What Is CPAP?
CPAP, or continuous positive airway pressure, is a
treatment that uses mild air pressure to keep your airways open while you
sleep. CPAP is used for people who have breathing problems, such as
sleep
apnea.
This treatment is done using a CPAP machine. CPAP
machines have three main parts:
- A mask or other device that fits over your nose
or your nose and mouth. Straps keep the mask in place while you're wearing
it.
- A tube that connects the mask to the machine's
motor.
- A motor that blows air into the tube.
Some CPAP machines have other features as well, such
as heated humidifiers. CPAP machines are small, lightweight, and fairly quiet.
The noise that they make is soft and rhythmic.
Overview
CPAP is the most effective treatment for obstructive
sleep apnea. Sleep apnea is a common disorder in which you have pauses in
breathing or shallow breaths while you sleep. When this happens, not enough air
reaches your lungs.
In obstructive sleep apnea, your airways collapse or
are blocked during sleep. The blockage may cause shallow breathing or breathing
pauses. When you try to breathe, any air that squeezes past the blockage can
cause loud snoring. Your snoring may wake other people in the house.
The mild pressure from CPAP can prevent your airway
from collapsing or becoming blocked. If your doctor prescribes CPAP, you will
work with someone from a home equipment provider (sometimes called durable
medical equipment, or DME) to select a CPAP machine.
Your doctor will work with you to make sure the
settings that he or she prescribes for your CPAP machine are correct. He or she
may recommend an overnight
sleep study to find the correct settings for you. Your doctor will want to
make sure the air pressure from the machine is just enough to keep your airways
open while you sleep.
There are many different kinds of CPAP machines and
masks. Be sure to tell your doctor if you're not happy with the type you're
using. He or she may suggest switching to a different kind that may work better
for you.
Outlook
CPAP has many benefits. It can:
- Keep your airways open while you sleep
- Correct snoring so others in your household can
sleep
- Improve the quality of your sleep
- Relieve symptoms of sleep apnea, such as
excessive daytime sleepiness
- Decrease or prevent
high
blood pressure
Many people who use CPAP report feeling better once
they begin treatment. They feel more attentive and better able to work during
the day. They also report fewer complaints from bed partners about snoring and
sleep disruption.
Who Needs CPAP?
You may need CPAP if you have obstructive
sleep
apnea. CPAP is often the best treatment for adults who have this
condition.
Children also can have obstructive sleep apnea. The
most common treatment for children is surgery to remove the tonsils and
adenoids. If symptoms don't improve after surgery, or if the condition is
severe, CPAP may be an option.
If you have sleep apnea symptoms, your doctor may
recommend an overnight
sleep
study. A sleep study measures how much and how well you sleep. It also can
show whether you have sleep problems and how severe they are. (For more
information, see "What To Expect Before Using
CPAP.")
Your doctor will likely refer you to a sleep
specialist for the sleep study. Sleep specialists are doctors who diagnose and
treat people who have sleep problems.
A special type of CPAP device is used to treat
breathing disorders that are similar to sleep apnea, such as chronic
hypoventilation or central sleep apnea. In these conditions, the airways aren't
blocked. However, the brain may not send the signals needed for breathing to
occur properly. This causes breaths that are too shallow or slow to meet your
body's needs.
In central sleep apnea, you may stop breathing for
brief periods. This disorder can occur alone or with obstructive sleep apnea.
Only a sleep study can find out what type of sleep apnea you have and how
severe it is.
In addition to CPAP, there are other positive airway
pressure devices. If you don't feel that CPAP is working for you, talk to your
sleep specialist about other possible options.
What To Expect Before Using CPAP
Before your sleep specialist prescribes CPAP, you'll
likely have a
sleep
study called a
polysomnogram,
or PSG.
A PSG usually is done while you stay overnight at a
sleep center. This study records brain activity, eye movements, heart rate,
blood pressure, and other important data while you sleep.
What To Expect During a Polysomnogram
Your sleep specialist may suggest a split-night
sleep study. During the first half of the night, your sleep will be checked
without a CPAP machine. This will show whether you have
sleep
apnea and how severe it is.
If the PSG shows that you have sleep apnea, you may
use a CPAP machine during the second half of the split-night study. A
technician will help you select a CPAP mask that fits and is comfortable.
While you sleep, the technician checks the amount of
oxygen in your blood and whether your airways stay open. He or she adjusts the
flow of air through the mask to find the setting that's right for you. This
process is called CPAP titration.
