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Treatment for sleep apnea
CPAP (Continuous Positive Airway Pressure)

CPAP is the most widely recommended treatment for moderate to severe obstructive sleep apnea.

CPAP entails wearing a mask-like device while you sleep, which provides pressurized air to prevent the airway from collapsing. Most CPAP units are the size of a tissue box and many now come with a built in humidifier for comfort. Cpaps come in several models and makes. The two best known brands are probably the Resmeds and Respironics. The lower end models do not provide data recording (although I think all record compliance in case the insurance or Medicare needs to know if the patient is using their machine). A ramp feature makes it easier for a patient to get used to the pressure by starting the pressure lower and gradually raising it to the prescribed pressure. Often times once the patient has become accustomed to treatment they no longer need the ramp feature. Epr, cflex, and aflex (other machines may have different names for this technology) offers exhalation relief. This means when you breathe out the pressure drops slightly to make it "more natural". Many use this feature and I, for one, still use the cflex mode on my machine. If at all possible, make sure that you get a data capable machine. This data allows the machine, with the help of a data card and additional software, to monitor your events while using the machine. Insurance will not cover the external software needed for your computer to monitor it yourself -- but many DME's will download the data for a small fee.

While CPAP works very well in preventing apnea symptoms, many people find the apparatus uncomfortable and difficult to use. Luckily, recent advancements to CPAP technology have made these once cumbersome devices much lighter, quieter and much more comfortable. Recent refinements include options such as:

“Bilevel PAP,” which switches from higher to lower air pressure during the exhalation, making breathing easier for some. Often insurance companies require you to "fail" using cpap before paying for this machine as it is more expensive. People that need higher pressure often benefit from bilevels since the pressure can be adjusted at a wider range than what epr, cflex, or aflex can offer.

“AutoPAP”, which uses an internal regulator that adjusts pressure rather than remaining at one fixed setting. These machines are able to offer lower pressures and increase the pressure when they "sense" an event. I have a Respironics M series apap and love it. I am able to monitor my therapy and for most of the night have a lower pressure with it increasing only when needed.

Codes for apaps and cpaps are the same. It is to your benefit to see if your doctor will prescribe an apap instead of a just a "plain" cpap. In prescribing an apap be sure to have him write a range of pressures for the DME to go by.

Different types of masks are available and can make using the device more comfortable.

CPAP can cost $1000 or more (using a local DME) - but they are usually effective when used correctly. Unfortunately, many people don’t receive proper coaching and guidance for using these breathing devices, and give up on them quickly. If you are paying out of pocket or your insurance will reimburse you buying online can save you some money. Check out prices carefully and know what you are getting before you buy. If using a local DME do NOT sign any paperwork you do not understand. Be sure to ask about additional costs, etc.

The following tips may help you use CPAP more comfortably and successfully:

Take your time. Start by using your CPAP for short periods during the day. Use the “ramp” setting to gradually increase air pressure.
Make small adjustments to the mask, tubing and straps to find the right fit. Soft pads are available to cover the straps and reduce skin irritation.
Try masks of different sizes and types. A full mask might work better if you breathe through your mouth. A mask with nasal pillows should decrease nose discomfort. A mask with a chin strap will help keep your mouth closed and reduce throat irritation.
Put your CPAP unit under the bed if the noise bothers you.
Use a humidifier with the CPAP unit (or get a unit with a humidifier) to decrease dryness and skin irritation. Try a special face moisturizer for dry skin.
Try a saline nasal spray or a nasal decongestant for nasal congestion.
Keep your mask, tubing and headgear clean. Replace CPAP and humidifier filters regularly.
Work with your doctor or sleep specialist to ensure the right fit and find the right settings on your CPAP unit.
Find a support group or others who use CPAP to exchange tips and give and receive moral support.
Use the CPAP consistently – every night and during every nap. This will make the adjustment easier and ensure maximum benefit.

http://www.helpguide.org/life/sleep_apnea.htm contributed much of the above information in this discussion.

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