A Primer On CPAP Machines And CPAP Prescription
If you suffer from sleep apnea, you may experience every day how degrading this condition can be for the quality of your life. Common side effects like lack of energy, loud snoring, headaches, or sleep problems, including insomnia, can profoundly impact your relationships as well as your social and work life. Also, there is the mental pressure of constant worry that sleep apnea may lead to other, far more severe stroke or heart failure conditions.
Since untreated sleep apnea can have long-lasting effects on your whole life, the right treatment is crucial. If you think you may have sleep apnea, the best thing you can do is go to a sleep doctor and get a sleep study so you can get all the facts.
Advanced technology makes the usage of CPAP machines easier
It’s true, a sleep apnea diagnosis can be daunting, but the good news is that treatment and technology have advanced significantly in recent years. Most people experience immediate tangible benefits when they begin to treat it, especially in combination with using the right CPAP machine.
Also interesting: Snoring? Rule Out Obstructive Sleep Apnea (OSA)
CPAP machines (CPAP stands for “continuous positive airway pressure”) are essential in treating sleep apnea. New, technologically advanced CPAP machines can help you get a good night’s sleep without causing you to wake up often. The size of the devices and the noise level have decreased dramatically. Newer machines also offer different air pressure treatments that provide the exact amount of airflow needed for each apnea event.
What is sleep apnea?
Sleep apnea is a breathing disorder during sleep. The biggest problem is that most people with sleep apnea have never received an appropriate diagnosis and therefore don’t even know that they suffer from the effects. Yet sleep apnea can be life-threatening if left untreated.
One form of sleep apnea, obstructive sleep apnea (OSA), occurs when the throat muscles collapse during sleep, preventing air from entering the lungs. Certain factors contribute to the onset of obstructive sleep apnea, including obesity, large tonsils or adenoids, a crooked nasal septum, an enlarged tongue, a receding chin, a stuffy or blocked nose due to a cold, allergies, or smoking. Alcohol and sedatives can also contribute to OSA because they relax the throat muscles.
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The second type of sleep apnea is central sleep apnea (CSA). In patients with CSA, the brain temporarily stops sending signals to the muscles that control breathing. CSA results from conditions that affect the brainstem, such as stroke, obesity, bulbar poliomyelitis, encephalitis, Parkinson’s disease, arthritis, spinal radiation, and congestive heart failure.
And lastly, some people develop mixed sleep apnea, meaning the event begins as a central apnea and ends as obstructive apnea.
What is the primary therapy for sleep apnea?
The primary therapy recommended for both types of sleep apnea is a CPAP machine because they deliver compressed air through a mask while a person sleeps.
In general, CPAP machines work very well to prevent sleep apnea and therefore dramatically improve sleep. However, many people who begin CPAP therapy discontinue it because they find the devices uncomfortable and challenging to use. Fortunately, newer CPAP models offer more comfort and ease of use.
Do I need a prescription for a CPAP machine?
Yes, CPAP machines are considered a Class II medical device and, as such, require a prescription. The main reason for a prescription is that it includes specific pressure settings based on the sleep study results. Without a prescription that provides pressure settings based on your apnea/hypopnea index (AHI) and lowest oxygen saturation (SaO2), you can’t adjust the device adequately and may not receive the best care. Even worse, inadequate settings can be harmful to your health.
By the way, pressure settings should only ever be determined by a certified sleep specialist’s interpretation of your sleep study.
Another important reason why you need a prescription to purchase CPAP equipment is for your health insurance company to cover the cost. Without a prescription, they will not pay for the device.
How to get a prescription for a CPAP machine?
The easiest way to get a CPAP prescription is to undergo a supervised sleep study in a sleep clinic (Polysomnogram/PSG). A supervised sleep study in a sleep lab sounds worse than it actually is. All they do is fit leads and sensors all over your head and body, plug you into a few monitors, and send you off to bed. While your sleeping, the tech monitors everything.
