CPAP (continuous positive airway pressure) therapy is the number one treatment for obstructive sleep apnea - but this wasn’t always the case! Prior to the invention of the CPAP machine, those with severe obstructive sleep apnea often underwent invasive surgical procedures that removed a small section of the respiratory system believed to be causing sleep apnea issues. In some cases, some patients underwent a permanent tracheostomy.
Sleep apnea is a sleep-breathing disorder that can cause serious health problems. A person with sleep apnea will stop breathing throughout the night causing loud snoring and daytime sleepiness. If left untreated, it can cause stroke, hypertension, cardiomyopathy, heart attack, and diabetes.
When people talk about sleep apnea they are usually referring to obstructive sleep apnea however there are two types of sleep apnea. Central sleep apnea is a lot less common and occurs when the airway is open, yet the brain stops signaling the brain to breathe. This is an issue with the central nervous system and occurs when it stops functioning.
Obstructive sleep apnea is when a person experiences partial or complete blockage of their upper airway during the night. Breathing stops momentarily until the diaphragm and chest muscles work hard enough to open the airway again. When airflow resumes, it is usually with a loud gasp. Every time this happens, sleep is disrupted and the flow of oxygen to vital organs is limited. Additional physical changes occur as well. Blood pressure will go up, and heart walls will thicken because of the increased workload.
Due to the severe nature of sleep apnea, it should not go untreated. This is why those with sleep apnea in the 60s and 70s underwent surgery. As you can imagine, these surgeries came with greater risk and put a lot of emotional and physical strain on the patient. Thankfully, this is no longer the case because of the CPAP invention in 1976.
In the early 70s, researcher Eliot Philipson started to develop the CPAP to treat dogs with respiratory issues. The first model was essentially a vacuum that blew out air, providing positive airway pressure. In 1976, Colin Sullivan joined Eliot Philipson, and the CPAP we know today was developed. Initially, it was used to provide positive airway pressure for dogs notorious for breathing issues like pugs, bulldogs, and boxers. However, once Philipson and Sullivan found it successful, they refined their experiment and used it on a human patient with sleep apnea.
The original CPAP machine wasn’t the sleek, quieter version you see today. Instead, it was a paint compressor with its airflow reversed. It also had tubing and a face mask attached to the that would be fastened to an individual’s face. This first model was loud, and airflow was inconsistent, but even after just one night of use, the patient reported feeling more alert than they had in years.
Over the past few decades, the CPAP has improved significantly. Masks are more comfortable, and the machine is much quieter. In addition, users can choose a mask that suits their sleeping position, making it more comfortable and practical for them. For example, there are small nasal masks or full face masks that can be used. By choosing a more comfortable, less cumbersome mask, people are less likely to pull them off or adjust them in the night.
Even though the modern versions of the CPAP machine are much more comfortable and quieter than they were previously, some people still don’t find them comfortable and have trouble falling asleep with them. These individuals may be better suited for other methods, like positional therapy.
Positional therapy reduces sleep apnea by adjusting your sleeping position. For example, using a pillow that keeps your airway open at night. A buckwheat hulls pillow is firm yet flexible enough to keep your spine and airway properly aligned. This can help keep your airway open and reduce sleep apnea. In addition, this keeps the neck and head in the proper position so the soft tissue doesn’t collapse. To read more, check out our blog post on Positional Therapy: Properly Treat Sleep Apnea.
For optimal results, a person can use a CPAP and incorporate positional therapy. The CPAP will provide air pressure high enough to prevent your airway from collapsing when you sleep. The mask is sealed to your mouth and nose, allowing you to breathe in the pressurized air with ease. These benefits will be furthered when the head and neck are kept in proper alignment.
It’s essential to work with a specialist when using a CPAP as there are common problems that can arise, making it less effective. For example, the wrong size mask or wrong style could make you feel claustrophobic or not provide a stable fit. Even with the right fit, it can be challenging to get used to. A dry, stuffy nose can also occur if your mask is leaking or you are sensitive to the air pressure. If you get a dry, stuffy nose from using a CPAP machine, you may be better equipped with a CPAP machine that also has a heated humidifier. This uses nasal saline that can help you breathe easier. A CPAP humidifier will also help with dry mouth.
One of the most common issues when using a CPAP machine is difficulty falling asleep. Wearing the mask and the sound of the machine can make it hard for some people to fall asleep. To remedy this experts recommend practicing proper sleep hygiene. Good sleep habits will help you fall asleep at night, even with the CPAP machine. A natural sleep aid can also help you unwind at night and get into a proper sleep routine.
Other breathing machines may be prescribed depending on your needs. For example, the CPAP provides air pressure at one steady level throughout the night. This differs from the APAP (automatic positive airflow pressure) machine that checks your breathing throughout the night and automatically adjusts air pressure to compensate for any changes. The BiPAP (bi-level positive airflow pressure) is often used for those who can’t tolerate CPAP machines or who have central sleep apnea. This device has two pressures settings, one for exhaling and one for inhaling.
Although these devices are most commonly used to treat sleep apnea, they are increasingly being used to treat those with respiratory distress and provide a number of health benefits for those with sleep apnea.
- Reduces your risk of stroke and heart disease
Sleep apnea is associated with stroke. A meta-analysis reported that over 50% of individuals who experience a stroke also suffer from sleep apnea. Therefore, by reducing sleep apnea, you can reduce your risk of stroke.
- Lowers blood pressure
Hypertension is when your blood pressure is higher than normal. Although your blood pressure fluctuates typically throughout the day, it can put your health in jeopardy when it is consistently high. Studies found that CPAP use can decrease blood pressure in those with hypertension.
- Decrease depression and feel more alert
Research has found that sleep apnea patients are more likely to experience depression. This can be improved when a person uses a CPAP machine. Studies have found that CPAP users who wear their CPAP for 7 hours a night report feeling more alert and less depressed.
- Reduces UARS
UARS (upper airway resistance syndrome) is a sleep disorder that is between full sleep apnea and mild snoring. This occurs when the loose tissue in the airway reduces in diameter, causing constriction and resistance. When UARS is left untreated, it often turns into obstructive sleep apnea. Although positional therapy (e.g., buckwheat pillow) can help with UARS, a CPAP is another recommended option.
You need to have a doctor’s prescription to get a CPAP machine. A CPAP machine is considered a Class II Medical Device and therefore Federal and State laws require a prescription for it to be sold. The same applies to APAP and BiPAP machines. If you believe you have sleep apnea and are snoring a great deal, you can see a doctor who will refer you to a sleep lab. A sleep lab will monitor your breathing and movements in order to determine if you have sleep apnea.
Before prescribing a CPAP, your doctor may make some recommendations first. For example, if you are overweight and get minimal exercise, your doctor may suggest weight loss. Positional therapy and a supportive pillow may also be recommended. Alternatively, you could try oral appliance therapy. Oral appliance therapy involves wearing a removable oral appliance when you go to bed. The two most common devices are mandibular-repositionable devices (MRDs) and tongue-retaining devices (TRDs), which help keep the airway clear.
The CPAP won’t work for everyone and you could experience some side-effects. Though it is less invasive than surgery, side effects include skin irritation, nosebleeds, discomfort, dry mother, aerophagia, and even infections. To avoid infection, you must clean your mask and filter daily according to the manufacturer's instructions.
A CPAP machine is a life-changing option for many. If you feel tired every day or your family complains about your snoring, you should speak with your doctor about your options and see if a CPAP could help you.
