Sleep apnea (sleep apnea) is a group of sleep disorders that cause you to have frequent breathing pauses during sleep. The most common type is obstructive sleep apnea (OSA), which is caused by contraction of the throat muscles.
Central sleep apnea is caused by problems with brain signals that prevent normal breathing. Less common, complex sleep apnea syndrome means you have both obstructive sleep apnea and central sleep apnea.
If left untreated, these sleep disorders can be life-threatening. Here we focus on the treatment of obstructive sleep apnea (OSA)
If you are diagnosed with sleep apnea, your doctor may recommend a breathing machine called a positive airway pressure (PAP) device to keep your airways open during sleep.
These machines attach to a mask that you wear over your nose and sometimes your mouth. While you sleep, the PAP machine provides just enough air pressure to prevent your upper airway from collapsing. This allows you to breathe easily and fall asleep without waking up.
There are three main types of machines used to treat 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 sleep apnea treatment that's best for you.
What is APAP?
Automatically adjusting positive airway pressure (APAP) machines increase or decrease the level of positive airway pressure based on changes in airflow.
It works with pressure settings from 4 to 20 centimeters of water column (cmH2O), giving you the flexibility to help you find your ideal pressure range.
As you change sleeping positions or go through different sleep stages, these different pressures allow the machine to automatically adjust to your different pressure needs throughout your sleep. The APAP machine automatically increases as needed to allow for normal breathing during sleep.
When you have OSA, the APAP machine adds enough pressure to return your breathing to normal. While you sleep, the machine's air pressure increases and decreases as needed to keep your airways open.
What is CPAP?
Continuous positive airway pressure (CPAP) devices are the most commonly used machines to treat sleep apnea.
CPAP works by providing a steady, continuous pressure during inhalation and exhalation. Unlike APAP, which adjusts pressure based on your inhalation, CPAP provides a pressure rate while you sleep.
While a sustained rate of pressure can help, this method can cause respiratory discomfort. Despite this, CPAP is still most commonly used because it is the simplest and most widely studied method of treating sleep apnea.
Sometimes, when you try to exhale, the pressure may still pass through, making you feel like you are suffocating. One way to solve this problem is to reduce the pressure rate. If this still doesn't help, your doctor may recommend an APAP or BiPAP machine.
What is BiPAP?
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 your nose.
CPAP usually provides a single pressure, while BiPAP provides two pressures: inspiratory pressure and expiratory pressure. These two pressures are called inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP).
BiPAP machines are sometimes 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 a similar low-range pressure zone to APAP and CPAP, but they offer a higher peak pressure flow of 25 cmH2O. So if you need medium to high pressure range, this machine is the best.
CPAP provides a steady, continuous pressure rate for both inhalation and exhalation. BiPAP and APAP devices are other options that allow for better control of the pressure needed to keep the upper airway open during sleep.
Potential Side Effects of APAP, CPAP, and BiPAP
One of the most common side effects of PAP machines is that they can make it difficult to fall asleep and stay asleep.
Like sleep apnea itself, frequent insomnia can increase your risk of metabolic disease, as well as heart disease and mood disorders.
Other side effects include:
- Runny or stuffy nose
- Dry mouth (common in people who wear full face masks and people who wear nasal masks but breathe through the mouth)
- Tooth decay
- Facial mask irritation to skin
- Bloating and nausea caused by pressure in the stomach
- Bacteria and subsequent infections caused by not cleaning equipment properly
Positive airway pressure therapy may not be suitable if you have any of the following conditions:
- Bullous lung disease
- cerebrospinal fluid leak
- Frequent nosebleeds
- Pneumothorax (collapsed lung)
Which machine is right for you?
It's not uncommon to not find the perfect PAP device the first time and cycle through a few different masks before finding the one that works for you. Even so, you should give both the device and the mask a chance before moving on to the other.
Using a PAP device for the first time is a new experience, so give yourself time to adapt. Going from not using a CPAP to sleeping with one can be scary and take some getting used to. However, the vast majority of people do, and once they finally get quality sleep, they actually enjoy their CPAP.
Insurance coverage may vary, with most companies covering CPAP machines first. This is because CPAP costs less and is still effective for most people.
If you cannot tolerate CPAP or if CPAP is not effective in treating your sleep apnea, your doctor may recommend another PAP device, such as APAP or BiPAP
Other treatments for sleep apnea
Oral appliances such as mandibular advancement devices or tongue retention devices are alternative treatment strategies for OSA. These devices may be available to patients with mild to moderate OSA who are unable to use a PAP machine.
Various surgical approaches have also been explored for OSA. They are primarily used in people with severe obstructive disease in the upper airways who are unable to use a PAP machine or oral device.
Even if you do use a CPAP or other machine, you may need to develop other habits to help treat sleep apnea.
lifestyle changes
In addition to using a PAP machine, your doctor may recommend the following lifestyle changes:
- lose weight
- exercise regularly
- Quitting smoking, it can be difficult, but your doctor can create a plan that works for you
- Reduce alcohol or avoid alcohol altogether
- Use a decongestant if you have frequent nasal congestion due to allergies
Change your bedtime
Because PAP treatment carries the risk of disrupting sleep, it is important to control other factors that may make it difficult to fall asleep. consider:
- Remove electronic devices from the bedroom
- Read, meditate, or do other quiet activities an hour before bed
- Take a hot bath before going to bed
- Install a humidifier in your bedroom to breathe easier
Operation
If all treatments and lifestyle changes don't make any significant difference, you may consider surgery. The overall goal of surgery is to help open your airways so that you don't rely on a pressure machine to breathe while you sleep.
Depending on the underlying cause of your sleep apnea, surgery may come in the following forms:
- Tissue contraction at the top of the throat
- tissue removal
- soft palate implant
- Jaw repositioning
- Hypoglossal nerve stimulation (an implantable medical device that reduces the occurrence of OSA by electrically stimulating the hypoglossal nerve, which causes tongue movement)