When the sleep study is finished, a certified sleep physician interprets the results and recommends device pressure settings based on your AHI and lowest oxygen saturation value (SaO2). He then can either write the prescription or forward the prescription recommendations to a licensed physician.
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You receive a prescription for one of the following CPAP machines: a standard CPAP machine, an auto-adjusting CPAP machine, or a BiPAP machine (BiPAP stands for “bi-level positive airway pressure”).
Do I really need to undergo a supervised sleep study in a lab?
If you don’t want to do a sleep study in a clinic, you can also do an unsupervised home sleep study (Home Sleep Test/HST) in the comfort of your home. Sometimes, the home sleep test will be sufficient to diagnose your apnea and allow a doctor to write you a CPAP machine prescription.
However, it may also be the case that you don’t receive a prescription for a CPAP machine (unless follow-up polysomnography is performed) but will instead get an Automatic Positive Airway Pressure (APAP) machine, which offers only a range of pressure levels.
Why is that? Home sleep test results are obviously less accurate than results from a supervised study, so you basically have only data for a pressure range rather than a specific pressure.
Also interesting: Why Can CPAP Cause Gas or Stomach Bloating? And How to Prevent It
Honestly, you should always try to get a supervised sleep study to make sure you’re getting a prescription for the proper machine. Again, supervised sleep studies less scary than you may think, and you’ll end up with much more detailed results to determine the exact pressure needed for your CPAP therapy.
Can I also get a prescription for a CPAP machine online?
In some cases, a remote physician (teledoc) can read your unsupervised sleep test results and, if they deem it appropriate, write you a prescription for a CPAP machine.
Some companies like The CPAP Shop or Aeroflow can help you with this and help you determine if you are eligible to receive an online prescription after you send in your home sleep test for evaluation. If so, they also help you obtain that prescription and your CPAP device through relationships with board-certified teledocs.
You should not try to get a CPAP prescription online purely based on your answers to questionnaires without the assistance of a certified teledoc. Several online services (or online marketplaces offering used equipment) offer this ‘fast-track’ prescription model, but getting CPAP prescriptions online is much less accurate and risky than doing so from a certified doctor who has reviewed your medical records and test results.
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So it’s important to go through your treating doctor and purchase or rent your device and accessories from a known and reputable durable goods provider. Keep in mind that it’s about something as crucial as breathing regularly at night, so it pays to make sure you’re using the correct device with the right settings.
What are the different types of CPAP machines?
Although all CPAP machines have in common that they provide airflow to your airway through a tube connected to a mask interface that you wear while sleeping, they are different types of machines with some significant differences.
Standard CPAP device
If you are diagnosed with mild or moderate sleep apnea and don’t move much during sleep, you may want to choose a standard CPAP device. These devices deliver a constant single, fixed air pressure to your airway throughout the sleep cycle.
The device typically starts at a comfortable breathing level and then ramps up to the required pressure within a specified time frame. The air pressure is determined by your sleep physician’s prescription. Typically, it is the minimum amount of air pressure needed to keep your airway open.
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Although a standard CPAP machine is a relatively simple device with few bells and whistles, it can dramatically improve your sleep and overall health. However, suppose you are tossing and turning during sleep or have a more irregular breathing pattern. In that case, you may need a more robust and technologically advanced device that can adjust pressure levels.
Automatic CPAP machine (APAP)
Our sleep habits and patterns during the night vary and are unique. Auto-adjusting CPAP devices (APAPs) automatically adjust the amount of pressure delivered for each breath. This self-regulating function is convenient if your breathing changes between light and heavy and you’re tossing and turning during sleep. The device always delivers precisely the pressure needed to prevent your airway from collapsing during sleep.
The automatic pressure adjustment is also why users of this type of PAP device often report a more effective sleep apnea therapy. Another benefit is that by delivering just the right pressure, APAP machines also help reduce aerophagia, the swallowing of air that can lead to bloating.
