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CPAP Therapy


If you're diagnosed with sleep apnea, your doctor may prescribe treatment with CPAP. If so, he or she will need to find the correct airflow setting for your CPAP machine. To do this, you may need to go to a sleep center to have a PSG. Or, you may be able to find the correct setting at home with an autotitrating CPAP machine.

An autotitrating CPAP machine automatically finds the right airflow setting for you. These machines work well for some people who have sleep apnea. A technician or a doctor will teach you how to use the machine.


What Is CPAP?



CPAP, or continuous positive airway pressure, is a treatment that uses mild air pressure to keep the airways open. People who have breathing problems, such as sleep apnea, typically use CPAP.


CPAP also may be used to treat preterm infants whose lungs have not fully developed. For example, doctors may use CPAP to treat infants who have respiratory distress syndrome or bronchopulmonary dysplasia (brong-ko-PULL-mun-ary dis-PLA-ze-ah).


The main focus of this article is CPAP treatment for sleep apnea, although treatment in preterm infants is discussed briefly.



CPAP treatment involves a CPAP machine, which has three main parts:


  • A mask or other device that fits over your nose or your nose and mouth. Straps keep the mask in place while you're wearing it.

  • A tube that connects the mask to the machine's motor.

  • A motor that blows air into the tube.


Some CPAP machines have other features as well, such as heated humidifiers. CPAP machines are small, lightweight, and fairly quiet. The noise that they make is soft and rhythmic.


CPAP often is the best treatment for obstructive sleep apnea. Sleep apnea is a common disorder that causes pauses in breathing or shallow breaths while you sleep. As a result, not enough air reaches your lungs.


In obstructive sleep apnea, your airway collapses or is blocked during sleep. When you try to breathe, any air that squeezes past the blockage can cause loud snoring. Your snoring may wake other people in the house.


The mild pressure from CPAP can prevent your airway from collapsing or becoming blocked.


Your doctor will work with you to make sure the settings that he or she prescribes for your CPAP machine are correct. He or she may recommend an overnight sleep study to find the correct settings for you. Your doctor will want to make sure the air pressure from the machine is just enough to keep your airway open while you sleep.


There are many kinds of CPAP machines and masks. Let your doctor know if you're not happy with the type you're using. He or she may suggest switching to a different type that might work better for you.


CPAP also is used to treat preterm infants whose lungs have not fully developed. For this treatment, soft prongs are placed in an infant’s nostrils. The CPAP machine gently blows air into the baby's nose, which helps inflate his or her lungs.



CPAP has many benefits. It can:



  • Keep your airway open while you sleep

  • Correct snoring so others in your household can sleep

  • Improve your quality of sleep

  • Relieve sleep apnea symptoms, such as excessive daytime sleepiness

  • Decrease or prevent high blood pressure



Who Should Use CPAP


Continuous positive airflow pressure (CPAP) is the best treatment for most people with obstructive sleep apnea. It is safe and effective in patients of all ages, including children. If you only have mild sleep apnea and do not feel very sleepy during the day, you may not need to use it.


After using CPAP regularly, many patients report the following:


  • Better concentration and memory

  • Feeling more alert and less sleepy during the day

  • Improved sleep for the person's bed partner

  • Improvements in work productivity

  • Less anxiety and depression and a better mood

  • Normal sleep patterns

  • Improvement in heart and blood vessel problems, such as high blood pressure



A similar machine, called BiPAP (bi-level positive airway pressure) is used as an alternative to CPAP. With this machine, the pressure changes while a person breathes in and out.


These devices are useful for children and adults with collapsible airways, small lung volumes, or muscle weakness that makes it difficult to breathe, such as muscular dystrophy.



How the CPAP Works

The CPAP works in the following way:


  • The device is a machine weighing about 5 pounds that fits on a bedside table.

  • A mask fits over the nose. A tube connects the mask to the CPAP device.

  • The machine delivers a steady stream of air under slight pressure through this tube into the mask.


CPAP will be started while you are in the sleep center for the night. Sometimes, it can be started on the same night you have your sleep study.



The doctor, nurse, or therapist will help choose the mask that fits you best. They will also help adjust the settings on the machine while you are asleep. The settings on the CPAP machine depend on the severity of your sleep apnea.


If you are using the CPAP machine but your sleep apnea symptoms do not improve, the settings on the machine may need to be changed. Some patients can be taught to adjust the CPAP at home. Otherwise, you will need to make trips to the sleep center.


CPAP works by steadily increasing pressure in your airway. Newer devices, called autotitrating positive airway pressure (APAP), can respond to changes in pressure in your airway as they occur. This may be more comfortable, and it also can help you avoid overnight stays and other trips to the hospital.



Getting Used To The Device


It can take time to become used to a CPAP device. The first few nights of CPAP therapy are often the hardest. Some patients may sleep less or not sleep well at the start of the treatment.


Patients who are having problems may tend not to use CPAP for the whole night, or even stop using the device. However, it is important to use the machine for the entire night or for as long as possible.




Common complaints include:

  • A feeling of being closed in (claustrophobia)

  • Chest muscle discomfort, which usually goes away after a while

  • Eye irritation

  • Irritation and sores over the bridge of the nose

  • Nasal congestion and sore or dry mouth

  • Noise that interferes with sleep (although most machines are quiet)

  • Nosebleeds

  • Upper respiratory infections




Many of these problems can be helped or prevented
by the following methods:


  • Ask your doctor or therapist about using a mask that is lightweight and cushioned. Some masks are used only around or inside the nostrils.

  • Make sure the mask fits correctly. It should not be too tight or too loose, and it should not leak any air.

  • Try nasal salt water sprays for a stuffed nose.

  • Use a humidifier to help with dry skin or nasal passages.

  • Keep your CPAP equipment clean.

  • Place your CPAP machine underneath your bed.


Your doctor or therapist can lower the pressure on the CPAP machine and then increase it again at a slow pace. Some new machines can automatically adjust to the pressure that is needed.

Alternative Names:


Continuous positive airway pressure; CPAP; Bilevel positive airway pressure; BiPAP; Autotitrating positive airway pressure; APAP; nCPAP

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