Continuous positive airway pressure (CPAP) has become the first line of treatment for:
- Obstructive sleep apnea (OSA)
- Some forms of central sleep apnea (CSA)
Creates a "pneumatic splint" for the upper airway, preventing the soft tissues of the upper airway from narrowing and collapsing.
Pressurized air is sent from a flow generator through air tubing and a mask to the face - through to the upper airway.
Titration
Higher pressures may cause:
- Noise disturbance
- Claustrophobia
- Nasal irritation
These potential side effects can be minimized with appropriate equipment selection and heated humidification.
For patients who don't tolerate CPAP, AutoSet or Bilevel therapy are an alternative.
Mask Fitting
An essential element of treatment success. Higher pressures more likely produce air leak and patient discomfort. Most masks require tighter headgear at higher pressures, and tightening may cause pressure sores.
Initial Response to Treatment
Patients with severe sleep apnea may experience:
- A few days of sleep rebound, with more REM and delta sleep than normal1
- Intense sleep (on first treatment night)
- Some self-limiting nasal congestion
Once a patient's sleep debt resolves, sleep patterns should return to normal.
Approximately 10% CPAP users have some congestion after the six months of treatment. Symptoms may result from:
- Pressure-sensitive mucosal receptors responding with vasodilation and mucus production
- Fixed nasal obstruction (from either polyps or deviated septum)
- Allergic rhinits
Heated humidification can help these conditions, although for fixed obstruction it represents a second line treatment.
AutoSet™ therapy may also resolve nasal congestion and irritation because it lowers mean treatment pressures, thereby reducing pressure-related side effects.
Reference
1 Richards GN, Cistulli PA, Ungar RG, Berthon-Jones M, Sullivan CE. Mouth Leak with Nasal CPAP Increases Nasal Airway Resistance. Am J Respir Crit Care Med. 1996 Jul; 154(1): 182-6.