According to the American Sleep Apnea Association, using CPAP (Continued Positive Air Pressure) therapy is the most effective way to reduce both the intensity and frequency of recurrent breathlessness during sleep – a common sleep apnea symptom that is found to be most distressful by patients.
Given this background, one could presume that a majority of sleep apnea patients find relief by using the CPAP. The reality, however, is somewhat different. According to the Journal of Respiratory Therapy, CPAP therapy meets with only 46% patient compliance after 3 months of use. Of the people who continue with the therapy after this phase, 37% eventually abandon it completely.
The high rate of discontinuation with CPAP, considered to be the gold standard in apnea treatment, is a matter of grave concern for many new candidates looking for viable and patient-friendly sleep apnea treatment options.
What is needed is a pragmatic and unbiased review of the pros and cons of using CPAP. Is the therapy over-rated? Are patient complaints fully justified? Are there new and improved versions of the CPAP machines that can adequately address some of the issues raised by users who are partially dissatisfied, or those who reject the therapy option as non-feasible?
To understand why CPAP is rejected by so many sleep apnea patients, one has to keep in mind that many patient complaints are focused around the difficulty of using the CPAP mask, one of the most important components of CPAP therapy. The mask, fitted on the nose, mouth, or both, acts as the conduit of carrying the pre-measured pressurized air to the lungs to prevent it from collapsing during sleep. It is connected to the main CPAP device with the help of a hose, through which the air flows.
When the cons of CPAP take over
Let us look at some of the common side-effects of CPAP that cause people to abandon the device:
- Mask causing skin laceration at the bridge of the nose
- Constant airflow causing dry mouth and throat
- Feeling of bloating
- Perception of embarrassment – the device, the mask and the tube could make an ugly sight at the bedside of many patients
- Objection from bed partner
- Feeling of claustrophobia when wearing the mask
Looking at the good side of CPAP
As far as the good aspects of CPAP is concerned, there are numerous points in its favor:
- Adjustable pressure mode for patient compliance.
- Most mask-related problems arise only when the mask is either too loose or too tight. If the mask can provide snug fitting many such problems can be solved. Moreover, the size of the masks can also be adjusted.
- CPAP can be continued in conjunction with several other therapy options for the treatment of sleep apnea.
- Separate attachments like humidifiers, etc are available to tackle the problem of dry mouth and throat. Such attachments can be plugged on to the CPAP device easily. Antihistamines and nasal sprays can also be used to minimize CPAP side effects.
- The CPAP machines are made portable and compact for ease of use during travel, easy storage, etc.
- Feelings of claustrophobia and anxiety can be managed with separate medication; these feelings have actually nothing to do with CPAP compliance.
- Most importantly, CPAP increases the level of oxygen in the blood by keeping the airway open during sleep.
Pros and cons of CPAP variants
For patients who are not too comfortable with CPAP therapy, doctors recommend using another later version of the CPAP called the BiPAP machine. This machine delivers two variants of pressure to the lungs – for inhalation it delivers higher amount called the Inspiratory Positive Airway Pressure (IPAP) and for exhalation it can be made to deliver slightly lower Expiratory Positive Airway Pressure (EPAP). This machine is generally recommended for patients who suffer from neuromascular and cardiopulmonary disorders over and above sleep apnea.
More expensive than the average CPAP, side effects of BiPAP are more or less the same as CPAP but possibly more tolerable for the typical user.
While the biggest advantage of this variant is that it delivers a different amount of pressure during inhalation and exhalation, one of the cons of this type of machine is that the amount of titrated pressure needs constant monitoring.
If you view the pros and cons of CPAP with an unbiased attitude, you might find the pros far outweighing the cons. Since discontinuation is a matter of personal choice and its use free from any obligation, one should not give this therapy a miss, just because some adverse reports seem to color the entire market of CPAP therapy.
Links to Studies on the Pros and Cons of CPAP