Health Column: Unmasking PAP machines: For those with sleep problems, device regulates breathing problems, device regulates breathing

Dr. Fredric M. Radoff

Dr. Fredric M. Radoff

Patients who have trouble sleeping because of sleep-disordered breathing no longer have to suffer as there are a number of treatment options available. One of those treatment options comes in the form of a positive airway pressure, or PAP, machine, which can cause a rather incomplete reduction in the amount of apneas experienced throughout the night.

The machines typically are used to treat sleep-disordered breathing, especially central sleep apnea which occurs when the brain doesn’t generate the signals for breathing or because breathing muscles are too damaged or weak to move air in and out of the lungs. It also treats more severe cases of obstructive sleep apnea which occur when the airway in the back of the throat becomes totally blocked, usually by the tongue and the soft palate coming into contact. The person is trying to breathe, yet the blocked airway won’t allow air to enter or leave the lungs.

PAP machines consist of a smaller computer-controlled fan that generates and regulates airflow. The output pressure parameters are determined, initially, during an overnight PAP titration study during which a sleep technician varies the airflow parameters with a remote control while closely monitoring the person sleeping in another room. Through on-board computer chips that are programmed to detect the abnormalities in an individual’s breathing rate, along with the amounts of inhaled and exhaled air, the PAP unit automatically adjusts the breathing rate and volume of air delivered to compensate for a person’s breathing abnormalities as they occur.

Most PAP machines have an integrated variable humidification system that also can warm the air delivered to the user. Numerous types of face masks or nasal pillow devices can be used to deliver air through a plastic hose that connects the PAP unit to a face mask or nasal pillow, depending on the person’s preference. Manufacturers have tried to make the masks as comfortable and tolerable as possible, as that can help improve compliance and use of the machine, which in turn, helps people get a better night’s sleep.

PAP machines have been around since 1981, when they were invented for home use by Dr. Collin E. Sullivan, an Australian pulmonologist. Sullivan wanted to provide continuous and constant positive airway pressure (CPAP), but realized some people were unable to tolerate exhaling against the air flowing at them, particularly at higher pressure levels, and when first trying to fall asleep. Since that time, PAP machines have been altered to gradually increase air pressure, and they now also can vary the delivered air pressure by a smaller, predetermined amount during the ramp onset period, the inspiratory phase, the expiratory phase or combinations of these.

And, another type of PAP machine, the Bi-Pap, was developed to detect the different airflow directions during inspiration and expiration and to lower the delivered air pressure during expiration, or air as it is exhaled. This also helps encourage patients to use the PAP unit and reduces the number of reflex central apneas caused by possibly excessive pressure.

Dr. Fredric M. Radoff is a neurologist specializing in sleep disorders medicine at The Center for Sleep Medicine, a partnership of Blount Memorial Hospital and East Tennessee Medical Group.

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