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APAP machines are typically software-enabled, or “smart” devices that can help you and your doctor fine-tune your therapy and monitor its effectiveness.
Auto-adjusting CPAP machines usually are slightly more expensive than a standard CPAP machine. However, many users find it’s worth the cost to receive optimized, effective treatment and fewer subsequent sleep studies.
Bi-Level CPAP Device (BiPAP)
First things first – the word BiPAP is a trademarked term by Philips but is now commonly used to refer to any CPAP that uses bi-level support. Other companies may use terms such as VPAP (variable positive airway pressure) or simply Bi-Level to refer to the same type of therapy for sleep apnea. I use the terms interchangeably in this article.
How does a BiPAP machine work?
While a standard CPAP machine prevents respiratory failure by delivering a single constant flow of air through a tube and into a face mask, a BiPAP device provides two set pressures, a higher pressure for inhalation and a lower pressure for exhalation. This way, it automatically adjusts air pressure during both inhalation and exhalation. During inhalation, the pressure increases to open the airway, and during exhalation, the bi-level device delivers pressure relief, or a decrease in pressure, to allow you to breathe closer to your normal breathing pattern.
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The drop in exhalation pressure is especially noticeable if you have a prescribed inhalation pressure of 15 cm or higher, as it allows you to exhale without having to fight a strong, constant pressure. If required, the exhalation pressure can be set as low as 4 cm (provided your sleep study determined this) and provide a more comfortable CPAP experience and thus a higher compliance rate.
Although bi-level air pressure treatment can help many, it may not be the perfect solution for everyone. Some advanced bi-level devices are used for more complex conditions or for ventilator support systems.
What is a BiPAP ST machine?
A more advanced device, a BiPAP ST device, provides spontaneous/cyclic (S/T) therapy. This device allows the patient to breathe at their normal, preset breathing rate. If the patient experiences apnea or their breathing drops below the preset rate, the device maintains the patient’s ventilation with a paced breath. The BiPAP ST device actually initiates a breath during therapy so that the patient receives a minimum number of breaths per minute.
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Spontaneous timing or ST-BiPAP therapy may be recommended for patients with central sleep apnea or certain lung disease types to help them take deeper breaths. Patients with unusual breathing patterns may also benefit from timed or volume-monitored BiPAP therapy.
Timed or volume-adaptive bi-level therapy is not usually prescribed for obstructive sleep apnea. These devices are the most technically sophisticated BiPAP devices available for home use.
CPAP masks
The CPAP machine is one thing; the CPAP mask is another. In fact, the mask is one of the most critical aspects of your sleep apnea therapy and should be selected for effectiveness, durability, and comfort.
The most common mask is a nasal mask that covers only the nose. When choosing the proper nasal mask, make sure that it fits your facial structure, meaning it should fit snugly, and seal well to prevent leakage.
Also interesting: How to Keep Snoring From Ruining Your Relationship
The second type of mask is the full-face mask, which is especially good if you breathe through your mouths while sleeping. Full-face masks form a seal over the nose and mouth, eliminating the need for a chin strap. If you use a nasal mask and continue to snore, it may be a good idea to switch to a full-face mask.
The third type of mask is the nasal pillow mask. These masks are particularly popular because the minimal design creates few pressure points on your face.
What are the side effects of using a CPAP machine?
As with any treatment for a disease or disorder, using a CPAP machine to treat snoring or sleep apnea can have side effects. However, the side effects are usually minor and much easier to manage than the dangers of not using a CPAP machine.
Here are some of the most common CPAP machine side effects:
Claustrophobia
Having to wear a mask on your face during the night can be uncomfortable at first, but it will become easier over time. A sleep technician should adjust the mask the first time you wear it to make sure it fits well and doesn’t bother you too much.
Start by wearing the mask for as long as possible, and gradually increase the length of time you wear it. You can also wear it for the first few days while watching TV or working on your computer. This way, you get used to the feel of the mask and the feel of the air pressure.
