Name of the Procedure:

Positive Airway Pressure Therapy (PAP Therapy)

Summary

Positive Airway Pressure Therapy is a treatment used to help people who have difficulty breathing during sleep, such as those suffering from sleep apnea. It involves wearing a mask over the nose or mouth connected to a machine that delivers a constant stream of air to keep the airway open.

Purpose

Positive Airway Pressure Therapy is primarily used to treat sleep apnea, a condition where breathing repeatedly stops and starts during sleep. The goals are to prevent airway collapse, improve sleep quality, reduce daytime sleepiness, and mitigate other health risks associated with untreated sleep apnea.

Indications

• Obstructive sleep apnea (OSA)
• Central sleep apnea (CSA)
• Complex sleep apnea syndrome
• Chronic obstructive pulmonary disease (COPD) with sleep-related breathing disorders
• Criteria: Diagnosed via sleep study, such as a polysomnogram or home sleep test.

Preparation

• Follow prescribed sleep study or diagnostic assessments to confirm the need and correct settings for PAP therapy.
• No specific fasting or extensive preparation is needed.
• Practicing with the mask beforehand can help in getting accustomed to it.

Procedure Description

1. Initial Setup: The patient undergoes a titration study to determine the appropriate air pressure settings.
2. Mask Selection: A mask fitting over the nose or mouth is selected based on comfort and effectiveness.
3. Machine Setup: The PAP machine is set up with the prescribed pressure settings and connected to the mask via tubing.
4. Usage: The patient wears the mask during sleep, and the machine delivers a steady or auto-adjusting stream of air.
5. Monitoring: Usage may be monitored over time with follow-up visits to ensure effectiveness and adjust settings if necessary.

Duration

The PAP therapy is used every night during sleep. Initial titration and setup take a few hours.

Setting

Usually done at home after initial setup and evaluation, which might occur in a sleep clinic or hospital.

Personnel

• Sleep specialist or pulmonologist
• Respiratory therapist
• Sleep technician (during initial diagnostic and titration studies)

Risks and Complications

• Nasal congestion or dryness
• Skin irritation from the mask
• Claustrophobia or difficulty tolerating the mask
• Rare: Sinus infections, eye irritation, or aerophagia (air swallowing) Management includes mask adjustment, humidifiers, or medical interventions.

Benefits

• Improved sleep quality and duration.
• Reduction in daytime fatigue and sleepiness.
• Decreased risk of cardiovascular issues associated with sleep apnea.
• Observable benefits may start within a few days to weeks of consistent use.

Recovery

• Post-procedure recovery involves getting accustomed to nightly use of the machine.
• Regular follow-ups to monitor therapy effectiveness and make necessary adjustments.
• Minimal downtime, as the patient continues normal daily activities.

Alternatives

• Lifestyle changes, such as weight loss or positional therapy.
• Oral appliances designed to keep the airway open.
• Surgical options, like uvulopalatopharyngoplasty (UPPP).
• Pros: Less invasive options might be more comfortable.
• Cons: May not be as effective in severe cases of sleep apnea compared to PAP therapy.

Patient Experience

• Initial discomfort or adjustment period to wearing the mask.
• Mild noise from the machine might require acclimatization.
• Most patients report significant improvement in symptoms within a few weeks.
• Providers may offer strategies for pain management and comfort measures, such as mask padding or using humidifiers to reduce nasal dryness.