CPAP/Bi-Level CPAP – A Machine That Helps People Dealing With Sleep Apnea

The problem of apnea, the temporary cessation of breathing, is not one that is confined to any race or gender. It is true that those who are overweight are more likely to experience symptoms, but no one, old or young, rich or poor, male or female, is exempt from the problem. And apnea (a word that comes from the Greek ap neus or “without breath”) comes in two major forms.

The more common form, usually called “obstructive apnea,” occurs when the muscles of the larynx or throat collapse, sealing the airway. Most commonly, this occurs during sleep, hence it is not unusual for a physician to use the acronym “OSA” or “obstructive sleep apnea” to describe the phenomenon. The rarer form, “central” apnea, occurs when the lungs fail to expand for any of a number of reasons. This is the form most commonly seen in children and the elderly. It is also, unfortunately, the less treatable form.

Introduction to CPAP: How It Works

Obstructive apnea can be treated by the use of an ingenious little machine known as the CPAP, or Constant Positive Airway Pressure machine. The device, when working properly, provides a steady stream of pressurized air through a mask to the apnea sufferer. This pressure accomplishes what the muscles fail to do: it keeps the airway clear of obstruction and allows normal breathing during sleep. The Bi-Level CPAP works similarly, but operates at two different levels of pressure. The pressure is designed to lessen during times when the body is sustaining air pressure (at the beginning of exhalation, for instance) and rise to full value during potential trouble spots (end of exhalation and throughout inhalation). Both, however, require adjustment, and some level of getting used to.

The standard device includes the compressor unit, a length of tubing, a mask similar to most oxygen/supplemental air delivery masks and, in most cases, a humidifier. The device is fairly quiet, similar in volume to a low-pitched air conditioner or white-noise machine. Airflow is adjustable, and is generally calibrated by a specialist or ear-nose-and-throat physician during sleep study. The bi-level device is two-toned in noise during its operation, with a soft hiss as of gas escaping when it shifts to the lower level of pressure.

How It Feels

The most common complaints of users of the device (in either form) are irritation from the mask, dryness of mouth, nose or throat, and the uncomfortable feeling of breathing into a moderately stiff breeze. For some, the discomfort outweighs the benefits and they discontinue use quickly. For others, the benefits outweigh the costs.

Softer masks, made from a modified nitrile or polyurethane, have recently become available on the market and may soon completely replace the more rigid masks. However, the softer and more contour-friendly masks come with a price: they wear out at nearly triple the rate of their hard-sided cousins and must be frequently replaced. Some apnea sufferers, especially those for whom the apnea is minor, have gotten sufficient air pressure delivered via nasal canula, to be helped by the device; the majority of sufferers do not fall into this category, though.

As noted above, the majority of devices are now equipped with a humidifying unit as well as the compressor to attempt to alleviate the dryness of mouth, nose or throat. This does, however, mean that extra care must be taken with the maintenance of the device to avoid the buildup of molds or algae in the water reservoir of the unit. And finally, as also mentioned above, the device comes in two basic flavors. The bi-level CPAP device can assist with the feeling of “breathing into the wind” that many users dislike.

Contraindications For Use

As has been noted, the CPAP device was originally created for OSA sufferers, and may have little to no effect on the conditions of those suffering from central apnea. While some “centrallers” have reported increased breathing, it is by no means universal. Additionally, the cost associated with the devices, since they are not generally covered by conventional health insurance unless the individual is diagnosed with OSA, can be prohibitively high. One must also consider the cost of the overnight sleep study required to calibrate the device.

Next Steps

If you are, or think you may be, an apnea sufferer, you may wish to consider the use of the CPAP device. Your primary care physician can point you to a reputable specialist who can better determine if your symtomology meets that of a typical apnea patient. Once such a determination is made, the specialist can better inform you as to treatments available for your condition and assist you in choosing the best one for your unique circumstances.

For some, the costs of the CPAP device, both financial and personal, are too high and use of the device is quickly discontinued. Surgical remediation is possible in some cases for these apnea sufferers, and less drastic means may also improve the symptoms of some people as well. However, for many, the use of CPAP or Bi-level CPAP guarantees full, deep sleep, which is not an option under other circumstances. Many individuals have contacted me in the past and explained what a difference the machine makes.

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