Continuous Positive Airway Pressure (CPAP)
Continuous positive airway pressure therapy (CPAP ) uses a machine to help a person who has obstructive sleep apnea (OSA) breathe more easily during sleep. A CPAP machine increases air pressure in your throat so that your airway doesn’t collapse when you breathe in. When you use CPAP, your bed partner may sleep better too.
You use CPAP at home every night while you sleep. The CPAP machine will have one of the following:
- A mask that covers your nose and mouth
- A mask that covers your nose only—called nasal continuous positive airway pressure, or NCPAP (this type of mask is most common)
- Prongs that fit into your nose
What To Expect After Treatment
It may take time for you to become comfortable with using CPAP. If you can’t get used to it, talk to your doctor. You might be able to try another type of mask or make other adjustments.
Why It Is Done
CPAP is the most effective nonsurgical treatment for obstructive sleep apnea. It is the first treatment choice for adults and the most widely used.
How Well It Works
CPAP is effective for treating sleep apnea:
- Research shows that continuous positive airway pressure (CPAP) decreases daytime sleepiness, especially in those who have moderate to severe sleep apnea.1, 2, 3
- Studies show that in people who have moderate to severe sleep apnea, nasal continuous positive airway pressure (NCPAP) lowersblood pressure during both the day and the night.4, 5
- CPAP is better than other nonsurgical methods for treating obstructive sleep apnea.6
- People with coronary artery disease who use CPAP for sleep apnea are less likely to have heart problems such as heart failure.
Problems that may occur with CPAP include:
- Excessive dreaming during early use.
- Dry nose and sore throat.
- Nasal congestion, runny nose, and sneezing.
- Irritation of the eyes and the skin on the face.
- Abdominal bloating.
- Leaks around the mask because it doesn’t fit properly.
Nosebleeds are a rare complication of CPAP.
You can expect mild discomfort in the morning when you first start using CPAP. Talk with your doctor if you don’t feel comfortable after a few days.
Relieving side effects
You may be able to limit or stop some of the side effects:
- If your nose is runny or congested, talk with your doctor about using decongestants or corticosteroid nasal spray medicines.
- Your doctor may be able to adjust your CPAP to reduce or eliminate problems.
- Be sure the mask or nasal prongs fit you properly. Air shouldn’t leak around the mask.
- Use a humidifier or a corticosteroid nasal spray medicine to reduce nasal irritation and drainage.
- You may want to talk to your doctor about trying other types of CPAP machines.
- One type of machine will start with a low air pressure and slowly increase the air pressure as you fall asleep. This kind of machine can help reduce discomfort caused by too much constant pressure in your nose.
- A bilevel positive airway pressure machine (BiPAP) uses a different air pressure when you breathe in than when you breathe out. BiPAP may work better than standard CPAP for treating obstructive sleep apnea in people who have heart failure.8 You may find BiPAP more comfortable than CPAP because you can breathe out against a lower air pressure. As a result, you may be more likely to continue the treatment. You will have to spend the night at a sleep laboratory to find the air pressure levels that work best for you.
- An auto-titrating continuous positive airway pressure (APAP) can automatically decrease or increase the air pressure as needed. This may make the machine more comfortable and easier to use.
What To Think About
When you are using CPAP, you need to see your doctor or sleep specialist regularly. You may also need more sleep studies to adjust the CPAP machine and check whether the treatment is working.
For best results, keep the machine clean. Follow the manufacturer’s instructions for cleaning the equipment. The machines are expensive. You may be able to rent a CPAP machine before you buy it. In some cases, you may be able to rent-to-own a CPAP machine. BiPAP and APAP machines are usually more expensive than CPAP machines.
The most common problem with CPAP is that people don’t use the machine every night. Or they take off the mask during the night because it becomes uncomfortable. Even one night of not using the machine can make you sleepy the next day. If you feel like you want to stop using CPAP for any reason, talk to your doctor. There may be other treatment options for you.
The U.S. Food and Drug Administration (FDA) has approved some brands of portable CPAP machines. You may be able to take a smaller CPAP machine on vacations or other types of trips.
- Giles TL, et al. (2006). Continuous positive airways pressure for obstructive sleep apnea in adults. Cochrane Database of Systematic Reviews (3).
- Hensley M, Ray C (2009). Sleep apnea, search date May 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Weaver TE, et al. (2012). Continuous positive airway pressure treatment of sleepy patients with milder obstructive sleep apnea: Results of the CPAP Apnea Trial North American Program (CATNAP) randomized clinical trial. American Journal of Respiratory and Critical Care Medicine, 186(7): 677–683.
- Barbe F, et al. (2010). Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. American Journal of Respiratory and Critical Care Medicine, 181(7): 718–726.
- Marin JM, et al. (2012). Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA, 307(20): 2169–2176.
- Lam B, et al. (2007). Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnea. Thorax, 62(4): 354–359.
- Milleron O, et al. (2004). Benefits of obstructive sleep apnea treatment in coronary artery disease: A long-term follow-up study. European Heart Journal, 25(9): 728–734.
- Khayat RN, et al. (2008). Cardiac effects of continuous and bilevel positive airway pressure for patients with heart failure and obstructive sleep apnea. Chest, 134(6): 1162–1168.
|Primary Medical Reviewer||Anne C. Poinier, MD – Internal Medicine|
|Specialist Medical Reviewer||Mark A. Rasmus, MD – Pulmonology, Critical Care Medicine, Sleep Medicine|
|Current as of||January 14, 2014|
Bilevel Positive Airway Pressure
Bilevel Positive Airway Pressure (BiPAP) is a proprietary name of Respironics, Inc. for continuous positive airway pressure (CPAP) with pressure support breaths. It is used during noninvasive positive pressure ventilation. It delivers a preset inspiratory positive airway pressure (IPAP) during inspiration and expiratory positive airway pressure (EPAP). BiPAP can be described as a continuous positive airway pressure system with a time-cycled or flow-cycled change of the applied pressure level. CPAP, BPAP and other non-invasive ventilation modes have been shown to be effective management tools for chronic obstructive pulmonary disease, acute and chronic respiratory failure.
Another term for bilevel positive airway pressure, and the term becoming increasingly adopted by the medical community, is non-invasive positive pressure ventilation (NIPPV) or non-invasive ventilation (NIV).
Bilevel positive airway pressure is used when positive airway pressure is needed with the addition of pressure support. Common situations where positive airway pressure is indicated are those where taking a breath is difficult. These include pneumonia, chronic obstructive pulmonary disease, asthma and status asthmaticus.