CPAP

Clinical
Continuous positive airway pressure (CPAP) is a method of respitary ventilation, used
in the treatment of Obstuctive sleep apnea (OSA). People who suffer with OSA
experience episodes during sleep, when the muscles that normally hold the throat open
relax during sleep and allow it to narrow, trying to inhale will suck the throat
completely closed and air cannot pass at all. This is an obstructive sleep apnea episode;
episodes can last as long as two minutes and only ends when the victim wakes up. This
cycle may be repeated hundreds of times a night while the sufferer has no idea it is
happening. General symptoms are Fatigue and tiredness during the day. Loud snoring;
if the loud snoring is repeatedly punctuated by brief periods of silence or choking
sounds, the individual is certain to have obstructive sleep apnea.
Diagnosing OSA is based on your medical and family history and on sleep studies.
A sleep study is the most accurate test for diagnosing sleep apnea. It captures what
happens with your breathing while you sleep. The study uses A polysomnogram PSG),
This test records brain activity, eye movement and other muscle activity, Breathing and
heart rate.
Cpap is the most effective method to manage OSA. The CPAP provides a pneumatic
stent for the upper airway, eliminating the airway collapse during inspiration. Sufficient
pressure is introduced to eliminate apneas, hypopneas, and snoring. The pressure base
line is raised from zero to a positive number. i.e. the CPAP is set to 10 cmH2O. The
patient then breathes spontaneously on this higher baseline pressure, therefore the
patient is not allowed to exhale completely so that as he breathes, his airways are
subjected to a positive pressure throughout both inspiration and exhalation.

This pressure time curve shows that as the patient breathes, the pressure only varies a
bit between inspiration and exhalation

The criteria for determining the amount of pressure is traditionally determined

during polysomnography by trained technicians. In some centres, this is performed
as a split-night study, with data from the first half of the night used for diagnosis of
OSD. Once this diagnosis is made, the second half of the night's study is used to
determine the optimal amount of pressure The amount of pressure delivered is
reported as cm H2 O. An average starting point for CPAP would be 8-10 cm H2
Technical

The most common CPAP used at this hospital is the Resmed S8 Escape II. It has a pressure
range of 4 – 20 CmH2O which can be adjusted using the clinician’s menu, and has the
advantage of being easily calibrated. The clinicians menu gives access to a range of features
which include

Expiratory pressure relief (EPR).

EPR detects the beginning of exhalation and reduces motor speed to drop pressure. The
patient or clinician chooses one of three comfort levels to determine the degree by
which pressure will drop.

Setting 1 = mild comfort (1 cm H20)

Setting 2 = medium comfort (2 cm H20)
Setting 3 = maximum comfort (3 cm H20)

CPAP start pressure.

The Start pressure has a range of 4 – 20 CmH2O, allows the CPAP to build up to the
set pressure after a few seconds

CPAP Pressure

The Set pressure has a range of 4 – 20

Calibrate

Allows the clinician to calibrate the set pressure

Used Hours

Allows the clinician to monitor the patient’s usage

Patient menu

Allows the patient to set the ramp time, the ramp time allows the patient to run the
CPAP at a lower pressure for up to a maximum of 30minutes

The S8 Escape II allows for a humidifier to be added, a humidifier moistens the air and
improves your comfort, and may resolve symptoms such as:

• Nasal congestion, dryness, or tenderness

• Mouth breathing (commonly referred to as "mouth leak")
• Dry throat
Planned Preventative Maintance (PPM)

A PPM generaly consits of a series of tests, aimed at the prevention of breakdowns and
failures. For a CPAP these tests are

Visual inspection

Check the unit for any damage or contamination, clean unit with a detergant wipe,
change filter

Functionality test

Connect a calibrated mamometer, power up CPAP, CPAP will display set pressure,log
set pressure and confirm it is within spec. It has been agreed between Respiratory and
Bioengineering that the set pressure can have a tollerance of +/- 1 CmH2O. If the set
pressure is out of spec, then it can be calibrated using the calibrate feature.
Log hours of use check functionality

Electrical safety test

Perform electrical safety test, for most CPAP’s it is class 2CF