CPAP

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Obstructive sleep apnea is a common breathing disorder that is said to affect at least 2% to 9% of adults (1) in the U.S., although many people are unaware they have the condition.

An individual with obstructive sleep apnea displays multiple brief periods during sleep when they are unable to breathe, as their throat muscles relax and allow tissue in the back of the mouth to block the airway. Snoring, waking up choking, and gasping for breath are common signs of the disorder.

A doctor may prescribe continuous positive airway pressure (CPAP) therapy to help patients with obstructive sleep apnea obtain more restful sleep and minimize their symptoms. Only a medical professional can diagnose obstructive sleep apnea and provide treatment options, but understanding CPAP therapy can help you go into your next appointment better prepared.

What is CPAP Therapy?

CPAP therapy uses pressurized air to prevent the airway from closing during sleep, thereby allowing patients with obstructive sleep apnea to breathe more consistently. Determining the right pressure setting is a critical component of the success of CPAP therapy, so medical professionals perform titration tests (2) to determine the optimal setting for each individual.

What Does CPAP Therapy Treat?

CPAP therapy is one of the most common treatment options for obstructive sleep apnea. Symptoms of obstructive sleep apnea include snorting, gasping, choking, trouble sleeping through the night, and restlessness. A bed partner may be able to observe signs of the disorder while you sleep. Once awake, those with obstructive sleep apnea may also notice a sore throat, headache, dry mouth, and excessive sleepiness.

CPAP therapy may also be used for preterm infants (3) with respiratory distress syndrome.

While CPAP therapy is beneficial for many individuals, it is not ideal for everyone. Those who are not breathing spontaneously require other treatment options. Additionally, CPAP therapy may not be appropriate (4) for people who display:

  • Uncooperativeness or extreme anxiety
  • Limited consciousness that prevents them from protecting their airway
  • Respiratory arrest
  • Significant respiratory secretions
  • Cardiorespiratory instability
  • Facial trauma, including burns
  • Surgery to the face, esophagus, or stomach
  • Air leak syndrome
  • Severe cases of nausea and vomiting
  • Chronic obstructive pulmonary disease (COPD) or asthma with carbon dioxide retention

How Does a CPAP Machine Work?

CPAP therapy involves several components that work together to deliver pressurized air. The added pressure helps keep the airway open as you breathe in and out. The setup must be cleaned regularly for safety. Most CPAP machines include three parts:

Motorized Fan and Filter: The motor takes in air, pressurizes it, and sends it through a tube toward the mask. A filter helps ensure the air is clean before it passes into your nose or mouth. Many CPAP machines also include a humidifier to reduce irritation to the mouth and nasal passages. While pressure setting options vary between machines, the recommended levels generally lie between 4 cm H2O and 20 cm H2O (5), where cm H2O refers to centimeters of water pressure. Your physician will determine what setting is appropriate for you.

Face Mask: The face mask delivers the pressurized air into the airway. Nasal CPAP masks cover just the nose, whereas full face masks cover the mouth and nose. Alternatively, a tube can be inserted deeper into the nose so the air does not need to pass through the nostrils. A secure fit and proper seal are essential for effective CPAP therapy. Usually, a strap or headgear holds the mask in place.

Hosing: The motor and the face mask are connected by a hose. Different lengths and types of hosing are available. The hose should connect securely to both the machine and the mask, with no leakage.

Alternatives to CPAP Therapy

CPAP therapy is generally considered the best option for treating obstructive sleep apnea, but some may find the device claustrophobic, inconvenient, or costly. These issues may lead people to stop using their CPAP device (6) over time. However, there may be alternatives to CPAP therapy:

  • BiPAP: Bi-level positive airway pressure (BiPAP) is a different form of positive airway pressure therapy that uses two separate pressure settings: one for inhalation and one for exhalation. While BiPAP machines tend to be significantly more expensive, some people may find it easier to breathe with a BiPAP device compared to a CPAP device.
  • Nasal EPAP: Nasal expiratory positive airway pressure (7) (nasal EPAP) devices are applied to the nostrils and do not require a motor or a fan, as they leverage the sleeper’s exhalations to create pressure in the airway.
  • Mandibular Advancement Device: Mandibular advancement devices (8) temporarily move the lower jaw forward to limit airway compression caused by gravity when lying down.
  • Tongue Retaining Device: A tongue retaining device holds the tongue in place (9) so that it does not fall to the back of the mouth and block the airway.
  • Orofacial Myofunctional Therapy: Orofacial myofunctional therapy trains the muscles in the upper airway (10), which may help reduce the severity of obstructive sleep apnea.
  • Surgery: Several surgical options may help cure or lessen the severity of symptoms. These include removing the tonsils or adenoids (11), removing excess tissue from the throat, moving the jaw forward (12), and contracting the tongue via stimulations to the hypoglossal nerve (13).
  • Weight Loss: While weight loss is unlikely to resolve obstructive sleep apnea completely, it may help to improve symptoms for some patients.
  • Changing Sleep Position: When lying on the back, gravity allows the tongue and larynx (voice box) to block the airway (14). Side sleeping may relieve symptoms for sleepers whose obstructive sleep apnea is caused by these structures.
  • Limiting Alcohol: Alcohol (15) can aggravate snoring, alter sleep quality, and increase the number of breathing lapses for people with obstructive sleep apnea.

References

+ 15 Sources
  1. 1. Accessed on August 22, 2021. https://www.merckmanuals.com/professional/pulmonary-disorders/sleep-apnea/obstructive-sleep-apnea
  2. 2. Accessed on August 22, 2021. https://pubmed.ncbi.nlm.nih.gov/17162992/
  3. 3. Accessed on August 22, 2021. https://pubmed.ncbi.nlm.nih.gov/31014448/
  4. 4. Accessed on August 22, 2021. https://pubmed.ncbi.nlm.nih.gov/29489216/
  5. 5. Accessed on August 22, 2021. https://pubmed.ncbi.nlm.nih.gov/18468315/
  6. 6. Accessed on August 22, 2021. https://pubmed.ncbi.nlm.nih.gov/27542595/
  7. 7. Accessed on August 22, 2021. https://pubmed.ncbi.nlm.nih.gov/28901030/
  8. 8. Accessed on August 22, 2021. https://pubmed.ncbi.nlm.nih.gov/33170490/
  9. 9. Accessed on August 22, 2021. https://pubmed.ncbi.nlm.nih.gov/33170490/
  10. 10. Accessed on August 22, 2021. https://pubmed.ncbi.nlm.nih.gov/30233265/
  11. 11. Accessed on August 22, 2021. https://pubmed.ncbi.nlm.nih.gov/29148201/
  12. 12. Accessed on August 22, 2021. https://pubmed.ncbi.nlm.nih.gov/26606321/
  13. 13. Accessed on August 22, 2021. https://pubmed.ncbi.nlm.nih.gov/31584412/
  14. 14. Accessed on August 22, 2021. https://pubmed.ncbi.nlm.nih.gov/25154495/
  15. 15. Accessed on August 22, 2021. https://pubmed.ncbi.nlm.nih.gov/32513091/

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