Sleep apnea is a sleep disorder characterized by pauses in breathing during sleep. These episodes, called apneas (literally, "without breath"), each last long enough so one or more breaths are missed, and occur repeatedly throughout sleep. The standard definition of any apneic event includes a minimum 10 second interval between breaths, with either a neurological arousal, or a blood oxygen desaturation of 3-4 percent or greater, or both arousal and desaturation. Sleep apnea is diagnosed with an overnight sleep test called a polysomnogram.
Clinically significant levels of sleep apnea are defined as 5 or more events of any type per hour of sleep time (from the polysomnogram). There are three distinct forms of sleep apnea: central (0.4%), obstructive (84%), and complex (complex is a combination of central and obstructive) (15%). Breathing is interrupted by the lack of effort in central sleep apnea; in obstructive sleep apnea, breathing is interrupted by a physical block to airflow despite effort. In mixed sleep apnea, there is a transition from central to obstructive features during the events themselves.
Regardless of type, the individual with sleep apnea is rarely aware of having difficulty breathing, even upon awakening. Sleep apnea is recognized as a problem by others witnessing the individual during episodes or is suspected because of its effects on the body. Symptoms may be present for years, even decades without identification, during which time the sufferer may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance.
A continuous positive airway pressure (CPAP) machine is used mainly by patients for the treatment of sleep apnea at home. Obstructive sleep apnea occurs when the upper airway becomes narrow as the muscles relax naturally during sleep. The CPAP machine stops this phenomenon by delivering a stream of compressed air via a hose to a nasal pillow, nose mask or full-face mask, splinting the airway (keeping it open under air pressure) so that unobstructed breathing becomes possible, reducing and/or preventing apneas and hypopneas. This has the additional benefit of reducing or eliminating snoring.
The CPAP machine blows air at a prescribed pressure (also called the titrated pressure). The necessary pressure is usually determined by a sleep physician after review of a study supervised by a sleep technician during an overnight study in a sleep laboratory. The titrated pressure is the pressure of air at which most (if not all) apneas and hypopneas have been prevented, and it is usually measured in centimeters of water (cm H2O). The pressure required by most patients with sleep apnea ranges between 6 and 14 cm H2O. A typical CPAP machine can deliver pressures between 4 and 20 cm H2O. More specialized units can deliver pressures up to 25 or 30 cm H2O.
CPAP treatment can be highly effective in treatment of obstructive sleep apnea. For some patients, the improvement in the quality of sleep and quality of life due to CPAP treatment will be noticed after a single night's use.
Prospective CPAP candidates are often reluctant to use this therapy, since the nose mask and hose to the machine look uncomfortable and clumsy, and the airflow required for some patients can be vigorous. Some patients adjust to the treatment within a few weeks, others struggle for longer periods, and some discontinue treatment entirely.
Given that sleep apnea is a chronic health issue and doesn't go away, ongoing care is needed to maintain CPAP therapy.