Sleep Apnea Treatment
Nasal CPAP
The most common and gold standard non surgical treatment for sleep apnea is Continuous Positive Airway Pressure (CPAP) therapy. A CPAP machine is usually about the size of a portable radio. 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 the collapse of musculature and soft tissue of the airways. The pressure is set according to the patient's level of sleep apnea and the resistance in the soft tissue. A Bi-Level Positive Airway Pressure (BiPAP) machine delivers air at two pressure levels during inhalation and exhalation of air.
A CPAP machine is a medical device and manufactured under the guidelines and certification of the Food and Drug Administration (FDA). Patients with sleep apnea will need an evaluation by a licensed physician for diagnosis. Sleep studies are preformed to diagnose and evaluate the severity of sleep apnea. The fitting of a CPAP mask and the settings are preformed by a licensed physician and sleep technologist.
There are several CPAP manufacturers that offer different types of machines with different features. Your physician will recommend the type of CPAP unit and mask for you. A CPAP machine is typically covered by insurance as a durable medical equipment benefit. This is most often rented or purchased through a home health care company, also known as a durable medical equipment company.
Talk to your doctor 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. More sophisticated machines with higher costs are not always automatically covered by insurance but may be covered with a specific physician prescription and documented failure to respond to standard CPAP treatment.
Some machines can monitor how often you use the CPAP, while others can also record if you had any apneas while using the machine (this can indicate a need to adjust the pressure). Your doctor may want to download this data periodically to verify the adequacy of your treatment, and the compliance monitor can also be an important feature if you need an objective verification that you are obtaining sufficient amounts of sound sleep. For the data to be downloaded, you may have to take the machine in to the sleep center or home care company. If the data are embedded in a small, thin card, you may be able to take or to mail the card to the sleep center or home care company. You may be able to send the data via a telephone modem (supplied with the machine) that does not require Internet access.
In addition to the machine, you will need a mask or some type of interface. The mask fit is also critical to you. Again, talk to your doctor and home care company representative about your choice of interfaces, and keep in mind that the mask may be manufactured by one company and the CPAP by another.
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