Stuffy nose or irritation
The air delivered by the CPAP machine is generally very dry, which may cause some discomfort, such as a runny nose, sneezing, or nosebleeds. This usually subsides after a few days but if the problem persists, try using a humidifier to add moisture to the air. Some CPAP machines even have built-in humidifiers.
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If your machine doesn’t have a built-in humidifier, consider a stand-alone humidifier or a new machine with a built-in humidifier. Keep in mind that if you start using a humidifier, your doctor may need to adjust the pressure levels if you haven’t a device where the pressure is automatically adjusted.
Difficulty breathing through your nose
Your nasal and pharyngeal passages must open to relieve sleep apnea and snoring. If you have a hard time breathing through your nose, a CPAP machine may not be effective. An ENT doctor can help diagnose allergies or sinus problems that may be obstructing your nasal passages.
Swallowing air (autophagy)
Aerophagy occurs when air from a CPAP enters the esophagus and stomach instead of the airway and lungs. This can cause bloating and distension of the stomach. It is common and can occur in anyone who uses CPAP.
If you find that you are swallowing air when using a CPAP machine, try using only a pillow to flatten your sleeping position, or talk to your doctor about reducing the machine’s pressure or changing the type of device.
You can find more advice on how to prevent stomach bloating in the blog post Why Can CPAP Cause Gas or Stomach Bloating? And How to Prevent It.
Headaches and head pressure
If you have a cold or flu, the blockage may cause pressure to build up or headaches. In that case, it may be necessary to suspend the use of your device until symptoms subside.
Sleeping problems due to noise
Older machines tend to make a humming or vibrating noise. If you have an older device, keep it as far away from you as possible. If you still can’t sleep because of the noise, switch to a newer model or try noise-canceling headphones.
Also interesting: How to Sleep Well When It’s Noisy?
Difficulty going to the bathroom
For nighttime bathroom trips, don’t remove the mask. Just pull it off the tube or device. If you keep the mask on, you should be able to go back to sleep more quickly.
What to do if I see no improvement?
If you don’t notice any improvement from CPAP use, you should keep a sleep diary. Record if you have headaches, if you are tired, rested, or wake up regularly during the night (remember to record the hour). If your sleep apnea has not improved after about a month, you should contact your doctor again (and remember to take your diary with you).
Can I travel with my CPAP machine?
CPAP manufacturers have made great strides in meeting the needs of those who want to travel with their CPAP equipment. Gone are the days when taking a CPAP machine and battery on a trip required another suitcase.
Today’s CPAP machines are sleek and lightweight; they’re not much bigger than an alarm clock, weigh only a few pounds, and can run on virtually any power supply. If you’re traveling abroad, all you need is a plug adapter.
Although camping requires a battery, rechargeable lithium batteries are lightweight and work for many hours (if a humidifier is not used).
If you plan to go on a long-haul flight, it’s worth checking with the airline if they provide a CPAP machine. Today most airlines have approved devices for use on international flights, as long as you provide documentation from your doctor or sleep clinic.
For more information on traveling with a CPAP machine read my blog post How to Travel Easily And Safely With Your CPAP Machine.
Summary
Sleep apnea is a severe condition, and if you think you may have it, don’t take it lightly. Sleep apnea and snoring usually are well treated with CPAP machines that deliver positive airflow pressure to open the airway and relieve sleep apnea. Since airflow pressure requirements vary, you should participate in a sleep study to determine which device and settings are best for you.
While using a CPAP device may take some time to get used to, you likely will experience an almost immediate improvement in your quality of life. Many people have found that once they got used to wearing a CPAP machine at night, they don’t want to miss it anymore. They feel less sleep deprived and wake up feeling more refreshed.
And if you’re traveling a lot, using a CPAP machine no longer has to interfere with that lifestyle either, as many devices today are lightweight and portable.