CPAP Machines


Positive airway pressure (PAP) is a method of respiratory ventilation used primarily in the treatment of sleep apnea, for which it was first developed.

PAP ventilation is also commonly used for critically ill patients in hospital with respiratory failure, and in newborn infants (neonates). In these patients, PAP ventilation can prevent the need for endotracheal intubation, or allow earlier extubation. Sometimes patients with neuromuscular diseases use this variety of ventilation as well. Often people with brain injury need these machines, as well as speech therapy to try to compensate for impaired use of the body, including the airway passages.

Respironics Optilife CPAP Machine
Respironics REMstar CPAP Machine
Aeiomed Everest CPAP Machine

Choosing the Right CPAP Machines

The most common treatment for sleep apnea is CPAP, or Continuous Positive Airway Pressure, therapy. A CPAP machine is usually about the size of a shoebox but CAN be smaller. A flexible tube connects the machine with a mask or other interface device that is worn over the nose and/or mouth. CPAP works by pushing air through the airway passage at a pressure high enough to prevent apneas and can be prescribed for both obstructive and central sleep apnea. The pressure is set according to the patient's sleep apnea.

Because CPAP is a medical device, all CPAP units must have Food and Drug Administration (FDA) approval before they can be sold. For the same reason, you must have a physician's prescription in order to obtain a CPAP. (In this publication, "CPAP," considered a generic term and not a brand name, can refer to any positive pressure device.)

There are several CPAP manufacturers that offer different types of machines with different features. Once you have been diagnosed with sleep apnea and have been prescribed CPAP therapy, you may be able to choose one machine among the many offered. A CPAP, typically covered by insurance as a durable medical equipment benefit, is most often rented or purchased through a home health care company, also known as a durable medical equipment company. CPAPs may also be purchased over the Internet. However, before buying a machine, it is generally a good idea to rent one first (on a rent-to-own plan if possible) for several weeks to make sure that the machine has all the features you need, and to determine if CPAP is working as it should.

Talk to your doctor and your home care company representative about which machine is best for you and your lifestyle. Keep in mind the restrictions on cost and/or provider which your insurance company may impose. Some insurance companies will cover only certain types of CPAP devices. In deciding which CPAP machine to use, think about what features you want or need. Options include a carrying case, the ability to convert to foreign currents (automatically or with additional equipment), the capability to adjust for different altitudes, an attached heated humidifier, ramping (which allows for a gradual increase in pressure), DC (direct current) operations via a car or boat battery, and bright colors. Bi-level devices with two different pressures--one for inhalation and a lower pressure for exhalation--are also available. In addition, the Food and Drug Administration (FDA) has approved some auto-adjusting devices for the market; these machines are designed to sense varying pressure needs as you sleep and to change the pressure automatically as needed. The latest type of machine to receive FDA approval is equivalent to a CPAP with continuous or constant pressure for inhalation, but it has flexible lower exhalation levels. The exhalation pressure is determined partly by the machine, which responds to the user's exhalation patterns, and partly by the user, who selects one of three settings.

How they Work

A continuous positive airway pressure (CPAP) machine was initially used mainly by patients for the treatment of sleep apnea at home, but now is in widespread use across intensive care units as a form of ventilation. Obstructive sleep apnea occurs when the upper airway becomes narrow as the muscles relax naturally during sleep. This reduces oxygen in the blood and causes arousal from sleep. The CPAP machine stops this phenomenon by delivering a stream of compressed air via a hose to a nasal pillow, nose mask or full-face mask, splinting the airway (keeping it open under air pressure) so that unobstructed breathing becomes possible, reducing and/or preventing apneas and hypopneas. It is important to understand, however, that it is the air pressure, and not the movement of the air, that prevents the apneas. When the machine is turned on, but prior to the mask being placed on the head, a flow of air comes through the mask. After the mask is placed on the head, it is sealed to the face and the air stops flowing. At this point, it is only the air pressure that accomplishes the desired result. This has the additional benefit of reducing or eliminating the extremely loud snoring that sometimes accompanies sleep apnea.

The CPAP machine blows air at a prescribed pressure (also called the titrated pressure). The necessary pressure is usually determined by a sleep physician after review of a study supervised by a sleep technician during an overnight study (polysomnography) in a sleep laboratory. The titrated pressure is the pressure of air at which most (if not all) apneas and hypopneas have been prevented, and it is usually measured in centimetres of water (cm H2O). The pressure required by most patients with sleep apnea ranges between 6 and 14 cm H2O. A typical CPAP machine can deliver pressures between 4 and 20 cm H2O. More specialized units can deliver pressures up to 25 or 30 cm H2O.

CPAP treatment can be highly effective in treatment of OSA. For some patients, the improvement in the quality of sleep and quality of life due to CPAP treatment will be noticed after a single night's use. Often, the patient's sleep partner also benefits from markedly improved sleep quality, due to the amelioration of the patient's loud snoring.

Given that sleep apnea is a chronic health issue and doesn't go away, ongoing care is needed to maintain CPAP therapy. Based on the study of cognitive behavioral therapy (referenced above), ongoing chronic care management is the best way to help patients continue therapy by educating them on the health risks of sleep apnea and providing motivation and support.

Care and Maintenance

Care and maintenance As with all durable medical equipment, proper maintenance is essential for proper functioning, long unit life and patient comfort. The care and maintenance required for PAP machines varies with the type and conditions of use, and are typically spelled out in a detailed instruction manual specific to the make and model.

Most manufacturers recommend that the end user perform daily and weekly maintenance. Units must be checked regularly for wear and tear and kept clean. Poorly connected, worn or frayed electrical connections may present a shock or fire hazard; worn hoses and masks may reduce the effectiveness of the unit. Most units employ some type of filtration, and the filters must be cleaned or replaced on a regular schedule. Sometimes HEPA filters may be purchased or modified for asthma or other allergy clients. Hoses and masks accumulate exfoliated skin, particulate matter, and can even develop mold. Humidification units must be kept free of mold and algae. Because units use substantial electrical power, housings must be cleaned without immersion.

In cold climates, humidified air may require insulated and /or heated air hoses. These may be bought ready-made, or modified from commonly available materials (aluminium foil and bubble-wrap insulation. Noisy machines may be distanced from the sleeper by extension hoses between the machine and the sleeping person.

Modifications are usually needed by the end-user. Straps are easily twisted wrongly (add hot-melt glue or silicon rubber on the "wrong" side). Fittings and buttons are invisible or without adequate





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