Continuous positive airway pressure, or CPAP, is a non-invasive treatment method intended for patients who are experiencing respiratory distress but are still able to maintain their own airway. CPAP was originally used for people who experience obstructive sleep apnea to increase pressure in the upper airway and prevent tracheal collapse during sleep. However, it has been found to be a great tool in the pre-hospital setting and decreases the need for more invasive airway management, such as intubation. Although effective, endotracheal intubation can be difficult in the field and contains some complications and disadvantages. If used early enough, CPAP can prolong the need for intubation or even replace the need for it altogether. It is important to remember though, that CPAP only treats the symptoms of respiratory distress; it does not fix the main problems the patient is suffering from.
Who needs it?
Continuous positive airway pressure is indicated for patients whose oxygen demand has exceeded their ability to compensate for their lack of oxygen. It has been proven to be extremely helpful for people with fluid in their lungs (pulmonary edema), Chronic Obstructive Pulmonary Disease (COPD), and acute bronchospasms, such as asthma. Other reasons people may need CPAP include toxic inhalation, drowning, flail chest and various lung infections such as pneumonia. It should be used on patients who are alert and able to follow commands, show signs of respiratory distress, have rapid breathing, and a pulse oximetry of less than 90%. It is important, however to follow your protocols on when to use CPAP.
How it works
Continuous positive airway pressure improves ventilation and respiration by increasing the pressure in the lungs. The continuous pressure opens up the alveoli and prevents them from collapsing. This allows more oxygen to be forced across the alveolar membrane, and pushes out any fluid in the lungs, forcing it back into the pulmonary circulation. This improves oxygenation to the blood and eases the work of breathing. In addition, it increases intrathoracic pressure, which decreases venous return to the heart. This decreases the hearts preload, which is especially beneficial for patients suffering from pulmonary edema caused by congestive heart failure. However, it can result in hypotension.
Using CPAP
The CPAP device generally consists of a generator, corrugated circuit tubing, a one-way valve with a filter, and a mask. Be sure to have a full oxygen cylinder because CPAP uses a large amount of oxygen. Connect the circuit and attach it to the oxygen cylinder. Apply the mask to the patients face and allow them to hold it to get comfortable with it. The device may be scary to some patients or might make them feel claustrophobic. They may need to be coached through the experience until they are comfortable with it. If it is their first time using it, explain that it feels like they are sticking their head out of a car window and they must exhale against the resistance. The resistance on expiration is called positive end-expiratory pressure, or PEEP. There is a valve that controls the PEEP setting and it should be set between 5-10 cm H2O. Once they are comfortable with the mask, attach the head strap and ensure a tight seal around the nose and mouth. Continue to reassess the patients’ lung sounds and vitals.
Contraindications
Although CPAP is effective for patients in respiratory distress, it will not breathe for them and therefore should not be used on unconscious patients or patients with altered mental status. It should not be used in cases of hypoventilation or any cases of airway compromise. Due to the air pressure, there is a risk of aspiration and so it should not be used on patients who are experiencing any nausea or vomiting. Do not use it if you are unable to obtain a tight mask seal such as with patients who have too much facial hair or facial trauma. Do not use if you suspect the patient has a pneumothorax. And lastly, do not use it if the patient is not able to tolerate it.
CPAP is an important treatment for obstructive sleep apnea, but it may be frustrating at first. Learn how to avoid uncomfortable masks and other common CPAP problems.
By Mayo Clinic StaffContinuous positive airway pressure (CPAP) therapy is a common treatment for obstructive sleep apnea. A CPAP machine uses a hose connected to a mask or nosepiece to deliver constant and steady air pressure to help you breathe while you sleep.
Common problems with CPAP include a leaky mask, trouble falling asleep, a stuffy nose and a dry mouth.
But if a CPAP mask or machine doesn't work for you, you have other options. And most CPAP masks can be adjusted to help make them more comfortable.
Here are 10 common CPAP problems and what you can do about them:
1. The wrong size or style CPAP mask
Work closely with your health care provider and the CPAP supplier to make sure you have a CPAP mask that fits properly. People have different face shapes, so the right mask style and size for someone else may not work for you.
Try a different mask. A range of CPAP masks is available. For example, some feature full face masks that cover your mouth and nose, with straps that stretch across your forehead and cheeks. These may make some people feel claustrophobic, but they work well if you prefer to breathe through your mouth during sleep. They also provide a stable fit if you move around a lot in your sleep.
Other masks feature nasal pillows that fit under your nose and straps that cover less of your face. These can feel less cumbersome.
Nasal pillows may work well if you wear glasses or read with the mask on, because some don't block your eyes as much as full face masks do. However, this mask style may not be an option if you move around a lot in your sleep or sleep on your side.
Pay attention to size. Most masks come in different sizes. Just because you're a certain size in one mask doesn't mean you'll be the same size in another. CPAP masks are usually adjustable.
Ask your doctor or CPAP supplier to show you how to adjust your mask to get the best fit. Manufacturer product instructions also can help show you how to do this. A properly fitting mask shouldn't be uncomfortable or cause pain.
