I Hate CPAP!

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CPAP stands for continuous positive airway pressure. Its meant to act as an airway “splint” to keep the upper airway open.  This, in turn, prevents any apeas (ie interruptions in cpapbreathing) that can interrupt sleep. Well!? if CPAP is so beneficial then why do I hate CPAP! The simple response is that, not all patients are alike.

Not all sleep apnea is the same and not all sleep patients are equal.

It important to note that there are varying degrees of severity of obstructive sleep apnea (OSA). Some OSA is only in certain sleep stages. Other times only in certain sleeping positions. So its important to know that not all OSA requires CPAP!  What?!  Really?  Not all OSA requires CPAP?!  Although CPAP is the standard of care, it takes a skilled sleep physician to see if CPAP is right for you. It is much easier to prescribe CPAP than find a reason not to place some one on CPAP.  Those who are most likely to benefit from CPAP are patients that are sleepy and have moderate to severe OSA.

To CPAP, or not to CPAP, that is the question!

Is a Mandibular Advancement Device for me?

Well then who should be on CPAP?  If you have mild OSA you might do well with other interventions such as mandibular advancement devices (MAD), a mouth device to keep you jaw from dropping at night during certain sleep positions and sleep phases. mandibular-advancement-deviceA MAD is worn like a mouth guard and prevents snoring and sleep apnea by moving the mandible (lower jaw) forward slightly. It is usually only meant for mild to moderate OSA or those who have not tolerated CPAP. This is a good alternative also if your snoring or apneas are mostly on your back.  Research has should that MAD do benefit patients. It works on snoring, sleepiness, and improving blood pressure issues.

I only snore on my Back!

Obstructive sleep apnea is usually worse in the supine position, ie sleeping on your back. For that reason some people just merely need to stay off their back to sleep better. This can be done by using a side-sleeper pillow or similar devices. In the past, people would sew tennis balls on a night shirt to stay off their backs.  Now there are apps or even specialized belts that help out with this.

 

Go from a “C” to “B”

Lastly, could you need BPAP? BPAP, sometimes called BiPAP, stands for bi-level positive airway pressure. BPAP is meant for patient who do not tolerate CPAP. It uses two pressures instead of one. In other words if you are on CPAP you can be on a pressure of 8 cmH2O, for example. On BPAP your pressures would look like 8/4 cmH20. BPAP for some people is more natural as it is able to mimic normal breathing.

Ok, you hate your CPAP. Do not get discouraged.

Talk to your doctor about options. Maybe there are options. Just remember that OSA is associated with high blood pressure, stroke and even death if severe enough. There is light at the end of the tunnel!  Maybe CPAP is not right for you, but talk to your doctor before you give up.

disclaimer- this is not meant to be medical advise.

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