Sleep Apnea - CPAP
CPAP: Continuous positive airway pressure. CPAP is the “gold standard” in the treatment of severe obstructive sleep apnea. It is often the best treatment for moderate sleep apnea and often used to treat snoring. The problem is compliance. With both the dental appliances and CPAP, compliance is an issue. Studies have however shown that the dental appliances have a much higher compliance than CPAP.
CPAP is the first-line treatment in OSA. CPAP can be daunting and difficult. This leads to noncompliance resulting in poor quality treatment. A significant number of patients eventually abandon therapy. Approximately 23% of patients, mostly in the first year abandon treatment. This figure is extremely variable with values ranging between 4 and 74% depending on the study.
Patients with obstructive sleep apnea treated with CPAP wear a face mask during sleep which is connected to a pump (CPAP machine) that forces air into the nasal passages at pressures high enough to overcome obstructions in the airway and stimulate normal breathing. The airway pressure delivered into the upper airway is continuous during both inspiration and expiration.
Nasal CPAP is currently the preferred treatment for moderate to severe obstructive sleep apnea. CPAP is safe and effective, even in children. Daytime sleepiness improves or resolves. Heart function and hypertension also improve. And, importantly, the quality of life improves.
At first, CPAP patients should be monitored in a sleep lab to determine the appropriate amount of air pressure for them. The first few nights on CPAP tend to be difficult, with patients experiencing less sleep. Many patients at first find the mask uncomfortable, claustrophobic or embarrassing. 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.
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.
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
Many people who use CPAP report feeling better once they begin treatment. They feel more attentive and better able to work during the day. They also report fewer complaints from bed partners about snoring and sleep disruption.
In some preterm infants whose lungs have not fully developed, CPAP improves survival. It also can reduce the need for steroid treatment for the lungs.
Also, in some infants, CPAP prevents the need to insert a breathing tube through the mouth and into the windpipe to deliver air from a ventilator. (A ventilator is a machine that supports breathing.) CPAP treatment is less invasive than ventilator therapy.