What Is Automatic Positive Airway Pressure (APAP)?

If you’ve been diagnosed with sleep apnea, it means your breathing gets shallow or even stops and restarts while you’re asleep. Often, the first treatment your doctor may have you try is a device to keep a positive airway pressure.

These machines pump air into your lungs and keep your throat from closing up during your slumber. One type is automatic (sometimes called auto-titrating) positive airway pressure, or APAP.

How APAP Works

Besides APAP, there are two other major types of positive airway pressure machines. One is CPAP, or continuous positive airway pressure. The other is BiPAP, or bilevel positive airway pressure.

APAP uses software to automatically adjust the amount of air to match your needs during the night.

For instance, sleeping on your back can interrupt your breathing more often because it relaxes your tongue and jaw and blocks airflow. If that happens, APAP raises the air pressure. Your doctor will set the upper and lower limits of air pressure depending on what’s best for you.

Why Use APAP?

Studies show that all types of positive airway pressure may work equally well to help you sleep normally. Standard CPAPs have a long track record and are the most widely used. They’re also simpler and less expensive than the other machines.

Some insurance plans may have you start with CPAP first, then switch to APAP or BiPAP if you don’t get relief.

APAP may be a better choice for you if you want your airflow to vary during your sleep to match your needs. Reasons include if you:

  • Toss and turn in bed
  • Are a deep sleeper
  • Often have allergies or a stuffy nose
  • Drink alcohol close to bedtime
  • Lose or gain weight often
  • Want to avoid a doctor visit for every air pressure change
  • Are uncomfortable with fixed air pressure from CPAP

Compared to CPAP users, people who try APAP report a very slightly better quality of life and less daytime sleepiness.

Drawbacks of APAP

These complex machines use algorithms to constantly calibrate the amount of pressure needed to keep your upper airway from collapsing. They can be expensive, and your insurance plan may not pay for it.

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Other issues to consider with APAP include:

Apnea type. APAP has not been well studied with people who have central sleep apnea syndrome. It happens because of faulty signals from your brain to the muscles that control your breathing. The more common obstructive sleep apnea happens when something blocks your upper air passageway.

Health problems. You may not be a candidate for APAP if you have heart failure, chronic obstructive pulmonary disease (COPD), or if your breathing problems stem from obesity or opioid use.

Leaks. Your APAP may not work right if your mask fits poorly or if the seal isn’t tight enough. This can be a problem especially if you tend to move a lot during sleep or if you need high air pressure.

How to Use It

APAP comes with a mask that you wear over your mouth. It’s connected to a small device that gently pushes air into your throat.

If your sleep apnea is uncomplicated, you might be able to start using your APAP right away after your doctor diagnoses you, without visiting a sleep center first.

After your training, make sure you’re confident that you know how to use your APAP. Your checklist may include:

  • Check that the mask fits properly before you start.
  • Let your doctor know if the mask doesn’t stay on or leaks air.
  • Give yourself time to get used to the machine and the varying air pressure.
  • Ask your doctor if it’s a good idea to track your symptoms to see how much APAP helps.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on February 21, 2020

Sources

SOURCES:

American Association of Speech Technologists: “Pros and Cons of APAP Therapy.”

American Association of Sleep Technologists (AAST): “Comparison of CPAP Versus APAP,” “Pros & Cons of APAP Therapy.”

American Sleep Apnea Association: “CPAP vs. APAP.”

Journal of Clinical Sleep Medicine: “Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure: An American Academy of Sleep Medicine Clinical Practice Guideline.”

National Institutes of Health: “Sleep Apnea Information Page,” “Sleep Apnea.”

UpToDate: “Initiation of positive airway pressure therapy for obstructive sleep apnea in adults.”

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