Positive Airway Pressure (PAP) therapy is a common, non-invasive medical treatment designed to help individuals with sleep-related breathing disorders. This therapy is used to treat obstructive sleep apnea (OSA), a condition where the airway repeatedly collapses during sleep, causing pauses in breathing. The PAP system works by gently delivering a stream of pressurized room air through a mask worn over the nose or mouth. This consistent airflow acts as a pneumatic splint, preventing the soft tissues in the throat from collapsing and allowing for stable, uninterrupted breathing throughout the night. It leads to improved sleep quality and reduced daytime sleepiness.
How Positive Airway Pressure Works
The mechanism of PAP therapy is the application of continuous air pressure to the patient’s upper airway. During obstructive sleep apnea, the muscles supporting the soft palate and tongue relax, which can cause the airway to narrow or completely collapse. This blockage prevents air from reaching the lungs, leading to a drop in blood oxygen levels and a brief, disruptive awakening. The machine delivers pressurized air through the mask and into the back of the throat, effectively “splinting” the airway open. This positive pressure creates an aerodynamic cushion that physically holds the surrounding tissues away from the breathing passage. By keeping the airway clear, PAP therapy eliminates the breathing pauses and the associated drops in oxygen, which allows for restorative sleep.
Comparing Different Types of PAP Devices
The term PAP covers several distinct devices, each modulating air pressure differently.
Continuous Positive Airway Pressure (CPAP)
CPAP is the most common form, delivering a single, fixed pressure setting throughout the entire night. This constant pressure is determined during a sleep study and is the standard for straightforward obstructive sleep apnea cases.
Automatic Positive Airway Pressure (APAP)
APAP machines automatically adjust the pressure level throughout the night. APAP devices use advanced algorithms to monitor the user’s breathing patterns and increase the pressure only when a narrowing or obstruction is detected. This flexibility is beneficial for individuals whose pressure requirements change depending on their sleep stage or sleeping position.
Bi-level Positive Airway Pressure (BiPAP)
BiPAP provides two distinct pressure settings: a higher pressure for inhalation (Inspiratory Positive Airway Pressure or IPAP) and a lower pressure for exhalation (Expiratory Positive Airway Pressure or EPAP). This difference in pressure makes exhaling against the airflow feel more comfortable, which can improve adherence for patients requiring higher overall pressure settings. BiPAP is often prescribed for complex cases, such as central sleep apnea or certain respiratory conditions, or for patients who struggle to tolerate the fixed pressure of CPAP.
Key Components of the PAP System
A complete PAP system involves a coordinated set of physical components. The main machine unit, often called the flow generator, quietly draws in room air, filters it, and pressurizes it to the prescribed setting. An air filter purifies the air before it is delivered to the user.
The pressurized air travels from the machine through the tubing, a flexible hose connecting the flow generator to the interface worn by the user. Many machines feature an integrated heated humidifier, which is a water chamber that warms and moistens the air. Humidification is recommended to prevent common side effects like nasal dryness, congestion, and dry mouth caused by the constant airflow.
The interface, or mask, is the final component and is tailored to the patient’s breathing habits and comfort. Mask types include:
- Nasal pillows: Small cushions that fit directly into the nostrils, suitable for those who breathe exclusively through their nose.
- Nasal masks: Cover the entire nose, offering a stable seal.
- Full-face masks: Cover both the nose and the mouth, often necessary for mouth-breathers or individuals who experience chronic nasal congestion.
Beginning and Maintaining PAP Therapy
Starting PAP therapy requires patience and a commitment to acclimation, as getting used to sleeping with a mask and pressurized air takes time. Practice wearing the mask during the day while relaxing to build familiarity and reduce feelings of claustrophobia. Many modern devices include a “ramp” feature, which starts the pressure at a low, comfortable level and then gradually increases it to the prescribed setting, allowing the user to fall asleep more easily.
Common initial challenges include air leaks, which can be solved by adjusting the mask headgear or trying a different mask style. Dry mouth is usually addressed by increasing the heat or humidity setting on the machine. Consistent use is necessary, as the therapeutic benefits are cumulative, and the machine should be used for all sleep periods, including naps.
Proper maintenance is necessary to ensure the therapy remains effective and hygienic. The mask, tubing, and water chamber should be washed daily or weekly with mild soap and water, then allowed to air dry completely. Filters must be inspected and replaced regularly to ensure the air delivered is clean. Distilled water should be used in the humidifier to prevent mineral buildup. Regular follow-ups with a healthcare provider are important to monitor progress and make any necessary adjustments to the pressure settings.