamPort is a nasal positive airway pressure interface that can be used with multiple modes of treatment including:  CPAP, automatically titrating CPAP, BiPAP/VPAP, or ASV.  Since it is an exclusively nasal interface, it would not work well for people who require an oral/nasal mask.  It also may not fit well with someone who has a full moustache, because facial hair may prevent the adhesive from making a seal.   

BleepSleep DreamPort is now FDA approved and is in the process of production and marketing.  It will be available to patients soon.   

Long-acting Melatonin

Darius Zoroufy

Feb 17

Long-Acting Melatonin

The National Sleep Foundation explains that “Melatonin is a natural hormone made by your body’s pineal (pih-knee-uhl) gland. This is a pea-sized gland located just above the middle of the brain. During the day the pineal is inactive. When the sun goes down and darkness occurs, the pineal is “turned on” by the SCN and begins to actively produce melatonin, which is released into the blood. Usually, this occurs around 9 pm. As a result, melatonin levels in the blood rise sharply and you begin to feel less alert. Sleep becomes more inviting. Melatonin levels in the blood stay elevated for about 12 hours — all through the night — before the light of a new day when they fall back to low daytime levels by about 9 am. Daytime levels of melatonin are barely detectable.”

Bright light exposure, such as that from handheld electronics, can suppress our own natural melatonin production, and busy lives can affect sleep schedules. One half to two-thirds of adults experience insomnia. Many people often try melatonin when they try an over-the-counter supplement to treat difficulty falling asleep or staying asleep. Supplemental melatonin can often be helpful to reduce the time to fall asleep at the beginning of the night (reduce sleep onset latency). When using melatonin to treat sleep onset insomnia it is best to take it about 90 minutes before bedtime and to maintain a consistent bedtime and wake time schedule.

Difficulty remaining sleep is also known as sleep maintenance insomnia. This may occur in a pattern of frequent awakenings, awakening during the night and not returning to sleep, or a combination of both. Standard-release melatonin tablets before bedtime may not help maintain sleep. Sustained release melatonin can help people with sleep maintenance insomnia who are responsive to supplemental melatonin.

A number of high-quality long-acting, sustained-release formulations of melatonin are available. Natrol Time Release Melatonin 5 mg tablets delivers 100% vegetarian melatonin in a biphasic distribution, which means some of the melatonin is released immediately and some of it is released slowly.

Nature’s Bounty Dual Spectrum Bi-Layer Melatonin 5 mg tablets are also sustained release tablets that release some of the melatonin immediately and some of the melatonin over the course of the night.

Adrien Gagnon — Melatonin 10 mg (Extra-Strength Dual Action Time-Release), Fast-Dissolving Natural Sleeping Aid are non-GMO, gluten-free, vegan fast-dissolving tablets that provide 5 mg of fast acting melatonin and 5 mg of delayed release melatonin.

Nature’s Essentials Melatonin 10 mg releases 3mg of melatonin quickly and 7mg gradually using “advance cyclosome liposomal technology”. It is also non-GMO, gluten free, and vegetarian.

Respro Labs Natural Melatonin Stress Relief and Sleep Aid Patches are 3 mg, 7 mg, and 10 mg patches deliver melatonin through the skin rather than in pill form. Using a patch can provide consistent amount of melatonin through the night to reduce awakenings during the night.

Some people find that combining melatonin with other natural products such as chamomile, valerian, and L-theanine.

Whenever using any supplements or medications, it is always a good idea to review any supplements and over-the-counter medications with your doctor. Whenever a condition does not improve as expected, your doctor can help.

This article and all articles and posts are for informational or educational purposes only and are not to be used as medical advice or to treat any specific medical condition.


Eversleep 2 - by 

Darius Zoroufy, M.D. 


I tested the EverSleep 2 sleep tracking and management system.   

Over the last few years patients are asking more and more about the data their wearable devices tell them about their sleep.  The majority of these devices rely on an accelerometer to detect movement.  To understand how a fitness tracker can detect sleep, first we need to understand how it detects activity like counting your steps each day.  Fitness trackers use a very small system of capacitors to detect acceleration. Remember that acceleration is not velocity or speed.  That’s why your FitBit will not count any movement as you sit in seat 26E (middle seat) even though you are flying at 583 mph in a 737.    

