CPAP Therapy How it Works, Getting Set up, & Results

CPAP Therapy: How it Works, Getting Set up, & Results

Do you feel like you may have sleep apnea, or have you already been diagnosed with it? If so, it can be a burden on your daily life, mentally and physically. You might notice that you can no longer focus as well as you used to or you are not performing very well in work or school.

Luckily, there is a highly effective and beneficial treatment for sleep apnea. CPAP therapy is a non-invasive and simple to use approach to treating sleep apnea and providing you with a good night's sleep.

What is Sleep Apnea?

Are you suffering from daytime sleepiness? Do you have a hard time falling asleep at night or staying asleep? Does your spouse complain that you constantly snore? If you answered yes to any of these, then you may have sleep apnea.

OSA or Obstructive Sleep apnea is a condition where you stop breathing for short periods while you sleep. It can range from mild apnea to extremely severe and can be life-threatening if left untreated.

What Causes Sleep Apnea?

There are two main types of sleep apnea, obstructive and central. Each of these causes you to stop breathing throughout the night but for different reasons.

Obstructive Sleep Apnea (OSA)- OSA is caused by a partially or fully blocked airway during sleep. This type is the most common form of sleep apnea. Many factors can play a role in causing obstructive sleep apnea, including:

  • Being overweight (about half of the treated OSA patients are overweight)
  • Thick neck size
  • Large tonsils and adenoids
  • Deviated Septum
  • Overbite
  • Smoking
  • Menopause in woman

Central Sleep Apnea (CSA)- CSA is less common but does occur. This type of apnea is caused by the brain failing to send the proper singles to tell your respiratory system that it is time to take a breath. The main contributor to CSA is people who have had previous medical issues such as a heart attack or stroke.

Signs of Sleep Apnea

Signs of Sleep Apnea

If you have any of these signs or symptoms, you may have sleep apnea:

  • Snoring
  • Pauses in breathing at night
  • Daytime sleepiness
  • Difficulty falling or staying asleep
  • Insomnia
  • Morning headaches
  • Dry mouth
  • Irritability
  • Depression
  • Forgetfulness
  • Wetting the bed (mainly in children)
  • Nightmares
  • Weight gain

How to Treat Sleep Apnea

CPAP therapy is the best treatment for those suffering from sleep apnea and has changed and improved tremendously over the years. If you or someone you know has been diagnosed with sleep apnea, CPAP therapy may be the solution you have been waiting for.

Untreated Sleep Apnea

Those with sleep apnea can have less intense symptoms and never relate it to their severe sleep apnea, then some have extreme symptoms, but their apnea is mild. Each person is different, and every case will vary. However, the results could be detrimental.

  • High blood pressure
  • Stroke
  • Heart attack
  • Weight gain (obesity)
  • Diabetes
  • Depression
  • Poor motor functioning skill
  • Slow reaction time

How CPAP therapy Works

If you suspect you have sleep apnea, your doctor will recommend you go through a sleep study. A sleep study test determines whether or not you do have apnea and how severe it may be. This test will also show your doctor whether you have OSA, CSA, or a mixture of both. This information is necessary for treatment.

If you are diagnosed with sleep apnea, you follow up with a titration study that will give your respiratory therapist an idea of how to treat your apnea.

Types of Sleep Studies

There are different types of studies you may be required to take, and sometimes, you may have to take multiple tests before you get a proper diagnosis and treatment. These studies are usually done one night at a time.

Polysomnography - A polysomnography or PSG is the diagnostic sleep study that determines if you have sleep apnea. It will also give your doctor an idea of just how serious it is. Results can range from mild, moderate, severe, to extremely severe.

CPAP Titration - If you are diagnosed with sleep apnea, you are required to take a CPAP (continuous positive air pressure) study. This study will give your respiratory therapist a starting point for treatment. Your CPAP test results will determine how much air was needed throughout the night to control your apnea.

Bipap Titration - The BIPAP (bilevel positive airway pressure) study is for those who do not benefit from CPAP treatment.

Auto-Titration Study - The auto-titration study is the only test that lasts more than one night. You are set up with a CPAP machine that fluctuates in pressure throughout the night until a final result shows what your ideal pressure set would be.

