Friday, March 03, 2006

Practice Parameters for BiPAP and CPAP

The American Academy of Sleep Medicine has issued "Practice Parameters for the Use of Continuous and Bilevel Positive Airway Pressure Devices to Treat Adult Patients With Sleep-Related Breathing Disorders"; here is the abstract:
Positive airway pressure (PAP) devices are used to treat patients with sleep related breathing disorders (SRBD) including obstructive sleep apnea (OSA). Currently, PAP devices come in three forms: (1) continuous positive airway pressure (CPAP), (2) bilevel positive airway pressure (BPAP), and (3) automatic self-adjusting positive airway pressure (APAP). After a patient is diagnosed with OSA, the current standard of practice involves performing full, attended polysomnography during which positive pressure is adjusted to determine optimal pressure for maintaining airway patency. This titration is used to find a fixed single pressure for subsequent nightly usage. A task force of the Standards of Practice Committee of the American Academy of Sleep Medicine reviewed the available literature. Based on this review, the Standards of Practice Committee developed these practice parameters as a guideline for using CPAP and BPAP appropriately (an earlier review and practice parameters for APAP was published in 2002). Major conclusions and current recommendations are as follows: 1) A diagnosis of OSA must be established by an acceptable method. 2) CPAP is effective for treating OSA. 3) Full-night, attended studies performed in the laboratory are the preferred approach for titration to determine optimal pressure; however, split-night, diagnostic-titration studies are usually adequate. 4) CPAP usage should be monitored objectively to help assure utilization. 5) Initial CPAP follow-up is recommended during the first few weeks to establish utilization pattern and provide remediation if needed. 6) Longer-term follow-up is recommended yearly or as needed to address mask, machine, or usage problems. 7) Heated humidification and a systematic educational program are recommended to improve CPAP utilization.8) Some functional outcomes such as subjective sleepiness improve with positive pressure treatment in patients with OSA. 9) CPAP and BPAP therapy are safe; side effects and adverse events are mainly minor and reversible. 10) BPAP may be useful in treating some forms of restrictive lung disease or hypoventilation syndromes associated with hypercapnia.
Recommendation number 7 is significant. This should help patients get insurance reimbursement for having heated humidifiers added to their CPAP machines.

3 comments:

Totally Total said...

I am a 24 year old male and have been totally blind for nearly 9 years. As a totally blind person, I’ve had the normal sleep-wake cycle problems that are common. These have never before affected my job performance as it has now. This started on March 2, and continues even now. Maybe the first few days, I should have taken care of this but instead I dealt with the 3-4 hour a night sleep and went to work. I ended up leaving early to catch up on sleep and am still having the issues. Now, I’m sleeping about 7.5-9 hours but like from 3 AM to around 12-1 PM. I’ve had this before but almost never for weeks at a time. The other problem is that, I worry about not being able to reshape my sleep patterns and, that keeps me up even longer. I also am afraid of having serious reactions to not sleeping a good amount of hours. For example, I get a head ache, feel like I have a small amount of shaking internally, when I force myself to stay up to try and compensate for the sleep cycle. I think to myself, oh, I’ve been up almost 20 hours on only 4:45-5 hours of sleep. Anyway, I wish you could clear up that these reactions are just in my head or give some perspective on them. I have been to my family doctor and she prescribed Rozerem. I took it but felt very sleepy the next day, and it wasn’t enough to actually put me to sleep. I still drifted around 3. I tend to do a lot of worrying about not falling a sleep and it looks like to spite my apparent sleep-wake cycle shifts, it looks like I’m also starting or continuing to suffer from Psychophysiological insomnia so I made an appointment with a psychologist to help with the mental health aspects of it. I didn’t continue the rozerem because it is new and it made me feel so awful. Should I make an appointment with a sleep specialist to help treat the probable life-long bouts of sleep-wake cycle changes? I really don’t want to take a sleep medicine like Rozerem for the rest of my life. I understand you’re not able to actually “practice” medicine here but am interested in your comments of the generals of my situation. Thanks

Totally Total said...

I am a 24 year old male and have been totally blind for nearly 9 years. As a totally blind person, I’ve had the normal sleep-wake cycle problems that are common. These have never before affected my job performance as it has now. This started on March 2, and continues even now. Maybe the first few days, I should have taken care of this but instead I dealt with the 3-4 hour a night sleep and went to work. I ended up leaving early to catch up on sleep and am still having the issues. Now, I’m sleeping about 7.5-9 hours but like from 3 AM to around 12-1 PM. I’ve had this before but almost never for weeks at a time. The other problem is that, I worry about not being able to reshape my sleep patterns and, that keeps me up even longer. I also am afraid of having serious reactions to not sleeping a good amount of hours. For example, I get a head ache, feel like I have a small amount of shaking internally, when I force myself to stay up to try and compensate for the sleep cycle. I think to myself, oh, I’ve been up almost 20 hours on only 4:45-5 hours of sleep. Anyway, I wish you could clear up that these reactions are just in my head or give some perspective on them. I have been to my family doctor and she prescribed Rozerem. I took it but felt very sleepy the next day, and it wasn’t enough to actually put me to sleep. I still drifted around 3. I tend to do a lot of worrying about not falling a sleep and it looks like to spite my apparent sleep-wake cycle shifts, it looks like I’m also starting or continuing to suffer from Psychophysiological insomnia so I made an appointment with a psychologist to help with the mental health aspects of it. I didn’t continue the rozerem because it is new and it made me feel so awful. Should I make an appointment with a sleep specialist to help treat the probable life-long bouts of sleep-wake cycle changes? I really don’t want to take a sleep medicine like Rozerem for the rest of my life. I understand you’re not able to actually “practice” medicine here but am interested in your comments of the generals of my situation. Thanks

jodie said...

I have a question I am hoping someone can answer. I have been joyfully using a CPAP machine for probably four years now. I am so addicted to my machine that I often wear it even if I am taking a short 20 or 30 minute nap. My concern though is the gastric distress that is caused from having the air blowing into my lungs all night long. It would seem that the excess air goes into the stomach cavity and then gets into the digestive system where it creates gastric pressure, etc etc.. It seems nobody comments about this concern - and I know for a fact from talking to other CPAP users - I am not the only one suffering. What I am wondering is if the BiPAP machine might cause less of this issue. I have excellent medical coverage - but I hate to switch from my beloved CPAP machine if the BiPAP isn't going to help with this one major side effect. Can anyone comment on this?