In some cases, this isn't done all in the same
night. Some people need to go back to the sleep center for the CPAP titration
study. Your sleep specialist will decide which type of study is best for you
and leave instructions with the technician.
What To Expect After a Polysomnogram
Your sleep specialist will review the results from
your sleep study. If CPAP will benefit you, he or she will prescribe the type
of CPAP machine and the correct settings for you.
Most health insurance companies now cover CPAP
treatment. You may want to contact your health insurance provider to learn more
about this coverage.
Your sleep specialist may be able to refer you to a
local home equipment provider. The home equipment provider will use your
prescription to set up your CPAP machine. Ask your sleep specialist to
recommend a home equipment provider that has a lot of experience with CPAP.
It's important to continue to work with your sleep
specialist as you adjust to CPAP treatment. Talk to him or her about how to
handle followup questions. Your sleep specialist can answer some questions, but
your home equipment provider may need to address others.
Selecting a CPAP Machine and Mask
CPAP units come with many features designed to
improve fit and comfort. Your home equipment provider will help you select a
machine based on your prescription and the features that meet your needs.
You may be able to use the CPAP unit for a trial
period to make sure you're happy with your choice.
There are many types of CPAP masks. The fit of your
mask is important, not only for comfort, but also to keep air from leaking out.
A mask that fits will help maintain proper air pressure and keep your airways
open.
CPAP masks come in different shapes, sizes, and
materials. Some fit over your nose and mouth; others only cover your nose. Some
masks can be worn with eyeglasses. If you need oxygen, masks are available that
have room for an oxygen tube.
Nasal pillows may be used instead of a mask. Nasal
pillows are small, flexible, mushroom-shaped cones that fit into each
nostril.
Let your home equipment provider know whether your
sleep on your back, side, or stomach. Different types of plastic tubing connect
the mask to the CPAP machine. Some types may make it easier for you to sleep on
your side or stomach.
What To Expect While Using CPAP
CPAP is a long-term treatment. Many people have
questions when they first start using CPAP.
Talk to your sleep specialist about how to handle
followup questions. He or she can answer some questions, but your home
equipment provider may need to address others. Ask your sleep specialist to
recommend a home equipment provider that has a lot of experience with CPAP.
To achieve the full benefits of CPAP, use it every
time you sleep—during naps and at night. Most people should use CPAP for
at least 7.5 hours each night for the best results.
The CPAP Machine
It can take time to adjust to using CPAP. It may
feel strange wearing a mask on your face at night or feeling the flow of air.
Some people feel confined by the mask. If you feel this way, it may help to
adjust to the mask slowly.
First, hold only the mask up to your face for short
periods during the day. Next, try wearing it with the straps for short periods.
Then, add the hose.
Breathing with a machine doesn't feel natural. If
your machine has a "ramp" feature, you can use it to slowly "ramp up" from a
lower air pressure to the pressure that's needed to keep your airways open
during sleep. Once you're comfortable using CPAP during the day, try using it
at night while you sleep.
Relaxation exercises, such as progressive muscle
relaxation, help some people adjust to using CPAP. Talk to your doctor about
whether relaxation exercises may help you.
If you're having trouble adjusting to the mask or
the CPAP machine, contact your home equipment provider. Your provider may have
staff who can help you adjust. You may want to try a different mask that has
fewer straps or less contact with your skin.
Followup Care
Your sleep specialist may ask you to schedule a
followup visit about a month after you begin using CPAP. He or she will want to
see how well you're adjusting to treatment. After that, you may have followup
care every 6 or 12 months.
Your sleep specialist may need to adjust the air
pressure setting of your CPAP machine if:
- You gain or lose a lot of weight
- Your symptoms, such as daytime sleepiness,
persist or recur
- You have another treatment for
sleep
apnea, such as upper airway surgery or a mouthpiece
Benefits of CPAP
CPAP has many benefits. It can:
- Keep your airways open while you sleep
- Correct snoring so others in your household can
sleep
- Improve the quality of your sleep
- Relieve symptoms of sleep apnea, such as
excessive daytime sleepiness
- Decrease or prevent
high
blood pressure
With CPAP, you may fall asleep faster and wake fewer
times during the night. The pauses in breathing that are typical with sleep
apnea won't interrupt your sleep.
Studies also show that treatment with CPAP is linked
to a decrease in reported car accidents and near accidents. Some studies have
shown that CPAP improves reaction times, concentration, and memory in people
who use the treatment.
Many people who use CPAP report feeling better once
they begin treatment. They feel more attentive and better able to work during
the day. They also report fewer complaints from bed partners about snoring and
sleep disruption.
