CPAP Therapy and Obstructive Sleep Apnea: How It Works, Benefits and What to Exp...

Quick Takeaways

• CPAP therapy uses gentle, pressurized air to keep your airway
  open during sleep, helping support easier breathing and more restful
  sleep.¹
• Consistent CPAP use may help improve energy, focus, heart health
  and mood, while reducing symptoms like snoring and daytime
  fatigue.²
• It can take some time to get used to CPAP therapy, but many
  people report feeling better once they become comfortable using
  it.²
• Continuous positive airway pressure (CPAP) is the most effective
  treatment for adults with OSA. Alternative treatment options may be
  available if CPAP is not the right fit.³

Understanding sleep apnea

Sleep apnea is a condition where breathing stops and restarts many
times throughout the night.^3,4 These breathing pauses can
make it harder for your body to get enough oxygen. It can also affect
the quality of your sleep

Types and diagnosis

The two main types of sleep apnea include:⁴

• Obstructive sleep apnea (OSA). Obstructive sleep
  apnea is a condition where your upper airway becomes blocked repeatedly
  during sleep. These blockages can reduce or completely stop the flow of
  air, causing your breathing to pause throughout the night.
• Central sleep apnea (CSA). Central sleep apnea
  is a condition where your brain doesn’t send signals to the muscles that
  control breathing, causing breathing to pause during sleep.
  • Treatment-emergent central sleep apnea (TECSA).
    For people living with TECSA, breathing pauses continue even after sleep
    apnea treatment begins. Instead of an airway blockage, these pauses
    occur because the brain does not send the signal to
    breathe.⁵

If your doctor thinks you might be at risk of sleep apnea, they may
prescribe an overnight sleep test to help make a diagnosis. This test
collects information from your body as you sleep, including your
breathing patterns and oxygen levels. A sleep test can be done at home
or in a sleep lab.⁶

The information from the sleep test helps your doctor determine if
you have a sleep condition like sleep apnea.⁶ It can also
help them find out which type of sleep apnea you have and its
severity.

Common causes and risk factors

Sleep apnea is a common condition — nearly 1 billion people are
living with sleep apnea across the globe⁷ — with a variety of
causes and risk factors. For some people, it’s caused by unique body
structures such as a smaller airway. Sleep apnea can also be genetic,
meaning your family history could play a part in your diagnosis.

Risk factors for sleep apnea include:

• Excess weight. Fat deposits around your neck and
  throat can put pressure on your airway, making it
  narrower.⁸
• Age. As you get older, changes to the soft
  palate in your mouth and the structures around your upper airway can
  affect how you breathe. As a result, the likelihood of sleep apnea can
  increase with age.
• Certain health conditions. Conditions including
  diabetes, high blood pressure, heart disease and mental health
  disorders, such as anxiety and depression, can also be risk factors for
  sleep apnea.⁹

If you have sleep apnea, you may want to avoid behaviors such as
smoking and alcohol use.⁸ These substances relax your muscles
and cause inflammation in your airway, which can worsen your symptoms.
The same can happen when you take medications designed for muscle
relaxation, including certain sedatives and
tranquilizers.⁸

How sleep apnea impacts health and wellbeing

Untreated sleep apnea can increase your risk for conditions like
heart disease, stroke and type 2 diabetes.⁹ And because sleep
apnea tends to disrupt your sleep, it can largely impact other areas of
your life. You might notice changes in your mood, memory and ability to
focus.^{8, 11,12} Over time, these symptoms can also affect your
relationships and your job performance.

Untreated sleep apnea can also increase your risk of workplace or
motor vehicle accidents.¹³ In one study, researchers found
that people with obstructive sleep apnea (OSA) were almost twice as
likely to have an accident on the job.¹⁴

That’s why it’s important to get treatment — it may help lower your
risk of other health conditions, reduce your likelihood of a workplace
or traffic accident, and help you feel more rested and alert. Many
people who use continuous positive airway pressure (CPAP) therapy — the
most used and understood method for treating sleep apnea — report a
higher overall quality of life.¹⁵

What is CPAP therapy, and how does it work?

