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CPAP Therapy Basics

What is CPAP Therapy?

Continuous positive airway pressure (CPAP) therapy is the safest and most predictably effective treatment for sleep apnea. CPAP therapy works by maintaining an open, obstruction-free airway through the flow of pressurized air. CPAP therapy (also referred to simply as PAP – positive airway pressure therapy) is administered by a CPAP machine, which uses room air and electricity to create pressure that holds the airway open throughout the breathing cycle. This pressurized air is delivered to the patient through a flexible tube and a soft mask over the patient’s nose, or nose and mouth.

Initially developed in the 1980s, CPAP therapy continues to operate under the same fundamental principle of using air pressure to keep the patient’s airway open during sleep. Thanks to steady technological development and advancements in CPAP equipment design, modern CPAP therapy is a more refined, user-friendly experience, with CPAP machines smaller, quieter and more efficient.

“The basic principles of sleep apnea therapy really haven’t changed very much,” explains Sleep Direct founder and Board Certified Sleep Physician Dr. Dan Root. “When we’re dealing with obstructive sleep apnea (OSA), which is mostly what we deal with, the therapy is all about keeping the airway open. So the concept is the same – using air pressure to keep the airway open as the primary therapy – but the current treatment tools are much better.”

“CPAP was originally developed in the ‘80s but became much more friendly in the 2000s,” continues Dr. Root. “The older CPAP machines were quite loud and the masks weren’t very comfortable. Now the machines are smaller, quieter and more portable. They even can run on 12 volts now. There are also a wider variety of CPAP mask designs available, which are more comfortable. All of these developments have been really beneficial for patients and their CPAP therapy options.”

CPAP Therapy Machines

A variety CPAP machine types are utilized to treat sleep apnea. Positive airway pressure (PAP) remains the underlying operating principle behind all of these different machines, but there are important distinctions with each type and an array of advanced features available. Some of these features are comfort or performance-oriented upgrades, while others are medical necessities to treat the various forms of sleep apnea, or they are required by the severity of symptoms. (Read Sleep Apnea Facts & FAQ for more information about sleep apnea.)

  • Standard CPAP – CPAP machines deliver airflow at a fixed pressure setting for the treatment of OSA. Many of these fixed-pressure CPAP machines still offer comfort-enhancing features like an adjustable ramp setting, which lowers initial pressure to help people fall asleep faster. While a standard CPAP might be considered a no-frills option, it’s usually quite cost-effective for the majority of patients with mild to severe sleep apnea.

  • AutoPAP (APAP/Auto-CPAP) – AutoPAP (automatic positive air pressure) therapy works like standard CPAP, but automatically adjusts air pressure based on the needs of the patient. An AutoPAP machine’s internal electronics and algorithms can sense, or even anticipate, obstructive events and automatically modify the pressure setting accordingly. Since AutoPAP drops pressure levels when less pressure is required by the patient, it may, therefore, be more comfortable than a standard fixed pressure CPAP. These machines also commonly eliminate the need to spend a night in the sleep lab determining appropriate treatment pressures. The refinements of AutoPAP machines, which are virtually identical in size and shape with their CPAP counterparts, make them quite popular and they are fast becoming the preferred first-choice option for sleep apnea therapy.

  • Bi-Level PAP (BiPAP/BPAP) – Bi-Level PAP machines use air pressure to keep the airway open like CPAP, however, they deliver a different pressure setting during inhalation versus exhalation. Bi-Level therapy is typically prescribed for patients requiring higher pressure settings for severe OSA, with a lower exhalation pressure helping make the therapy more comfortable. It may also be used when patients need extra ventilation.

  • ASV / BiLevel ST – Asynchronous Servo Ventilation (ASV) and Bi-Level ST are advanced PAP therapies used to treat central sleep apnea (CSA), as well as other medical conditions involving a decreased respiratory drive. While ASV and Bi-Level ST use slightly different strategies, both play a more active role in initiating breathing (ventilation) of patients with CSA. A Bi-Level ST machine offers different pressures for inhaling and exhaling, just like a standard Bi-Level machine, but will intervene if an extended breathing pause (aka apnea) is detected. ST stands for “spontaneous timed” – allowing patients to breathe spontaneously but initiating a breath when an apnea pause exceeds the timing trigger.


Diagnosis and CPAP Therapy Prescription

A decision about what type of CPAP machine to use and the correct settings is determined by the patient’s clinical situation with some deference to personal preference. For most patients, this process begins by consultation with a medical provider or sleep professional followed by sleep testing of some sort. In the past, sleep testing was predominantly done at a sleep lab or hospital for the initial sleep apnea diagnosis and followed up by another sleep study using CPAP to determine the optimal pressure settings. However, as the technology of sleep testing and CPAP therapy has improved, so have the diagnostic tools used by medical professionals. Most patients can now undergo their initial sleep study at home, and CPAP therapy can also commonly be started at home with Auto-CPAP. (For more in-depth information read How Do I Get CPAP Prescription and Sleep Apnea Diagnosis.)

“Most patients are now diagnosed and treated for obstructive sleep apnea entirely at home,” says Dr. Root. “In the traditional model, even up to a few years ago, the standard process was a diagnostic study in the sleep lab and then bringing most people back for a second night with CPAP to figure out the appropriate treatment settings. But with the AutoPAP machines now being so good, we don’t need to do that, so we can save a lot of time and money by just starting therapy at home.”