You may feel better after the first night you use
CPAP. You may wake feeling refreshed, alert, and in a better mood. You also may
feel less tired during the day.
However, it may take a week to a month to adjust to
CPAP. Some people have trouble falling asleep when they first start using CPAP.
This problem usually is short term and goes away as you adjust to the
treatment.
Even if you don't notice a change right away, stick
with the treatment. The benefits are worth it. Once you adjust to using CPAP,
you'll sleep better.
What Are the Risks of CPAP?
CPAP is a safe, painless treatment. Side effects and
other problems usually are minor and can be treated or fixed. Talk to your
doctor if you're having problems using CPAP. He or she can suggest ways to
handle or treat these problems.
Although these problems can be frustrating, stick
with the treatment. The benefits of CPAP are worthwhile.
Side Effects
Mask Allergies and Skin Irritation
CPAP masks may cause skin allergies or skin
irritation. If this happens, try a different type of mask.
CPAP masks come in different shapes, sizes, and
materials. Some have fewer straps and less contact with your face. Certain
masks may irritate your skin less than others.
If you have trouble finding a mask that works for
you, talk to your sleep specialist about nasal pillows. These are small,
flexible, mushroom-shaped cones that fit into each nostril.
Dry Mouth
Dry mouth may be due to the CPAP itself or from
breathing through your mouth at night. A CPAP machine that has a heated
humidifier may help relieve this side effect.
If dry mouth persists, your sleep specialist may
recommend a chin strap to keep your mouth closed or a different type of
mask.
Talk to your sleep specialist if dry mouth
continues. It may mean that your mask is leaking air. The air may be going into
your open mouth and causing dry mouth.
Congestion, Runny Nose, Sneezing, Sinusitis, and
Nosebleeds
Congestion, runny nose, sneezing, sinusitis, and
nosebleeds can occur while using CPAP. A CPAP machine that uses a heated
humidifier can help relieve these side effects. Also, make sure that your mask
fits properly.
Some people find that using a saline nasal spray at
bedtime prevents these side effects. If these steps don't work, talk to your
sleep specialist. He or she may prescribe a steroid nasal spray.
Stomach Bloating and Discomfort
Stomach bloating and discomfort may be due to a
problem with the air pressure setting of your CPAP machine. If you have stomach
bloating and discomfort, talk to your sleep specialist. He or she may adjust
the settings of your machine to relieve these side effects.
Problems With the CPAP Equipment
Mask Leaks
A number of different things can cause a CPAP mask
to leak. To avoid a leak, follow the instructions that come with the mask. Try
washing the mask daily. Also, wash your face and use a moisturizer so your skin
is moist before you put on the mask.
It may help to adjust the mask's straps. When straps
are too loose or too tight, a leak may happen. You may need to select a
different size or type of mask.
When a CPAP mask leaks air, you don't get the proper
amount of air pressure. Also, leaks can lead to skin or eye irritation.
Very small leaks don't stop the machine from
producing the correct amount of air pressure. But small leaks can cause a
shrill sound that disturbs the sleep of others in the house.
Don't use tape or grease on a mask to prevent leaks
unless your home equipment provider or sleep specialist advises you to.
Air Pressure Problems
The air pressure from CPAP makes some people feel
like it's hard to exhale or like they're choking or suffocating. Some people
swallow air, which may cause burping.
If you have problems with the air pressure from
CPAP, it may help to use the "ramp" feature on your CPAP machine. The feature
allows the machine to slowly "ramp up" from a lower air pressure to the
pressure that's needed to keep your airways open during sleep.
If your machine doesn't have this feature or if it
doesn't help, talk to your sleep specialist. He or she may suggest a different
CPAP machine. If that doesn't work, your sleep specialist may suggest another
type of positive airway pressure.
Mask Removal
To get the full benefit of CPAP, you should use it
every time you sleep. Some people remove the CPAP mask while they're asleep. If
this happens, you may be able to solve the problem by:
- Finding a mask that fits better.
- Using a CPAP machine that has a humidifier. This
might make the treatment more comfortable and stop you from removing the
mask.
- Using a chin strap to hold the mask in
place.
Some CPAP machines come with an alarm that sounds if
the mask comes off.
Noise
Most new CPAP machines are fairly quiet. The noise
that they make is soft and rhythmic. If there's still a noise that bothers you,
check the air filter to make sure the machine is working right. Your sleep
specialist or home equipment provider also can check the machine for you.
