Do you wake up in the morning after a long night’s sleep and wonder why you still feel tired? Do you feel unfocused, drained, and have difficulty concentrating on tasks during the day? Has a loved one complained about your excessive snoring episodes? If so, read on! This article covers everything you ever wanted to know about Sleep Apnea treatment and CPAP therapy.
Let’s start with the basics. An “apnea” is a temporary cessation of breathing. Therefore, “Sleep Apnea” is a temporary cessation of breathing that repeatedly happens during sleep. That’s a simple definition, but there’s so much more to it than that.
Sleep Apnea occurs in roughly 22 million Americans with many of those cases being undiagnosed1. When a person sleeps, the muscles of the tongue and throat could relax and expand to a size larger than they are when the person is awake.
The relaxed muscles take up extra space, and as a result, the airflow to the lungs becomes blocked. With the airway blocked, air from the nose and mouth cannot reach the lungs, and the person wakes up, often gasping and choking for air. Because this process happens repeatedly throughout the night, a person rarely gets the rest they need to function at their highest levels throughout the day.
What are the Symptoms?
Symptoms of Sleep Apnea can include the following1:
- Daytime drowsiness
- Difficulty concentrating
- Fatigue, despite sleeping at least 8 hours
- Loud snoring that can be heard in another room
- Waking up at night gasping or choking
- Sleep restlessness
If left untreated, these symptoms may worsen over time. It’s important to treat Sleep Apnea if you’ve received a diagnosis.
It can be caused by a number of different risk factors1, including:
- Family History2
- Alcohol Use2
How is Sleep Apnea Different From Snoring?
Vibrations of the soft pallet tissues of the neck and throat cause snoring and are not the same thing as Obstructive Sleep Apnea or OSA. Snoring doesn’t mean the airway is completely blocked, as is the case with OSA. A person can snore but still have air reach the lungs.
Snoring so loud that it’s heard in another room is one of the most noticeable symptoms of OSA, along with other symptoms like gasping and choking. However, just because a person snores, that doesn’t always mean they have OSA. In order for a person to be diagnosed with OSA, other symptoms must be present too.3.
What Are the Three Types of Sleep Apnea?
There are three types of Sleep Apnea4:
- Complex (Mixed)
Obstructive Sleep Apnea
OSA is the most common form of Sleep Apnea, affecting 4% of men and 2% of women in America today, with roughly only 10% of cases being diagnosed1. It’s a condition that arises when excess tissues of the tongue, mouth, and throat expand during sleep and partially or completely block the airway, depriving the person of oxygen.
Sometimes breathing can stop for 10 seconds or longer, and the person will wake up choking and gasping for air. The person has to wake up to breathe, and then quickly falls back asleep, where the process repeats.
This cycle happens throughout the night, and when the person finally wakes up for the last time in the morning, they feel exhausted and fatigued. They may have slept for 8 hours, but don’t feel rested.
Symptoms of OSA
Symptoms of OSA include:
- Loud snoring that can be heard in another room
- Daytime Fatigue
- Falling Asleep While Driving or Bored
- Sleeping for 8 or More Hours, yet Still Feeling Tired
- Difficulty Concentrating and Focusing on Tasks
OSA is caused by some different risk factors, including obesity, large neck size, and could also be caused by genetics and heredity.
Some people naturally have a more narrow throat than other people, and when you add in other risk factors, the conditions are right for developing OSA4.
Treatment for OSA
In most cases, treatment for OSA doesn’t require surgery. CPAP therapy is the usual treatment for OSA. CPAP therapy (or PAP therapy) as it’s sometimes called, uses a machine with a motor to pressurize the outside air gently and then connecting it to your airway using a hose and mask.
This pressurized air acts as a splint, opening up the airway so that the person can breathe. It’s important to note that CPAP therapy isn’t a cure for OSA. It simply minimizes the effects of the symptoms.
Central Sleep Apnea
Central Sleep Apnea (CSA) is different from Obstructive Apnea in a few different ways. In Central Apnea, the brain sometimes doesn’t send signals to the lungs to breathe. Without the instruction to breathe, the person fails to draw a breath.
In OSA, the signal to breathe is there, but because of blockages in the airway, breathing is unable to take place. Central Apnea is a lot less common than OSA.
