Your choice of machine depends on the following:
- The type of sleep apnoea you have, e.g.
- central sleep apnoea (CSA) (brain fails to send the right signals to the breathing muscles); or
- obstructive sleep apnoea (air cannot flow due to obstruction of airway);
- upper airway respiratory syndrome (UARS) (a condition between mild snoring and full-blown sleep apnoea).
- The severity of your sleep apnoea and other conditions that limit your breathing at night during sleep.
- How you react to the therapy.
The Continuous Positive Airway Pressure (CPAP) machine is a device that maintains a constant continuous positive airway pressure. The pressure at which the machine works must be set before use to manage the user’s condition correctly.
The CPAP machine helps for the following:
- Light, medium or severe sleep apnoea;
- Obstructive sleep apnoea;
- Upper airway respiratory syndrome; and
The constant airflow provided by the CPAP machine prevents the soft palate from dropping and blocking the airway. Therefore, you will be able to breathe and maintain good oxygen levels throughout the night.
Upper airway respiratory syndrome (UARS) does not totally block your airway but your soft palate drops and decreases your airway causing difficulty breathing thus making it more difficult for air to reach your lungs. You have to work harder and harder for oxygen to reach your lungs. You brain compensates by waking you. If this condition is not treated in time, it could lead to central sleep apnoea.
When you snore, the soft loose tissue in your throat vibrates when you breathe. Initially snoring may only be an irritating sound. However, it could be the first indication that you are developing upper airway respiratory syndrome and later central sleep apnoea.
The CPAP machine will improve your nightly sleep. The machine should be used throughout the night.
When your sleep improves, your health improves almost immediately. You stop snoring and you are less sleepy during the day. Your concentration improves. Although you might not realise it, the management of your sleep apnoea may prevent long-term health issues such as chronic high blood pressure, cardiovascular disease and the risk of suffering a stroke.
The machine consists of three parts – a fan, a pipe and a mask.
The fan takes filtered air from the atmosphere and compresses it. The heightened air pressure is sent into the airway via a pipe and a mask. A humidifier can be connected to prevent the airway from drying out.
The mask can either cover only the nose or both the nose and the mouth. The choice of mask depends on the client’s preferences and the shape of the client’s face. One should try the different options and decide which works the best for you.
CPAP machines and their components must be tested, replaced and serviced from time to time.
The automatic positive airway pressure (APAP) machine is a self-adjusting positive airway pressure machine. It automatically adjusts the air pressure to a comfortable level for the user without the user having to programme it beforehand. The APAP machine is beneficial for individuals who require varied air pressures during the night. The APAP machine adjusts according to your ideal pressure for every breath you take.
This clever feature of the APAP will benefit the people who:
- suffer from allergies;
- sleep on their backs;
- suffer from apnoea during shallow rapid eye movement (REM) sleep (during dream sleep).
If your sleeping pattern varies during the night, APAP therapy will be more comfortable for you.
Although the CPAP helps people with obstructive sleep apnoea, these people will be able to sleep more comfortably with the APAP machine, as they will feel that they can breathe more naturally.
The APAP is better for you if your apnoea increases during the shallow REM sleep stadium and is not as present during other stages of sleep. It could be uncomfortable if the higher pressure as set by the CPAP is used during other stages of sleep. The APAP sets the pressure according to your individual requirement.
If you move a lot while you sleep – sometimes lying on your side and sometimes on you back – your sleep apnoea episodes may changes with your sleeping position. One position could require higher pressure than another sleeping position. Due to gravity the soft palate sags when you lie on your back and a higher pressure is required to open the airway.
The APAP is also ideal for people who want to start therapy immediately and do not want to wait for the titration test to confirm to what pressure the CPAP must be set.
The adaptability of the APAP to makes provision for the following:
- The position in which you sleep;
- Changes in your sleep pattern; and
- Colds or allergies.
The APAP machine can be pre-set like the CPAP. However, the CPAP can never work like the APAP.
The BiPAP would be the correct choice if the patient cannot handle one constant pressure for both inhaling and exhaling. In other words, the patient cannot adjust to the high pressure against which to exhale. The BiPAP delivers a lower pressure for exhaling. Thus, making it easier to exhale.
When a person suffers from serious sleep apnoea, which requires high inhalation pressure, it could be difficult to use the nose or full mask at this high pressure. A setting for a lowered exhalation pressure could assist with breathing out.
When a person cannot exhale enough, it could lead to a heightened nitrogen level, which could lead to the person not inhaling enough oxygen. The build-up of nitrogen may lead to the lowering of the oxygen gas level in the bloodstream and organ damage.
There are underlying health problems that can impede your ability to exhale at high pressure. These include chronic obstructive lung diseases, central sleep apnoea, hypoventilation due to obesity and a combination of sleep apnoea and chronic obstructive lung diseases (overlapping syndrome) or a restrictive element that affects your breathing when you sleep.
The BiPAP can decrease the need for the use of ventilators – forced ventilation through tracheal intubation (putting a bendable plastic tube in the airway). Unpublished studies indicate that periods of hospitalisation, intensive care and deaths decrease with the use of the BiPAP.
BiPAP machines can be connected to oxygen generators (which concentrate oxygen from air by removing the nitrogen) to supply air that has been oxygen enriched to clients. This can help to increase the oxygen levels of people with limited lung and gas exchange ability.
BiPAP therapy is an alternative for people who struggle to exhale against heightened pressure e.g. patients in intensive care who hyperventilate or patients who struggle to breathe, according to the article “Non-invasive positive ventilation” from the Essential Coronavirus collection of the Annals of Internal Medicine, an academic magazine of the American College of Physicians. This magazine is one of the most quoted and influential speciality magazine in the world. https://acphospitalist.org/archives/2010/09/tech.htm. Similar information can be found under the title: ICU Lessons on COVID-19 From Italian Front Line: Be Flexible https://www.medscape.com/viewarticle/927432