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Nasal CPAP

CPAP stands for "continuous positive airway pressure." CPAP pumps air under pressure into the airway, keeping the windpipe open during sleep. The forced air delivered by CPAP prevents episodes of airway collapse that block the breathing in persons with obstructive sleep apnea and other breathing problems.

It is sometimes called nasal continuous positive airflow pressure (nCPAP).

Alternative Names

Continuous positive airway pressure; CPAP; Bilevel positive airway pressure; BiPAP; Autotitrating positive airway pressure; APAP; nCPAP

Information

WHO SHOULD USE CPAP

CPAP can successfully treat most people with obstructive sleep apnea . It is safe and works well for people of all ages, including children. If you only have mild sleep apnea and do not feel very sleepy during the day, you may not need it.

After using CPAP regularly, you may notice:

  • Better concentration and memory
  • Feeling more alert and less sleepy during the day
  • Improved sleep for your bed partner
  • Being more productive at work
  • Less anxiety and depression and a better mood
  • Normal sleep patterns
  • Lower blood pressure (in people with high blood pressure)

CPAP works by keeping a steady pressure of forced air in your airway to keep it open. Other devices work in slightly different ways to treat sleep apnea:

  • Autotitrating positive airway pressure (APAP) changes pressure throughout the night based on your breathing patterns.
  • Bilevel positive airway pressure (BiPAP) has a higher pressure when you breathe in and lower pressure when you breathe out.

BiPAP is useful for children and adults who have:

  • Airways that collapse while sleeping, making it hard to breathe freely
  • Decreased air exchange in the lung
  • Muscle weakness that makes it difficult to breathe, due to conditions such as muscular dystrophy

CPAP or BiPAP may also be used by people who have:

HOW CPAP WORKS

When using CPAP:

  • You wear a mask over your nose or nose and mouth while you sleep.
  • The mask is connected by a hose to a small machine that sits at the side of your bed.
  • The machine pumps air under pressure through the hose and mask and into your airway while you sleep. This helps keep your airway open.

You may start to use CPAP while you are in the sleep center for the night.

  • Your health care provider will help choose the mask that fits you best.
  • They will adjust the settings on the machine while you are asleep.
  • The settings will be adjusted based on the severity of your sleep apnea.

If you are using CPAP but your symptoms don’t improve, the settings on the machine may need to be changed. Your health care provider may teach you how to adjust the CPAP at home. Or, you may need to go to the sleep center to have it adjusted.

GETTING USED TO THE DEVICE

It can take time to get used to using a CPAP device. The first few nights of CPAP therapy are often the hardest. You may not sleep well at the start of treatment.

If you are having problems, you may be tempted not to use CPAP for the whole night. However, you’ll get used to it more quickly if you use the machine for the entire night.

When using CPAP for the first time, you may have:

  • A feeling of being closed in (claustrophobia)
  • Chest muscle discomfort, which usually goes away after awhile
  • Eye irritation
  • Redness and sores over the bridge of your nose
  • Runny or stuffed-up nose
  • Sore or dry mouth
  • Nosebleeds
  • Upper respiratory infections

Many of these problems can be helped or prevented.

  • Ask your doctor or therapist about using a mask that is lightweight and cushioned. Some masks are used only around or inside the nostrils.
  • Make sure the mask fits correctly so that it doesn’t leak air. It shouldn’t be too tight or too loose.
  • Try nasal salt water sprays for a stuffed nose.
  • Use a humidifier to help with dry skin or nasal passages.
  • Keep your CPAP equipment clean.
  • Place your CPAP machine underneath your bed to limit noise.
  • Most machines are quiet, but if you notice sounds that make it hard to sleep, tell your doctor or therapist.

Your doctor or therapist can lower the pressure on the CPAP machine and then increase it again at a slow pace. Some new machines can automatically adjust to the pressure that is needed.

References

Basner RC. Continuous positive airway pressure for obstructive sleep apnea. N Engl J Med. 2007;356:1751-1758.

Epstein LJ, Kristo D, Strollo PJ Jr., et al.; Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management, and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5:263-276.

Kushida CA, Littner MR, Hirshkowitz M, Morgenthaler TI, Alessi CA, Bailey D, et al. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep. 2006 Mar;29(3):375-80.

McArdle N, Singh B, Murphy M. Continuous positive airway pressure titration for obstructive sleep apnoea: automatic versus manual titration. Thorax. 2010;65:606-611.

Morgenthaler TI, Aurora RN, Brown T, Zak R, Alessi C, Boehlecke B, et al. Practice Parameters for the Use of Autotitrating Continuous Positive Airway Pressure Devices for Titrating Pressures and Treating Adult Patients with Obstructive Sleep Apnea Syndrome: An Update for 2007. An American Academy of Sleep Medicine Report. Sleep. 2008 Jan;31(1):141-7.

Tomfohr LM, Ancoli-Israel S, Loredo JS, Dimsdale JE. Effects of continuous positive airway pressure on fatigue and sleepiness in patients with obstructive sleep apnea: data from a randomized controlled trial. Sleep. 2011;34:121-126.

Updated: 11/30/2013

Allen J. Blaivas, DO, Clinical Assistant Professor of Medicine, Rutgers New Jersey Medical School, Attending Physician in the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Veteran Affairs, VA New Jersey Health Care System, East Orange, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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