Symptoms of CSA
Symptoms of CSA are many, and can include:
- Shortness of Breath that Goes Away When You Wake Up
- Your Bed Partner Notices You Have Extended Periods Where You Don’t Breathe at Night
- Difficulty Staying Asleep
- Extreme Daytime Fatigue
It’s not normal for your brain to stop sending the signal to breathe to your lungs!
Developing Central Apnea
Typically, CSA develops over time from several different conditions such as heart failure or stroke. Here’s a complete list of the conditions that can lead to developing Central Apnea:
Cheyne-Stokes Breathing: Typically found in those with heart failure or stroke. Cheyne-Stokes Breathing is characterized by a gradual decrease in breathing effort over the course of the night. Breaths become shallower, quieter, and softer and eventually breathing stops altogether. Cheyne-Stokes Breathing is the leading cause of CSA.
Opioid Induced CSA: Opioid painkillers are often prescribed to minimize pain for surgeries and certain treatments like cancer. Opioids are very effective in minimizing pain, but they can cause a lot of severe consequences for the body.
Those on opioids often experience everything from constipation to headaches as these powerful drugs dull many of the senses and signals that travel throughout the body. In some people, opioids can cause the brain not to send a signal to the lungs to breathe, causing CSA to develop.
High Altitudes: Those living in, or visiting, a high altitude environment may notice the higher elevations induce Cheyne-Stokes Breathing. Higher elevations have thinner air and less oxygen than you’d find at sea level.
The lack of oxygen can lead to shorter, more rapid breathing, and this can cause Cheyne-Stokes Breathing which then leads to developing Central Apnea.
Treatments for CSA vary. As with OSA, PAP therapy is a common form of treatment for CSA. While some users may use CPAP therapy to treat CSA, BiPAP therapy has also been shown to be effective. Some BiPAP models have the ability to prompt breathing if the person hasn’t taken a breath over a certain period of time.
BiPAP devices are similar to their CPAP cousins by delivering gently pressurized air through an elongated tube (also called a hose) to a mask that connects to the mouth or nose.
BiPAP machines also use one specific pressure for inhalation and then a second pressure for exhalation, unlike CPAP machines which deliver a constant therapy pressure all night long. On BiPAP machines, the pressure setting can be set to a lower pressure on exhalation to make it easier to breathe out.
Complex (Mixed) Sleep Apnea
Complex or Mixed Sleep Apnea is a disorder in which OSA and CSA exist at the same time. The person has periods of Obstructive Apneas during the night, which also coincide with periods in which the brain doesn’t send the right signals to the lungs to breathe. Researchers for the Mayo Clinic discovered Complex Sleep Apnea in 20065.
It was initially discovered in a group of patients that appeared to have OSA, but for whom CPAP therapy wasn’t fully effective. It was only then, by looking deeper, that researchers discovered that the patients had CSA also in play.
This new condition was called Complex Sleep Apnea, and at that point, a search for a more effective form of treatment began5.
Treating Complex Sleep Apnea
Complex Apneas can be treated with ASV (Adaptive Servo-Ventilation), and is a form of treatment that functions much like a brilliant and sophisticated APAP. Adaptive Servo-Ventilation analyzes each breath and supplies the exact amount of pressure the person needs for respiration.
When a person has greater trouble breathing, the machine helps manage and mitigate those breathing difficulties and when the person’s breathing returns to normal, the device adjusts again, making breathing 50% less difficult, increasing user comfort and making the ASV a very effective treatment for Complex Apnea.
How to Find Out if You’re Experiencing Sleep Apnea
Getting diagnosed is the first step to treatment. It’s important to point out that many things can cause poor sleep, and Sleep Apnea isn’t always the cause of sleep issues. To be sure, you’ll need to undergo a sleep study. Sleep studies can either be done in a sleep lab or sometimes at home.
Sleep studies measure things like blood oxygen levels, the number of times you stop breathing, and the number of obstructive events that take place while you sleep. The results are calculated into a score called an AHI which is a composite measure of your sleep, and based on this figure the doctor can make a diagnosis.
Who Can Diagnose It?
Many different health care providers can diagnose Sleep Apnea, and can also write a prescription for the most common form of treatment — CPAP therapy. To get a CPAP machine from CPAP.com, you have to have a prescription from a physician that specifies a treatment pressure.
