continuous positive airway pressure (CPAP) - Sleep Physiology

What is CPAP?

Continuous Positive Airway Pressure (CPAP) is a therapeutic device commonly used in Sleep Medicine to treat Obstructive Sleep Apnea (OSA). This condition is characterized by repeated episodes of partial or complete obstruction of the upper airway during sleep, leading to disrupted sleep and decreased oxygen levels.

How does CPAP work?

CPAP works by delivering a constant stream of air through a mask worn over the nose or mouth. This positive pressure helps to keep the airway open, preventing the collapse that leads to apneas and hypopneas. By maintaining airway patency, CPAP ensures continuous airflow, improving sleep quality and oxygenation.

Who needs CPAP therapy?

CPAP therapy is primarily recommended for individuals diagnosed with moderate to severe OSA. Diagnosis typically involves a polysomnography or a home sleep apnea test, which measures various physiological parameters during sleep. Based on the Apnea-Hypopnea Index (AHI), a sleep specialist can determine the severity of OSA and the need for CPAP therapy.

What are the benefits of CPAP?

The benefits of CPAP therapy are numerous. Patients often report significant improvements in daytime sleepiness, cognitive function, and overall quality of life. CPAP can also reduce the risk of cardiovascular complications associated with untreated OSA, such as hypertension, stroke, and heart disease.

Are there any side effects of CPAP?

While CPAP is generally well-tolerated, some patients may experience side effects such as nasal congestion, dry mouth, or skin irritation from the mask. These issues can often be mitigated with proper mask fitting, humidification, and regular cleaning of the CPAP equipment. In some cases, patients may require a different type of mask or adjustments to the pressure settings.

How to ensure compliance with CPAP therapy?

Compliance with CPAP therapy is crucial for its effectiveness. To improve adherence, patients should receive thorough education on the importance of CPAP and proper usage techniques. Regular follow-up with a sleep specialist can help address any concerns and make necessary adjustments. Utilizing CPAP compliance monitoring can also provide valuable feedback and encourage consistent use.

What are the alternatives to CPAP?

For patients who cannot tolerate CPAP, alternative treatments include oral appliances, positional therapy, and surgical options. Oral appliances can help reposition the jaw and tongue to keep the airway open. Positional therapy involves strategies to avoid sleeping on the back, where apneas are more likely to occur. Surgical options, such as uvulopalatopharyngoplasty (UPPP) or hypoglossal nerve stimulation, may be considered for severe cases or those unresponsive to other treatments.

Conclusion

CPAP therapy remains the gold standard for treating moderate to severe OSA. Its ability to maintain airway patency and improve sleep quality has made it a cornerstone of Sleep Medicine. While there may be some challenges associated with its use, proper education, follow-up, and alternative options can help ensure effective management of OSA and improved patient outcomes.