In case your physics is a bit rusty, remember that acceleration is the change in velocity occurring in a specific time.  a = Δv / Δt  So when your wrist changes speed during your stride, the acceleration is detected and from that wrist movement, body movement is extrapolated.  Of course, your wrist may undergo acceleration and the accelerometer signals may be decoded incorrectly.  For example, I drove for 2 hours on a very bumpy road a couple of years ago. As my car bounced along, so did my wrist.  At the end of the drive my Fitbit had counted almost 4000 steps, even though I had only been sitting.   

(Here is a great demonstration of activity detected by a wrist accelerometer.)   

(If you really want to know how accelerometers work, check this out.

Even though fitness and activity trackers are not perfectly accurate, they can provide helpful information to guide our behaviors.  For example, my outdoor thermometer may be 3 or 4 degrees off, but it is accurate enough to let me know if I should wear a jacket.   

By 2016 more than 100 million fitness and activity trackers were made per year, and the market continues to grow.  The devices are getting better and adding more functions to distinguish themselves.   

Sleep occurs when cortex of the brain changes state and the electrical activity of the cortical cells begins to slow.  Sleep stages are measured by using an electroencephalogram in a controlled environment by a trained EEG or sleep technologist.  Electrodes are attached to the scalp to measure microvolt signals.  These recordings are interpreted using specialized equipment that costs hundreds of thousands of dollars.  Interpreting the data correctly requires years of training and experience 

Fitness and activity trackers shortcut this process by measuring sleep using the same accelerometer to estimate how deeply asleep you are.  These devices use record movements in a manner similar to a validated clinical sleep testing process called actigraphy.  Estimating sleep by recording wrist movement might seem wildly inaccurate, until you think about how your hands move while you are awake.  Beginning in infancy humans move their hands continuously as the output of their cognition and as their means for interacting with the world.  As we become drowsy and fall asleep, our sensory processing and cognitive activity decrease and consequently so do our hand movements.  The recorded wrist movements from an activity tracker can be interpreted to estimate sleep stages.  Fitness trackers that also measure heart rate can include that data to improve the accuracy of sleep stage determination.   

Recently, I bought an EverSleep 2 device, because it had features, I have not seen in other wearable devices.  EverSleep 2 was successfully crowdsource funded by IndieGoGo in 2017, receiving 224% of their target funding.  Since then EverSleep has become increasingly popular due to its many features that record physiological data and then present it in an organized, user-friendly app that provides interpretations of the data that are meaningful.  The app has additional features not seen in many other trackers:  it provides personalized sleep advice to modify behaviors to improve sleep quality.   

EverSleep 2 presents data in the app in an easily understood "Overview” display that give the user data about their sleep plotted on a graph that shows their specific numbers in relation to normal values.   


Under the “Details” tab the EverSleep app graphs the oxygen saturation, heart rate, motion, and sleep.  You can expand the graph to get a closer look at specific parts of the night.  They have even added a feature that is very helpful to sleep specialists:  the numerical and graphical data can be exported as a PDF to review with your physician.  The format of the PDF report is similar to the reports generated by clinical oximetry recording devices, so a physician will find it easy to integrate the data into a clinical assessment.   

Perhaps the most useful aspect of EverSleep 2 is the “Coaching” tab.  This feature takes the data from the nightly recordings and provides comments that reinforce positive data such as  

“Your profile says that you sometimes wake up during the night, but not last night!” 

“Sweet! CPAP seems to be working for you!” 

Each message has the option to “Read More” for more detailed information.   

The Coaching tab also provides specific comments that integrate the recorded data with the user-supplied data to provide personalized advice.   



Recording oxygen data is unusual for a consumer sleep tracker, but it is a very helpful feature.  EverSleep is careful to note that this is not a medical device, so it has not been validated to diagnose disorders or to direct treatment.  Nevertheless, the oximetry data can draw attention to potential areas of concern.  For example, if EverSleep detects episodes of low oxygen, it could suggest that sleep apnea or other respiratory disorders could be contributing to poor sleep.  If the person is already using CPAP or some other treatment for sleep apnea, EverSleep can confirm how well sleep apnea is controlled.   

Eversleep also records and detects snoring which could be a sign of sleep apnea, which can interfere with sleep quality and can increase the risk of cardiovascular disease.  In many cases, a person has no idea that they have sleep apnea.  Although EverSleep does not diagnose sleep apnea, it can detect snoring and oxygen changes that may suggest that further testing for sleep apnea is warranted.   

