Sleep apnea is one of the potentially dangerous for human health and life syndromes. It is characterized by frequent breathing stops during sleep that, ultimately, lead to the development of respiratory failure, daytime sleepiness, breach of the general structure of sleep, and more serious consequences. Usually, the disease is accompanied by loud snoring, heart rhythm disorders, and high blood pressure. These factors cause the risk of myocardial infarction. The most effective method for apnea treatment is the machine one, the positive effect of which has been repeatedly proven by studies and experiences in the application (Manuel & Hardinge, 2012). Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP) therapy are the treatment machines for sleep and breathing disorders, which create the desired airflow at a certain pressure (Arias, 2014). This air is breathed in by a patient with sleep apnea at night through a mask that ensures the prevention of pauses in breathing and snoring. The method was introduced in 1981 by Australian professor C. Sullivan and, unfortunately, is still underestimated and requires further study (Arias, 2014). Therefore, the purpose of the current paper is to discuss pros and cons of CPAP/BiPAP therapies, as well as their action, peculiarities of use, their effects, and complications.
As a result of the therapy, during sleep, the airway flow in the departments of the nasopharynx and pharyngeal region of the ring decreases. This process takes place in case of the syndrome of obstructive sleep apnea (Manuel, & Hardinge, 2012). CPAP therapy is carried out by means of compact programmable devices with a miniature compressor feeding the airways of the patient with pressurized air through a mask. A humidifier is often used in such devices, creating a comfortable environment for the patient. Patient independently dons and removes the mask and, if necessary, can disconnect it at any time from the machine. CPAP machine is usually very well tolerated and gives a pronounced effect immediately after the application. If necessary, it is possible to use it every night or evening. The device is easy to take along for the ride. In addition to conventional CPAP devices that have fixed therapeutic pressure (chosen by the doctor), there are auto-CPAP machines, which have integrated the algorithm for automatic regulation of therapeutic pressure in the system, depending on the degree of obstruction. They are widely used in the CPAP therapy. The use of such devices is particularly important in cases where the degree of respiratory failure in a patient varies depending on the sleep stage or body position (Positive airway pressure, n. d).
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The most common side effects of the CPAP therapy are irritation in the guise of the facial skin (about 50%), dry mucous membranes of the nasopharynx (30%), rhinorrhea or nasal congestion (25%), and eye irritation (25%). Nevertheless, these effects are not serious and continuing CPAP therapy does not interfere with the common life of a patient (Manuel & Hardinge, 2012). Using more comfortable masks and moisturizers effectively eliminates most of these side effects. More serious complications of the CPAP therapy, such as sinusitis, conjunctivitis, or nasal bleeding, are rare. Cancelling the hardware treatment (even if it has been carried out for a few years) does not entail any complications, except for the gradual return of the original symptoms. The use of the device does not cure a person, but as a result, the normal rhythm, effective breathing, and sleep structure are restored eliminating the risk of sudden death or cardiac arrest from lack of oxygen. In addition, the increased risks of heart attacks, strokes, high blood pressure mainly in the night and morning hours are reduced. Fatigue, weakness, daytime sleepiness, heaviness in the head in the morning usually disappears after the first week of the machine usage (Positive airway pressure, n. d.). The positive effects of the CPAP machine are significant not only for the patient. For example, the risk of car crashes and other accidents due to unexpected falling asleep is significantly reduced after the use of the device. Numerous studies have shown that the use of CPAP therapy is accompanied by a rapid and complete disappearance of the symptoms of obstructive sleep apnea (OSA). Nevertheless, further treatment for the normalization of the hormone metabolism, which improves the cardiovascular system, is required (Manuel & Hardinge, 2012).
