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Jay Summer, Staff Writer
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Dr. Anis Rehman, Endocrinologist
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People who are diagnosed with a sleep-related breathing disorder are often prescribed a treatment called positive airway pressure (PAP) therapy. Although there are multiple ways of delivering PAP therapy, continuous positive airway pressure (CPAP) is a common sleep apnea treatment.
Consistent use of a CPAP machine provides both short- and long-term benefits to people diagnosed with sleep apnea. Learn about using a CPAP machine, choosing the right machine for you, and tips to help you get the most out of CPAP therapy.
A CPAP machine is a bedside device that delivers positive airway pressure and is used to treat obstructive sleep apnea (OSA) and other breathing problems. People with OSA experience an abnormal number of shallow breaths or complete lapses in breathing while asleep. Abnormal nighttime breathing can result in snoring, daytime tiredness, nighttime awakenings, and a variety of other health complications.
CPAP therapy may also be prescribed to treat central sleep apnea (CSA), another sleep-related breathing disorder. In people with CSA, breathing slows or stops due to a lapse in the signals from the brain that regulate breathing.
To help reduce periods of abnormal breathing in people with sleep apnea, a CPAP machine pushes air into a person’s airway, keeping it open as they sleep. As a result, sleepers treated with CPAP should experience fewer obstructive apneas and central apneas during sleep.
A CPAP machine operates by pushing air through a tube into a sleeper’s nose, mouth, or both as they sleep. This air applies pressure to the airway, reducing the likelihood the airway will collapse and obstruct breathing. With a traditional CPAP machine, air is pushed out continuously at one fixed rate of pressure.
CPAP machines are not the only machines that can provide positive airway pressure. Understanding the differences among the various machines that deliver PAP therapy may help shed light on why a certain type of machine is recommended by a doctor or sleep specialist.
CPAP machines may deliver air at a fixed rate, or may continually change the rate of airflow based on internal technology that senses changes in a person’s breathing during sleep. When a CPAP machine emits air at varying levels of pressure, it is called an auto-titrating CPAP (APAP or auto-CPAP).
Instead of emitting a fixed rate of air, an APAP machine senses when a person’s airway is likely narrowed or blocked, then increases pressure to open the airway. On average, an APAP delivers air at a lower rate than a CPAP machine that uses a fixed rate of airflow. As a result, people using an APAP may be better able to tolerate therapy.
Unlike a fixed-rate CPAP machine that delivers air at a constant pressure, a bilevel positive airway pressure (BiPAP or BPAP) machine pushes out air at different rates, depending on whether a sleeper is breathing in or breathing out. Generally, the rate of airflow is higher as a person inhales and lower as a person exhales.
In addition to releasing air at two fixed rates of airflow, some BiPAP machines are capable of releasing air at an adaptable rate based on what the machine determines is necessary to reduce abnormal breathing. In these instances, the machine is called an auto-titrating BiPAP.
Generally, a CPAP machine is the first type of treatment prescribed to a person with obstructive sleep apnea (OSA). BiPAP may be recommended to people with OSA who do not respond well to a CPAP machine. BiPAP therapy may also be prescribed to people who have both OSA and another type of sleep-disordered breathing.
An adaptive servo-ventilation (ASV) machine is primarily used to treat people with central sleep apnea when a CPAP machine is not effective in reducing abnormal breathing. Like a BiPAP machine, an ASV releases air at different rates of pressure when a person breathes in and when they breathe out. Also, the machine delivers air at a pre-set rate of pressure when it detects the person has stopped breathing.
Like APAP and some BiPAP machines, ASV machines can also be auto-titrating. The auto-titrating ASV machines use technology to determine how much air a sleeper needs to keep their airway open as they breathe out. As a result, the auto-titrating ASV machines release air at varying pressure during exhales.
Although CPAP machines can vary somewhat depending on the manufacturer, they generally contain these components:
CPAP masks designed for at-home use come in a variety of styles. A doctor can help choose the mask that offers the best fit.
While not typically used in a person’s home, other types of CPAP masks may be used in hospitalized patients. For example, a nasopharyngeal mask involves inserting tubes into the nose that extend into the throat.
The primary benefit of using a CPAP machine is a reduction in episodes of abnormal breathing during sleep. As a result, CPAP therapy may improve symptoms associated with sleep-disordered breathing, resulting in:
Consistently using a CPAP machine overtime can provide additional benefits. For example, CPAP use may:
Although CPAP machines are very useful for treating sleep-disordered breathing, many people do not use their prescribed machine as much as recommended. Using a CPAP machine may produce side effects, such as:
When a person first begins using a CPAP machine, they might find the mask uncomfortable. They may also feel embarrassed or claustrophobic while wearing it. A person’s doctor or sleep specialist can help to minimize side effects by making adjustments or trying another mask type, or by offering suggestions to make using a CPAP machine more comfortable.
Fortunately, there are ways to make using a CPAP machine feel more comfortable if you experience discomfort or side effects at first.
CPAP machines are classified as medical devices, so they are only available with a prescription. If you are diagnosed with sleep-disordered breathing and your doctor or sleep specialist wants you to try CPAP therapy, they will likely prescribe the best CPAP machine for you. Of course, you can ask questions and give feedback if you feel the machine they choose is not a good fit.
CPAP machines range from about $500 to $1,000 or more. Optional features like a heated humidifier can add to the cost of a CPAP machine.
Health insurance may cover some or all of the cost of a CPAP machine. Check with your insurance provider or doctor to learn how much you would have to pay out-of-pocket for a CPAP machine. Follow-up visits with a doctor or sleep-specialist may be required for continued coverage of your CPAP machine.
If you are diagnosed with obstructive sleep apnea and both your doctor and CPAP supplier are enrolled in Medicare, then Medicare will cover some of the cost of your CPAP machine. Initially, they may only cover a three-month trial, then require additional doctor’s visits before continuing coverage. You may still have to pay out-of-pocket for 20% of the cost of a CPAP machine and accessory supplies, like the mask and tube.
The first step in getting a CPAP machine is to see a doctor to learn if CPAP therapy is right for you. After an initial evaluation, a doctor may refer you to a sleep specialist, who can order a sleep study if they suspect you have a form of sleep-disordered breathing. If the sleep study confirms that you could benefit from CPAP therapy, your sleep specialist or doctor will instruct you on how to select and purchase a CPAP machine.
A fixed-air CPAP releases air at a constant rate of pressure, regardless of whether or not you are breathing normally or experiencing a lapse in breathing. An APAP machine uses sensors and technology to determine when a person has slowed or stopped breathing. Then, the APAP adjusts its airflow accordingly.
Since an APAP machine can detect when a person has stopped or slowed their breathing, it can also provide an estimate of how many abnormal breathing events a person experiences per night and per hour. The machine can also detect when the mask is leaking air.
Staff Writer
Jay Summer is a health content writer and editor. She holds a B.S. in psychology and master's degrees in writing and public policy.
Endocrinologist
MD
Dr. Rehman, M.D., is a board-certified physician in Internal Medicine as well as Endocrinology, Diabetes, and Metabolism.
