APAP Machine

An APAP (automatic positive airway pressure) machine is a type of medical device that most commonly helps treat obstructive sleep apnea (OSA). If you have OSA, you temporarily stop breathing while you’re sleeping. This affects your sleep quality and can affect your mental and physical health.

An APAP machine takes in air from the surrounding environment and pressurizes it. It then blows a range of strong, direct air pressure either through your nose or through your mouth and nose (depending on the type of mask) to your airway. This pressurized air widens your throat and gently keeps the back part of the roof of your mouth (soft palate), tongue and uvula from collapsing. This allows you to breathe continuously while you sleep and improves your overall sleep quality.

An APAP uses an algorithm to self-regulate. The algorithm is like a set of instructions that helps the machine learn your breathing patterns so it can adjust its levels. For example, you may need higher pressure levels if you’re sleeping on your back or in rapid eye movement (REM) sleep. Sensors in the machine recognize changes to your breathing patterns, and the algorithm changes the air pressure according to your needs.

There are many different names for an APAP machine, including:

• Auto-adjusting airway pressure therapy
• Auto-adjusting CPAP
• Auto-CPAP
• Automatic CPAP machine
• Auto-titrating airway pressure machine
• Auto-titrating CPAP
• Automatic positive airway pressure

What happens during APAP therapy?

A basic APAP machine includes a:

• Filter to purify the air before it enters your airway
• Mask that fits over your mouth and/or nose with straps that help secure the mask to your face and prevent air from leaking out
• Tube or hose that connects the mask to the APAP

It’s important to find an appropriate space for your APAP. A good space should:

• Be close to an electrical outlet
• Be free from anything that makes it difficult to access or turn on the machine
• Provide sturdy support for your machine, like a bedside table or nightstand

To set up your APAP, you’ll:

1. Insert the filter into the machine
2. Attach the hose
3. Connect the hose to the mask
4. Plug in the machine
5. Put the mask over your mouth and/or nose and adjust the straps to secure it in place
6. Turn on the machine

How do I get used to an APAP machine?

It can be difficult to get used to an APAP machine. These tips can help you adjust:

• Practice breathing through your mask during the day before you attach it to the machine
• Attach the mask to the machine and turn the device on while you do something relaxing, like reading a book or watching TV
• Take a nap while using APAP
• Go to bed a little earlier than usual to give yourself time to get comfortable
• Help relax your mind by taking a warm bath or shower before bed, practicing progressive muscle relaxation or guided imagery, or playing white noise, pink noise or nature sounds
• Use mouth tape or a chin strap to keep your mouth closed if your mask only covers your nose
• Wash your face with warm water and soap or a facial cleanser so it’s easier for the mask to create a good seal

How long will I need to use an APAP machine?

It depends on how long you have obstructive sleep apnea. Some people need to use an APAP machine or another type of positive airway pressure device for the rest of their lives. A healthcare provider will let you know what to expect according to your unique situation.

What are the benefits of an APAP?

The main benefit of using an APAP machine is that it recognizes subtle changes in your breathing and adjusts the air pressure. This reduces breathing interruptions while sleeping and improves your overall sleep quality. The benefits of better sleep quality include:

• Feeling more rested, which can help your ability to think (cognitive function)
• Less daytime sleepiness (hypersomnia)
• Improved mood
• Snoring less than usual

APAP machines also work well to adjust to changes that may affect your sleep, like small weight changes, drinking alcohol or using sedatives.

What are the downsides of an APAP?

It can be difficult to adjust to sleeping with an APAP machine. Many people initially find it uncomfortable and confining, which can make falling asleep frustrating. You may also feel self-conscious about using it. APAP machines can also be relatively large — about the size of a shoebox. It can take up valuable room on your bedside table or in your luggage if you’re traveling.

APAP machine algorithms are also imperfect. It may receive incorrect data if you have a leak in your mask or hose. This can cause the machine to use the wrong pressure levels. It isn’t dangerous. But you may not see the same benefits.

APAP machines can also be expensive. Not all health insurance providers may cover an APAP machine.

What are the side effects of using an APAP?

Using an APAP may cause:

• Bloody nose
• Dry mouth
• Nasal congestion
• Runny nose
• Skin discoloration (red, purple, brown) or chafing

You can help prevent some of these side effects by:

• Using the heat and humidity settings on the machine, if available
• Running a humidifier in your room
• Using a mask that properly fits around your mouth and/or nose
• Trying different types of mask liners

Who should not use APAP?

Healthcare providers may not recommend an APAP if you have:

• A body mass index (BMI) greater than 30 (have overweight/obesity)
• Central sleep apnea (a problem with your brainstem that affects how you breathe when you sleep)
• Chronic obstructive pulmonary disease (COPD)
• Congestive heart failure
• Opioid use disorder
• A neuromuscular disorder

When should I call my healthcare provider?

It can take some time to adjust to using an APAP. Reach out to a healthcare provider if you’re having any problems. They can offer advice to help you adjust, suggest a different type of mask or even recommend a different type of positive airway pressure device.

What is the difference between APAP and CPAP?

APAP and CPAP machines are both types of positive airway pressure devices. But a CPAP machine provides a fixed level of pressure as you sleep. An APAP machine adjusts its pressure levels according to your breathing patterns.

Are there alternatives to an APAP machine?

Yes. Positive airway pressure devices are the most common sleep apnea treatment. But you may also be able to treat sleep apnea with one or more of the following:

• Jaw surgery so soft tissue doesn’t press on your airways
• Weight management to help reduce your risk of sleep apnea
• Medications such as tirzepatide (Zepbound®, Mounjaro®) to help with weight loss
• Neuromuscular electrical stimulation (NMES) to prevent your tongue and upper airway muscles from blocking your airways
• Nose surgery (septoplasty) to straighten nasal tissues so it’s easier for air to travel
• Oral appliance therapy to move your jaw to a better position to open your airways
• Positional therapy to help you sleep on your side or stomach, which may reduce apnea episodes