Name of the Procedure:

Positive Airway Pressure (PAP) Therapy

Common Names: CPAP (Continuous Positive Airway Pressure), APAP (Automatic Positive Airway Pressure), BiPAP (Bilevel Positive Airway Pressure)

Summary

Positive airway pressure therapy involves using a machine to provide continuous airflow through a mask to keep the airway open during sleep. It is most commonly used to treat sleep apnea and other sleep-related breathing disorders.

Purpose

PAP therapy is primarily used to treat obstructive sleep apnea (OSA), where the muscles in the throat relax excessively during sleep, causing airway blockage. The goal is to ensure a steady flow of air, prevent airway collapse, enhance sleep quality, and reduce related health risks like cardiovascular disease and daytime fatigue.

Indications

• Diagnosis of obstructive sleep apnea (OSA)
• Persistent snoring associated with periods of apnea
• Daytime sleepiness
• High blood pressure resistant to standard treatments
• Heart failure related to sleep-disordered breathing

Preparation

• Attend a sleep study or home sleep apnea test to confirm diagnosis.
• No fasting required; normal diet and routine can be followed.
• Specific instructions on mask fitting and machine settings will be provided.

Procedure Description

1. Diagnosis and Prescription: Initial diagnosis is confirmed via sleep study, followed by a PAP therapy prescription.
2. Equipment Setup: A PAP device and a properly fitting mask are provided.
3. Mask Fitting: Various mask types are tried to find the most comfortable and effective fit.
4. Usage: The machine is set up next to the bed and delivers a continuous stream of air through the mask.
5. Monitoring and Adjustments: The settings might be adjusted over time based on comfort and effectiveness, often monitored remotely by a healthcare provider.

Tools, Equipment, or Technology:

• PAP machine (CPAP, APAP, or BiPAP)
• Mask (nasal, full face, or nasal pillows)

Anesthesia or Sedation: Not applicable.

Duration

The setup and initial fitting typically take about 1-2 hours. Usage of the machine is nightly during sleep.

Setting

• Home setting for therapy use.
• Sleep center for initial diagnostic testing and follow-up.

Personnel

• Sleep specialist or pulmonologist
• Respiratory therapist or PAP specialist
• Sleep technician (for sleep studies)

Risks and Complications

Common:

• Mask discomfort
• Nasal congestion or dryness
• Skin irritation around the mask

Rare:

• Aerophagia (excessive air swallowing)
• Respiratory infections
• Feelings of claustrophobia

Management includes mask adjustments, humidifier use, and patient education.

Benefits

• Improved sleep quality
• Reduced sleep apnea symptoms
• Lower risk of cardiovascular events
• Enhanced daytime alertness
• Generally, benefits are realized within the first few nights of use.

Recovery

• Routine use; adaptation phase can range from a few days to a few weeks.
• Follow-up appointments for equipment adjustments and efficiency reviews.
• Long-term adherence to therapy is required.

Alternatives

• Lifestyle changes (weight loss, positional therapy)
• Oral appliances (mandibular advancement devices)
• Surgical options (uvulopalatopharyngoplasty, nerve stimulation)
• Pros and cons: PAP therapy is non-invasive and effective for most patients, while alternatives may offer benefits but involve more risks or less consistent outcomes.

Patient Experience

• Initial discomfort due to mask and air pressure, which usually resolves with time and adjustments.
• Common experiences include improved alertness, mood, and reduced snoring.
• Patients are encouraged to follow tips for comfortable use, such as using a humidifier and keeping the equipment clean.

Pain management includes adjusting the fit of the mask and using nasal sprays if needed. Comfort measures can include specialized pillows and relaxation techniques before bed.