Before your new device leaves our warehouse, it will be programmed with your treatment pressure, so that when you get it, it’ll be ready to go.
In order for CPAP.com to accept the prescription, it has to be written by a doctor or nurse practitioner with the following credentials:
- MD – Medical Doctor
- DO – Doctor of Osteopathy
- NP – Nurse Practitioner
- PA – Physician’s Assistant
- DDS – Dentist
We can also accept prescriptions from the following prescribers:
- ARNP – Advanced Registered Nurse Practitioner
- FNP- Family Nurse Practitioner
- PhDNP – Ph.D. Nurse Practitioner
- PA-C – Physician’s Assistant Certified
- MO – Medical Officer (US Military Physician with officer rank)
- ND or NMD- Licensed Naturopathic Doctor
- Otolaryngologist or ENT – Ear, Nose, and Throat Doctor
- MBBS – International (MB – Bachelors of Medicine, BS – Bachelors of Science)
- MBBS, FRACP – (MBBS, Fellow of the Royal Australasian College of Physicians)
We cannot, however, accept prescriptions from professionals with these credentials:
- FCCP – (U.S. and Canada) stands for Fellow of the College of Chest Physicians
- RN – Registered Nurse
- M.S.N RN – RN w/Master’s of Science in Nursing
- B.S.N. – Bachelor’s of Science in Nursing
- LVN – Licensed Vocational Nurse
- LPN- Licensed Practical Nurse
- RMA – Registered Medical Assistant
- CMA – Certified Medical Assistant
- DPM – Doctor of Podiatric Medicine (Podiatrist)
These requirements are specified as a part of state and federal laws and regulations and are not the result of an internal policy on our part.
Treatments and Best Practices
Depending on a number of factors, including how severe your symptoms are, and what type you have, your doctor may recommend some of the following non-invasive therapy options6:
- Treatment with a CPAP Machine
- Treatment with an APAP Machine
- Treatment with a BiPAP (BiLevel) Machine
These are the among most common and least invasive treatment options. In rare cases, your doctor may recommend surgery. In most cases, insurance covers your treatment. How much each person’s responsibility will vary from provider to provider.
Now, let’s go over the most common forms of treatment one at a time.
A CPAP machine is a form of Sleep Apnea treatment that takes the air you breathe and gently pressurizes it. The air then travels down a long tube, known as a hose, and connects with your airway using a specially designed CPAP mask that keeps the air pressure from escaping.
When you breathe in, the pressurized air opens your airway, allowing the air to reach your lungs. All forms of PAP therapy work this way. The machines differ from one another in the way that these CPAP machines choose the target pressure. “CPAP” is an acronym that stands for “Continuous Positive Airway Pressure.”
CPAP machines are programmed with one set pressure, and cannot change the amount of pressure on their own.
Of the different PAP therapy devices, CPAP machines are the least expensive and can be purchased anywhere from $250 – $500.
APAP machines also work by pressurizing the outside air. Unlike CPAP machines, which deliver therapy air at one set pressure, APAP machines study your breathing and automatically decide which pressure is best for you. They can change pressures as many times as necessary during the night, each time giving you exactly the right amount of pressure.
APAP machines are the preferred type of treatment device to CPAP machines for this very reason. “APAP” stands for “Automatic Positive Airway Pressure.” The “automatic” part of the name comes from the fact that an APAP machine can adjust pressure automatically, while a CPAP is “continuous” and only delivers therapy air at one pressure.
Because of the ability to set pressures automatically, APAP machines are a little more expensive than CPAP machines, and range in price between $500 – $1000.
BiPAP (BiLevel) Machines
“BiPAP” stands for “BiLevel Positive Airway Pressure” and means the device uses two different set pressures, one for use while inhaling, and one for use while exhaling. The pressure on exhale is lower than the one on inhale and is designed to increase user comfort by making it easier to breathe out.
Some BiPAP machines can choose the pressures on inhalation and exhalation automatically and are sometimes referred to as “Auto BiLevel” machines.
Even though BiPAP machines may seem like the most capable of all CPAP devices, it’s not accurate to think of BiPAP machines as a “better APAP.” Only a doctor can know if a BiPAP is right for you. For most people that experience OSA, an APAP or a CPAP machine will be more than adequate for your needs.
BiPAPs are more often used by those that have CSA or Complex Apnea, and can even sometimes help with COPD.