How Does a CPAP Machine Work?

How Does a CPAP Machine Work

Once your physician has your CPAP or auto titration study results, they will help you find a Home Care Vendor that works well for you and accepts your insurance. A home care vendor is the office you will visit to get set up with your machine, see your respiratory therapist, and get all of your supplies for the machine.

A respiratory therapist follows your machine usage and data and reports back to you and your physician if they notice anything that doesn’t seem right on your therapy reports. (We will discuss this further in a little bit.)

The machine provides pressurized air through a mask to you while you sleep, providing you continuous air when you cannot breathe yourself.

Parts of a CPAP machine

  • The machine itself
  • Water Chamber
  • Tube
  • Mask
  • Mask cushions
  • Head strap
  • Chinstrap

Unlike an oxygen tank, a CPAP machine uses pressurized room air to open the collapsing airway in the back of your throat, obstructing your breathing ability. It does not provide continuous oxygen. With this constant pressure, your throat will stay open, allowing a continuous flow of air to blow into your mouth and/or nose, giving you the appropriate oxygen levels your body needs throughout the night.

A CPAP machine is set from pressures of 4cm to 25cm or an auto setting that fluctuates between various levels of pressure throughout the night, blowing more air when you need it and less when you do not. The air pressure that you need is determined by the CPAP study you previously had completed.

After turning on your CPAP machine, room air will filter through a heated humidifier and travel up a tube, which may also be heated, and through a mask that you wear throughout the night.

Getting Set Up

As previously mentioned, you will be contacting a respiratory therapist to get set up with a CPAP machine after you have completed your sleep tests. Your respiratory therapist will go over your test scores at your appointment and let you know the appropriate pressure setting to aid with your apnea.

You will then get a CPAP machine after the respiratory therapist adjusts the settings accordingly. (You should never attempt to change your machine levels on your own.)  You will then be fitted with a mask and given detailed instructions on how to use the machine. You can expect this appointment to last upward of an hour or so because you must understand everything from using the device to cleaning it.

Your therapist will also show you the different masks and CPAP accessories you can purchase to make the therapy detailed specific to your comfort. Talk to your therapist and make sure you get any questions you have answered at your appointment.

Getting Fitted

Getting Fitted

For your initial appointment and setup, you will receive all the equipment you need to start using your machine, including the mask, tubing, filters, the machine itself. Insurance usually covers the basic supplies under the DME (durable medical equipment) coverage. 

When you are first set up, you will be fitted with the proper mask. The respiratory therapist will put the mask on you, try the machine with the mast on, and make sure it is the right fit and type.

There are many different styles and sizes of masks you can choose from, such as:

  • Full face mask - These masks are as they sound and cover your entire face. They are the most commonly used style when you take your sleep test and are great for those who sleep with their mouths open at night.
  • Nasal mask - This mask covers just over your nose pushing the air around the nostril area, which will go up and through your nose.
  • Nasal Pillow mask - The nasal pillow mask is like the regular nasal mask in that it goes directly over your nose, not your mouth. However, this mask also provides soft pillow pads that fit inside the beginning of your nostrils to force air directly up into your nose.

These masks all serve their own purpose but will provide the same benefits. The one you choose will be something you discuss with your respiratory therapist and isn’t necessarily based on your preference.

Although your sleep care team wants you to be as comfortable as possible, the mask you receive will be whichever one is most beneficial to your apnea. For example, a person who breathes through their mouth at night would not benefit from a nasal mask or nasal pillow mask. Their best option is going to be the full-face.

To hold your mask in place, you will need a head strap or headgear. Headgear comes in a few different options and will make wearing your mask feel more secure. This strap can be fitted but will also have the capability of being loosened or tightened. You should always wait to adjust your mask until you are in a room with your respiratory therapist.

Again, your comfort is very important, but you have to be comfortable while still benefit from the therapy. Just a simple loose strap or one that is too tight can interfere with your treatment.

Once you get fitted and feel comfortable working your CPAP machine on your own, you are good to go.

Getting Supplies

After your setup, you will need to purchase new supplies every few months, depending on the product and your insurance. Most insurance will only cover a new machine every five years. However, the supplies will need replacing more frequently.