If you have sleep apnea, there’s a good chance your doctor will
recommend continuous positive airway pressure (CPAP) therapy. It’s a
drug-free sleep apnea treatment with virtually no side
effects.² When used as directed, CPAP therapy can help
alleviate OSA symptoms after the first night of use.¹⁷

How CPAP works

CPAP therapy uses a mask that fits over your nose and/or mouth,
connected to a machine that delivers a steady flow of air.¹⁸
This air is designed to keep your airway open and reduce breathing
pauses while you sleep.

CPAP therapy differs from oxygen therapy. While both machines deliver
air, a CPAP machine doesn’t add oxygen. Instead, it uses pressurized air
to prevent your airway from collapsing as you breathe in and out.

What’s included in a CPAP system

When you get a CPAP system, it usually comes with these important
pieces of equipment:

• Device: A CPAP device uses a motor to pull in
  air, compress it, and push it through the tubing and into your mask. It
  creates a steady flow of air at a set pressure.
• Tubing and filters: Built-in filters clean the
  pressurized air, removing dust and other tiny particles. The CPAP tubing
  carries clean air from the machine to the mask.
• Humidifier (optional): Some CPAP systems have
  humidifiers that add moisture to the air to reduce dryness and
  irritation.
• Mask: This piece fits over your nose, mouth or
  face, creating a gentle seal and keeping air from leaking out of the
  sides.

Choosing the right CPAP mask

For CPAP to work, it’s important to have a mask that fits right. It
can take a few tries to find the right mask, and it’s not uncommon for
people with sleep apnea to change their mask.

Consider the following mask options when getting started on CPAP
therapy.

Main types of masks

There are three main types of CPAP masks: nasal, nasal pillow and
full-face.¹⁹ You can also get hybrid masks designed to suit
different comfort needs or preferences.

Nasal masks

Nasal masks cover only your nose, creating a seal around your nasal
area and delivering pressurized air directly into your nostrils. With
its lightweight and compact design, this type of mask may feel
comfortable and natural for some CPAP users. Nasal masks are ideal for
people who typically breathe through their nose while sleeping.

Nasal pillow masks

Nasal pillow masks feature small cushions that fit at the entrance of
your nostrils. The minimalist design reduces contact with the face,
which people may prefer if they’re sensitive to pressure, experience
pressure sores, or have facial hair.²⁰ Nasal pillow masks can
also be a good option if you move around a lot while you sleep or prefer
a lighter and more open type of CPAP mask.

Full-face masks

This type of CPAP mask covers the nose and mouth to create a seal
that helps minimize air leaks caused by the mouth opening while you
sleep.²¹ It delivers consistent air pressure to both the nose
and mouth, which can help you breathe comfortably. You might choose a
full-face mask if you have frequent nasal congestion or if you breathe
through your mouth.

Other types of masks

Hybrid CPAP masks combine features of nasal, nasal pillow and
full-face masks, and may be an option if conventional designs aren’t the
right fit. If breathing through your nose is difficult, an oral mask
might be the right choice. You can also find total face masks that fit
around your mouth, nose and eyes.

Tips for the best mask fit

When it comes to CPAP masks, a proper fit can make all the
difference. Your mask should feel snug but not restrictive.

As you think about the options, consider a professional mask fitting.
A CPAP specialist can help you find a mask style and size that supports
both comfort and a secure fit. They can also show you how to adjust the
headgear to help minimize air leaks while you’re sleeping. For example,
you might want to tighten the straps evenly to reduce pressure points. A
CPAP specialist can help you find a mask style and size that supports
both comfort and a secure fit. They can also show you how to adjust the
headgear to help minimize air leaks while you’re sleeping. For example,
you might want to tighten the straps evenly to reduce pressure
points.

As you get started with CPAP, your doctor may recommend that you
reassess your mask choice occasionally. Changes in your sleep apnea,
pressure settings or face structure may affect which mask type feels the
most comfortable and works best for your needs.

