Positive Airway Pressure
Positive Airway Pressure machines
3 types (plus a hybrid):
o CPAP (blows air at the therapeutic pressure at you all the time, whether you are breathing in or out)
o BPAP (jumps the pressure up to the therapeutic pressure when you breathe in, then drops the pressure down when you breathe out)
o APAP (sits at a low pressure and only jumps it up to the therapeutic pressure when your throat starts to collapse)
o Hybrid (is both a CPAP and an APAP). You should generally purchase this, unless there is a good reason why not – there are 3 such machines, the AirSense 10 For Her (ResMed), the Dreamstation (Phillips), & SleepStyle (Fischer & Paykel).
o There are many machines; made by different manufacturing companies
§ Basically, they all do the same 4 things
· Pressurize the air
· Filter the air
· Humidify the air
· Record the functional data of your use – especially your apnea frequency, the leaking of your mask, the hours of your use and presents this data to you on your machine after your sleep.
§ They differ in other functions that are not core issues for example:
· Drop the pressure a little when you breathe out – more comfortable
· Can start the pressure automatically when you breathe in and turn the pressure off when you take it off in the night when you go for a bathroom break or in the morning when you get up for the day.
· Presents your night data in more sophisticated ways – many machines will now send you, the information mentioned above, on your computer or your smartphone. This allows you to stay in charge of this disease in the years to come. You will always know if your sleep apnea is under control or not, whether your mask is holding the pressure well, and whether the machine is reporting your hours of use accurately.
o The PAP system consists of a machine, a hose, a mask and headgear to hold the mask on your face.
o Masks – about 20 of them
§ 3 classes (2 nasals and 1 full face; about 7 masks in each class and 3 sizes for each mask)
· Nasal masks
o Prongs / cushions - fit inside your nostrils
o Cups – fit over your nose
· Full-face masks - fit over your nose and mouth
At-Home APAP Titration Study:
o Under prescription a Respiratory Company of your choice will rent you an APAP system.
o You will be provided with an APAP machine set to a range that will cover the CPAP therapeutic pressure needed by most people.
o This machine will provide you and your sleep doctor with details of your 1-month trial. These data will be reviewed by your sleep doctor at the end of the 1-month trial to ensure you have been set at the optimum range and that your sleep apnea is under control.
o If everything is controlled (apneas, oxygen levels, sleep fragmentation, & snoring), then you will receive a purchase prescription.
InLab CPAP Titration study
o run in the Sleep Laboratory
o will try masks from all classes on you before you go to bed; you will choose some that are comfortable, and we will use those during the night
o we will watch to see if you are a mouth breather; if a bit, then you can often still use a nasal mask with a chin-strap; if you are a big mouth breather, a full-face mask will be more comfortable for you.
o We will raise the pressure slowly through the night to find the lowest effective pressure (that which controls the apnea, the snoring, your wake ups, and your oxygen levels).
Post-titration you will have:
§ a prescription that will allow you to trial or purchase a positive airway pressure (PAP) system
§ a list of Respiratory Companies:
· From whom you can purchase your PAP system. They will show you the different PAP machines and tell you about their differences. They will train you in their use.
· They will show you and try you on different masks (tried at your therapeutic pressure); don’t buy the first mask you try on; try a number of them before choosing. Remember all masks you buy have a 1-month trial warrantee. If it does not work well for you, you may take it back in the first month and trial another mask with reimbursement of the cost of the initial mask.
· They will look after you for technical problems initially and over the years to come. If you are having difficulty, don’t wait; call your Respiratory Company. They are very knowledgeable and will be able to help you.
· They will sell you new equipment when necessary
· They will check your machine for you (take it in annually for this)
· They will download the data of your machine, on request, and send it to your doctor to monitor so that developing problems can be identified early; or they will allow you and your doctor to download your machine’s data from a protected site on the Internet.
· The Hybrid machines - will send you a report every day that will tell you how you did last night (non-breathing events, mask leaks, hours of use), so you will be able to know whether your apnea is under control / your mask is working well, and your machine is measuring and remembering your use hours accurately. This puts you in charge of this disease.
Using your machine at home:
· you will then take it home and start using it to help your sleep.
· Please read carefully the 4 skills you need to acquire to make a success of you PAP treatment (above on page 6).
· Go back to your Respiratory Company for help with technical problems
· Go back to your doctor (here at the Sleep Clinic initially; later to your Family Doctor who will be supervising your sleep apnea treatment) for clinical problems (ongoing or return of sleep apnea symptoms or the worsening of sleep apnea associated diseases – described above). Once you have been stabilized on successful treatment, you will be returned to your Family Doctor for follow-up. You can be referred back to the Sleep Clinic for further assessment or care at any time.
I hope you will be successful in mastering your PAP treatment and avoid the many serious problems that untreated sleep apnea causes.
Dr. John B. Carlile 2022