People change CPAP to BiPAP methods in case the patients have severe sleep apnea, mixed types of central and obstructive sleep apnea, the presence of other respiratory pathologies, for example, chronic respiratory failure, or so-called Cheyne-Stokes breathing, and some other diseases. The device uses a special compressor that, through a tube and a nasal mask, provides auxiliary ventilation. A distinctive feature of the BiPAP machines is the fact that they create the pressure of different value at the input and output tubes. Unlike invasive ventilation, which requires a tracheostomy or endotracheal tube, the BiPAP therapy breathing is conducted through the natural airways (Smith & Lasserson, 2009). The BiPAP machines pumps the air under pressure into the natural airways. The level of pressure depends on the phase of inhalation and exhalation. In the breathing circuit device, there is a sensor detecting the respiratory effort of the patient in real time. As soon as the patient begins to inhale, the device increases the therapeutic pressure and helps the patient breathe. At the beginning of exhalation, the device quickly reduces the pressure and prevents a person from breathing. The difference between the pressure of the inspiratory and expiratory pressure may be 10-15 cm of water column (Arias, 2014). This fact ensures that the auxiliary ventilation, in which the tidal volume increases, improved gas exchange in the lungs and reduces the work of the respiratory muscles.
The use of this treatment in patients with chronic respiratory failure improves quality of life and increases its duration. Therapeutic devices are compact and are fairly simple to maintain. When one picks up a therapy, the regimen patient can be treated at home. However, the BiPAP devices are, as a rule, used in special clinics and under the doctors observation. In case of a successful completion of the trial therapy, the BiPAP patient is transferred to the home treatment (Positive airway pressure, n. d.). At the first stage, ventilation is carried out in the daytime and nighttime in the form of short courses in order to let the patient adapt. With time, the BiPAP treatment duration is gradually increased, leading to a night of sleep. At severe respiratory failures and respiratory infections, the therapy sessions are arranged further in the daytime. In parallel with BiPAP therapy, a long-term oxygen therapy can be administered. In this case, oxygen is additionally supplied to the mask with a special port. Sometimes the BiPAP therapy is recommend during exercise. Auxiliary ventilation during exercise improves exercise tolerance, and creates favorable conditions for the cardiovascular system and muscle training. With effective treatment, a positive BiPAP therapy is already apparent after a couple of hours after the procedure. In this case, a decrease of shortness of breath, increased blood oxygen saturation, reduced heart rate, and a general improvement in the body is marked (Arias, 2014). Therapy has beneficial effect on the condition of cerebral blood flow.
Comparison and Effect
Both treatment methods have around 90% efficiency (Arias, 2014). Against the background, the CPAP therapy decreases the variability of blood pressure, improves dynamics of the daily index of blood pressure; meanwhile, medication does not give a statistically significant reduction in blood pressure during sleep. Against the background of CPAP/BiPAP therapy for 12 years, the risk of mortality from cardiovascular disease is decreased by 10 times (Smith & Lasserson, 2009). This is a very impressive figure. Abnormal breathing during sleep is a component of the pathogenic process of developing hypertension, being relatively widespread. Treatment of the respiratory disorders during sleep using CPAP/BiPAP therapy leads to a decrease in blood pressure and reduces the risk of death from cardiovascular disease.
The devices in particular and method as whole have several disadvantages, which were numbered above. In addition, the ways for improvement for these problems were given; it allows making a conclusion that they are not as severe as they seem to be. Moreover, they are negligible on the background of the advantages introduced by both therapies. The CPAP/BiPAP therapy is a highly effective treatment for diseases from moderate to severe obstructive sleep apnea. The only difference in these methods is that the CPAP therapy can be used domiciliary from the very beginning of the treatment. On the opposite, the BiPAP therapy is firstly used at clinics since the device is aimed at treating severe sleep diseases and requires constant monitoring of the patients state. However, after the first positive results of the treatment, the BiPAP therapy also can be used at home.
It is worth to mention that sometimes up to 500 pauses in breathing per night, the total duration of which is up to 4 hours, can be observed. This effects leads to both acute and chronic oxygen deficiency, significantly increases the risk of serious cardiovascular complications of hypertension, heart rhythm disorders, stroke, myocardial infarction, and sudden death. Therefore, the CPAP and BiPAP therapy methods are among the most appropriate treatment methods for people having severe sleep apnea since even, in the first night, the use of therapy shows the positive result and eliminates the symptoms of apnea and snoring with time. In the morning after the CPAP therapy, the symptoms such as high blood pressure, headaches, and frequent nighttime urination disappear. Therefore, these two methods are extremely useful and effective in the treatment of sleep apnea.