CPAP To Treat Sleep Apnea

September 16, 2011

A comfortable bedOne of the most common ways to treat sleep apnea is through the use of air pressure. This is known as Positive Airway Pressure. The machines are commonly referred to as CPAP machines although there are really 3 basic types of machines as you’ll see below.

They work by using air pressure to keep your airway from collapsing. The amount of pressure required to achieve this varies from patient to patient. It can also change from night to night for a given patient.

Pressure provided by the machine is measured in mm of mercury (mmHg) and ranges from 4 to 20.

Masks

The pressurized air is blown through a tube and into your airways, usually through a mask fitted over the nose (known as a nasal mask). Other forms of masks are available (oral, full face and total face) as well as devices that are inserted into your nostrils (nasal pillows and prongs).

The different styles of masks, etc. are designed to be as comfortable as possible for different people. You will need to experiment to see which is right for you and the way that you sleep. Most people use the nasal masks, but they are not the best if you move around a lot in your sleep or if you sleep on your stomach (which you shouldn’t do anyway — plug from my chiropractor 8=)

The Machines

A CPAP SystemThere are 3 categories of machines that are used to provide the pressure. Once again, the variety allows for you to find a machine that is comfortable for you to use while providing relief from your apnea.

CPAP

The most common machines used to treat sleep apnea are CPAP (Constant Positive Airway Pressure) machines. These devices are set at a constant air pressure which your doctor will prescribe. This setting is the one that is the lowest setting that provides relief during your sleep studies.

The drawback to this is that the pressure is often higher than your body really needs. On nights where you have been drinking alcohol you body needs more pressure to keep the airways open. If you gain or lose weight this will also affect your pressure needs.

However, for people who have a relatively low pressure setting that works, these machines are the simplest and least expensive.

APAP

APAP (Automatic Positive Airway Pressure) machines function in much the same way as CPAP. The difference is that they will automatically sense and adjust the pressure you require through the night. When you are lightly sleeping the pressure will be lower. If you are having a bad night and require higher pressure, the machine automatically adjusts.

This allows the machine to determine the lowest pressure that you need to avoid apnea. A CPAP machine must be set at a level that is appropriate for your worst episodes and is often higher than necessary for most of the time you use it.

BiPAP

One problem with CPAP and APAP is that the pressure is constant, even when you are exhaling. BiPAP (BiLevel Positive Airway Pressure) are designed to help people who have trouble exhaling under the constant pressure of a CPAP, especially when the prescription is high.

There are 2 settings on a BiPAP machine. The higher pressure is applied when you inhale (IPAP setting) and the lower one when you exhale (EPAP setting). This reduces the effort required when exhaling without reducing the effectiveness of the therapy.

The Drawbacks

While CPAP, APAP and BiPAP machines are literally life savers for people who suffer from sleep apnea, they have drawbacks as well.

Comfort

The first one that you’ll encounter is that they are uncomfortable. It can be difficult to get used to wearing a mask with the straps and tubes. Working with your health professional can help you to find the most comfortable fit for you.

You may also have trouble dealing with the pressure. It does take some getting used to. For me, these two problems were somewhat mitigated since I was so sleep deprived that I was able to fall asleep instantly (I could have slept on a rock). So I was able to get used to them very easily. But I know that many people struggle with this and some cannot adjust to it at all.

Noise

Another problem is the noise. The machines are quieter than they used to be, but there is still a certain level of noise from the machine and also from the tubing and mask. You obviously will be breathing out and that air escapes through vents. The design of the vents has improved but there is still enough noise to wake a light sleeper.

My wife has adjusted to the noise level — it sure beats my snoring and snorting that she used to put up with. It has become part of the ambient noise, but she struggled with it at first. I keep my machine on the floor and that helps. It also helps to make sure that you have a tight, comfortable fit — leaks are very noisy!

Nasal Congestion

The biggest drawback for me is that a nasal mask only fits over the nose. When I am stuffed up with allergies or a cold it is impossible to use the mask properly. This requires that I take some kind of decongestant before bed on those nights. I’m not a big fan of cold medicines but they are preferable to sleep apnea.

I could switch to a full face mask, but then I’d be tempted to breathe through my mouth. I like the fact that the nasal mask forces me to breathe through the nose as it is more comfortable for my throat.

Humidity

For many people, humidity is a big problem. I don’t know why I don’t struggle with this, but many people find that their nasal passages and throat become very dry when using CPAP. If you have this problem then a humidifier will help.

Pretty much every machine sold today has an optional humidifier attachment or has one built in. They use heat and water to moisturize the air flowing through the tubing to the mask. You can adjust the heat level to create as much or as little moisture as you need to keep from getting dried out.

In the winter when the air is extra dry I sometimes use the humidifier on my machine without heat. But I rarely notice a difference if I forget to fill it.

Portability

Finally, a CPAP machine is not really portable. Sure, you can pack up the machine and mask and take it with you. But you can’t nap on the sofa or sleep on an airplane with it. At least, not easily.

There are travel machines that are smaller and easier to use if you travel a lot. But your options for sleeping are limited by where you are able to set up the machine.

Bill (LoneWolf) Nickerson

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