Positive pressure airflow therapy delivered through a mask to keep the upper airway open during sleep or to provide ventilatory support. Reduces the apnea index and decreases daytime sleepiness.
Indication
- Moderate to severe obstructive sleep apnea syndrome (AHI ≥ 15) confirmed by polysomnography
- Mild sleep apnea (AHI ≥ 5) accompanied by excessive daytime sleepiness, hypertension, cardiovascular disease, or stroke history
- Central sleep apnea syndrome and mixed-type sleep-related breathing disorders
- Obesity hypoventilation syndrome and daytime hypercapnia (elevated PaCO2)
- Chronic hypoventilation due to neuromuscular diseases (ALS, muscular dystrophy) and chest wall disorders
- Hypercapnic respiratory failure during COPD exacerbations requiring noninvasive mechanical ventilation (BiPAP)
- Temporary CPAP use in acute cardiogenic pulmonary edema
Preparation
- Overnight polysomnography (sleep study) or, in selected patients, a home sleep test
- Assessment of apnea-hypopnea index (AHI), oxygen saturation pattern, and comorbidities
- Evaluation of facial anatomy, nasal congestion, and selection of an appropriate mask (nasal/oronasal/pillow)
- Patient education on issues such as claustrophobia, dry mouth, and skin sensitivity
- Arterial blood gas and pulmonary function testing in patients considered for BiPAP
How it's performed
- At the start of therapy, an appropriate pressure range is determined by automatic (APAP) or titration study; CPAP delivers a single pressure, while BiPAP applies separate inspiratory and expiratory pressures
- An appropriate mask is fitted, leak control is performed; humidification and a heater are added if needed
- During the first nights, gradual adaptation is facilitated using the ramp feature
- Device usage data (adherence, leak, residual AHI) is monitored via cloud-based software
- In hypoventilation and neuromuscular diseases, BiPAP/AVAPS modes are used, and supplemental oxygen is added if required
- The patient is taught how to clean the device, tubing, and mask, and how to change the filter
Post-procedure
- After the first month, adherence, symptom improvement (daytime sleepiness, morning headache), and device data are evaluated
- If needed, pressure settings are re-titrated, the mask is changed, or humidification is increased
- At least one annual check; reassessment is performed in cases of weight change, pregnancy, or new comorbidities
- Monitoring of accompanying conditions such as hypertension, atrial fibrillation, and diabetes
- Regular replacement of device parts (mask 6-12 months, tubing 6 months, filter 1-3 months)
Risks
- Facial redness, pressure sores, or irritation at the nasal bridge due to mask pressure
- Air leak, dry mouth, nasal congestion, or runny nose
- Abdominal bloating and swallowing of air during breathing (aerophagia)
- Sensation of claustrophobia and difficulty adapting to the mask
- Very rarely, middle ear and sinus pressure changes, and pneumothorax
FAQ
Is the CPAP device used lifelong?
Obstructive sleep apnea is generally a chronic condition, and effective treatment requires continuity. Weight loss, surgery, and certain positional measures may reduce the need for therapy; the decision is made together with your physician.
What is the difference between CPAP and BiPAP?
CPAP delivers a single continuous pressure and is the primary treatment for obstructive apnea. BiPAP applies different pressures during inhalation and exhalation; it is preferred in hypoventilation, neuromuscular diseases, and certain COPD patients.
Can I use the device while traveling?
Yes. Modern devices are small and compatible with airplane cabins. A travel adapter and, if needed, a battery accessory are recommended. For air travel, a report stating that the device is a medical device is helpful.
Can I treat sleep apnea by losing weight alone?
Weight loss and lifestyle changes can significantly reduce the AHI, but in moderate to severe cases they may not be sufficient on their own. Device therapy is continued while these measures are also strongly recommended.
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