CPAP

The most common and effective treatment for obstructive sleep apnea (OSA) and snoring is a CPAP (Continuous Positive Airway Pressure) machine. CPAP delivers a constant pressure of air via a sealed mask over the nose or nose and mouth. Most patients report an instant and dramatic improvement in their quality of life after just the first night on CPAP. CPAP and its variants are the only treatments that will completely eliminate obstructive sleep apnea.

Snoring and OSA are the results of a partial or complete obstruction of the upper airway. When you breathe in, the expanding lungs lower the air pressure throughout the airway which creates a situation where soft tissue in the upper airway can collapse, partially or completely blocking airflow. CPAP increases the air pressure by a set amount that differs from patient to patient, leaving the airway open and allowing the user to breathe normally again. A CPAP machine does not breathe for you, it is simply acting as a splint, holding the airway open and allowing normal respiratory function.

CPAP is not a cure for sleep apnea, it is an ongoing treatment that the user would expect to continue to sleep with every night for the rest of their life. Although CPAP can be difficult to become accustomed to for a lot of people, most people will be able to get used to it and once they have even one good night’s sleep on CPAP, the benefits outweigh the hassle. This is especially true for those with severe OSA who feel the worst effects of sleep deprivation caused by the frequent awakenings.

Our sleep study reports give a good indicator whether or not CPAP would be suitable for your needs based on the number of obstructive respiratory events per hour and the level of blood oxygen desaturation caused by the reductions in breathing. More than 30 respiratory events per hour is considered severe sleep apnea and is usually recommended to be treated with CPAP. Our sleep studies are conducted in the comfort of your own home and are the most accurate way of determining the severity of OSA and therefore the most appropriate treatment option for each individual person. Conducting the sleep study at home rather than in an unfamiliar hospital setting gives accurate data that is more reflective of a normal night’s sleep as you will be more relaxed and likely to achieve a better sleep.

CPAP is rarely used by people with mild or moderate OSA because the benefits of the treatment are less than for those with severe OSA, but the hassle, cost and difficulty to tolerate remain the same. The only time CPAP would be recommended for someone with mild OSA is if they have significant daytime sleepiness, hypertension, heart palpitations or other OSA-related symptom and need to completely rid themselves of their sleep apnea.

Many CPAP machines now have comfort features to aid treatment adherence. Heated tubing keeps the air inside the tube from condensing against the sides of the tube and making gargling noises or spitting water into the user’s face. Condensation in a CPAP tube occurs when the relatively warm air inside the tube meets the walls of the tube which are cooled by the room air, especially on colder nights. The second main comfort feature commonly found in modern CPAP machines is pressure relief, which lowers the pressure by between 1cmH2O and 3cmH2O during exhalation. This makes it easier to breathe against the pressure and helps sleep onset.

A variant of CPAP is an automatic device known as APAP. An APAP machine can be set to a minimum and maximum pressure which allows the algorithm programmed in the machine to adjust the given air pressure depending on real time breathing patterns. This is especially useful for people whose sleep apnea varies greatly between different sleep stages or positions. The user can fall asleep with a relatively low pressure and only when the machine detects obstructed breathing will it increase the pressure until breathing becomes regular again.

BiPAP stands for Bi-level Positive Airway Pressure and is usually reserved for when CPAP is not able to adequately treat sleep apnea. BiPAP gives a higher pressure when the user breathes in than when they breathe out which aids comfort if a high pressure is needed and can force the body to breathe at a normal rate. It is effectively a more extreme version of pressure relief. Where the inhalation/exhalation pressure difference for CPAP pressure relief is between 1cmH2O and 3cmH2O, BiPAP’s pressure difference is between 4cmH2O and 10cmH2O. It is not the same as a ventilator, because although it has a lower pressure to breathe against, there is still a positive pressure coming from the machine. BiPAP is used when someone is intolerant of high CPAP pressures or if a high CPAP pressure is still unable to adequately treat sleep apnea.