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 CPAP 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 CPAP – Bi-level
devices use two different pressures to support the
airway - a stronger pressure is delivered during
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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Auto CPAP- 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
life-long.
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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