Positive Airway Pressure (PAP) Therapy for Sleep Apnea

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Raj Dasgupta, MD

Positive airway pressure (PAP) therapy helps treat sleep apnea. It uses a machine that blows air into a mask you wear while sleeping. This air keeps your airway open, so you can breathe normally. It’s important to use the machine every time you sleep, even for naps, to get the best results.

PAP therapy is safe and works well for most people. But if you have certain conditions like bullous lung disease, pneumothorax, cerebrospinal fluid leak, or severe nosebleeds, talk to your doctor before starting this treatment.

Conditions Treated by PAP Therapy

Positive Airway Pressure (PAP) Therapy

Here are some problems that Positive Airway Pressure (PAP) Therapy can help with:

1. Obstructive sleep apnea (OSA)

This happens when someone stops breathing during sleep because their airway gets blocked.

2. Snoring

When the flow of air into the lungs is blocked, it can cause snoring. This happens when extra air goes into the mouth and vibrates the soft tissue of the palate.

3. Central sleep apnea (CSA)

Breathing pauses during sleep that aren’t caused by a blockage but by problems with the central nervous system.

4. Upper airway resistance syndrome (UARS)

A condition where the upper airway narrows during sleep, leading to poor sleep quality. It can cause snoring, feeling tired during the day, trouble thinking clearly, not feeling rested after sleep, and waking up frequently during the night.

Types of Positive Airway Pressure Therapies

There are three main types of Positive Airway Pressure (PAP) therapies: Continuous Positive Airway Pressure (CPAP), BiLevel Positive Airway Pressure (BiLevel), and Auto-titrating devices.

1. Continuous Positive Airway Pressure (CPAP)

Continuous Positive Airway Pressure (CPAP) therapy delivers a fixed level of air pressure throughout inhalation and exhalation. It’s usually the first choice for treating sleep disordered breathing. While effective for many, it might not work for everyone. If symptoms persist, adjustments or trying other PAP options like BiLevel or Auto-titrating devices may be necessary.

2. BiLevel Positive Airway Pressure (BiLevel)

BiLevel Positive Airway Pressure (BiLevel) machines provide two different pressures: higher during inhalation and lower during exhalation. This helps the lungs work more efficiently. Most BiLevel machines adjust pressures based on your breathing, but some patients with complex pulmonary issues might need fixed respiratory rates.

3. Auto-titrating devices

Auto-titrating devices adjust air pressure based on your breathing patterns, allowing pressure variation through the night. They’re useful for those needing higher pressure at certain times, like when sleeping on their back or during REM sleep. These devices can adapt to minor weight changes or sedative use, but mask leaks might affect their accuracy.

Each type of PAP therapy has its advantages and considerations. Discussing options with a healthcare provider can help find the most suitable treatment for individual needs.

For mild cases of sleep apnea, you may use some anti-snoring devices or anti-snoring mouthpieces.

Tips for Using Positive Airway Pressure (PAP) Therapy

Here are some easy tips for using Positive Airway Pressure (PAP) therapy:

  1. Stay consistent: Even if you wake up during the night, try to keep your PAP mask on. Sleep apnea is often worse during the early morning hours, so using your PAP consistently is crucial.

  2. Prevent condensation: If you notice water building up in your mask or tube (called “rain out”), try putting the tube under the covers if you use a heated humidifier and keep your room cool. Some condensation is normal, but too much can be bothersome.

  3. Manage your tube: Keep the connector tube out of the way by looping it through the headboard or wedging it between the mattress and the wall. Make sure there’s enough slack to move comfortably.

  4. Protect your skin: Reduce skin irritation by alternating between two masks and selecting different styles to prevent pressure points. Don’t tighten the mask too much—just enough to prevent leaks. Clean your mask regularly with a gentle, dye-free, perfume-free soap.

Tips for Properly Fitting Your Mask

Getting the right fit for your mask is important for a good night’s sleep. Here are some tips:

  1. Ideal Fit: Ideally, a trained sleep technologist or respiratory therapist should help you with the fit. However, even if it feels perfect in the lab, things might change at home. Your mask should be snug but not so tight that it feels glued to your face. It should have some give, so it moves with you during the night to maintain the seal. For most nasal mask styles, there should be enough slack in the headgear to allow you to pull the mask about an inch away from your skin.

  2. Fixing Leaks: If your mask leaks, try pulling it away from your face and then reseating it. If that doesn’t work, check the straps. If a nasal mask is leaking, it might be because the strap kitty-corner to the leak is too tight or the one closest to the leak is too loose. Make sure the tension of the straps is equal.

  3. Dealing with Claustrophobia: Feeling claustrophobic? Changing to a different mask style might help. Try a nasal pillow style or, surprisingly, a mask that covers both your nose and mouth. You can also try holding the mask in place with your hand for a few minutes before putting on the headgear.

  4. Heated Humidification: PAP therapy can make your sinuses dry and the cold air from the machine might irritate them. Adding heated humidification can help reduce dryness and congestion, which can minimize mouth breathing. Just be careful not to set the heated humidification too high, as it could lead to excessive condensation or “rain out.”

Side Effects of PAP Therapy

Using PAP treatment is generally safe and works well for sleep apnea. But getting used to wearing the mask and breathing with the air pressure might take some time. As you adjust to your new machine, you might notice:

  • Stuffy nose
  • Headaches
  • Irritated skin
  • Feeling bloated in your stomach

These side effects usually don’t last long and can be eased by:

  • Trying different mask styles
  • Using a humidifier to moisten the air

Why Is PAP Therapy Prescribed?

PAP therapy is prescribed because the air pressure needed to keep the airway open varies for each person. This pressure, measured in cm H2O, prevents airway collapse during sleep. If it’s too low, the airway can collapse; if it’s too high, you can over-breathe, both impacting sleep quality.

Factors like OSA severity and airway structure determine the right pressure, found during a CPAP Titration sleep study. PAP treatment types include CPAP, BiLevel, and Auto-Titrating Devices.

While generally safe and effective, some conditions like bullous lung disease or severe nosebleeds may warrant caution. Always inform your doctor of any relevant health issues.

Need professional help to diagnose and address your sleep problems? Schedule an online consultation with sleep specialist Dr. Owen Napleton.

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