Continuous positive airway pressure, or CPAP, is The most common treatment is recommended. For obstructive sleep apnea (OSA). CPAP involves wearing a mask that matches over the nose, under or above the nose, or over the nose and mouth, through which pressurized air is delivered through a tube from a machine to the upper airway during sleep. Can be kept open. CPAP is really helpful by American Academy of Sleep Medicine (AASM) as initial treatment for moderate or severe OSA, and in mild cases of OSA when related to insomnia, sleep disturbances, or excessive daytime sleepiness. When used consistently, and when treatment is effective, CPAP improves daytime sleepiness, quality of life, and may have positive effects on cardiovascular and metabolic health.
The effectiveness of CPAP is determined by correct and consistent use of the device, as OSA is a chronic disease that requires long-term treatment. Most sleep doctors, myself included, recommend that insomniacs use their treatment each time they go to sleep, to get essentially the most profit. While there are various patients who love their CPAP machines and report the treatment to be life-changing, and can’t sleep without CPAP, there are others who learn to just accept and tolerate CPAP because They either appreciate the functional advantages (resembling improved mood and fewer daytime sleepiness) or the clinical improvements they experience from using the device. However, many patients struggle with CPAP.
CPAP just isn’t easy and there are common complaints.
Despite the various potential advantages, estimates of CPAP adherence from clinical data and insurance groups suggest that roughly 50% of CPAP users either don’t reach minimum adherence criteria or discontinue treatment. Each patient is exclusive and could have individual struggles with CPAP. However, there are common themes amongst users. Some common complaints I hear from patients who’ve difficulty tolerating CPAP are:
- Mask problems, including mask discomfort, skin irritation or scarring, feelings of claustrophobia, or discomfort with the looks of wearing a mask
- Dryness, especially waking up with a dry mouth
- Removing the mask while sleeping
- Stress intolerance, either from an excessive amount of pressure or from enough pressure; Difficulty respiration against CPAP pressure; or swallowing air (aerophagia)
- Breathing that feels out of sync.
- Machine noise disturbs the patient or their bed partner.
Troubleshooting problems with CPAP tolerance
First and foremost, patients must partner with their doctor and healthcare team. OSA is a serious disease that requires treatment. Before starting treatment, patients must be educated about OSA, study all treatment options and latest technologies, and know what to anticipate from CPAP. Patients profit from close clinical follow-up, including review of their CPAP device data (which can also be necessary for continued insurance coverage). Family and/or partner support can also be necessary, as friends or family may also help encourage and support CPAP use.
Other suggestions for improving the method:
- Behavioral and drugs interventions. Cognitive behavioral therapy or short-term use of sleep medications may also help people adjust to CPAP.
- The right mask. If the mask doesn’t fit, the treatment may not work well. There are many sizes and forms of masks, including nasal masks that fit above or below the nose, nasal pillows that fit within the nose, full face masks that cover the mouth and nose, hybrid masks that fit over the nose Sitting down covers the mouth, and even helmet masks that cover the face. A mask is really helpful when patients begin treatment, and several other fittings could also be required.
- Breathing through the mouth There is one other factor to think about regarding masks. When the patient sleeps with the mouth open, the CPAP pressure is released through the mouth. This causes dryness, and in addition prevents CPAP from keeping the upper airway open. Mask leaks may end in noise and mask removal during sleep. A mask covering the mouth could also be required, although sometimes wearing a chinstrap can keep the jaw closed and stop mouth respiration.
- Correct pressure. Some people need more pressure on their back versus their side, or in a single stage of sleep versus one other. While a pressure range may be helpful, if the range is simply too wide, the machine may not adjust quickly enough to fulfill pressure needs. Changes in weight may affect pressure requirements. Tracking device data and/or review with a therapeutic sleep study in a sleep lab may also help discover optimal pressures.
- Address co-existing conditions. Some people use CPAP repeatedly, tolerate it, but still get sleepy. CPAP just isn’t an alternative to inadequate sleep. Insomnia can coexist with other sleep problems that may contribute to daytime sleepiness. Sometimes CPAP just isn’t tolerated because sleep is poor, or fragmented because of other problems resembling anxiety, PTSD, insomnia, poor sleep habits, or circadian disorders. These other issues have to be addressed.
- Consider alternative treatments. CPAP is a first-line treatment, but not the one treatment for OSA. If CPAP just isn’t tolerated or desired, consider combination therapy or alternative therapies.
New CPAP innovations may also help.
Quite a lot of technological advances can improve the comfort and effectiveness of CPAP. Some of them are included.
- Warm irrigation, a soothing intervention that may also help with nasal congestion and dryness.
- Ramp-up features that allow the machine to begin at low or minimal pressure while the patient adjusts and falls asleep
- Expiratory pressure relief, where the pressure from the machine is reduced barely during exhalation, is particularly helpful when a better pressure setting is required to maintain the airway open.
- Auto-titrating CPAP machines, which permit a pressure range to be set. The machine itself adjusts the pressure when it senses that kind of pressure is required to maintain the airway open. This is useful for many who need more pressure in a single body position (back vs. side) or sleep phase (dream/REM sleep vs. nondream/NREM).
- Modems that allow the machine to transmit data (either via cellular or Wi-Fi), so each the patient and their doctor can determine the effectiveness of the treatment.
The bottom line
CPAP is an efficient treatment for OSA. If you're scuffling with CPAP tolerance, don't hand over, but discuss with your physician. Appropriate education, support, personalized therapy, latest technologies, and shut clinical follow-up can improve the method and improve treatment outcomes.