What is CPAP?

CPAP stands for Continuous Positive Airway Pressure. It’s a device attached to the nose or face. It is a popular treatment that uses mild air pressure to keep your breathing airways open while you sleep.

How do I know if I need CPAP?

When evaluating sleep apnea, your otolaryngologist may ask the following questions:

• Does your snoring disturb your family and friends?
• Do you have excessive daytime sleepiness?
• Do you wake frequently throughout the night?
• Have you had episodes of obstructed breathing during sleep?
• Do you have morning headaches or tiredness?

After a review of your medical history and an examination of your airway, your ENT doctor will order a home apnea test study (HSAT).

How does CPAP work?

There are three basic parts that make up a CPAP machine: motor, hose, and mask.

The motor brings in air from the room to pressurize it according to your pressure setting. The air is room temperature, and some machines have a water tank to moisturize the air. The motor also includes a filter to remove impurities from the air. Motors on most machines run quietly, and will not interrupt sleep.

The pressurized air then moves from the motor, through the connected hose to the mask.

The mask, which fits snug on your face, moves the pressurized air into your airway and lungs continuously, to prevent any collapse or obstruction.

Masks come in a variety of fits and mainly come in three different types. Nasal pillows fit directly into nostrils. This can benefit patients who feel claustrophobic since it tends to feel more open and free. Nasal masks fit over the nose only, and full-face masks cover your nose as well as your mouth. Full-face masks can be beneficial to mouth breathers

Patients that have improper masks tend to be non-compliant with their CPAP therapy.

What are the benefits of CPAP?

Appropriate use of CPAP can help improve:

• Daytime alertness
• Concentration
• Snoring
• Emotional stability
• Medical conditions

Is CPAP dangerous?

Generally, CPAP is safe. The air that CPAP delivers is generally ‘regular air’ – not concentrated oxygen. As such, CPAP is a relatively very safe medical treatment.

What are the side effects of CPAP?

Most people find CPAP comfortable and adjust well in wearing the device every night.  But in some cases, CPAP causes a few unwanted side effects. Although the side effects from CPAP are not usually serious, they can be annoying.

• Pressure sores-this occurs if the mask is too tight. Select a mask that fits comfortably or change the style and size of the mask.
• Dry nose, mouth and throat-the continuous flow of air can lead to drying of the upper airways. Use of a humidifier or moisturizer can ease the dryness.
• Leaky mask-if the mask is not fitted properly, air can leak around the side. Choose a well fitted mask and adjust it appropriately.
• Claustrophobia-wearing a mask that covers your mouth or face might lead to claustrophobia and anxiety making it difficult to feel comfortable and fall asleep. Consider using a nasal mask or nasal prongs to only cover the nose.
• Stomach bloating-air intended for the lungs might inadvertently enter the stomach leading to belly full of gas. A reduction in air pressure setting might do the trick.

How often should I clean my CPAP machine?

It is important to clean your mask and tubing every day.

How long will I use CPAP?

CPAP is a lifestyle change. It works best when used every night, for the entire time you are sleeping. You also should use CPAP when you are napping. Just one night without the treatment can have a negative impact on your health. The more you use CPAP, the better you will feel.

What are the alternative treatments to CPAP?

Alternative options depend on the cause of the obstructive sleep apne or snoring or excessive daytime sleepiness.

Conservative measures

• Weight loss-if your BMI is above 30 or collar size is above size 17 in men and 16 in women, loss of weight coupled with an exercise regime will lead to improvement.
• Tobacco and alcohol-these can cause your tongue and throat muscles to relax; avoid tobacco or alcohol for at least 4 hours before bed.
• Sleep position-risk of snoring is higher when you sleep on your back rather than your side. A simple device that can be made at home is a snug-fitting T-shirt with a pocket sewn over the spine and tennis balls placed in the pocket.

Nasal patency

• Nasal decongestants-the nose is the narrowest part of the airways. Nasal congestion can impair airflow through the nose. We suggest that individuals who snore only during a common cold receive a trial of decongestant therapy before bedtime during colds
• Intranasal steroids-nasal congestion from allergic rhinitis (nasal allergies) or chronic sinusitis may improve on intranasal steroids.
• Nasal dilators-these are devices that aim to open up the front of the nose which is the narrowest part of the airway.

Mechanical approaches

• Oral appliances-Oral appliances fit in your mouth or over your teeth while you sleep and increase the size of the upper airway, which decreases snoring. They are indicated to treat snoring when conservative therapies have failed or are inappropriate for the individual patient. OA typically work by advancing the lower jaw, changing the position of the roof of the mouth or pulling forward the tongue. They are fitted by a dentist.

Surgical options

• UPPP-This is the most common surgery to reduce or eliminate the bulky tissue in your throat.
• Palatal implants-this procedure stiffens the roof of your mouth making it less floppy.
• MMA-this aim at adjusting the bony structures and advancing the jaw
• Dental surgery-the bony structures of the mouth and jaw are adjusted
• Nasal surgery-correction of a deviated nasal septum, enlarged nasal turbinates or nasal polyps improve airflow through the nose

Disclaimer

The content on the Nairobi ENT website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions.

References

1. Force, A.O.S.A.T, and American Academy of Sleep Medicine. “Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults.” Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 5.3 (2009): 263.