Continuous Positive Airway Pressure (CPAP) and Bi-Level PAP for Obstructive Sleep Apnea
Traditional therapy for obstructive sleep apnea includes nightly use of continuous positive airway pressure (CPAP). During sleep, CPAP patients wear a face mask connected to a pump that forces air into the nasal passages at pressures high enough to overcome obstructions in the airway and stimulate normal breathing.
There are two major types of positive airway pressure devices: Nasal CPAP and Bilevel positive airway pressure, or BiPAP.
In nasal CPAP, the airway pressure delivered into the upper airway is continuous during both inspiration and expiration.
BiPAP differs from CPAP in that the pressure during expiration may be adjusted separately from the pressure delivered during inspiration. This ability to set independent pressures during inhalation and exhalation result in lower average airway pressures than those produced by nasal CPAP.
CPAP may entail the use of a mask over just the nose, or a mask covering both the nose and mouth (oronasal mask). Nasal masks are used more commonly than oronasal masks.
Still other systems such as auto-CPAP adjust the pressure automatically as a person’s breathing changes during the night. Developments in CPAP technology have also led to smaller, lightweight, better fitted and cushioned masks, which alleviate half the discomfort associated with CPAP.
Pros and Cons of CPAP and BiPAP
The Pros: Overall, many experts consider nasal CPAP the best treatment for severe obstructive sleep apnea. CPAP and BiPAP are safe and effective, even in children. Tissues are prevented from collapsing during sleep, and apnea is effectively prevented without surgical intervention.
- Daytime sleepiness improves or resolves
- Heart function and hypertension improve
- Quality of life improves
- Survival rates may increase, according to some studies
- Therapy improves obstructive sleep apnea, mixed apneas and some central apneas.
The Cons:
- When first using a CPAP machine, patients must be monitored in a sleep laboratory in order to determine the appropriate amount of air pressure. While this may only take one night, some patients require additional testing. The first few nights of using CPAP tend to be difficult, with patients experiencing less or poorer sleep.
- Many patients find the mask uncomfortable, claustrophobic or embarrassing.
- Most CPAP patients often suffer from at least one side effect related to forced air delivery, and about half of CPAP patients discontinue treatment. Side effects may include:
- Sensation of suffocation/ claustrophobia
- Difficulty exhaling
- Inability to sleep
- nasal congestion
- sore eyes
- sore or dry throat
- headaches
- abdominal bloating
- chest muscle discomfort (caused by increase in lung volume)
- nosebleed
- mask-related problems such as rash, skin abrasions, and conjunctivitis (from air leakage)
- Since CPAP is not a cure and must be used every night for life, non-compliant patients experience a full return of obstructive sleep apnea and related symptoms.
- The sound of the machine may be disruptive.
While compliance with CPAP can be a problem, we have found that regular, close and personalized follow-up with our patients significantly improves their therapeutic experience and helps them overcome the difficulties associated with initiating CPAP or BiPap therapy.
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