EverSleep 2 is extremely lightweight;  I barely felt that I was wearing it.  Since it is not an exercise tracker, it does not have to be rugged and waterproof.  The tracker itself is shaped like a watch with a thin band that hold it on the wrist.  The oxygen sensor probe extends from the tracker and wraps around a finger.  EverSleep suggests the user secure the sensor with a small piece of tape.  Once the tracker and sensor are in place and the app has been started it is easy to forget that it is there.  In the morning, simply remove the tracker and stop the recording.   

EverSleep 2 is currently for sale for $199, which purchases the sleep tracker that records sleep quality and sleep interruptions, sleep duration, movement, and snoring, as well as the oximeter which records oxygen levels and heart rate.  It also includes the app which interprets the data and provides meaningful, personalized assessments and recommendations.  I believe that EverSleep 2 will be a valuable tool to help many people improve their sleep quality and their health.   

 Check out EverSleep on Twitter: @GetEverSleep

MedCline Positional Therapy Wedge


Review by:

Darius Zoroufy, M.D.

December 16, 2018


There are many reasons people may benefit from sleeping with their head and upper body elevated.  Acid reflux, snoring, and nasal congestion can improve when sleeping in a semirecumbent position.  Adjustable beds can be expensive and require a specialized bedframe.  Regular foam bed wedges are inexpensive but sleeping on one does not easily allow a person to sleep on their side.  Side sleeping can help with acid reflux and comfort. 

MedCline is a bed wedge that is different that a standard bed wedge.  It is a comfortable memory foam wedge that has a flat top at the head and a comfortably angled torso portion.  What makes MedCline unique is the “arm pocket” that allows the user to tuck their arm taking the pressure off the shoulder.  Since shoulder discomfort is one of the reasons side sleeping is uncomfortable, this “arm pocket” is a great feature. 

When I used MedCline I found it easy to use.  There is no assembly instructions and installation is just a matter of putting it on the bed.  It is 30 inches wide so it takes up half of a queen size bed providing enough room to roll from one side to back to the other side.  It comes with a body pillow that supports side sleep. 

MedCline reports that 95% of people using MedCline report better sleep and 93% report reduced nighttime heartburn when using MedCline.  A published study showed that the MedCline positional therapy device is effective reduction of heartburn

When I tried my MedCline I found it to be as comfortable in all positions.  

Although MedCline does not show specific data on their website, their positional therapy device may help to reduce snoring in some people.  I often recommend MedCline for those who would benefit from a bed wedge. 


Zinus Pressure Relief Memory Foam Cloud Mattress Review

In sleep medicine clinic one of the more common and easily solvable problems interfering with good sleep is an old, bowing, uncomfortable bed.  After spending thousands of dollars at a department store mattress department or a bed store in a strip mall, people are reluctant to discard their investment and spend thousands more with a high pressure salesperson.  Buying a mattress has been about as fun as buying a used car.  They are pleasantly surprised when I tell them that buying a mattress in 2018 is much easier and much less expensive than it has been in the past.   After reviewing and recommending mattresses for patients and Twitter followers it was finally time to upgrade my own bed.  Our 10-year-old Spring Air pillow top mattress has served us well.  But now even with a memory foam mattress topper Holly and I have been feeling stiff in the morning.  It was time to follow my own advice and buy a comfortable mattress at a good price.  The advice I offer to my patients is to research the available products online by first checking Consumer Reports for their comprehensive, objective reviews.   Other online mattress reviews can be biased by payments from mattress manufacturers.  Beginning in 2006 online mattress companies have been taking over the mattress industry with high quality, value-priced mattresses that can meet nearly everyone’s needs.  The hard part is choosing the best mattress for our own bedroom.  

The Black Friday sales this year brought the already great prices on many of these mattresses even lower.  I decided that now was the time buy.  You have probably heard of many of the highly rated brands such as Tuft & Needle, Casper, Tempurpedic, and Purple.  The luxury brand Duxiania makes wonderful, well-designed beds, but at $5000-15,000 they are well out of my price range.   A few months ago my daughter needed a new mattress for her apartment at college.  I wanted a comfortable mattress for her, but cost was also an important factor.  The Zinus Green Tea Memory Foam Pressure Relief Mattress was available on and was available for Prime shipping.  She found it to be “comfy” and her roommate (her sister) needed a mattress, to replace her lumpy, second hand mattress so I bought the same mattress for her.  Not to be left out, my third daughter got the same mattress.  

