Positive Airway Pressure (PAP) Therapy

Positive Airway Pressure (PAP) therapy is a widely used treatment for sleep apnea that uses a stream of compressed air to keep the airway open during sleep. In PAP therapy, patients wear a mask connected to a machine that blows pressurized air into the upper airway. This airflow prevents the airway from collapsing, allowing normal breathing throughout the night. For the best results, it's important to use the PAP machine every time you sleep, including during naps. PAP therapy is effective because it ensures a steady supply of air, keeping the airway unobstructed and promoting regular breathing. This treatment is crucial for anyone with sleep apnea, as it can significantly improve sleep quality and overall health.

PAP therapy is used to treat several sleep-related breathing disorders, including:

Obstructive Sleep Apnea (OSA): This condition occurs when a person stops breathing during sleep due to a blockage in the airway.

Snoring: A common condition caused by airway obstruction, leading to the vibration of soft tissue in the palate as air is redirected into the mouth.

Central Sleep Apnea (CSA): Characterized by pauses in breathing during sleep, not due to airway obstruction but due to issues with the central nervous system.

Upper Airway Resistance Syndrome (UARS): A condition where the upper airway is partially blocked during sleep, leading to disrupted sleep, snoring, daytime sleepiness, cognitive issues, unrefreshing sleep, and frequent awakenings.

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Types of PAP

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Continuous Positive Airway Pressure (CPAP)

CPAP devices provide a constant, predetermined level of air pressure throughout the night. This consistent pressure remains the same during both inhalation and exhalation. CPAP is often the first line of treatment for sleep-disordered breathing and is known for its straightforward approach to keeping the airway open. It is the most commonly used PAP therapy due to its effectiveness for many patients with sleep apnea.

BiLevel Positive Airway Pressure (BiPAP)

BiPAP devices deliver two different pressure levels: a higher pressure during inhalation and a lower pressure during exhalation. This dual pressure system helps the lungs operate more efficiently and can provide up to 30 cmH2O of pressure. BiPAP is often prescribed for patients who have difficulty tolerating CPAP or who experience persistent low oxygen levels despite CPAP use. It can also be beneficial for individuals with more complex pulmonary conditions, such as chronic pulmonary disease or emphysema, as well as for treating central sleep apnea (CSA).

Auto-Titrating Positive Airway Pressure (APAP)

Auto-titrating PAP machines, or "Auto-CPAP", adjust the air pressure based on changes in your breathing patterns throughout the night. These devices use an algorithm to increase pressure when breathing is compromised and decrease it when normal breathing resumes. APAP machines are ideal for individuals who require higher pressure only during certain times, such as when sleeping on their back or during REM sleep. The variable pressure feature ensures that patients receive the minimum necessary pressure, improving comfort. APAP devices can also adapt to minor weight fluctuations or the effects of alcohol or sedatives.

What to Expect?

PAP therapy requires a prescription because the air pressure needed to keep your airway open, known as the therapeutic pressure, varies for each person. This pressure is measured in centimeters of water (cmH2O), and most PAP machines can be adjusted to deliver pressures between 4 and 20 cmH2O. Getting the pressure setting right is crucial: if it's too low, your airway may still collapse; if it's too high, you might be over-ventilated. Both scenarios can negatively affect your sleep quality. Factors influencing the therapeutic pressure include the severity of obstructive sleep apnea (OSA) and the structure of your airway. Your optimal pressure level is usually determined during a CPAP titration sleep study.

Adjusting to PAP therapy can take some time, typically ranging from a few weeks to a few months. It's important to recognize that this is a significant lifestyle change, requiring both mental and physical adaptation. Reminding yourself of the importance of this treatment can help you stay motivated and compliant with your therapy.

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Reference

Mount Sinai - National Jewish Health - Respiratory Institute (n.d.). Understanding PAP - A Guide to Positive Airway Pressure (PAP) Therapy. Mount Sinai - National Jewish Health. https://www.mountsinai.org/files/MSHealth/Assets/HS/Locations/Respiratory-Institute/Understanding-Positive-Airway-Pressure-PAP-Therapy.pdf
Stanford Medicine Health Care (n.d.). Positive Airway Pressure (PAP) Therapies. https://stanfordhealthcare.org/medical-treatments/p/positive-airway-pressure-therapies.html#:~:text=With%20PAP%20therapy%2C%20you%20wear,apnea%2C%20thus%20allowing%20normal%20breathing.