Sleep / Treatment

The first weeks with CPAP

What does CPAP do?

In sleep apnea, the soft tissues in the throat relax during sleep and narrow the airway. Breathing stops or weakens for a while. A CPAP (continuous positive airway pressure) device gives you air at a slight pressure through a mask.¹

You can think of it like a half-deflated inflatable tent. If you blow a little air into it, the tent stands up. CPAP creates the same kind of support inside the airway. When the airway stays open, breathing continues without interruption.¹

The expert guideline strongly recommends this treatment for people with sleep apnea who have excessive daytime sleepiness.³

Mask types

• Nasal mask: Covers only the nose. For many people it is the first option tried.
• Nasal pillows: Two small cushions that sit at the entrance of the nostrils. They take up little space on the face. They may suit people who wear glasses or who feel closed in.
• Full face mask: Covers the nose and mouth together. It can be considered for people whose nose is often blocked or who sleep with their mouth open.

Research shows that masks covering the nose and mouth together need a higher pressure on average, and that use stays lower.⁵ Even so, the right mask varies from person to person. If you are not comfortable, you may want to try another type or size.

Common problems in the first week

Most complaints about CPAP are mild and can be solved.² Common ones, and questions you could ask:

• Dry mouth or nose: Does my device have a heated humidifier, and how do I change its setting?²
• Air leak: Is the mask the right size? How tight should the straps be? If air leaks from my mouth, do I need a different mask?²
• Mask marks or a sore on the bridge of the nose: Is the mask too tight? Would another type of mask suit me better?²
• Feeling closed in: Could I try a mask that takes up less space? Would it help to wear the mask during the day, in front of the television, to get used to it?²
• Bloating, wind (aerophagia): Air may be going into the stomach. Does the pressure need to be reviewed?²

The expert guideline recommends education at the start of treatment and solving problems early.³ In other words, calling when you have a problem is part of the treatment.

How long do you need to use it?

There is a measure you will hear often: at least 4 hours a night on at least 70% of nights. This measure was used as the definition of "regular use" in a study published in 1993.⁶ It later became established as a lower limit in much research and practice.

But 4 hours is a lower limit, not a target. A study in 2007 found that people who used it for longer each night returned to normal in greater proportions.⁴ In short, using it for the whole time you sleep is best.

Cleaning and care

Every device and mask has its own instructions; follow them first. Most CPAP parts can be cleaned with mild soap and water as described in the user manual.⁷ Be careful with devices that claim to clean with ozone or ultraviolet light. The US Food and Drug Administration (FDA) states that it has not authorised any of these products.⁷ Ask your device supplier how often the mask and tubing should be replaced.

Devices and SGK in Türkiye

In the Health Implementation Communiqué (SUT) of Türkiye's Social Security Institution (SGK), these devices are listed under "non-invasive mechanical ventilation devices". Under article 3.3.6, CPAP is provided on the condition that it is returned to the institution and against a signed undertaking.⁸ If the institution has no device in stock, the cost of a device bought by the patient is covered under certain rules, with prior approval. The cost of a device bought without approval is not covered.⁸

Under article 3.3.6.A-1, in summary:⁸

• A health board report is required for the device. The report is issued by a hospital that has a sleep centre.
• The report includes three physicians from chest diseases, psychiatry or neurology.
• An all-night diagnostic test and a titration test, in which the pressure is set, are required. The reports of these two tests are attached to the health board report.
• The report states the treatment pressure, the type of device and accessories such as the mask. A heated humidifier is included with the device.
• If the device is used for less than 1,200 hours a year, the patient is reassessed. Whether treatment continues is decided with a new board report.

We could not find a period in this article for how often the device or mask is renewed. Ask your doctor and the provincial SGK directorate about renewal and the current rules. The communiqué changes often.

Other treatment options

CPAP is not the only way. An oral appliance (a plate made by a dentist that moves the lower jaw forward) is recommended for patients who cannot use CPAP or prefer another option.⁹ In apnea that increases only when lying on the back, positional therapy may help; but its effect is smaller than CPAP.¹⁰ A weight loss programme is recommended for people who are overweight.¹¹ For some patients who cannot use CPAP, a surgical assessment is also an option.¹² Talk to your doctor about which suits you.