A few days ago our new Zinus Pressure Relief Memory Foam Cloud Mattress arrived at our front door.  Today we opened it up.  This is my first “bed-in-a-box” and I found that the process could not have been easier.  

The interior flap of the box cheerfully greeted me with, “Hello, wonder has arrived.”  Opening the box revealed the mattress wrapped in clear plastic and an envelope with instructions that describe the process of unpacking the mattress.  Less than 5 minutes later the mattress was unfolded and expanding on my Zinus SmartBase Platform Bed Frame.  The mattress was already taking shape 60 seconds later.  The cover is made of attractive, soft quilting and quality edge piping.  It already seemed like this was $300 well spent for this queen sized mattress.   

It can take a bed-in-a-box 4 – 6 hours to expand to 90% of its full size and then another 4 – 6 hours to expand to its full size.  We left the mattress to do its thing for the afternoon.  Then we made the bed.  It is always a good idea to use a mattress protector to keep dust from accumulating in the quilted cover of your new mattress.  We are using the SafeRest Premium Hypoallergenic Waterproof Mattress Protector.  

Then it was time to take the mattress for a spin.  The mattress is “plush” and soft.  It cradles pressure points when lying on my side and is supportive when lying on my back.  Both of us tend to have back pain and we prefer to sleep on a bed that is in that Goldilocks zone of neither too hard nor too soft.  The old wisdom that having an extra firm mattress if you have a back pain is simply false.  The best mattress for people with back trouble is one that is supportive and yields to the body’s contours.  This mattress does that very well.  Movement on one side is stabilized when one person rolls over the other side does not feel vibration.  

Even though Consumer Reports does not rate Zinus beds, my verdict on the Zinus Pressure Relief Memory Foam Cloud Mattress is positive.  Not only is it better than the Spring Air Mattress it is replacing, but it is simply an excellent bed.  It is too early to tell how durable this mattress will be.  

I will be recommending this bed to my patients who want a comfortable, inexpensive replacement to their old bed.  If you want a comfortable mattress at a great price, I suggest that you consider Zinus.  

Cefaly: External Trigeminal Nerve Neurostimulation for Migraine Headaches

Review by Darius Zoroufy, MD

I have had migraine headaches my entire life.  My earliest childhood memories are little preschool Darius asking his mom to help him because my head hurt.  I had intermittent headaches throughout childhood.  As I grew up, so did my headaches.  They became much more frequent and more severe.   Although ancient civilizations may not have been drilling holes in skulls of living people to relieve headaches, my headache pain has been bad enough that I would have agreed to trepanation, if a 7000 year old South American healer with a chisel and hammer were offering one.  

When I get a migraine the intensity of the pain is somewhere between moderate (stubbing my toe) and severe (pounding my thumb with a hammer – repeatedly).  I do not get visual auras, but I do get cognitive slowing and my coordination is affected.  When I repeatedly fail to correctly enter the password that unlocks my clinic computer, it is like the sky starting to darken before a Midwestern thunderstorm.    

Triptans, a class of medicines that work on specific serotonin receptors, usually lessen my headaches, but it is a little bit like my first try at snowboarding:  I stood up after each fall, but I grew weary of my head slamming into the ground.  I have tried a lot of preventative medications, to no avail:  

  • Beta blockers – no help and really fatigued

  • Topirimate (Topamax) – minimal change and cognitive changes (a.k.a. “Dopamax”)

  • Gabapentin – no help

  • Riboflavin + Coenzyme Q10 + Butterbur + Magnesium – bright yellow urine, which is amusing, but not particularly useful

  • Daily exercise – I am in better shape, but I still get headaches.  

This year my migraines have decided to visit me nearly every day.  In order to avoid missing work I have taken extremely high doses of sumatriptan (i.e. 400 mg oral + 18 mg subcutaneous) to relieve the pain so I can work.  Unfortunately, relieving the pain does not relieve the cognitive and coordination problems.  I can do my work, but it takes me a lot longer.  

