The enemy of health-restoring sleep, OSA affects more than 18 million Americans. It occurs when the walls of the throat collapse and cause breathing to stop repeatedly during sleep. It can also complicate other serious medical conditions. CPAP uses a machine and mask to provide air at a higher pressure to the throat, keeping it open during sleep.
Over time, he considered the treatment more of a burden, especially keeping the CPAP machine clean and taking it along when he traveled. Clinical Topics: Sleep Apnea. Summary: When patients with OSA are unwilling or unable to tolerate CPAP therapy, the following options should be considered: First, evaluate the patient for proper mask fit, excessive leak and proper pressure settings. Current compliance software can aid in this evaluation. Consider weight loss, either though diet or bariatric procedures for obese patients.
Most patients will require other therapy in addition to weight loss, as most patients will have clinically significant residual OSA despite substantial weight loss. Thus, follow up objective testing is recommended after significant weight loss is achieved to objectively determine the need for ongoing therapy.
Oral appliances are reasonable alternatives to CPAP therapy, especially in patients with mild to moderate disease. A trained dentist should fit and adjust the device and objective testing after device titration is recommended to document treatment efficacy.
Upper airway surgery can be considered for patients who cannot tolerate CPAP or oral appliance therapy. Current data evaluating various procedures are limited and more information is required to determine which procedures may benefit certain patient groups. Newer interventions such as nasal expiratory resistive and oral negative pressure devices may offer alternatives for some patients.
These devices tend to work better in patients with less severe disease, and significant residual sleep disordered breathing should be expected in many patients. Long-term data is not available for either one of these interventions. There are currently no medications recommended to treat OSA. The impact of diet and lifestyle management strategies for obstructive sleep apnoea in adults: A systematic review and meta-analysis of randomised controlled trials.
Sleep Breath. Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: A randomized controlled trial. Practice parameters for the treatment of snoring and Obstructive Sleep Apnea with oral appliances: An update for Snoring should never occur with adequate CPAP pressure. If the CPAP device is set properly, the constant flow of air will keep the airway from collapsing and will also eliminate the vibration of tissue that causes snoring.
If you are snoring with your CPAP mask on, and the mask is not leaking, talk to your healthcare provider. The pressure likely needs to be increased to be fully effective.
In addition, witnessed pauses in breathing or episodes where you wake up gasping or choking when using the treatment are signs that the pressure is improperly set. The apnea-hypopnea index AHI indicates the number of breathing disruptions that occur per hour of sleep. If the AHI is greater than 5, as can sometimes be provided on the CPAP display in the morning or with associated apps, the pressure should be increased. If you experience these difficulties, you should speak with your sleep doctor about having the pressure adjusted.
Some people notice a significant improvement with the use of CPAP in a matter of days or weeks. This may be experienced as fewer awakenings, more refreshing sleep, decreased daytime sleepiness, or improvements in concentration, short-term memory, or mood.
If the symptoms that prompted your evaluation for sleep apnea return, this could suggest that the CPAP is not working optimally and you should speak to your healthcare provider. The most common complaint would be the return of excessive daytime sleepiness , often manifest by prolonged or frequent daytime naps. This could be due to unrecognized mask leak or even an inadequate treatment pressure. Weight gain, alcohol use near bedtime, and aging may all lead to the need to increase CPAP pressures.
Therefore, if you find that your symptoms have recurred , check in with your sleep doctor to see if things can be improved by adjusting your setting.
Unfortunately, CPAP machines do not last forever. These devices do have some degree of built-in obsolescence, meaning that they will gradually begin to fail and require replacement with a new device. Print This Page Click to Print. Peg haburp. I could not use a CPAP but eventually got used to a bipap. What is a bipap? You might also be interested in…. Improving Sleep: A guide to a good night's rest When you wake up in the morning, are you refreshed and ready to go, or groggy and grumpy?
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