What Is CPAP Therapy?

CPAP (continuous positive airway pressure) machines pump air into the lungs of people who have breathing problems -- usually sleep apnea. CPAP machines should not be used for COVID-19 coronavirus patients as they spread the virus farther.

Continuous positive airway pressure (CPAP) means maintaining a constant air pressure in a person’s airway by making air continuously flow into the airway. This keeps the airway open and clear and prevents it from collapsing.

CPAP therapy is an effective home treatment for people who can spontaneously breathe, but have difficulty breathing while asleep. CPAP keeps a patient’s airway continuously open and stimulates breathing by pumping air with a machine.

A CPAP machine may consist of:

• An apparatus to wear on the face such as
• full-face mask that covers the entire face
• full mask that covers the nose and mouth 
• nasal mask that covers the nose
• nasal pillow that sits below the nose
• nasal prongs that go into the nostrils
• A motor that pumps the air
• A tube that connects the machine to the mask

A sleep doctor or a pulmonologist usually first monitors the patient in a sleep lab to determine optimal air pressure for the individual. The doctor helps select the right kind of mask that fits the individual’s need. The patient will need to sleep with the mask on every night with the CPAP machine turned on.

Positive airway pressures machines are primarily of three kinds:

• CPAP: Continuous positive airway pressure that delivers constant and steady air pressure.
• APAP: Autotitrating (adjustable) positive airway pressure that changes air pressure according to the breathing pattern.
• BiPAP: Bilevel positive airway pressure that delivers air with different pressures for inhalation and exhalation.

CPAP cannot be used for people who are not spontaneously breathing. CPAP is primarily used by people who have breathing difficulties while asleep. 

People who have certain diseases or conditions may find it difficult to breathe while asleep, due to obstruction or collapse of the airway. This is called obstructive sleep apnea. This may lead to:

• Reduced sleep and poor sleep quality
• Snoring
• Reduced oxygen intake
• Hypertension
• Daytime sleepiness
• Mood swings
• Impaired cognition
• Fatigue
• Obstructive sleep apnea may be caused by
• Obesity
• Respiratory disorders
• Muscle weakness from muscular diseases
• Tissue growth in the airway
• Swelling or growth of tonsils and adenoids
• Hypothyroidism

CPAP may also be used for breathing difficulties caused by

• Lung tissue diseases such as pulmonary fibrosis
• Airway diseases such as
• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Certain viral and bacterial infections of the respiratory system
• Central sleep apnea (breathing stops and starts several times during sleep due to neurological disorders)
• Heart failure
• Infant respiratory distress syndrome in newborn infants

CPAP is not advised for patients in certain conditions that include:

• Trauma or injury to the face
• Nausea and vomiting
• Copious secretions in the airway
• Unconscious or not spontaneously breathing
• COVID-19 coronavirus disease

No, according to The American Society of Anesthesiologists. 

According to their guidance for clinicians treating patients with COVID-19 coronavirus, CPAP machines may deliver adequate oxygen, but they also aerosolize the virus in the infected person’s breath and spread it around the area, increasing infection risk.

The ASA recommends direct endotracheal intubation for COVID-19 patients with acute respiratory failure.

CPAP is found to be very effective in keeping the airway open in people with sleep apnea. The benefits include

• Normal sleep patterns
• Improved sleep quality
• Better concentration and memory
• Alertness during the day
• Elimination of snoring
• Lowering of hypertension
• Improved general health
• Improved quality of life

CPAP therapy is quite safe and can be used even for infants. It may take a little while to get used to the CPAP machine and its noise; however, most of the latest machines are almost silent.

The CPAP may have a few side effects that include

• Claustrophobia
• Nasal congestion and runny nose
• Nosebleeds
• Eye irritation
• Dryness of mouth
• Redness or soreness where the mask fits
• Chest muscle discomfort
• Upper respiratory infections

Some of the effects can be mitigated by:

• Using the CPAP for short periods initially and acclimatizing
• Using padding and making sure the mask fits well
• Keeping the equipment clean
• Using humidifiers
• Using nasal saline spray