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What is Continuous Positive Airway Pressure (CPAP) Therapy?

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CPAP therapy is the most common form of treatment for patients diagnosed with obstructive sleep apnea.

Obstructive sleep apnea occurs when a patient's breathing becomes blocked by tissues that collapse into the airways in the upper respiratory system.

CPAP machines are devices comprised of three parts (a motor, a hose, and a mask) that work together to deliver a prescribed amount of pressurized air that acts as a splint to keep the airways free of obstructions.

Based on a patient's sleep study, a sleep specialist will determine the appropriate amount of air pressure needed to keep the airways from becoming blocked during sleep.

How does the CPAP device work?

There are three main components to a CPAP machine:

  • cartoon_cpap-250Motor. The CPAP motor sits close to the patient's bed and draws in room temperature air that it compresses to the specified pressure. The air intake portion of the machine has changeable filters to prevent dust and particulates from getting into the machine. Most newer CPAP machines come with an attachable water chamber that acts as a humidifier. The humidifier helps moisturize the air being delivered to keep the patient's nasal passages and airways from drying out. CPAP machine motors are also extremely quiet and barely register above a whisper.
  • Hose. Most CPAP hoses are 6 foot in length (although variable sizes are available) and are simply the delivery system for the pressurized air to travel from the motor to the mask. Most hoses are heated to prevent water condensation from building up when used with a humidifier.

  • Mask. CPAP masks come in a variety of shapes and styles to help maximize comfort for the patient. Finding the right CPAP mask is one of the most important aspects of therapy compliance as comfort preferences vary from patient to patient. There are 3 basic styles of CPAP masks: nasal pillows, nasal masks, and full face masks. If you are unsatisfied with your CPAP mask talk with your DME provider about a new mask trial.

     

CPAP care. CPAP masks and the filters for the machines need to be cleaned and replaced regularly. Make sure to talk with your DME provider about best equipment care practices and replacement schedules.

CPAP Results

Once CPAP therapy begins patients will begin to see the positive benefits in just a few weeks. For CPAP therapy to deliver best results, patients need to use their CPAP device regularly. Some of the signs that CPAP therapy is working are:

  • wide_awake-250Elimination of snoring and nightly apnea events.

  • Improved quality of sleep.

  • Increased alertness during the day.

  • Considerable reduction of daytime drowsiness.

  • Lower overall blood pressure (both at night and during the day).

  • Prevention or reversal of serious medical conditions such as heart diseases and stroke.

Alternatives to CPAP

Although CPAP therapy is the most common form of treatment for obstructive sleep apnea, sometimes the individual may have trouble tolerating CPAP (we have written an article here to address some of thos issues). Some of the alternatives are very similar to CPAP therapy in that they deliver pressurized air to the respiratory system but do so in different ways. Other alternatives include oral devices and even surgery.

  • APAP therapy (automatic positive airway pressure). Similar to CPAP therapy, APAP devices use pressurized air to prevent obstructions from occuring. Unlike a CPAP machine which is set to a single pressure setting, an APAP machine has a low pressure range setting and a high pressure range setting that it fluctuates between depending on the pressure needed at that moment. APAP machines have sensors that can detect breath-by-breath needs of the patient and can adjust the level of pressure at any given moment to fit the patient's breathing needs.

  • BIPAP therapy (bilevel positive airway pressure). Patients with high pressure needs from severe sleep apnea, often complain of the difficulty of exhaling against the incoming pressure of a CPAP machine. BIPAP machines adjust the level of pressure being delivered based on whether the patient is inhaling or exhaling.

  • Oral/Dental Devices. While not usually recommended for patients with moderate to severe sleep apnea, patients with mild symptoms may benefit from an oral device.

    • Mandibular advancement devices (MADs). These devices look very similar to sports mouthguards. These devices push the lower jaw down slightly and pull the tongue forward to keep tissues from blocking the respiratory system. MADs can also be worn while using CPAP therapy to help reduce air pressure needs.

    • Tongue retaining mouthpiece. This oral device is worn to adjust the position of the tongue during sleep to prevent it form collapsing backwards. It is placed on the tip of the tongue and rests on the user's lips.

  • Adenotonsillectomy. This type of surgery is typically done as a first measure in children diagnosed with sleep apnea when the obstructions are caused by the enlargement of the lymphatic adenoids and/or tonsils. 
  • Nasal Surgery. When symptoms of OSA are caused or aggravated by a deviated septum, collapsed or narrowed nasal valve, or enlarged turbinate tissues, nasal surgery may be a viable option. Patients with mild sleep apnea may have their breathing troubles eliminated entirely by the surgery. However, patients with moderate to severe OSA sometimes have nasal surgery to help reduce their CPAP pressure settings, making therapy compliance more tolerable.

  • Maxillomandibular Advancement (MMA) surgery.  In this surgery, upper and lower parts of the jawbone are moved forward to create an enlarged space behind the tongue and soft palate, making obstructions less likely.
  • Tracheostomy- In the most extreme cases of obstructive sleep apnea, where other treatments and surgeries have failed to produce positive results, a doctor may recommend a tracheostomy. In this procedure a surgeon creates a permanent opening in the windpipe and inserts a breathing tube. A valve on the breathing tube allows it to be closed during the day for normal breathing and speaking, and opened at night so that air can enter at a point below the obstruction, thus bypassing it.



 

 

 

 

 

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