2. Trouble getting used to wearing the CPAP mask
First, try wearing just the CPAP mask for short periods of time while you're awake — for example, while watching TV. Then try wearing the mask and hose with the machine turned on during the day while you're awake.
Once you get used to how that feels, start using the CPAP machine every time you sleep — including during naps. Only using the CPAP machine every now and then may delay getting used to it. Stick with it for several weeks or more to see if your mask and pressure are right for you.
3. Difficulty tolerating forced air
You may be able to overcome this by using a machine with a "ramp" feature. This setting allows you to start with low air pressure. The machine then automatically and slowly increases the air pressure to your prescribed setting as you fall asleep. Your doctor can adjust its rate.
If this feature doesn't help, talk with your doctor about changing to a machine that automatically and constantly adjusts the pressure while you're sleeping. An example is a bi-level positive airway pressure (BPAP) machine that delivers more pressure when you breathe in (inhale) and less when you breathe out (exhale).
4. Dry, stuffy nose
Check to make sure your mask fits well. A leaky mask can dry out your nose. If you have to tighten the straps often to prevent air leakage, the mask does not fit properly.
A CPAP machine that features a heated humidifier, which attaches to the air pressure machine, can help. You can adjust the level of humidification. Using a nasal saline spray at bedtime also can help ease a dry, stuffy nose.
5. Feeling claustrophobic
Practice using your mask while you're awake. First, just hold it up to your face without any of the other parts. Once you're comfortable with that, try wearing the mask with the straps.
Next, try holding the mask with the attached hose on your face, without using the straps. Turn on the CPAP machine, perhaps with the ramp feature turned on. Next, do this using the straps too. Finally, try sleeping with the mask and machine on.
Relaxation exercises, such as progressive muscle relaxation, may help reduce anxiety related to CPAP use.
If you're still feeling claustrophobic, talk to your doctor or CPAP supplier. It may help to get a different size mask or try a different style, such as one that uses nasal pillows.
6. Leaky mask, skin irritation or pressure sores
A leaky or an ill-fitting mask means you're not getting the full air pressure you need, and you may be irritating your skin. The mask can also direct air into your eyes, causing them to become dry or teary.
Try adjusting pads and straps to get a better fit. If the mask fits over your nose, make sure it doesn't sit too high on the bridge of your nose, which can direct air into your eyes.
You may need to ask your CPAP supplier to help you find a different size mask, particularly if your weight has changed a lot. Or try a different style mask such as one that uses nasal pillows. If you develop skin deterioration or sores, such as on your nose, tell your doctor promptly.
7. Difficulty falling asleep
Wearing the mask alone for some time during the day may help you get used to how it feels and make it easier to fall asleep at night.
Machines with the ramp feature that slowly and gradually increase the air pressure to your prescribed pressure setting as you fall asleep may make you more comfortable at bedtime.
Following good general sleep habits also is helpful. Exercise regularly and avoid caffeine and alcohol before bedtime. Try to relax. For example, take a warm bath before you go to bed. Don't go to bed until you're tired.
8. Dry mouth
If you breathe through your mouth at night or sleep with your mouth open, some CPAP machines may worsen dry mouth. A chin strap may help keep your mouth closed and reduce the air leak if you wear a nasal mask.
A machine with a full face mask that covers your mouth and nose also may work well for you. A CPAP-heated humidifier that attaches to the air pressure machine also may help.
9. Unintentionally removing the CPAP mask during the night
It's not unusual to sometimes wake up to find that you've removed the mask in your sleep. If you move a lot in your sleep, you may find that a full face mask will stay on your face better. You may have removed your mask while sleeping because you were uncomfortable. Consider trying a different type of mask that may fit you better.
You may be pulling off the mask because your nose is congested. If so, ensuring a good mask fit and adding a CPAP-heated humidifier may help. A chin strap may help keep the mask on your face.
If this is a consistent problem, consider setting an alarm for a time during the night so you can check whether the mask is still on. You could progressively set the alarm for later in the night if you find that you're keeping the mask on longer.
10. Bothersome noise
Most new models of CPAP machines are almost silent. But if you find that your machine's noise is bothersome, first check to make sure the machine's air filter is clean and unblocked. Something in its way may worsen noise. Ask your doctor or CPAP supplier how to properly clean your mask and hose.
If this doesn't help, have your doctor or CPAP supplier check the machine to ensure it's working properly. If the machine is working correctly and the noise still bothers you, try wearing earplugs or using a white noise sound machine to mask the noise. Placing the CPAP machine as far away from the bed as possible also may help make any machine noise less noticeable. Ask your doctor or CPAP supplier if extra tubing is available and right for your machine.
Time and patience are key to success
Using a CPAP machine can be frustrating as you try to get used to it, but it's important that you stick with it. The treatment is essential to avoiding complications of obstructive sleep apnea, such as heart problems and excessive daytime sleepiness.
Work with your doctor and CPAP supplier to ensure the best mask fit and device for you. Regular visits to your sleep doctor are important and can help troubleshoot any problems and adjust settings, if needed. It can take a while to find the correct settings and get used to the mask.
With time and patience, CPAP can positively affect your quality of life and health.
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Oct. 27, 2021
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