Sleep apnea is a group of sleep disorders that cause frequent pauses in breathing during your sleep. The most common type is obstructive sleep apnea (OSA), which occurs as a result of throat muscle constriction.
Central sleep apnea occurs from a brain signal issue that prevents proper breathing. Complex sleep apnea syndrome is less common, and it means that you have a combination of obstructive sleep apnea and central sleep apnea.
These sleeping disorders are potentially life threatening if left untreated. Here we focus on the treatment of obstructive sleep apnea (OSA)
If you have a sleep apnea diagnosis, your doctor may recommend breathing machines called positive airway pressure (PAP) devices to maintain an open airway during sleep.
These machines are hooked up to a mask you wear over your nose and sometimes your mouth. As you sleep, PAP machines provide air at a pressure just high enough to prevent the collapse of your upper airway. This allows you to breathe without much effort and sleep without waking up.
There are three main types of machines used in the treatment of sleep apnea: APAP, CPAP, and BiPAP.
Here, we break down the similarities and differences between each type so you can work with your doctor to help choose the best sleep apnea therapy for you.
An auto-adjustable positive airway pressure (APAP) machine increases or decreases the level of positive airway pressure in response to a change in airflow.
It works on a range of 4 to 20 centimeters of water column (cmH2O) pressure settings, which can offer flexibility to help you find your ideal pressure range.
These different pressures allow the machine to automatically adjust to your varying pressure needs throughout your sleep as you change sleeping positions or go through various sleep stages. The APAP machine increases automatically as needed to allow normal breathing during sleep.
When you have OSA, the APAP machine increases pressure just enough to return breathing to normal. The air pressure from the machine rises and falls while you sleep as needed to keep the airway open.
The continuous positive airway pressure (CPAP) unit is the most prescribed machine for sleep apnea.
CPAP works by delivering a steady continuous pressure during both inhalation and exhalation. Unlike APAP, which adjusts the pressure based on your inhalation, CPAP delivers one rate of pressure while you sleep.
While the continuous rate of pressure can help, this method can lead to breathing discomfort. Still, CPAP is used most often because it’s the simplest and most extensively studied treatment for sleep apnea.
Sometimes the pressure may still be delivered while you’re trying to exhale, making you feel like you’re choking. One way to remedy this is to turn down the pressure rate. If this still doesn’t help, your doctor may recommend either an APAP or BiPAP machine.
BiPAP refers to bilevel or two-level positive airway pressure.
Like CPAP, this OSA treatment works by sending air through a tube into a mask that fits over the nose.
While CPAP generally delivers a single pressure, BiPAP delivers two: an inhale pressure and an exhale pressure. These two pressures are known as inhalation positive airway pressure (IPAP) and exhalation positive airway pressure (EPAP).
BiPAP machines are sometimes also called BPAP machines. BiPAP was originally a brand name, but it has become synonymous with the machine itself and is now more common than BPAP.
BiPAP machines have similar low range pressure zones as APAP and CPAP, but they offer a higher peak pressure flow of 25 cmH2O. Thus, this machine is best if you need moderate- to high-pressure ranges.
A CPAP delivers steady continuous pressure rate for both inhalation and exhalation. BiPAP and APAP devices are other options that offer more control over the pressure needed to keep the upper airway open during sleep.
One of the most common side effects of PAP machines is that they can make it difficult to fall and stay asleep.
Like sleep apnea itself, frequent insomnia can increase your risk for metabolic conditions, as well as heart disease and mood disorders.
Other side effects include:
- runny nose or nasal congestion
- dry mouth (common for those who wear a full face mask and those with a nasal mask who breathe out of their mouth)
- dental cavities
- skin irritation from the mask
- feelings of bloating and nausea from air pressure in your stomach
- germs and subsequent infections from not cleaning the unit properly
Positive airway pressure therapy may not be suitable if you have any of the following conditions:
- bullous lung disease
- cerebrospinal fluid leaks
- frequent nosebleeds
- pneumothorax (collapsed lung)
CPAP is generally the first line of flow generation therapy for sleep apnea because it’s best studied of the noninvasive PAP devices.
It’s not unusual to not find the perfect PAP device the first time around and to cycle through a few different masks before you find the right one for you. Even then, you should give the device and the mask a chance before moving on to another.
Using a PAP device for the first time is a new experience, so give yourself time to adjust. Going from not using a CPAP to sleeping with one can be scary and takes some getting used to. However, the vast majority of people do, and actually love their CPAP once they’re finally getting quality sleep.
Insurance coverage can vary, with most companies covering CPAP machines first. This is because CPAP costs less and is still effective for most people.
If you’re not able to tolerate CPAP or the CPAP is unable to treat your sleep apnea effectively, then a doctor may recommend other PAP devices, such as APAP or BiPAP
Oral appliances like mandibular advancement devices or tongue retaining devices are an alternative therapeutic strategy for OSA. These devices may be offered to people with mild to moderate OSA who are not able to use a PAP machine.
A variety of surgical approaches have also been explored for OSA. They’re used primarily in people with severe, obstructing lesions of the upper airway who have been unable to use a PAP machine or an oral device.
Even if you do use a CPAP or other machine, you may need to adopt other habits to help treat sleep apnea.
In addition to using a PAP machine, a doctor may recommend the following lifestyle changes:
- weight loss
- regular exercise
- smoking cessation, which can be difficult, but a doctor can create a plan that works for you
- alcohol reduction or avoiding drinking altogether
- using decongestants if you have frequent nasal congestion from allergies
Changing your bedtime routine
Since PAP therapy poses the risk of interfering with your sleep, it’s important to take control of other factors that might make it hard to fall asleep. Consider:
- removing electronic devices from your bedroom
- reading, meditating, or doing other quiet activities an hour before bedtime
- taking a warm bath before bed
- installing a humidifier in your bedroom to make it easier to breathe
If all therapies and lifestyle changes fail to make any significant impact, you may consider surgery. The overall goal of surgery is to help open up your airways so you aren’t dependent on pressure machines for breathing while you sleep.
Depending on the underlying cause of your sleep apnea, surgery could come in the form of:
- tissue shrinkage from the top of the throat
- tissue removal
- soft palate implants
- jaw repositioning
- hypoglossal nerve stimulation (this is an implanted medical device that reduces the occurrence of OSA by electrically stimulating the hypoglossal nerve, which causes tongue movement)
APAP, CPAP, and BiPAP are all types of noninvasive positive airway pressure devices that may be prescribed for the treatment of sleep apnea.
Each has a similar goal of using air pressure to open an obstructed upper airway to allow air to flow easily in and out of the lungs during sleep.
Aside from positive airway pressure therapy, it’s important to follow your doctor’s advice on any recommended lifestyle changes.
All types of sleep apnea can be life threatening, so treating it now can greatly improve your outlook while also improving your overall quality of life.
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