Treatment Options for Obstructive Sleep Apnea Syndrome

Continous Positive Airway Pressure for Obstructive Sleep Apnea Syndrome

Continuous positive airway pressure (CPAP) is the treatment of choice for most patients with obstructive sleep apnea syndrome (OSAS). Although CPAP is not a curative treatment, studies have shown that it helps patients sleep better at night and also reduces excessive daytime sleepiness - the cardinal symptom of OSAS.

A CPAP machine is a device that consists of a fan blower, a face mask, and a flexible tube that supplies a continuous flow of air from the fan blower to the patient through the mask. The creation of continuous positive airway pressure prevents collapse of the upper airway during sleep throughout the respiratory cycle. The optimal level of continuous positive airway pressure necessary to control the symptoms of OSAS varies among individuals depending upon the severity of the condition. The optimal CPAP pressure is established by polysomnography (overnight sleep test) during which episodes of sleep apnea are monitored and recorded and various CPAP pressures are tested to determine the optimal pressure necessary to control the sleep apnea. In general, patients who are overweight or obese usually require higher CPAP pressures to control sleep apnea than patients who maintain normal body weight.

Because CPAP is a self-administered treatment, patient education is critical for ensuring compliance with this therapy. Patients and their bed partners must take an active role in ensuring compliance with this treatment by learning as much as possible about CPAP and the special features of the CPAP equipment. Estimates of long-term compliance rates with CPAP therapy range from 50% to 86% and the average number of hours of use ranges from 4-6 hours which, in many cases, results in improvment of symptoms.

Complications of CPAP Therapy

Although CPAP therapy is a safe and effective treatment modality for obstructive sleep apnea syndrome (OSAS), complications can occur that can lead to reduced patient compliance. Common complications associated with CPAP therapy include:

  • Difficulty tolerating air pressure
  • Improper-fitting face mask
  • Nasal complications
Difficulty Tolerating Air Pressure

Some patients experience discomfort from the rush of air pressure during CPAP therapy, particularly when exhaling. Some suggestions for overcoming this problem include:

  • Ask the sleep center or the CPAP vendor to check the air pressure to make sure that it is set to the correct pressure.

  • Many of the newer CPAP machines include a special feature called a "ramp" that enables patients to gradually increase the pressure during the initial 30 minutes of sleep. Using the "ramp" feature on your CPAP machine may help you to better tolerate the air pressure.

  • Ask the sleep center if a bilevel CPAP machine may be an option for you. Unlike a standard CPAP machine which delivers a constant air pressure during both inhalation and exhalation, a bilevel CPAP machine delivers air at two different pressures:

    • higher air pressure is delivered during inhalation
    • lower air pressure is delivered during exhalation
Improper-Fitting Face Mask

An improper-fitting CPAP face mask can cause both discomfort and can reduce the effectiveness of the treatment if the mask leaks air. Face masks are available in various shapes and sizes so it is important to select one that is optimal for you. Nasal pillows that blow air directly into the nostrils are also available and are an option for patients who cannot tolerate using a face mask.

Some patients also develop claustrophobia (fear of being in an enclosed space) from wearing the CPAP face mask. If this problem develops, it is important to speak with your health care provider to seek options to help you overcome your claustrophobia.

Nasal Complications

Some patients on CPAP therapy develop nasal complications such as nasal congestion, dryness of the nasal mucous membranes, and rhinorrhea ("runny nose"). Various strategies are available to help control nasal symptoms associated with CPAP therapy including:

  • Connecting a humidifier to the CPAP machine to add moisture to the air generated by the fan blower can help control nasal dryness and irritation.

  • Using a nasal saline spray before starting CPAP therapy can also help control nasal congestion and dryness.

  • Nasal sprays containing medications (e.g., steroids) are also available to help you better control nasal congestion and irritation.

  • Abrasions of the nose bridge is another relatively common nasal complication of CPAP therapy and is usually due to a very tight-fitting face mask. Adjusting the fit of the face mask usually helps to resolve this problem.