You can also purchase extra supplies from your DME provider for extra comfort and support. Things like a heated tube or a head strap are great to use to make your CPAP experience a little easier.

A wonderful extra is a cleaning machine for your CPAP. A dirty CPAP machine can lead to serious illnesses and infections. Keeping your machine clean is imperative, and purchasing a device that does the work for you makes it easier to stay on top of machine maintenance and your health.

Travel Machines -  If you travel a lot or spend your summers in one state and your winters in another, you have the option of purchasing a travel CPAP machine. They can be costly, and most insurances do not cover them, but they are smaller than the regular machines and are lightweight, making them ideal for travel.

If you travel with a CPAP machine, you will need to get a letter written and signed by your physician, not a physical therapist.

How to Clean Your CPAP Machine

How to Clean Your CPAP Machine

We previously discussed how important it is to make sure your CPAP machine is always clean. If you are unable to purchase a cleaning device, cleaning your machine manual is simple to do.

  1. Unplug your machine.
  2. Remove all attachments from the machine itself (tubing, mask, headgear).
  3. Wash your mask and headgear in clean or purified drinking water with soap, or use can rinse with mouthwash, then dry with a cloth and let them sit out to completely air dry.
  4. Wash your tubing in the same manner, running clean water through the tube then letting it sit out to air dry completely.
  5. Finally, remove the water reservoir (humidifier tub) and rinse it thoroughly with warm water and soap. You can also use a warm water/vinegar mix, let it soak, and then rinse it out and dry with a towel.


  • Never place any of your equipment in direct sunlight to dry.
  • Always use distilled water when cleaning your machine to avoid any mineral build-up.
  • Keep out of the reach of kids and dogs (buying replacement equipment could be           expensive if it is not time to replace through your insurance company).
  • Do not put your CPAP machine in the dishwasher.
  • Never use a harsh chemical on your machine or supplies.
  • Never submerge your machine in water.
  • Empty the water reservoir before traveling with your CPAP.

What Results Should You Expect From CPAP Therapy?

Do not expect the road ahead to be a breeze. While some people take to CPAP therapy immediately, it may take some time to get used to. Do not give up. Communicate with your respiratory therapist anytime you find yourself starting to struggle. Sometimes your pressures will need to be changed depending on your tolerance. Once you find the perfect settings, you will begin to notice many benefits.

How Will You Know if Your Pressure Needs to be Changed?

In the past, CPAP machines would use an SD card that recorded data from your breathing throughout the night. You would have to bring your card into the physical therapy office and they would run it through a machine that provided a printout of your usage and apnea notations.

These days, the majority of machines will have a Bluetooth wireless signal that will send your information directly to the respiratory therapist with a push of a button. This advancement in sleep medicine is beneficial for saving time and acting quicker if something is not going right.

If your data shows that you are still experiencing apnea throughout the night or symptoms related to high pressure, your respiratory therapist determines whether your machine needs the pressure adjusted.

  • Too much pressure- If there is too much pressure coming from your machine, you may notice symptoms of stomach pain, bloating, gas, pain or discomfort in your mouth and nose, etc.
  • Too little Pressure- If your pressure is set too low, you will experience more apnea events, daytime sleepiness, headaches, etc.

Once you start using your CPAP machine, your pressures are set to a correct level, and you become comfortable with it, you will begin to notice the benefits. You will have a much better sleep quality, less frequent night aerosols, and you will begin waking up well-rested. You will have more energy throughout the day, and your levels of daytime sleepiness should start to decline.

The benefits of CPAP therapy will show in your overall health, too, including reducing your risk of a heart attack or stroke, lowering your blood pressure, and improving your mental state.


Sleep apnea is a severe medical condition that many people do not even realize they have. It ruins your quality of sleep which has a significant impact on your quality of life. Using CPAP therapy to treat this condition is very beneficial and highly effective. Sticking with your recommended therapy and following the instruction provided by your sleep specialist and your respiratory therapist will help you live a longer, happier, and healthier life. Not to mention everyone living in your home will appreciate the silent, snore-free nights.

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