Because BiPAPs are significantly more complicated than CPAPs and APAPs, the price tag is the highest among PAP therapy devices. BiPAPs start out at $1,000 and can go for as much as $1,800, depending on what features each model has.
Advice for Loved Ones
Like many of you reading this article, I have OSA. I was diagnosed in June 2017 and was urged to get tested for OSA by my wife. I think that my journey to getting diagnosed was made possible because of her insistence that our care team look into it.
Successfully in treatment for over a year, I’ve noticed a lot of the benefits that come with Sleep Apnea treatment, and I largely have my wife to thank for that. Here’s some advice that I would give to significant others who have a partner with OSA.
1. Be a voice of encouragement, and help your partner talk to his or her doctor about sleep. When you’re a person who could potentially have OSA, you may not be aware of your symptoms, because you’re asleep when you experience them. Chances are, your partner has more details than you do, which is why it’s important for them to be involved when you talk to the doctor about potential sleep problems.
I’m glad my wife was able to help me begin my treatment journey. Her observations were constructive, and her kind encouragement was a big part of my getting better. It was her input that first helped me think of my snoring as potentially being OSA.
2. Starting CPAP therapy requires patience, and your help during the first few months will be invaluable. During the first few months of treatment, I would rip off my mask in the middle of the night and not realize it. When this became a regular thing, my wife started to help by learning how to convince me to put my mask back on when I would take it off.
It was then I noticed that my sleep started getting better. As a loved one of someone with OSA, it’s important to know that the first few months of having OSA are always going to be the most difficult. Being able to help your partner during this period of adjustment will be critical to their success with treatment.
3. Have a discussion with your partner about noise– before you decide on your equipment. Before investing in therapy equipment, it’s important that you both discuss how much noise is acceptable. All CPAP machines and CPAP masks make a degree of noise.
Different machines have different decibel ratings, and range from ultra-quiet to a little louder than a whisper. If you’re sensitive to noise while sleeping, you may want to get an ultra-quiet machine and a quiet CPAP mask to go with it. But if you don’t speak up, you may not like the results.
What Do I Need to Start CPAP Therapy?
Here’s the equipment you’ll commonly need to start CPAP therapy:
- CPAP Therapy Device (CPAP Machine, APAP Machine, BiPAP Machine)
- Hose (Tube That Connects the Machine to Mask)
- CPAP Mask (Full Face, Nasal Pillow, Nasal)
- Humidifier (Optional)
Here’s a rundown of the different supplies you’ll need for CPAP therapy and what they are.
CPAP Therapy Device
To get started with CPAP therapy, you’ll obviously need a CPAP machine! You could also need an APAP machine or a BiPAP machine, depending on what you are prescribed. If you have a prescription for a CPAP machine, you could upgrade to an APAP, but you couldn’t get a BiPAP machine. CPAP machines and the other two variants come in a wide range of options and features.
Some are geared more for travel, while others are designed to be ultra-quiet. Some machines have built-in humidification, while others offer it as an add-on. You have choices, and which CPAP machine you choose depends a lot on what your personal preferences are. CPAP.com has published a helpful resource: our APAP machine comparison chart, which will help you find the machine with the features you’re most interested in.
As with any major purchase, it’s important to do your research before you buy. Look around, compare features, and make sure you are getting a machine that’s going to work well for you.
A CPAP hose is a tube, usually about 6 feet long, that connects from the CPAP machine to the CPAP mask. Hoses can be standard, with no heating coils, or can come with a heating system. Why would a hose need a heater? When using a heated humidifier, sometimes the air can cool as it travels through the hose.
Cooler air holds less water than warmer air. As the air cools, it can no longer hold the moisture it’s carrying from the humidifier. As a result, condensation forms in the hose and can end up splashing the user. This process is called “rainout,” and a heated hose can stop rainout by keeping the humidified air at the same temperature as it travels through the tube.
Because the air never cools, it doesn’t have to release the water it’s carrying. Heating coils prevent rainout and are a reason so many people choose to use a heated hose.
A CPAP mask is where the CPAP hose carrying the pressurized air meets the face. It is the CPAP mask’s job to maintain a seal around the mouth, nose, or nostrils so that the pressurized air cannot escape. When the CPAP mask does its job, the air remains fully pressurized as it travels down the airway, enabling it to act as a splint, opening the airway and allowing much-needed oxygen to reach the lungs.
