CPAP Treatment for Sleep Apnea

CPAP is Continuous Positive Airway Pressure. It is commonly used to treat obstructive sleep apnea by providing a flow of positive-pressure air through a mask to open the upper airway while the child is asleep. The flow produces an air cushion that keeps the airway from closing shut. The goal of CPAP is to enable the child to have regular or normal breathing, eliminate snoring, and restore normal sleep patterns.

BiPap

BiPap is an alternative to CPAP. Unlike CPAP, BiPaP has two different pressure settings for inspiration and exhalation. The variation in pressure with breathing patterns may make it more comfortable to use. BiPaP is used in patients that are unable to take deep breathes by themselves. These patients may be overweight, have a neuromuscular disorder, stiff lungs (restrictive lung disease) or is not able breath on their own (central apnea).

Components of a CPAP System

• Headgear: A cap or strap system used to hold the nasal mask in place. There are several designs, which are made specific to the type of mask selected.

• Mask: Used to deliver ventilation to the upper airway. There are several different models available from various manufacturers. Typically the choice of mask is based on patient preference.

• Exhalation Port: A fixed leak near the patient’s mask that allows for exhalation of CO2.

• Circuit: The tubing that connects the unit to the nasal mask. Delivers pressure and allows for both inspiration and exhalation.

• Machine: Provides pressure generated by a blower.

Getting Started with CPAP

Your child is seen in the sleep clinic by a specialist who will find a mask that is comfortable and that best fits your child. The mask usually covers just the nose. For some older children, the mask might fit over the nose and mouth. This type of mask is used when the nose is completely blocked. Once the right mask is found, a small hose to the CPAP or Bi-pap connects the mask. Each night, you or your child will place the mask on the face and start the machine. Ideally, the mask should fit snuggly enough to prevent air leaks, but not too tight or there may be skin breakdown.

Following the clinic visit, a sleep study will be arranged for titration of the CPAP or Bi-pap to the correct pressure setting. This must be done in the sleep lab under the careful observation of a trained sleep technician to ensure a safe setting that will best treat your child’s particular breathing problem.

After the titration study has been complete, a physician will order the equipment from a medical equipment company, who will contact you directly to set up delivery. This may take 1-2 weeks depending on insurance authorization procedures.

You and your child should return to the sleep clinic 1 month after therapy has been started. Our nurse practitioner will evaluate your child’s response to therapy and assist with any problems or concerns that you may have. Please make sure that you bring your child’s mask with you to this visit.

How to Help Your Child Get Used to CPAP

1. Let your child hold and feel the CPAP mask. Before having her wear the mask on her face, it may be helpful to hold the mask up to your face or that of a stuffed animal or doll. Allow your child to put the mask on her face (without the headstraps) by herself. Practice this step several times during the first day.
2. Attach the head straps and have your child wear the CPAP mask for 10 minutes while awake; children over 7 years should be able to tolerate 15 minutes. A pleasant distraction such as television, video game, or storybook during this period can help the time pass quickly. Practice this step twice a day until your child can wear the mask without anxiety.
3. With the mask on your child's face, attach the mask to the CPAP device, and switch the unit "on". Have your child practice breathing through the mask for 15 minutes while watching television, reading, or performing some other sedentary activity. Avoid mask removal before the designated time. When this step can be achieved with cooperation, advance to the next step.
4. If your child normally takes a nap, use the CPAP during scheduled one-hour naps at home. When this is tolerated, progress to the next step.
5. Use CPAP during the initial 3-4 hours of nighttime sleep for a few nights.
6. Use CPAP through an entire night of sleep.

Your child’s comfort/anxiety level as well as parental persistence will affect the pace of progress. Remember that no matter what our age, we are all anxious about unfamiliar situations. The more exposure to CPAP your child experiences, the greater his or her comfort level will be.

Common Problems Affecting Your Child's Ability to Wear CPAP

Lack of Humidification

In general, CPAP tends to dry out the air and therefore extra humidification is usually required. Most commonly a pass-over humidifier is used, although the amount of humification achieved by this means is less than that obtained by using a heated humidifier.

Occasionally too much humidification can irritate the inside of the nose and sinuses, and the temperature of heated humification may be too much. Personal adjustment is recommended. There should not be any water condensation in the mask.

Temperature

The air coming from CPAP can be cold and this can be corrected by ensuring the room temperature is adequate or by using a heated humidifier.

Skin Breakdown

Make sure that the mask fits correctly and avoid making the mask fit too tightly. The bridge of the nose can be protected with a Band-Aid or duoderm type dressing. It may be necessary to alternate different types of masks to avoid skin breakdown.

Eye Irritation

The mask may not fit correctly, or may be too loose. Make sure that the mask is snug to the face, but not so tight as to cause skin breakdown. Most children can tell you if the air is blowing into their eyes, indicating that the mask is too loose.

Nasal Allergies

Sometimes nasal allergies can be worsened by CPAP. Known allergens in the room should be removed. Frequent vacuuming may be required. Raise the CPAP blower off the floor. Keeping animals out of the bedroom may be helpful. Ensure that the CPAP filters are changed frequently. An in-line fine particulate filter may be useful (Respigard-II-Marquest Medical Products). It must be put in the line before the humidifier. Use only distilled water in the humidifier. Try with or without humidification. Try with or without heat if it is a heated humidifier.

An oral antihistamine taken before sleep or the use of a nasal antihistamine (e.g. Nasalcrom) or steroid spray (e.g.Vancenase) may be helpful. The effect of nasal steroids may take weeks.

Nasal Dryness

Use a humidifier either heated or regular pass-over humidifier. Use a saline nasal spray (e.g. Nasalide) before sleep at night.

Nasal Congestion

Check for nasal allergies and if so consider steps above. Use a nasal dilator during sleep such as Breathe-Rite strips over the nose.

Nasal Mucosa Irritation

Use a humidifier, preferably a heated humidifier. Use a saline spray (e.g. Nasalide) before sleep. Consider putting a small amount of ointment in the nostrils, such a Boroleum or Vaseline.

Unable to Fall Asleep with Mask On

Use a pressure ramp if possible, which gradually increases the pressure to the desired setting over a period of 20-45 minutes. Also consider waiting for 1 hour after your child has fallen asleep before placing the mask and starting the machine.

Skin Allergies

Make sure you have a hypoallergenic mask made of silicone. Consider using Nasal Pillows or other types of nasal mask to reduce mask contact with face.

Mouth Opening

Any of the above recommendations hay be helpful. In addition ensure that the CPAP pressure is optimal - contact you sleep specialist. Use a chinstrap. Consider using Nasal Pillows instead of a mask.

Revised 7/9/04