Nasal CPAP

Nasal CPAP

Definition

CPAP stands for "continuous positive airway pressure." CPAP is a treatment that delivers slightly pressurized air during the breathing cycle.

This keeps the windpipe open during sleep and prevents the episodes of blocked breathing in persons with obstructive sleep apnea and other respiratory problems.

It is sometimes called nasal continuous positive airflow pressure (nCPAP).

Alternative Names

Continuous positive airway pressure; CPAP; Bilevel positive airway pressure; BiPAP

Information

WHO SHOULD USE CPAP

Continuous positive airflow pressure (CPAP) is the best treatment for obstructive sleep apnea. It is safe and effective in patients of all ages, including children.

After using CPAP regularly, many patients report the following:

• Better concentration and memory
• Feeling more alert and less sleepy during the day
• Improved sleep for the person's bed partners
• Improvements in work productivity
• Less anxiety and depression and a better mood
• Normal sleep patterns

A similar machine, called BiPAP (for bilevel positive airway pressure) is used as an alternative to CPAP. With this machine, the pressure changes while a person breathes in and out.

These devices are useful for children and adults with collapsible airways, small lung volumes, or muscle weakness that makes it difficult to breathe.

CPAP or BiPAP may also be used by people who have:

• Acute respiratory failure
• Central sleep apnea
• COPD
• Heart failure

HOW CPAP WORKS

CPAP works in the following way:

• The device is a machine weighing about 5 pounds that fits on a bedside table.
• A mask fits over the nose. A tube connects the mask to the CPAP device.
• The machine delivers a steady stream of air under slight pressure through this tube into the mask.

The doctor, nurse, or therapist will help choose the mask that fits you best. They will also help adjust the settings on the machine. The settings on the CPAP machine depend on the severity of your sleep apnea.

If you are using the CPAP machine but your sleep apnea symptoms do not improve, the settings on the machine may need to be changed. Some patients can be taught to adjust the CPAP at home. Otherwise, you will need to make trips to the sleep center.

GETTING USED TO THE DEVICE

It can take time to become used to a CPAP device. The first few nights of CPAP therapy are often the most difficult. Some patients may actually sleep less or not sleep well at the start of treatment.

Patients who are having problems may tend not to use CPAP for the whole night, or even stop using the device. However, it is important to use the machine for the entire night.

Common complaints include:

• A feeling of being closed in (claustrophobia)
• Chest muscle discomfort, which usually goes away after a while
• Eye irritation
• Irritation and sores over the bridge of the nose
• Nasal congestion and sore or dry mouth
• Noise that interferes with sleep (although most machines are quiet)
• Nosebleeds
• Upper respiratory infections

Many of these problems can be helped or eliminated by the following methods:

• Ask your doctor or therapist about using a mask that is lightweight and cushioned. Some masks are used only around the nostrils.
• Make sure the mask fits correctly. It should not be too tight or too loose, and it should not leak any air.
• Try nasal salt water sprays for a stuffed nose.
• Use a humidifier to help with dry skin or nasal passages.
• Keep your CPAP equipment clean.
• Place your CPAP machine underneath your bed.

Your doctor or therapist can lower the pressure on the CPAP machine and then increase it again at a slow pace. Some new machines can automatically adjust to the pressure that is needed.

References

Basner RC. Continuous positive airway pressure for obstructive sleep apnea. N Engl J Med. 2007;356:1751-1758.

Tice JA. Portable devices used for home testing in obstructive sleep apnea. California Technology Assessment Forum. March 11, 2009. Accessed June 9, 2010.

Patel NP, Ahmed M, Rosen I. Split-night polysomnography. Chest. 2007;132:1664-1671.

Epstein LJ, Kristo D, Strollo PJ Jr., et al.; Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management, and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5:263-276.

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Review Date: 9/15/2010
Reviewed By: Denis Hadjiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.