Breathing-assistance devices

Continuous Positive Airway Pressures (CPAP): “Nasal CPAP” is the treatment of choice for most people with obstructive and mixed apnoea. It is the most reliable and effective treatment in most cases. Hundreds of thousands of CPAP devices are now in use treating obstructive apnoea worldwide. An added advantage with this treatment is the elimination of snoring. It involves using a small air blower device connected by a hose to a nose mask you wear while you are asleep – much like a regular oxygen mask, with straps to keep it in place. Essentially, this device blows air into your nose to keep your airway from collapsing and creating an obstruction by increasing the air pressure in your airways. It isn’t as unpleasant as it sounds – most people get used to the sensation fairly quickly. Admittedly, having to wear a face mask to bed is not the most attractive thing in the universe. Most bed partners are usually happy to live with it rather than snoring! It is infinitely preferable to the effects of apnoea, both the fatigue and other physical effects (additional strain on the heart). The exact results vary, but a great many people report significant changes in their lives when they start using CPAP – they feel more awake, more alive – “like a whole person”, in some cases.

Bi-Level Positive Airway Pressure: Bi-level positive airway pressure is a variation of CPAP. Instead of providing air at a constant, fixed pressure all night, the machine “senses” how much air the person needs, based on inspiration and expiration, and varies its level of pressure accordingly. On inspiration, a higher pressure is needed to prevent Apnoeas, Hypopnoeas, or snoring. But on expiration, the patient typically requires less pressure. What is the purpose of this? Well, some people find that they simply cannot sleep with regular CPAP due to the constant air pressure. Bi-level pressure helps this problem by providing less pressure when you are breathing out (expiration) and more when breathing in (inspiration). Bi-level pressure devices are significantly more expensive than a regular CPAP.

Responsive and “smart” airway pressure devices: In the belief that the reduction of total airway flow would provide greater comfort to the patient and encourage patients to use the airway pressure treatment on a regular basis, several manufacturers have begun to offer a new generation of treatment devices. These devices incorporate flow and pressure sensors and automatic regulation systems. There are three basic approaches. One tries to keep overall pressure requirements low by using high pressure only when there is a specific problem, but this requires a very rapid increase in pressure if a problem is detected. The second varies the pressure delivered, providing less when problems are absent, and raising the pressure gradually as problems appear. The third gradually raises and lowers the pressure as conditions require, but also changes the pressure within a specific breath if an emerging problem is detected. Compared to CPAP, “smart” devices may offer greater patient comfort, insofar as the overall pressure is reduced, providing that the changes in pressure reduce or eliminate apnoea, snoring, or flow limitation, and also provided that the changing pressures are tolerated by the patient. They may be used for patients whose pressure requirements may vary during the course of the night, from night to night, and over longer periods of time. As professionals in the field of sleep disorders gain experience of these devices and their appropriate applications, they may provide an additional path of relief for selected patients. As with any new form of treatment, physicians and patients may need to review studies of each device before selecting the one most appropriate to the needs of a specific patient.

Tongue-restraining devices (TRDs): This is a suction cup that is gripped with the teeth and which sucks the tongue forward, thus opening the airway behind the tongue. People who snore only when lying on their back, and whose tongue is the main source of obstruction, sometimes find this device helpful.

Mandibular Advancement Devices (MADs): These are specialised dental devices (must be fitted by a dental surgeon) which clamp your teeth and jaw joint to “pull forward” the jaw to allow more space for breathing. They are only worn at night (removable) and initial research shows a certain amount of success, however side effects include excess salivation and joint pain (soreness) in some cases. They must be worn all night every night. While a relatively new way of managing sleep Apnoea, further design modifications are needed.

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