Rehabilitation Medicine

Positive Airway Pressure (PAP) Therapies
Positive airway pressure (PAP) therapy is a generic term applied to all sleep apnea treatments that use a stream of compressed air to support the airway during sleep. With PAP therapy, you wear a mask during sleep. A portable machine gently blows pressurized room air from into your upper airway through a tube connected to the mask. This positive airflow helps keep the airway open, preventing the collapse that occurs during apnea, thus allowing normal breathing. For optimal improvement, it's important to use your PAP machine every time you sleep – including naps.
Overall PAP therapy is a safe and effective treatment, however there are a few counter-indications. Be sure to tell your doctor if you have bullous lung disease, pneumothorax, cerebrospinal fluid leak or severe epistaxis (nosebleeds).
Conditions Treated
Obstructive sleep apnea (OSA)
Occurs when a patient stops breathing during periods of sleep; usually as a result of blockage (obstruction) in the airway.
Snoring
A very common condition caused by the obstruction of air into the lungs. The "extra" air gets redirected into the mouth, creating a vibration of the soft tissue of the palate.
Central sleep apnea (CSA)
Pauses in breathing while asleep that are not caused by an obstruction but rather by a disorder of the central nervous system.
Upper airway resistance syndrome (UARS)
A condition in which the upper airway is reduced during sleep, resulting in disturbed sleep; can lead to snoring, daytime sleepiness, cognitive impairment, un-refreshing sleep, and frequent arousals from sleep.
Types of Positive Airway Pressure Therapies
There are three main types of PAP treatment available.
•Continuous positive airway pressure
•BiLevel positive airway pressure
•Auto-titrating devices
What To Expect from PAP Therapy
PAP therapy is a prescribed treatment because the air pressure required to stabilize the airway, known as the therapeutic pressure, is different for everyone. The treatment pressure is measured in centimeters of water (cm H2O) and most machines can be set by the provider to deliver pressures between 4 and 20cm H2O. The correct setting is critical because if the air pressure is set too low, the airway can still collapse. If it's set too high, you can become over-ventilated. Either scenario will have a negative impact on your sleep quality. Several factors impact the therapeutic pressure, including severity of OSA and structure of the airway. An individual's therapeutic level is determined during a continuous positive airway pressure (CPAP) titration sleep study.
•PAP tips
•Mask fitting tips
•Adjusting to PAP therapy
Local Durable Medical Equipment Companies
The process of obtaining a CPAP or Bi-level unit and any related medical equipment once you have a prescription requires a few steps. Your prescription will specify the type of therapy needed (for example CPAP versus BiLevel) and your therapeutic pressure. In addition, the physicians should have indicated certain accessories, such as specific mask types, chin strap, or humidifiers, which are essential to the proper delivery of positive airway pressure.
•DME checklist
•DME vendors
Local Durable Medical Equipment Companies
The process of obtaining a CPAP or Bi-level unit and any related medical equipment once you have a prescription requires a few steps. Your prescription will specify the type of therapy needed (for example CPAP versus BiLevel) and your therapeutic pressure. In addition, the physicians should have indicated certain accessories, such as specific mask types, chin strap, or humidifiers, which are essential to the proper delivery of positive airway pressure.
•DME checklist
•DME vendors
•Side Effects of PAP Therapy
•PAP treatment is very safe and effective for treating sleep apnea, however it can take time to get used to the feeling of the mask and breathing against the positive air pressure. When adjusting to your new machine, you may experience nasal congestion, headaches, skin irritation or stomach bloating. Most of these side effects are temporary and can be reduced by changing the mask style or using a heated humidifier to add moisture to the air. See positive airway pressure (PAP) therapy tips for techniques to resolve issues. If symptoms persist, be sure to contact your physician.