Dr. Wong

I asked my primary care doctor for help and he suggested that I seek advice from a neurologist.  So a few months ago I began to see Dr. Anna Wong in the neurology department of Seattle’s Swedish Medical Group.  Dr. Wong and I have cared for some of the same patients so I knew that she is a smart and compassionate physician, well-liked and respected by patients and her physician colleagues.  After a thorough assessment, Dr. Wong suggested that I consider Botox injections to reduce the frequency and severity of my migraines.  When used for migraine, Botox is administered differently than for cosmetic purposes, instead focusing on the forehead, temples, back of the head, and shoulders.  My first round of Botox seemed to reduce my headaches for a few weeks, but the effect wore off about 1 month into the 3 month cycle.  My second round of Botox seemed to only slightly reduce my headaches.  I decided to go back to Dr. Wong and ask for help.  


In addition to ordering an MRI to look for things that are unlikely but not impossible (e.g. tumor, aneurysm, clot, Chiari Malformation, abcess, etc.), Dr. Wong asked me if I wanted to try Cefaly.  I said yes, because I had a headache at the time and I would have said yes, if she had pulled out a chisel and a hammer and offered trepanation.  She explained that Cefaly is an electrical neurostimulation device that stimulates the first (V1) branch of the trigeminal nerve with a specific pattern of pulses that can diminish migraine pain during a headache and can reduce the frequency of migraines.  Her office has a Cefaly Dual demonstration device and she let me borrow it that afternoon.  

First use of Cefaly

The medical assistant cleaned my forehead with an alcohol prep pad and then applied the gel electrode above my eyebrows, explaining that I should keep the electrode, since it is reusable for 20 uses.  She then took out a lightweight silver object with a power button on the front and a couple of magnetic electrode contacts on the back.  She popped it onto my forehead electrode where the magnets held it in place.  She pushed the button once for a one hour session, and I walked back to my office (conveniently located in the same medical building).  

For the first few minutes, nothing seemed to happen.  I was just standing there with a silver diamond on my forehead as if I were an alien from the planet Dork.  Then I started to feel something. At first, it was like an itching, prickling sensation.  Then it moved on to a buzzing.  The sensation increased for about 10 minutes and then stabilized.  I could feel it in my forehead, temples, and even my upper eyelids.  I found the feeling somewhat uncomfortable, yet relaxing and pleasant, like a deep tissue massage:  it hurts, but you don’t want it to stop.  

As far as my headache, it felt like it was being driven back from my temples to the base of my skull.  The longer the device was on, the more my headache diminished.  After an hour the headache pain was minimal and the surface of my head felt a gentle, pleasing numbness.  I definitely wanted to try it again.  

The next day Dr. Wong let me borrow their Cefaly for the weekend to test it at home.  She told me that I can use it as much as I wanted to, so I did.  On Saturday, I used Cefaly for 3 one hour “acute” sessions and 3 twenty minute “prevent” sessions and I did not have a migraine all day.  I am aware that 4 hours of use per day is not the recommended dose, but there does not seem to be any downside to using Cefaly and I would do just about anything not to have a headache.  On Sunday I used Cefaly again, but the battery had been depleted, so I needed to recharge it.  While it was plugged in, I decided to write this review as I sat pining for it.  

Cefaly is best used when relaxing.  The sensation is intense enough to be distracting, so it is best not to work or drive while using it.  It is probably best to use it for the 20 minute “Prevent” mode right before going to sleep and for the 1 hour “Acute” mode when lying down and trying to get rid of a headache.  

What is Cefaly?

Cefaly is the brand name for an FDA approved device available to patients in the United States by prescription only.  It delivers an electrical current to a gel electrode applied to the forehead that delivers biphasic symmetrical pulses at a frequency of 100 Hz at a maximum current of 16mA.  This electrical current provides neurostimulation to both the left and right first branches of the trigeminal nerve (V1).  It has been shown in randomized, controlled trials to reduce the intensity of acute migraine headache pain by 59%, which was approximately twice the pain relief of the sham placebo device.  It has also been shown to prevent migraine headaches when used 20 minutes per day.  A randomized, placebo controlled, double blind trial showed a significant reduction in days per month with migraine, number of migraine attacks, severity of migraine headache, and number of doses of acute migraine medications.  

As I write this review I have the Cefaly I borrowed from Dr. Wong pleasantly buzzing away in the “Prevent” mode on my forehead.   I intend to get my own Cefaly Dual with both the “Acute” and “Prevent” modes to try to reduce the number of migraine attacks.  I will also recommend that any of my patients with migraines see Dr. Anna Wong to discuss options like Cefaly.  Since 18% of women and 6% of men suffer from migraines, this is a common problem and a non-drug solution like Cefaly can play an important role in their treatment plans.  

