Positive Airway Pressure Therapy

Positive airway pressure (PAP) therapy is a treatment for sleep apnea. PAP machines push air into your airways and lungs through a mask. Pressure from the airflow keeps your airway open and can help get more oxygen into your lungs.

The two common types of positive airway pressure therapy are:

• BPAP: Bilevel positive airway pressure machines deliver airflow at two different pressures. The pressure is lower when you’re exhaling and higher when you’re inhaling. This keeps your airways open but makes it easier to exhale.
• CPAP: Continuous positive airway pressure machines provide airflow at the same pressure whether you’re breathing in or out.

What does positive airway pressure treat?

Many people use CPAP or BPAP machines at home to treat sleep apnea. They can also help you breathe if you have:

• Heart failure
• COPD (chronic obstructive pulmonary disease)
• Hypercapnic respiratory failure
• Obesity hypoventilation syndrome

Healthcare providers also use positive airway pressure in certain emergency or intensive care situations.

How does positive airway pressure therapy work?

Sleep apnea creates pauses in your breathing or blocks air from getting into your body while you sleep. PAP machines push air through your airways and into your lungs. This allows the small air sacs in your lungs (alveoli) to stay open, so they get more oxygen and let more carbon dioxide out of your body. Your alveoli transfer the oxygen to your bloodstream, which delivers it to your tissues.

How do you use a PAP machine?

It’s important to properly set up your machine before using it. Your healthcare provider or medical equipment provider should instruct you on how to do this. You might need to:

• Put the machine on a stable surface.
• Check the filter.
• Set up the humidifier.
• Attach hoses to the machine and to the mask.

The basic steps to use a PAP machine once it’s set up include:

1. Put on your mask and adjust it according to your provider’s directions. You usually do this while sitting up.
2. Turn the machine on.
3. Lie down and readjust your mask as necessary.

What are the benefits of positive airway pressure therapy?

Benefits of PAP therapy for sleep apnea include:

• Less fatigue and increased energy during the day
• Improved thinking and memory
• Reduced risk of cardiovascular issues like stroke and heart attack
• Reduced snoring

What are the risks of PAP therapy?

Side effects may include:

• Congestion
• Runny nose
• Dry mouth
• Nosebleeds
• Feeling claustrophobic (trapped or closed-in) from the mask

Additional risks and drawbacks include low blood pressure and aspiration pneumonia. It's also possible to experience lung injury from too much pressure. But this is rare, and some devices or masks have safeguards to prevent it.

How long will it take for me to feel better?

If you have sleep apnea, it might take anywhere from a few days to a few weeks of PAP machine use to feel better. If you’re using a PAP machine for other conditions, ask your provider what to expect.

Is there anything I can do to make PAP therapy easier on me?

Adjusting to using a PAP machine might be difficult at first. It can help to:

• Get the right kind of mask. Learn what kinds of masks are available and which one might be best for you. Ask your healthcare or medical equipment provider for recommendations based on how you sleep.
• Get used to the mask. Without turning the machine on, try your mask on during the day or a little bit before bedtime. Getting used to the feeling while you’re awake can make it easier to fall asleep with it on.
• Be consistent. Use your machine every night. Using it inconsistently will make it harder to get used to and won’t help your symptoms improve.
• Try the ramp feature. If your machine has it, the “ramp” feature gives you lower air pressure as you’re falling asleep. After you’re asleep, it increases the pressure.

When should I call my healthcare provider?

Talk to your healthcare provider if you have any questions about your PAP machine, including:

• How to use it
• How to make it more comfortable or easier to get used to
• What to expect and when you’ll feel better

What’s the difference between positive and negative airway pressure?

The difference between positive and negative airway pressure is in the way the machine moves air into your lungs. Positive airway pressure pushes air into your lungs. Negative airway pressure (like an iron lung) causes your body to pull air into your lungs. It does this by changing the air pressure in a cylinder around your body, which creates a vacuum.