This is a question that is frequently asked, what is the difference between all of these treatments; and what machine is prescribed for what diagnosis?
First, let’s talk about “sleep-disordered breathing”. This means that during the night, the person who has a sleep disorder will exhibit some signs that things just are not right with their sleep and/or breathing during the night. Snoring is usually one of the most common symptoms. Snoring is the noise that the airway makes when it is obstructed. Pauses in breathing are a sure indicator that there is something going on with the airway that is not normal. Some of the more subtle signs, that we usually try to attribute to other things can be morning headaches, tiredness upon awakening, weight gain, forgetfulness, elevated sugar levels upon awakening, depression, heart arrhythmias, decrease in sex drive. We tend to think that most of these conditions are just a normal process of aging...but that is not always the case...if you have any of the above symptoms, especially combined with one or more others, (especially if you are told that you snore or stop breathing) then you may have some sort of sleep disorder. Most people have obstructive sleep apnea. This is when an “obstruction” causes closure, blockage, or severe narrowing of the airway. A person with this breathing disorder is normally ordered (by a physician) to utilize a CPAP or an AUTO CPAP unit. A CPAP (Continuous Positive Airway Pressure) unit delivers a single constant pressure to the airway to keep it splinted open all night long. The pressure that is needed is normally ascertained during a sleep study where a person goes to the sleep laboratory and sleeps overnight on a CPAP machine. The pressure on the CPAP is adjusted until an optimal pressure is achieved that keeps the airway patent throughout the night and helps to normalize oxygen levels during sleep.
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AUTO CPAP is a device that will constantly adjust in pressure to meet the demand of the airway in different situations such as, sleeping positions, lifestyle changes or habits, and varying sleep stages. The prescription will include low pressure and high pressure and the machine will adjust between those two parameters. The auto CPAP units allow patients who did not have a sleep test with the CPAP on, due to insurance constraints, etc., to have pressure delivered automatically. An auto CPAP is also a standard for obstructive sleep apnea and as home sleep testing has become more common. The current generation of PAP units has the ability to transmit data that gives a glimpse of your nightly treatment and if it is effective for your disorder. The data is available to both the doctor or sleep facility as well as to the user via an app. It is recommended that a heated humidifier be used with any of the PAP units as the sinuses and oral cavity can become quite dry during positive airway treatment. Heated humidification also helps to alleviate some allergy symptoms. All bedside units have the capability to incorporate a heated humidifier.
Bilevel or BiPAP is a machine that delivers two different pressures. One when the client inhales and one when the client exhales. BiPAP is most frequently used for the following diagnoses and situations. When a person requires high CPAP pressures (current CPAP units only go up to a pressure of 20cmH2o whereas a BiPAP unit can go up as high as 30cmH2o). When a person is intolerant of current CPAP or AUTOPAP pressures, many times BiPAP will be used. It is frequently used for cardiac issues, obesity hypoventilation, central sleep apnea, COPD, and for neuromuscular diseases such as ALS, MS, MD, and others. It is also used when oxygen levels are not being maintained during treatment with just a CPAP or AUTOPAP. Some BiPAP machines can act like a “non-invasive” ventilator for a client who needs augmented breathing day or night. BiPAP machines also come in an “auto” version, where just like the CPAP version, it will automatically adjust both inspiratory and expiratory pressures separately so that the treatment is customized breath by breath.
There are other “hybrid” BiPAP units out there that are usually not employed in the home very often. These hybrid units are seen and used most often in hospitals and rehabilitation facilities. They are more expensive than standard BiPAP machines and require a specific diagnosis for use.
Regardless of the type of PAP you may be using or ordered to use by your physician, there is a multitude of products to go with your device to enhance your treatment. There are many interfaces (masks that are used with PAP devices), there are bed pillows designed specifically for a PAP user. There are environmental sound machines and phone/computer apps with sounds and music to help initiate sleep. There are moisture-wicking bedclothes and bedsheets and lavender-scented everything. One word of caution, don’t ever put anything other than water (preferably distilled water) into your humidifier. No essential oils, etc. First of all, breathing in these substances may cause coughing or harm to the airway. Secondly, the oils will accumulate in the device and may cause it to break down prematurely. Damage from this type of use, will not be covered by the manufacturer’s warranty, which is normally 2 years.
Proper daily and weekly cleaning and periodic changing of filters and supplies will keep your PAP device running for years. It is recommended that you change the filter monthly or whenever it is dark in color or soiled. It is recommended that you replace your tubing as well as your mask and headgear at least every 3 months. The heated humidifier chamber can be changed every 6 months or sooner if needed. Daily cleaning should include washing your mask with mild soapy water, this is to remove skin oils from the mask so you can achieve a better seal each night and to prevent bacteria from growing on the product. Clean your heated humidifier chamber every morning by emptying its contents and washing the chamber with mild soapy water, let it air dry. The chamber should not be refilled until bedtime. The tubing should be washed weekly with warm, soapy water, rinsed, and hung up to air dry. The headgear that holds the mask on your face can be laundered in a mesh bag in the washer or by hand as needed. Do not put your headgear into the dryer. Let it air dry.
CPAP, AUTO CPAP and BiPAP therapy all require a prescription from your doctor to dispense. That prescription will include the type of machine that is required, and what pressure(s) the unit needs to be set to. The masks and supplies do not need a prescription to dispense. CPAP and BiPAP therapy are non-invasive treatments with proven success for the treatment of sleep-disordered breathing. The use of a PAP device can help give you more years in your life as well as enhance the quality of those years. This is a very common disorder and most providers are very in tune with its signs and symptoms. If you or someone you love may be suffering from a sleep disorder, make 2022 your year to treat it.
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