CPAP (Continuous Positive Airway Pressure) is a non-invasive therapy used to treat sleep apnea, primarily designed for obstructive sleep apnea (OSA). This therapy involves wearing a nasal or oronasal mask to deliver continuous positive airway pressure to the respiratory tract, preventing upper airway collapse during sleep and ensuring normal breathing. CPAP not only improves sleep quality but also reduces the risk of cardiovascular diseases and other complications, making it a widely recognized first-line treatment.
The CPAP system includes an air compressor, tubing, and mask. Patients wear it during sleep, and the device provides a steady stream of air at a preset pressure (usually between 6 to 18 cm H2O). The goal is to keep the airway open throughout the night and monitor the number of respiratory events and blood oxygen saturation to evaluate treatment efficacy.
CPAP is divided into fixed-pressure and auto-adjusting types. Fixed-pressure CPAP requires setting a fixed pressure based on sleep study results; auto-adjusting CPAP can dynamically adjust pressure according to the patient's sleep stage, enhancing comfort. Its mechanism involves applying continuous positive pressure when the patient falls asleep to counteract the forces causing airway collapse, preventing apnea or hypoxemia.
CPAP is mainly effective for obstructive sleep apnea, but it can also assist in treating central or complex sleep apnea. Built-in pressure sensors provide real-time feedback to ensure sufficient airflow to support the airway, and humidifiers add moisture to reduce mucosal dryness and discomfort.
Initial treatment requires a full-night polysomnography to determine pressure needs. When using the device, the mask should be cleaned and adjusted for a snug fit, and the machine should be placed on a stable surface beside the bed. It is recommended to use the device for at least 4 hours per night to achieve effective treatment.
Pressure settings should be adjusted by a physician based on AHI and positional variations. For example, lower pressures may be needed when lying on the side, while higher pressures are required when supine to counteract gravity. Some advanced models feature an "auto-adjust" mode that fine-tunes pressure based on real-time breathing conditions.
Common initial discomforts include nasal dryness, mask pressure marks, and ear pressure imbalance. Long-term use may cause nasal mucosal inflammation or dry mouth, with about 20% of patients discontinuing due to discomfort.
Serious complications include: pneumothorax (rare), increased intraocular pressure (caution in glaucoma patients), and increased risk of respiratory infections. Improper maintenance of the device may lead to bacterial growth; proper cleaning is essential.
Contraindications include inability to cough up phlegm independently, hypercapnia, and allergy to mask materials. Severe nasal septal deviation or sinus disease may impair efficacy and require ENT evaluation beforehand.
Usage precautions include avoiding alcohol or sedatives to prevent exacerbating respiratory depression; daily cleaning of tubing and filters, with replacement of consumables every 3-6 months. Gradual adaptation under medical supervision is recommended to prevent abandonment due to initial discomfort.
CPAP can be combined with weight management and oral appliances (such as mandibular advancement devices), but compatibility should be checked. When combined with oxygen therapy, pressure adjustments are necessary to prevent over-ventilation.
Patients who have undergone upper airway surgery may need re-calibration of CPAP pressure due to altered airway resistance. Patients on anticoagulants should protect skin contact areas of the mask to prevent pressure injuries.
Multiple randomized controlled trials show that regular use of CPAP reduces AHI by over 80%, and the Epworth Sleepiness Scale (ESS) score decreases by 2-3 points. Long-term follow-up indicates that CPAP users have a 40% lower risk of heart failure over five years and a 65% reduction in car accidents.
The 2017 Cochrane review states that CPAP is superior to other non-surgical treatments in reducing cardiovascular events and cognitive impairment. However, poor adherence (usage < 4 hours/night) can reduce efficacy by over 50%.
Alternative options should be chosen based on patient anatomy and comorbidities, but CPAP remains the first choice in terms of efficacy and cost-effectiveness. For example, normal-weight individuals may achieve similar results with oral appliances, but patients with severe anatomical narrowing still require CPAP for adequate airway expansion.
It is recommended to clean the mask and tubing daily with warm water and neutral soap, then air dry. The main unit should be wiped with a dry cloth, avoiding water contact. Weekly, use dedicated disinfectant tablets or diluted vinegar solution to clean the water chamber, and regularly replace replaceable filters. Ensure everything is completely dry before reassembling to prevent bacterial growth.
Can using humidification help alleviate dry mouth during initial CPAP therapy?The heated humidifier can effectively improve dry mouth issues. Adjust humidity to a comfortable level. If symptoms persist, check for mask fit or leaks, or consult healthcare providers for adjustments. Avoid prolonged use without humidification to prevent mucosal dryness.
Does long-term use of CPAP have negative health effects?CPAP therapy itself does not cause long-term harm, but improper use may lead to nasal irritation or skin pressure sores. It is recommended to use the device for at least 4 hours per night and to have regular follow-ups for adjustments. The machine should be inspected by professionals every 6 months to a year to ensure proper pressure settings and functioning of parts.
Will travel or being away from home affect treatment if CPAP cannot be used?Short-term interruptions (1-2 days) usually do not significantly impact long-term efficacy, but frequent interruptions may cause rebound symptoms of sleep apnea. It is advisable to carry portable devices or arrange accommodations in advance. When necessary, temporary alternatives provided by hospitals can be used, and regular use should be resumed promptly.
How long does it take to see significant improvement in daytime sleepiness after starting CPAP?Most patients notice increased daytime alertness within 1-2 weeks, but full benefits typically require continuous use for over 4 weeks. Consistent use with correct pressure settings should gradually reduce snoring and oxygen fluctuations. Tracking sleep diaries and undergoing repeat sleep studies (PSG) every 3-6 months can help evaluate progress.
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