CPAP (Continuous Positive Airways Pressure) is currently the most common and effective treatment of OSA. Although certain surgeries and dental devices are sometimes used to treat OSA, the preferred treatment is CPAP. CPAP is a non-invasive method of treating OSA that most people can adapt to and learn to live with fairly easily. The CPAP machine take room air, filters it out and sends it through a hose and mask at a higher pressure than the patient would ordinarily breathe. With the mask attached to the patients nose, the extra air pressure enters the airways freely. When the patient inhales, he/she must force against the continuous air pressure, which forces him/her to use the muscles in the airways momentarily. The use of these muscles allows the airway to stay open during exhalation.
While CPAP is an effective treatment for most people, it does have its drawbacks. Some people have difficulty tolerating a CPAP mask on their face blowing air at high pressures at them while they are trying to sleep. Between 65-75% of patients tolerate CPAP well, while the other 25-35% cannot and look to other treatment options. Claustrophobics often have difficulty with CPAP because they may see the mask CPAP mask as restricting. For these patients several types of masks have been developed that may help.
Most treatments for sleep apnea, including CPAP, usually need to be used throughout the lifetime. Dental appliances need to be worn throughout the lifetime, and sometimes even the surgeries for sleep apnea need to be repeated. Probably the most effective long-term treatment for OSA is a change in lifestyle. Increased exercise and changes in eating habits can decrease weight and change body composition, reducing the likelihood of the airway closing up at night. Usually, if the patient loses weight, the obstructions in the airways will be reduced or even eliminated.
Once the patient has been diagnosed with OSA during the baseline (diagnostic) polysomnography, a CPAP titration will be ordered. The hook up for a CPAP titration is the same as a baseline study, with the addition of a CPAP mask. The montage is the same for these two studies, with the two additional channels for a CPAP study: CPAP pressure and CPAP Flow.
During the CPAP titration the technician is to slowly increase the CPAP pressure until an optimal pressure has been reached for that patient. The results of this study are then compared with the results of the baseline polysomnography to see if CPAP is an effective treatment for that patient. These same parameters are compared at each separate pressure, so the physician can see which pressure the patient responded to the best. This allows the physician to prescribe an optimal pressure for each patient.
After the physician prescribes CPAP at an optimal pressure, the patient is set up through a homecare company with a CPAP machine that is set at the prescribed pressure. The patient is also fitted with a mask, which can usually be replaced every few months, depending on the insurance company.
