Although CPAP (Continuous Positive Airway Pressure) is effective in all patients with obstructive sleep - disordered breathing, not all patients are willing to use it because of:
Even when the patient is willing to give it a try, lack of close follow - up has resulted in compliance rates that are only in the range of 30 - 50 %.
The CPAP industry has tried to address these issues in a number of ways.
|More portable and less expensive devices.||Intelligent CPAP that uses the patient's snoring to adjust the pressure setting.|
|Standard CPAP mask and headgear.||Full facial mask for obligate mouth - breathers.||Gel - filled mask for improved seal and comfort.|
The latest advances in mask and CPAP design are shown below:
|"Stealth" DPAP shown with a "Phantom" mask.||The "Stealth" DPAP uses airflow to adjust the pressure setting.|
The diagram on the right shows the airflow and pressure tracings for the "Stealth". Note that the pressure starts to rise before the patient has finished breathing out. This strategy is used because recent studies have shown that the airway narrows at end-expiration. Therefore, increasing the pressure just before end-expiration may be better at preventing airway collapse and it may also allow for a more gentle transition from expiration to inspiration than you might get with standard BiPAP. Standard BiPAP does not start to increase the pressure until inspiratory flow is detected. (DPAP and BiPAP both allow setting of a lower pressure during expiration than during inspiration).
The diagram on the left shows the "Stealth" and the "Phantom" mask. Note that the "Phantom" mask has the tubing attached to the side and that there are wide flaps on each side. This allows the pressure from the mask and tubing to be distributed across the cheeks instead of mostly on the bridge of the nose as with standard CPAP masks.
This technology is 2 or more times as expensive as the types of devices and masks shown on the previous page. Also, there have not been any clinical trials that document whether this technology is worth the extra cost in terms of patient compliance.
Further Information on CPAP
The Effects of CPAP and Weight Loss