If the CPAP machine is working right, but the noise
still bothers you, try using earplugs or a white-noise sound machine.
Living With CPAP
CPAP is a long-term treatment. To achieve the full
benefits of CPAP, use it every time you sleep—during naps and at night.
Most people should use CPAP for at least 7.5 hours each night for the best
results.
CPAP machines are small, lightweight, and fairly
quiet. It's possible to take your machine with you when you travel.
Knowing how to maintain your CPAP machine is
important. You also should see your sleep specialist for ongoing care as he or
she advises.
Maintaining the CPAP Machine
It's important to properly maintain your CPAP
machine. Refer to the user manual or ask your home equipment provider how to
take care of the machine.
Parts of the machine need daily or routine care and
cleaning. For example, if your machine has a humidifier, you will likely need
to clean it daily. You also may need to replace parts of the machine after a
certain amount of time.
Your home equipment provider should be able to
provide replacement filters, masks, and hoses for your machine.
If you suspect a problem with your CPAP machine,
call your home equipment provider. Don't try to fix it yourself. There's a
small hole in most machines that lets the air that you exhale out and keeps the
air supply fresh. This isn't a defect in the machine, and you shouldn't try to
cover it.
Getting Ongoing Care
Many people have questions when they first start
using CPAP. Talk to your sleep specialist about how to handle followup
questions. He or she can answer some questions, but your home equipment
provider may need to address others.
It's important to continue to work with your sleep
specialist as you adjust to CPAP. Ask your sleep specialist to recommend a home
equipment provider that has a lot of experience with CPAP.
Your sleep specialist may ask you to schedule a
followup visit about a month after you begin using CPAP. He or she will want to
see how well you're adjusting to treatment. After that, you may have followup
care every 6 or 12 months.
Most CPAP machines record the amount of time you use
them on a computer card. Your sleep specialist may ask you to bring the card in
to see how well you're doing.
During followup visits, your sleep specialist may
need to adjust the air pressure setting of your CPAP machine if:
- You gain or lose a lot of weight
- Your symptoms, such as daytime sleepiness,
persist or recur
- You have another treatment for
sleep
apnea, such as upper airway surgery or a mouthpiece
During followup visits, be sure to tell your sleep
specialist if you're not happy with your CPAP machine. He or she may suggest
switching to a different machine that may work better for you.
Key Points
- CPAP, or continuous positive airway pressure, is
a treatment that uses mild air pressure to keep your airways open while you
sleep. CPAP is used for people who have breathing problems, such as
sleep
apnea.
- CPAP is the most effective treatment for
obstructive sleep apnea. Sleep apnea is a common disorder in which you have
pauses in breathing or shallow breaths while you sleep. When this happens, not
enough air reaches the lungs.
- CPAP is often the best treatment for adults who
have obstructive sleep apnea. Children also can have this condition. The most
common treatment for children is surgery to remove the tonsils and adenoids. If
symptoms don’t improve after surgery, or if the condition is severe, CPAP
may be an option.
- If you have sleep apnea symptoms, your doctor may
recommend an overnight
sleep
study. A sleep study measures how much and how well you sleep. It also can
show whether you have sleep problems and how severe they are. Your doctor will
likely refer you to a sleep specialist for the sleep study.
- Your sleep specialist will review the results
from your sleep study. If CPAP will benefit you, your sleep specialist will
prescribe the type of CPAP machine and the correct settings for you. Once you
have your CPAP prescription, you will work with someone from a home equipment
provider to select a CPAP machine that meets your needs.
- CPAP is a long-term treatment. Many people have
questions when they first start using it. Talk to your sleep specialist about
how to handle followup questions. He or she can answer some questions, but your
home equipment provider may need to address others.
- To achieve the full benefits of CPAP, use it
every time you sleep—during naps and at night. Most people should use CPAP
for at least 7.5 hours each night for the best results.
- CPAP has many benefits. It can:
- Keep your airways open while you sleep
- Correct snoring so others in your household
can sleep
- Improve the quality of your sleep
- Relieve symptoms of sleep apnea, such as
excessive daytime sleepiness
- Decrease or prevent
high
blood pressure
- With CPAP, you may fall asleep faster and wake
fewer times during the night. The pauses in breathing that are typical with
sleep apnea won’t interrupt your sleep.
- Many people who use CPAP report feeling better
once they begin treatment. They feel more attentive and better able to work
during the day. They also report fewer complaints from bed partners about
snoring and sleep disruption.
Links to Other Information About CPAP
NHLBI Resources
Non-NHLBI Resources
Clinical Trials
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