CPAP masks come in three basic mask styles: full face, nasal, and nasal pillow. The full face mask covers both the nose and mouth, giving the user the option of breathing through the nose or the mouth. A nasal mask covers the entire nose, while a nasal pillow mask uses comfortable pillows to seal around each nostril.
There’s no right or wrong mask style, and ultimately the one you choose should be the one that most closely matches your sleeping style. As a CPAP user myself, I can tell you the most important thing is that you should get a mask that matches how you
actually sleep and not the style you’d prefer. The right mask will make complying with therapy easier, and it’s better than trying to train yourself to use a mask that’s not for your preferred way to sleep.
Humidifiers are completely optional. Scientifically, a CPAP machine works just as well without a humidifier as it does when using one6. Humidifiers are used to add moisture to therapy air, so as you breathe, your sinuses and throat are less likely to dry out in the process.
When you wake up in the morning, you are less likely to feel as parched as you would if you weren’t using a humidifier. For this reason, many CPAP users feel like humidifiers are an essential part of therapy. There are three main types of humidifiers: built-in, integrated, and stand-alone humidifiers.
Built-in humidifiers are included with the purchase of the machine and are not marketed as an upgrade or an add-on. Integrated humidifiers are designed to work with one specific device only, and are marketed as an add-on or upgrade over the base machine design.
Sold as separate items, stand-alone humidifiers are designed to work with many different brands of machines. Typically customers purchase a stand-alone humidifier only when there is no built-in or integrated humidifier option available for a particular device.
Filters clean the air before it gets to your airway, removing dirt, allergens and sometimes, bacteria. Filters should be changed every so often and are a necessary part of CPAP therapy. How often? CPAP.com has created a handy chart showing the replacement schedule for filters and other disposable parts of your CPAP therapy. Follow the link to view the replacement schedule.
Benefits of CPAP Therapy
There are many reported benefits to CPAP therapy, including:
- Improved Brain Function
- Increased Ability to Concentrate
- Increased Daytime Energy
- More Restful, Productive Sleep
- Less Risk of Falling Asleep While Driving or Bored
The benefits of CPAP therapy will, for most people, outweigh any side effects. Reported side effects of CPAP therapy may include:
- Sometimes Feeling Gassy or Bloated
- Dried Out Nose and Throat
- Nasal Congestion
- Red Marks on the Face
It’s important to note that each person is different, and not all of these side effects will happen at the same time. You may experience none of these side effects, or you may experience a few of them. It depends a lot on the person. As a CPAP user for over a year, I can tell you that I experience occasional red marks on the face, but other than that, none of these other side effects impact me at all.
Your CPAP story may be different than mine, but in most cases, the benefits you’ll experience from faithfully using your CPAP machine will far outweigh any of the drawbacks.
So that wraps up our analysis of OSA, CSA, and Complex Apneas and how to treat it! For more information on CPAP machines, and CPAP masks please see the comprehensive guides that we’ve released on our blog. We want you to have the best CPAP experience possible, and live a longer, healthier life, and we hope you’ve learned a thing or two that can help you along in your treatment journey.
1. Amedee, Ronald G., MD, et al. Obstructive Sleep Apnea: A Growing Problem. Published in the medical journal “The Ochsner Journal” in Fall 2009. Accessed on August 28, 2018.
2. National Heart, Lung, and Blood Institute. Sleep Apnea Published on the National Heart, Lung, and Blood Institute’s official website. Accessed on September 24, 2018.
3. Maimon, Nimrod, M.D. and Hanly, Patrick J., M.D. Does Snoring Intensity Correlate with the Severity of Obstructive Sleep Apnea?. Published on October 15, 2010. Accessed on August 29, 2018.
4. American Sleep Apnea Association. Sleep Apnea Information for Individuals Published on the American Sleep Apnea Association’s official website. Accessed on September 24, 2018.
5. Mayo Clinic. Mayo Clinic Discovers New Type Of Sleep Apnea Published in the health news magazine “Science Daily” on September 4, 2006. Accessed on September 24, 2018.
6. Yu, Chung-Chieh et al. The Effects of Heated Humidifier in Continuous Positive Airway Pressure Titration. Published in the medical journal Sleep & Breathing in 2013. Accessed on September 19, 2018.
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.