Benefits of CPAP therapy

CPAP therapy has a range of benefits for your health and quality of
life.²² It may help:

• Prevent breathing pauses: CPAP therapy is
  designed to improve the flow of oxygen to your body and help you
  breathe. It can help lower your apnea-hypopnea index (AHI), or the
  number of times you stop breathing during the night, to a healthier
  level. CPAP therapy has been shown to reduce AHI by an average of
  86%.²³
• Improve sleep quality: CPAP therapy can help
  restore normal sleep cycles and may reduce daytime
  sleepiness.²
• Support physical health: Treating obstructive
  sleep apnea with CPAP therapy may lower blood pressure and support heart
  and brain health. It can reduce your risk of heart disease by
  64%.¹⁶
• Support mental health: Better sleep can help
  boost your mood, memory and concentration.²
• Reduce or eliminate snoring: CPAP helps you
  breathe throughout the night, which reduces noises like snoring or
  choking while sleeping. In turn, this may create a quieter sleep
  environment.²
• Improve lifespan: For people with sleep apnea,
  CPAP therapy has been shown to reduce the overall risk of death by as
  much as 37% and the risk of cardiovascular-related death by
  55%.²⁴

Getting used to CPAP

Adjusting to CPAP therapy is different for everyone; there isn’t a
one-size-fits-all approach. You may need to ease into the process as you
get used to the air pressure and learn to sleep with a mask.

What to expect in the first few weeks

When you start using a CPAP machine, you might notice results after
the first night, or it might take a few weeks to start feeling the
benefits. Keep in mind, it may take some time to get used to your CPAP
device.²⁵

During the first few weeks, it’s important not to get discouraged.
With CPAP therapy, consistency is key.

Common challenges and how to overcome them

As you get accustomed to CPAP therapy, here are a few common
challenges you might encounter and how to handle them:

• Dry nose or mouth: The air flowing into the CPAP
  mask can dry out your nose and mouth.²⁶ Consider using a
  saline spray before you go to sleep or adding a humidifier to your CPAP
  device.
• Mask discomfort: Make small adjustments to the
  straps so the mask doesn’t slip off or leave red marks on your skin. If
  that doesn’t work, talk to your doctor or your home medical equipment
  (HME) provider about trying different mask styles or sizes. Your
  provider might also need to adjust your CPAP machine settings.
• Air leaks or noise: If you wake up with dry eyes
  or hear a noise coming from your mask, you might have an air leak. Stop
  the leak by making sure the mask fits properly; it can help to adjust
  the straps while you’re lying down.
• Claustrophobia: Practice wearing the mask around
  the house while you’re awake to get used to the feeling.¹⁰
  This can help you adjust gradually before you wear it to sleep.

Adjusting to CPAP therapy may take time. By finding the right fit,
fixing air leaks and getting used to wearing the mask, you might find it
easier to stick to your sleep apnea treatment.²⁷ Be gentle
with yourself, and don’t quit or give up.

How to care for your CPAP equipment

Maintaining your CPAP equipment can help it last longer — and ensure
that you get the most from your treatment. While the specific steps
might vary depending on the model, here’s what’s usually involved in
caring for your CPAP system:

• Clean the mask cushion daily with mild dishwashing liquid and
  water.
• Clean the headgear, frame and tubing every week with mild soap
  and drinking-quality water.
• Replace your air filter every month for better air
  quality.
• Replace mask cushions around once per month.
• Replace mask frame and tubing every 3 months.
• Replace mask headgear every 6 months (or per manufacturer’s
  instructions).
• Store the CPAP device in a dry, clean place when it’s not in
  use.

Please refer to the product specific user guide for complete cleaning
instructions.

Other OSA Treatments

While CPAP therapy is the most used treatment for obstructive sleep
apnea (OSA), it’s not the only option.²⁸ If you’re having
trouble adjusting to CPAP, your doctor might recommend another
solution.

Alternatives to CPAP

Some of the most common alternatives to CPAP therapy include:

Oral appliances

Oral appliances are designed to help keep your airway open while you
sleep. This can make it easier to breathe, improve sleep quality, reduce
OSA symptoms like snoring and support better breath patterns during
sleep.

Two types of oral appliances for OSA include:

• Mandibular advancement devices (MADs) gently
  pull the lower jaw (mandible) forward. The tongue and soft tissues in
  the mouth also shift forward, making additional space in your throat for
  air to flow. In one study, up to 63% of participants using MADs reported
  that they stopped snoring due to a more open
  airway.²⁹
• Tongue retaining devices (TRDs) hold the tongue
  forward in the mouth via gentle suction, helping keep the airway
  open.³⁰ TRDs help keep the jaw still and focus on moving the
  tongue forward to keep your airway open while you sleep. They may be an
  option if CPAP or a mandibular advancement device (MAD) isn’t suitable —
  for example, if you don’t have enough teeth for a
  MAD.³⁰