Most modern CPAP machines also offer built-in wireless/Bluetooth connectivity, so the patient’s therapy data can be monitored and even adjusted remotely. In other words; getting diagnosed and treated for sleep apnea is easier than ever – and the results are worth the effort!

Therapeutic Results of CPAP Therapy

CPAP therapy delivers a wide range of benefits to patients. These include immediate positive changes in quality of life, as well as the potential improvement or reversal of long-term health impacts from sleep apnea. The individual results of CPAP therapy are as varied as the patients themselves, but for some the immediate outcomes are dramatic.

“I routinely have patients where sleep apnea therapy has changed their life,” says Dr. Root. “They feel like they can actually live again, where before they were miserable. I had one patient, who after one night of CPAP in the sleep lab, just hugged me in the morning. He hadn’t felt so good in 30 years.”

Typical results of CPAP therapy include:

  • Immediate reduction or elimination of snoring
  • Better sleep quality, with more restful, restorative sleep
  • Improved daytime alertness, cognition and ability to focus
  • Lower blood pressure
  • Improvement of abnormal heart rhythms like atrial fibrillation
  • Significant reduction of repeat cardiac events and improved heart function
  • Improvement of physical heart abnormalities, like enlarged size and thickening of the muscle tissue
  • Reduction of insulin resistance in diabetics
  • Improvement of sexual health, including erectile dysfunction

The most immediately noticeable benefit of CPAP therapy is the elimination (or dramatic reduction) of snoring. At least that’s the most immediately noticeable benefit to the patient’s long-suffering spouse or bed partner! In fact, the overnight change in snoring is so dramatic that it can be unnerving.

“It’s not uncommon for the first night of CPAP to actually freak out the spouse because there’s no more snoring and they’re so used to the noise. I’ve spoken with spouses that were staying up wondering if their husbands are still breathing,” explains Dr. Root. “But once they get used to it, the bedroom becomes a much better place to be.”

Improved sleep quality from CPAP therapy also reduces or eliminates the sleep apnea symptoms caused by sleep deprivation. Many patients report they feel more alert, with a better ability to focus. No more morning headaches or dry mouth. No more chronic daytime drowsiness. You feel better from CPAP therapy because you’re finally enjoying restful restorative sleep!

CPAP Therapy Improves Heart Health

The most destructive long-term consequences of untreated sleep apnea affect the cardiovascular system. Sleep disordered breathing triggers a number of physiological responses, including adrenaline surges in the bloodstream. These surges raise blood pressure and heart rate at a time where they are normally lower. The heart also has to pump extra hard to circulate enough oxygen. Eliminating the airway obstruction that causes apneas in OSA thereby eases the heart’s workload. Simply put, the resolution of airway obstruction helps improve overall cardiovascular health.

“When you eliminate sleep apnea and its related problems, you can decrease the amount of work your heart needs to do, so it can normalize its function,” says Dr. Root, noting the quantifiable, measured benefits of CPAP therapy on heart health include: “People with abnormal heart rhythms, such as atrial fibrillation, have twice the likelihood of staying in a normal heart rhythm if you treat the sleep apnea than if you don’t. Patients with heart failure can see a 10% improvement in heart function by using CPAP, and there can be a significant reduction in repeat cardiac events. Some patients with sleep apnea can also develop a thickening of the heart muscle, and you can see an improvement of that within six months as well.”

CPAP Therapy on Sex & Intimacy

There remains one more important quality of life improvement from CPAP therapy that is often unexpected by the patient, but certainly doesn’t go unappreciated.

“One of the things people complain about when first thinking about CPAP is that it’s really going to interfere with intimacy, but CPAP therapy tends to actually improve people’s sex life,” claims Dr. Root. “When you have untreated sleep apnea you’re often too tired for sex, and erectile dysfunction is associated with sleep apnea as well. CPAP therapy can eliminate these issues. It makes you feel more rested, makes the plumbing works better, and the partners don’t have to worry about the snoring anymore, so they can sleep better afterward. The whole sleep environment is better for everyone.”

Early development of erectile dysfunction in men is commonly associated with untreated sleep apnea. And while CPAP therapy can’t guarantee a reversal or improvement in ED, there is evidence that it can help.

“One patient came in with fatigue, erectile dysfunction and just didn’t feel well” relates Dr. Root on one particularly memorable case study. “I diagnosed him with sleep apnea and prescribed CPAP therapy. I told him that I didn’t expect it would fix his ED, but then four months later he came back somewhat both happy and angry with me. I’d led him to believe it would never get better, but once he got into his therapy for sleep apnea everything worked again and he was so happy. It just made a tremendous difference for him.”

CPAP therapy isn’t a panacea, but it does offer a practical solution to sleep apnea and the cascading health issues tied to it. While patients may not yield the dramatic overnight results reported by many who start CPAP therapy, there are important real-world health gains to be enjoyed from dedicated, steadfast compliance with properly setup CPAP therapy.

Don’t suffer in silence any longer. If you or your loved one suspect sleep apnea could be affecting your life contact a trusted medical professional and enquire about CPAP therapy.

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