As one person once asked, "Doc, why do you push this CPAP thing so hard?"  Nasal CPAP is our most inconvenient therapy for the treatment of obstructive sleep apnea/hypopnea (OSA).  It is unattractive.  It requires scheduled cleaning and the regular replacement of the CPAP accessories such as masks, filters, and headgear.  The machine and accessories must go where you go if you plan to sleep well. 
 
Why emphasize CPAP over other treatment for OSA?  The answer is simple.  For over 20 years nasal CPAP has remained the single most effective therapy.  The only other therapy that is similarly effective would be a tracheostomy (a permanent tube that is placed through the neck into the throat that opens a passage around the obstruction during sleep).
 
Nasal CPAP restores normal breathing in 95% of patients with OSA.  Even those with significant obstruction of airflow through the nose may benefit from nasal CPAP by using a full face mask that allows air to be delivered to either nose or mouth.  Continuing therapy whenever sleeping becomes the primary challenge for the CPAP user.
 
By restoring breathing to normal, sleep quality is significantly improved.  With proper adjustment of CPAP in the sleep laboratory under the care of an experienced technologist (as a reminder, not all sleep laboratories are accredited or have experienced and supervised technologist such as those at Sleep Medicine Associates of Texas), the continuity of sleep is improved.  Snoring is eliminated.  Nearly 90% of patients who have excessive daytime sleepiness when trying to read, work, or watch television report their alertness to be improved with effective CPAP therapy.  For those with high blood pressure, diabetes, or severe depression, between 40% and 60% will discover that blood pressure, blood sugar, or mood is more stable by regularly using nasal CPAP.
 
Although the staff and doctors at Sleep Medicine Associates of Texas (SMAT) put their skill and experience into the start of nasal CPAP for each user, the long-term challenge with CPAP therapy is to use it nightly whenever you sleep.  How is success with nasal CPAP defined?  Although doctors are interested in the improvement of symptoms such as snoring, daytime sleepiness, observed pauses in breathing during sleep, and various health parameters, the microchip inside of current CPAP devices provides valuable information about machine function, breathing efficiency, and use.  This internal information from the CPAP device permits refinement of therapy.  Based upon medical research, use of nasal CPAP, as defined by changes in symptoms and health risk, begins to show benefit when CPAP is used for > 4 hours on more than 70% of nights.  In the CPAP program at SMAT, over 85% of CPAP users average at least four hours or more of nightly sleep on their CPAP device.  As research shows that the highest likelihood of normal function occurs when CPAP is used for > 6 hours per night on most nights per month, SMAT doctors define "normal" as over 6 hours per night on > 90% of nights.  The SMAT CPAP program assists users to "normal" in 55-60% of CPAP users.
 
Many different health professionals advertise alternative treatments to nasal CPAP.  At SMAT, evidence from the medical literature guides decisions about treatment.  Below is a table that defines success rate according to the percentage of treated patients with OSA that have fewer than 10 obstructive episodes of sleep apnea/hypopnea per hour of sleep during initial treatment.  The estimate is also given for the successful use of the treatment after a year or more of therapy for patients at SMAT.

 

In summary, nasal CPAP is remarkably successful in returning breathing to normal.  Its inconveniences can be overcome by a majority of users.  Continued benefit can be seen year after year.  There are people who have used CPAP successfully for 25 years.  Although we continue to research alternative treatments to CPAP, at this time there is no treatment that matches the success of nasal CPAP.  Of course, decisions about treatment must be individualized by the doctor for each person.  There are times when surgery is appropriate or an oral appliance is a more viable alternative.  Much depends upon the severity that a person begins with and how much weight loss is needed.  Please talk with your SMAT physician if you have questions.