Positional therapy

This type of therapy uses devices or pillows that encourage
side-sleeping:

• Body pillows: These long pillows provide support
  and create a barrier that makes rolling onto your back more
  difficult.
• Cervical pillows: These contoured pillows are
  designed to support your neck’s natural curve, which may help promote
  comfortable neck support and support head and neck positioning in
  different sleep positions.
• Anti-snore pillows: These pillows often feature
  contours that may encourage side sleeping and help support head and neck
  alignment. Some include built-in elevation features. However, they may
  not work for everyone. One study found that anti-snore pillows helped
  participants with mild to moderate OSA but didn’t provide significant
  improvement for people with severe OSA.³¹
• Modern positional devices: Using gentle
  vibrations, these devices are designed to prompt position changes during
  sleep, which may help you stay off your back without fully waking you
  up.³¹

Surgery or nerve stimulation

When other treatment methods aren’t effective, your doctor may
suggest surgery or nerve stimulation devices.

• Nasal and sinus procedures: Procedures including
  septoplasty, turbinate reduction, nasal valve surgery or sinus
  procedures may help address blockages in the nose and sinuses that can
  contribute to obstructive sleep apnea (OSA).³²
• Palate and pharyngeal procedures: These
  procedures typically aim to improve and open the airway, supporting
  better airflow. They might include uvulopalatopharyngoplasty (UPPP),
  palate implants, radiofrequency ablation of the soft palate and
  laser-assisted uvulopalatoplasty (LAUP).^41,42,43
• Tongue-based procedures: If the tongue is too
  large or positioned in a particular way, it can block the airway when
  you’re lying down. Corrective options include tongue reduction and
  tongue advancement and stabilization.³³
• Skeletal procedures: Some procedures focus on
  the jaw and other bones in the face as a treatment option for OSA. They
  include distraction osteogenesis techniques, counterclockwise rotation
  of the maxillomandibular complex and maxillomandibular advancement
  (MMA).³⁴
• Hypoglossal nerve stimulation: In this
  procedure, a small device is implanted into the neck or
  chest.³⁵ It stimulates the hypoglossal nerve, which is
  intended to move the tongue forward during sleep to help reduce airway
  blockage.
• Tracheostomy: A surgeon creates a permanent
  opening into the trachea and inserts a tube into the opening. This tube
  helps people breathe at night through the trachea, completely bypassing
  the upper airway. Tracheostomies are generally only used for severe or
  life-threatening cases of sleep apnea or for people who haven’t had
  success with any other treatment options.³⁶

Complementary strategies

Your doctor may suggest additional strategies to help support your
sleep apnea treatment:

• Weight management: Even a small amount of weight
  loss may help reduce breathing pauses for some people. Studies show that
  losing 10% of your body weight can help lower your apnea–hypopnea index
  (AHI) by 26%.³⁷
• Good sleep habits: Build a sleep routine that
  includes going to bed and waking up at the same time every
  day.³⁸ Turn off your screens at least 30 minutes before you
  go to sleep and keep your bedroom cool and dark.
• Pre-bedtime food and drink: Do your best to stay
  away from alcohol, caffeine, sedatives and heavy meals before
  bed.³⁹
• Related health conditions: If you have nasal
  congestion or allergies that affect your breathing, treating them may
  make your OSA treatment more effective. Studies suggest that using
  corticosteroid therapy to manage rhinitis may help reduce AHI in people
  with OSA.⁴⁰

Living well with CPAP therapy

As you adjust to CPAP therapy, there are a few things you can do to
stay comfortable and motivated:

• Make using your CPAP a habit. Include CPAP as
  part of your bedtime routine by putting the mask on after another
  nighttime task, such as after brushing your teeth.
• Follow up with your doctor. Schedule follow-up
  appointments with your healthcare provider to check your progress and
  adjust settings as needed.
• Track your progress. Measure your sleep quality
  and energy levels to measure changes over time. The myAir^TM
  app from Resmed can help you track progress and access helpful tips in
  one place.
• Celebrate small wins. Remember that every night
  on CPAP therapy, you’re supporting better long-term health.

Getting used to CPAP therapy can take time, but many people report
that they feel better once they get comfortable. Using your CPAP machine
regularly and making adjustments as needed can help you sleep more
soundly and improve your overall health.

Looking to learn more about your sleep? Take the sleep assessment today.

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