If you’ve been diagnosed with obstructive sleep apnea (OSA) and a physician or sleep specialist has told you that you need to start CPAP therapy, you probably have a lot of questions. You’ve come to the right place. As an authority on all things CPAP-related, answering peoples’ questions about CPAP therapy and CPAP devices is what we do. We want you to feel comfortable with the life-changing therapy you’re about to begin.
The most important thing to know is that CPAP is going to improve your sleep, and therefore your health, almost immediately. Once you start treating your sleep apnea, you’ll stop snoring and you’ll see a noticeable reduction in daytime sleepiness, along with an improvement in your focus and attention.
Other benefits of using CPAP to treat your OSA are less visible, but just as important: managing your apnea can prevent or reverse serious, long-term health conditions like chronic high blood pressure, cardiovascular disease, and risk of stroke.
What Is Sleep Apnea (OSA)?
The first question you may have if you’re going to use CPAP is, “What exactly is sleep apnea? How do I know if I have it?”
If you snore, or if you’ve been told that you making gasping or choking sounds in your sleep, then it’s likely you have obstructive sleep apnea. You’re not alone. Sleep apnea is an extremely common condition affecting millions of people.
If you have obstructive sleep apnea, something is actually blocking your ability to take in the air you need to breathe. This happens when your airway relaxes during sleep. The muscles of the mouth or throat collapse, blocking the airway and preventing oxygen from getting into your lungs.
These temporary blockages or obstructions are events called “apneas,” and they can interrupt your breathing, which in turn raises your blood pressure and causes snoring.
Apneas can also wake you up with a characteristic gasp or choking noise, or even a cough, though you may not even realize this; it’s not uncommon for people with apnea to wake up dozens or even hundreds of times per hour without awareness, which leads to fragmented, poor-quality sleep (both for the individual with apnea and their bed partner).
If you have these apnea symptoms—along with symptoms like waking up with a headache or experiencing all-day drowsiness—you’ll need confirmation by a doctor before you can begin CPAP therapy.
What Is CPAP Therapy and How Does it Work?
Your next questions, if you have apnea, are probably related to the therapy itself. You may be asking, “What is CPAP and why do I need it?” or “What does a CPAP machine do?”
“CPAP” is the term for a machine used to treat mild, moderate, or severe sleep apnea. A CPAP machine (sometimes referred to as a “sleep apnea machine”) is a medical device that can be prescribed by a board-certified sleep specialist.
“CPAP” is an acronym describing exactly what the machine does: the four letters stand for continuous positive airway pressure. Your CPAP provides a constant, gentle flow of pressurized air that keeps your airway from collapsing while you sleep. This helps you breathe and maintain good blood oxygen levels throughout the night.
“CPAP therapy” is the term for the treatment approach itself. To get the best results, people diagnosed with sleep apnea are expected to use their CPAP machines consistently, all night every night.
CPAP Machines: Are They Hard to Use?
CPAP machines are not difficult to use. They’re simple devices, and the technology is improving all the time. The three main components are:
- Motor. The CPAP box or machine that sits on your bedside table is the CPAP motor. It’s a small, quiet compressor that takes in room temperature air and pressurizes it. The motor then delivers the gently pressurized and filtered air to your airway via a hose and mask (see below). Some people opt to use the humidifier that comes with the motor to keep their nose, mouth, and throat from getting dry.
- Hose. The CPAP hose, about 6 feet long, connects the motor to the mask. Hoses are specially designed to convey humidified air.
- Mask. Depending on your particular breathing issues and fit requirements, your CPAP mask may go over your nose or over your entire face (nose and mouth together). Another style is the nasal pillows CPAP mask, which inserts into the nostrils from below. Though the masks are easy to use and effective, comfort can be an issue; sometimes trial and error is required before you find the perfect CPAP mask fit that helps you comply with your therapy.
CPAP machines and their components do need to be tested, serviced, and replaced periodically, but this regular CPAP maintenance and upkeep is part of your prescription, and is typically covered by insurance.
Reasons for Using CPAP
You may be asking yourself, “Why do I need a CPAP machine?” CPAP can help treat the following conditions and issues:
- Obstructive Sleep Apnea (described above).
- Upper Airway Resistance Syndrome (UARS). A form of sleep-disordered breathing, UARS is the stage between mild snoring and full apnea. When your airway reduces in diameter due to loose tissue, this constriction creates resistance. Air still moves into your lungs, but not as easily. You may not experience apnea events where you stop breathing, but your sleep breathing will be heavy and labored. As you work harder and harder to breathe, your brain may compensate by waking you up. Left untreated, UARS almost always develops into OSA. CPAP is not necessarily the first line of treatment for UARS, but as the condition progresses, it’s often recommended to help keep the airway open.
- Snoring. We all know what snoring sounds like, but what does it look like? As the tissue in your throat loosens, it vibrates when you inhale and exhale. Snoring may begin as a harmless, irritating form of noise pollution, but it can be a sign of things to come. Snoring often progresses to UARS and ultimately to OSA.
Getting Prescribed to Use CPAP
How do you get started with CPAP therapy? The first step is getting a diagnosis. To confirm you have sleep apnea, you’ll probably need to have a sleep study (polysomnogram) conducted at a sleep clinic. (Some patients may qualify for a Home Sleep Study instead.) This overnight test allows sleep technologists to collect comprehensive data about your sleep, such as brain activity, blood oxygen levels, heart rate, and respiration.
If you do have apnea, sleep lab technologists will be able to track how often you stop breathing per each hour of sleep. After the study, they share these numbers with your sleep specialist, who will make a diagnosis as to your condition and its severity.
If the sleep specialist advises you use a CPAP machine, you may need a follow-up sleep titration study. This is a second overnight visit to the sleep center, to help determine which CPAP machine and mask are right for you. During this visit, you will sleep while trying a few different CPAP masks and machines. The technologist will test different air pressure calibrations to determine a level that will clear your airway obstruction without disturbing your sleep.
CPAP Therapy Is a Treatment, Not a Cure
CPAP therapy is remarkably effective, but only if you use it regularly. CPAP is a treatment, not a cure for apnea. You need to comply with the therapy by using CPAP daily or your apnea will continue as it did before you began treatment.
Why might people fail to comply with their CPAP therapy? A few reasons. Common barriers to good adherence include:
- A poorly fitting CPAP mask
- A problem with tolerating the air pressure
- Aerophagia—swallowing air, which can lead to gas, flatulence, bloating, burping, or discomfort
- Humidification issues (or lack thereof) irritating your throat and mouth
Fortunately, most of these CPAP intolerance issues can be addressed by having your equipment and settings adjusted or swapped out. Be sure to contact your sleep physician if you have problems. Remember, treating your apnea is a long-term commitment. You may need to make adjustments and modifications from time to time to keep your therapy working for you—but the boost in your sleep and health is well worth the effort.
David Repasky has been using CPAP treatment since 2017 and has first-hand experience with what it’s like to live with Sleep Apnea. He brings the patient’s perspective to the CPAP.com blog and has received formal training in CPAP machines, masks, and equipment.