SoClean Automatic CPAP Sanitizer

There are few products patients ask more about than the SoClean CPAP sanitizer.  This is probably due to a lot of well-targeted television ads.  An estimated 22 million people in the U.S. suffer from sleep apnea.  Since continuous positive airway pressure (CPAP, also:  BiPAP, VPAP, ASV, AutoSV, etc.) is the most safe and effective treatment for sleep apnea, millions of Americans are now regularly using CPAP to treat sleep apnea.  The airflow of CPAP is generated in a CPAP machine.  That air passes through a humidifier, through a tube where it ends in a mask over the nose or nose + mouth.  A strap around the head holds the mask in place.  CPAP machines have become smaller and quieter.  Humidifiers are better at conditioning the air.  Masks are lower profile and more comfortable than ever.  In our practice approximately 85% of people who start CPAP continue to use it regularly.  This is great step forward for successfully treating sleep apnea.

With all of these people regularly using CPAP for hours every night, CPAP machines and their components are accumulating many hundreds and even thousands of hours of use.  Like any item used on a person’s body for many hours, skin cells and oils, sweat, and mucus can collect.  The warm, humid environment inside the CPAP components can support the growth of bacterial and fungal microorganisms.  

When a patient receives a CPAP machine they are giving specific instructions about cleaning and maintaining their CPAP machine and its components as well as when they are supposed to replace the disposable components.  When speaking to patients, I explain that it is like owning a car:  it requires maintenance.  Items must be discarded and replaced and all of the items have their own schedules.  For example, you change the engine oil in your car every 3000-7500 miles and you replace the tires every 40,000-60,000 miles.   Replacing items regularly will reduce the buildup of microorganisms.  

Between replacement of these disposable items, CPAP components need to be kept clean.  Many people have no trouble washing their mask, tube, and humidifier canister regularly.  Some people, however, find that keeping up with regular washing and cleaning is a chore that they prefer to avoid.  SoClean is perfect for them.  

What is SoClean?

SoClean is an attractive white and blue box that sits next to a CPAP machine and is not used while CPAP is in use.  In the morning after taking off the CPAP mask, a wipe is used to remove skin oils from the mask.  Without detaching or disconnecting anything, the CPAP mask is dropped into the top of the SoClean and the lid is closed.  

That’s it.  

You do not even have to turn it on.  SoClean is programmed to turn on automatically at 10 AM.  This feature not only removes a step, but it prevents you from hearing noise when the machine cycles on.  

SoClean works by generating “activated oxygen” which is a fancy way of saying ozone or O3.  After generating ozone, it circulates it around the mask and headgear, through the tube, and through the humidifier canister and any remaining water.  Ozone reacts with microorganisms and kills them by oxidizing components of the cell wall and killing them.  The amount of ozone is relatively small and is not likely to have a significant impact when vented into the room.  

After SoClean cycles through the CPAP components it leaves no residual disinfectant, because ozone simply breaks down to atmospheric oxygen or O2.  Some people have reported a smell to their CPAP when they first turn it on.  I recommend that they turn on their CPAP for a couple of seconds before putting it on at night to vent the tube before use.  

Setting up SoClean

Before using SoClean for the first time you will have to make a minor configuration change to your CPAP.  SoClean requires that a different humidifier lid be installed so that ozone can circulate through the humidifier.  It is a fairly easy process and it only needs to be done once.  


If you travel with your CPAP you will need to replace the SoClean humidifier lid with the regular CPAP lid, so you can use your CPAP without your SoClean when you are away.  

Do I NEED a SoClean?

The short answer is: no. 

If you wash and clean your CPAP components as recommended when you first got your CPAP machine, and you replace all of your disposable components on time so that microorganism biofilms do not accumulate, you probably do not need to buy a SoClean.  

However, many people do not always keep up with the maintenance and replacement schedules for their CPAP.  Those people might have fungal and bacterial growth inside their humidifier, tube, and/or mask.  These people may benefit from purchasing and using a SoClean.  SoClean does not eliminate the need for CPAP care and maintenance, but it does reduce microorganism growth in CPAP components.  

SoClean is often discussed in sleep medicine clinic when discussing CPAP.  I often recommend it for my patients.  (As of this writing it is on sale.)