Breathing Easy: The Role of Positive Airway Pressure Therapy in Obstructive Sleep Apnea

OSA is characterised by complete or partial stop in breathing at night, leading to arousal from sleep and reduced saturation of oxygen. Commonly seen with obesity, large neck, chronic respiratory diseases. OSA leads to snoring, daytime sleepiness, reduced alertness, fatigue, which is treated by lifestyle changes, treating underlying conditions effectively.

What is Positive Airway Therapy? How does it help in OSA?

PAP means positive airway pressure. Continuous PAP (CPAP) is the most common form of PAP that is used for OSA treatment.

PAP is delivered using a mask that blows air into the throat through the nose or mouth, or both This blowing of air causes a positive pressure to hold the upper airway (back of the throat) open during sleep When the upper airway is open, airflow can pass to the lungs undisturbed.

What are benefits of PAP ?

• Helps reduce snoring

• Patients will sleep better without snoring or waking up

• Reduces desaturation & its harm on lungs

Continuous PAP (CPAP) vs Bilevel PAP (BiPAP)

• CPAP and BIPAP are common types of PAP therapy.

• CPAP delivers a fixed pressure to keep the airway open.

• BPAP is Bilevel PAP, improves comfort over CPAP

• It can also be used for patients who do not breathe enough on their own (hypoventilation)

Common Problems with PAP treatment

• Wrong size of mask - Choose the correct mask size according to your face. If you move around a lot while sleeping, you need a mask with greater stability

• A properly fitting mask shouldn't be uncomfortable or cause pain

• Difficulty tolerating forced air - Best to start with low pressures then gradually increase

• Dry, stuffy nose - Use machine with a heated humidifier, using a nasal saline spray at bedtime also can help.

• Feeling claustrophobic - Relaxation exercises may help reduce anxiety

• Skin irritation or pressure sores - have proper mask fit

• Difficulty falling asleep

• Dry mouth

• Unintentionally removing the mask during the night- Set alarms to check the fix of mask at night

• Bothersome noise made by machine

Tips to Improve use PAP Therapy better

• Ensure Proper Mask Fit - Choose a mask that fits comfortably to prevent air leaks and skin irritation. Adjust straps for a secure but not overly tight fit.

• Start Slow - Use the PAP machine while awake to get used to the sensation of wearing it. Gradually increase usage during sleep.

• Optimize Pressure Settings - Work with your healthcare provider to ensure the pressure settings are appropriate for your needs. Consider using an auto-titrating PAP machine if adjustments are needed.

• Use a Humidifier - If dryness or nasal congestion occurs, integrate a heated humidifier or use saline sprays to maintain comfort.

• Clean Equipment Regularly - Clean the mask, tubing, and water chamber weekly to prevent infections and maintain functionality.

• Address Noise Concerns - If machine noise is bothersome, position the machine further away or use a quieter model.

• Develop a Routine - Use PAP therapy consistently every night, even during naps, to form a habit and maximize benefits.

• Tackle Discomfort Proactively - Address issues like mask pressure marks or air swallowing (aerophagia) by consulting your provider for alternative masks or pressure adjustments.

• Leverage Technology - Many PAP devices have apps to track usage and provide feedback, helping to improve adherence.

• Seek Support- Join support groups or consult with a sleep specialist to share experiences and gain practical advice.

Summary

• PAP is a treatment option where air is delivered with pressure which keeps the upper airways from collapsing in sleep

• PAP is a good therapy option for CPAP, but compliance is difficult, can be done by using some tips