The "gold-standard" and most commonly prescribed method of treatment for obstructive sleep apnea is “continuous positive air pressure” or CPAP. A CPAP machine delivers air pressure of adjustable intensity through a mask worn during sleep.
CPAP is a well established treatment that many people get used to quickly, however some patients do not. There are three types of Positive Airway Pressure devices:
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Standard CPAP - Standard CPAP delivers a fixed pressure of room air. The air pressure forms a "splint" preventing the airway from collapsing during sleep. The pressure used is determined during a CPAP Titration study.
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Bi-level PAP – Bi-level devices use two different pressures to support the airway - a stronger pressure is delivered while inhaling and a lower pressure is used while exhaling. The change in pressure is determined by the patient's breathing pattern.
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AutoPAP- AutoPAP machines automatically adjust the pressure in response to a patient's needs throughout the night.
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CPAP Compliance
While CPAP is considered the “gold standard” for treatment of obstructive sleep apnea (OSA), it is not without its problems. CPAP, when used, will control obstructive sleep apnea 100% of the time but there is a problem with patient compliance. Compliance simply means that a patient is following their doctor’s orders to keep their disease problem under control. In the case of sleep apnea, it means that the patient is using the CPAP machine every night as recommended.
However, multiple research articles have shown that CPAP compliance can be as low as 50% because of discomfort and inconvenience. Obstructive sleep apnea sufferers who do not wear their CPAP machines increase their risk of heart failure, high blood pressure and stroke and are drowsy during the day and fall asleep while driving. OSA sufferers who stop wearing CPAP often snore, gasp and choke loudly disturbing their bed partners placing a strain on relationships and marriages. .
Some of the common problems that people experience with CPAP are:
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The mask is uncomfortable
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The mask is taken off at night without knowing it
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The mask is taken off at night to use the bathroom and it’s too much bother to put it back on
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The mask irritates the skin and the nose
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Air in the stomach or sinuses
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The mask leaks air
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The pressure of the CPAP is bothersome
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The CPAP machine is too noisy to allow sleep
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The tubing gets in the way
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You just can’t get used to the mask
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The mask gives you a feeling of claustrophobia
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Your nose can be stuffy because of a cold or allergies
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The air is too hot, too cold or too dry
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CPAP Compliance is difficult to determine but studies indicate that it is influenced by a variety of factors including:
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Severity of the sleep apnea
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Quality of patient training and education
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The mask is taken off at night to use the bathroom and it’s too much bother to put it back on
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Participation in a support group
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Claustrophobia
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Follow-up and monitoring by health care professionals
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Patient motivation
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Use of humidification
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Ramping feature of CPAP device (gradual increase in pressure as patient falls asleep)
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Treatment reactions
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Patient's age
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Whatever the reason, some people just cannot tolerate CPAP. If you are unable to tolerate CPAP, you may want to consider Oral Appliance Therapy.