Positive Airway Pressure Therapy for Sleep Apnea

With obstructive sleep apnea syndrome, physical blockages or obstructions in the airway occur during sleep, usually because the back of the tongue collapses against the soft palate and the soft palate collapses against the back of the throat.

Obstructions that cause breathing to stop completely for at least ten seconds are termed apneas. When breathing is substantially reduced for at least ten seconds, it is a hypopnea. Frequent apneas and hypopneas lead to numerous brief awakenings during sleep, arousals that are usually not remembered, and to sleepiness during waking hours. Preventing apneas and hypopneas prevents the sleep fragmentation, so treatment reduces the daytime sleepiness. The precise cause of obstruction is usually difficult to find, and many people have obstructions in more than one place.

Positive airway pressure, or PAP, is the most effective and most widely used method for treating obstructive sleep apnea, particularly in its severe form—25 or more apneas and hypopneas per hour. A PAP machine works by gently blowing pressurized  room air through the airway at a pressure high enough to keep the throat open. This pressurized air acts as a sort of splint. The pressure is set according to the patient’s needs, high enough to ensure that the airway is fully open when the sleeper inhales but not so high that the sleeper is disturbed by the sensation.  (The obstructions of the airway occur during sleep but not during waking hours partly because all muscles, including the muscles in the throat, relax during sleep.)

Modern PAP machines come in a variety of designs. Some simply provide an varying continuous stream of air, or continuous positive airway pressure (CPAP); others have two pressure levels, one lower to ease exhaling (BiPAP, or vary pressure during the breathing cycle in in a series of adjustments (VPAP).

Thus the patient and the patient’s physician are confronted with a number of choices when PAP therapy is prescribed. More information about choosing a PAP device is here. More information about breathing masks is here. Discuss with your doctor all of your options to find the setup that is best for you. Which equipment you choose is less important than that you actually use it.

For information on cleaning and maintanance for your PAP device click here.