Sleep Apnea

Treatments for Obstructive Apneas, CPAP and Similar Breathing Devices

Posted on 06. Dec, 2009 by admin in Treatments for Obstructive and Mixed Apneas

Breathing devices that treat obstructive apnea do so by using air pressure as a “splint” to hold the upper airway open and keep it from collapsing during sleep. Some sleep experts believe that, in addition, the higher than normal air pressure delivered by these devices may stimulate the person’s breathing reflexes. However, the primary role of air pressure devices is to act as an airway splint.

The most commonly used version of this system is called CPAP (pronounced “SEE-pap”). As mentioned previously, CPAP was developed as a treatment for sleep apnea by Sullivan and his research group in Australia in 1981. It was first used to treat sleep apnea patients in the United States in 1984.

CPAP is extremely effective. In fact, it is the most effective nonsurgical treatment for obstructive sleep apnea. For that reason, CPAP has become the treatment of choice at most sleep centers.

The standard CPAP system consists of a small, soft, rubbery mask that is worn over the nose (not the mouth) at night. The mask is connected by flexible tubing to an air pump, which provides continuous air pressure through the tubing and into the nose (Figures 7.2 and 7.3). As soon as the CPAP wearer begins to inhale, the air pressure stabilizes his soft palate and tongue and prevents his airway from collapsing. A pressure regulator is custom-set for him during a night in the sleep lab so that the CPAP delivers exactly enough air pressure to prevent his apnea events, but no more than necessary.

CPAP pressure is measured in centimeters of water (cm H2O), in much the same way that barometric pressure is measured in millimeters of mercury (mm Hg). Typical CPAP pressure settings range from 5 to 20 cm H2O.

In some severe cases of obstructive sleep apnea, oxygen may be prescribed in conjunction with CPAP or bi-level PAP.

Bi-level PAP (called BiPAP® by one manufacturer) is a refinement of CPAP. This system allows the air pressure to be set at two different levels. The pressure as the person inhales can be set higher to eliminate snoring, and the pressure during exhaling can be set lower, making it easier to exhale.

A new, developing, and experimental type of CPAP is often referred to as a “smart-PAP.” This machine attempts to change pressure in response to the user’s needs. The device senses the user’s breathing patterns and adjusts pressure to accommodate changes in breathing that occur throughout the night. There are several manufacturers of smart-PAPs, and each one uses different breathing signals to regulate their machines. Some designs are more comfortable for the user than others, and some are more appropriate for certain types of users.

These dual- and variable-pressure systems are now the prescribed treatment of choice for certain severe sleep apnea patients. However, at the time of this writing, the cost of such systems is still two or more times that of a standard CPAP, and there is little evidence of improved results. For many people with sleep apnea, the advantages probably would not justify the extra cost, nor would most insurance or health plans pay for the extra “bells and whistles” of a bi-level or smart-PAP unless one is specifically prescribed.

The technology in this field is changing rapidly. If you are a candidate for CPAP, talk with the staff at your sleep center and with a homecare representative about the various versions of breathing devices that are available. You may want to test more than one and decide which one suits you best.

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Tags: Breathing Devices, CPAP, Treatments for Obstructive Apneas