Differences Between CPAP, APAP, and BiPAP as Sleep Apnea Therapies

CPAP stands for continuous positive airway pressure. CPAP machines are used to treat sleep apnea, which means when a person’s throat closes up during sleep due to blocked or restricted airflow through the nose. CPAP devices use pressurized air to open up the nasal passages so that more oxygen can enter into your lungs and help prevent collapse of the chest cavity during sleep. CPAP machines have been around since the 1980s and they’re now available in various sizes. They come with different features such as a variety of settings, attachments, and accessories.

APAP stands for continuous positive airway pressure assisted ventilation. APAP machines are similar to CPAP machines except they allow you to breathe in fresh air instead of compressed air. APAP machines were designed specifically for patients who cannot tolerate or don’t want to wear a CPAP machine because it restricts breathing. These machines are usually smaller than CPAP machines and are used primarily in hospitals.

BiPAP stands for bi-level positive airway pressure. BiPAP machines are like APAP but they work differently. Instead of allowing you to breath in fresh air, these machines allow you to breathe out carbon dioxide (CO2) instead of oxygen. This is beneficial to people with sleep apnea because breathing out carbon dioxide prevents collapsing of the chest during sleep.

Ventilator assist device (VAD) machines are used to support someone’s breathing if they are unable to do so on their own. There are different types of VAD machines available such as volume-controlled VADs and pressure-controlled VADs. They are generally used to treat patients with severe respiratory illnesses.

What’s the difference between CPAP and APAP?

Both devices treat sleep apnea by providing positive air pressure into your throat. This prevents the throat from collapsing during sleep and allows for normal breathing.

Continuous positive airway pressure (CPAP) was the original treatment for sleep apnea. The air is pressurized at a higher level than atmospheric pressure so it keeps the airways open. The pressure is delivered through a mask that is fitted over your nose while you sleep. The air pressure can be adjusted by changing the settings on the machine or adjusting the size of the mask’s air inlet.

Continuous positive airway pressure assisted ventilation (APAP) is a newer treatment option that came about in the 1990s. APAP devices also provide positive air pressure into your throat to stay open, but these devices allow you to breathe fresh air instead of pressurized air. An APAP device may be a better choice for people who cannot tolerate the air pressure from a traditional CPAP machine.

Ventilator assist devices (VADs) are for patients who are unable to breathe on their own. These machines provide pressurized air into the patient’s lungs. The air flow is adjusted manually by a caregiver depending on the needs of the patient.

What are the types of ventilators?

There are two main types of ventilators: volume-controlled (VC) and pressure-controlled (PC). Each type has its specific use.

A VC machine measures the amount of air going into your lungs and makes adjustments as needed. A PC machine measures the pressure in your airways and adjusts the pressure of the air coming from the machine to open up your airways.

A PC machine is often used to prevent the chest from collapsing during sleep (a common problem in people with obstructive sleep apnea). A PC machine is also used when someone needs help breathing but does not need as much air, such as someone with a neuromuscular disease (such as muscular dystrophy).

A VC machine is often used for long-term breathing support because it provides a set amount of air.

What is a bilevel positive airway pressure (BPAP) device?

A bilevel positive airway pressure (BPAP) device is a machine that helps with both the inhalation and exhalation process. It consists of two parts: an inspiratory limb and an expiratory limb. During inhalation, air is supplied under positive pressure and this air supply is seamless from inhalation to exhalation. The expiratory limb of the machine allows the patient to breathe out and creates a slight negative pressure, which helps draw air into the lungs.

What is non-invasive ventilation (NIV)?

Non-invasive ventilation (NIV) is a type of ventilator that provides air pressure to help a person breathe without having tubes or a mask inside their mouth or nose. It is connected to a mask, which is worn on the face. An increase in air pressure from the machine causes the chest to expand and allows the person to inhale. The reduction of air pressure allows the chest to deflate and lets the person exhale.

What does non-invasive mean?

Non-invasive means that no part of the ventilator is inserted into the patient’s body. No surgical incisions are made and no surgery is needed for setup. A non-invasive ventilator, like the bi-level positive airway pressure (BPAP) device, is used to treat someone who is having trouble breathing by blowing air into their lungs. The mask is strapped on the patient’s face and air tubes connect the mask to the machine.

What is a tracheostomy?

A tracheostomy is an opening created in the trachea, or windpipe, and kept open with a cuffed tube. This is often called a “trach.” This breathing tube is placed into the windpipe through an incision in the neck. This surgery is performed in an operating room and requires general anesthesia.

Why might I need a tracheostomy?

The main function of the trachea is to deliver air to the lungs. The trachea branches off into two primary bronchi, which deliver air directly to each lung. When the trachea is damaged and not working correctly, a tracheostomy may be done to allow the patient to breathe directly through the skin. This prevents breathing problems and allows the lungs to function normally.

What are some relatively common complications of tracheostomy?

Most complications involve the site of incision on the neck. Most often, there is a small wound that fails to heal. There is a risk of infection around this area, as well.

Infection in this area is called a “cellulitis.” Cellulitis is an infection that involves the tissues surrounding the tracheostomy tube. If the wound does not heal or if there is repeated swelling in the area of the wound, contact your doctor.

How is a tracheostomy tube changed?

Tracheostomy tubes require regular care and changing by a medical professional. The tube is held in place by a cuff, which is inflated to seal the tube in the trachea. This cuff must be periodically checked for proper placement and proper inflation; otherwise, the tracheostomy tube may fall out or leak around the incision.

Tracheostomy Care at Home

A tracheostomy requires special attention to the skin surrounding the tracheostomy tube site. The skin must be kept clean and dry to prevent skin breakdown and infection. Most patients with a tracheostomy will require some home care, which will vary depending on your medical condition and the doctor’s orders.

Skin Care

Several factors can cause irritation or breakdown of the skin where the tracheostomy tube enters your neck. Skin breakdown is an common complication in patients with a tracheostomy. Signs of skin breakdown include redness or swelling around the incision site.

The following tips can help you avoid skin breakdown and keep the area around your tube site clean and healthy:

Wash your hands before touching the area around your tracheostomy tube site.

Gently clean the skin around the tracheostomy tube site 2 to 3 times a day with mild soap and water.

Pat, do not rub, the area dry.

Apply a small amount of antibiotic ointment at the tube site after cleaning to prevent skin irritation and keep the skin around the opening from drying out.

Avoid exposing the area to the sun. Use sunscreen if you must be outside for more than a short period of time.

More severe cases of skin irritation may require the use of an oil or water-based ointment to prevent the area from drying out. Be sure to follow all instructions provided to you by your doctor or the nurse assisting you with your tracheostomy care.

Tracheostomy Care With a Tracheostomy Tube

Tracheostomy tubes are designed to remain in place until medical staff replace them. Depending on the type of tracheostomy you have, the tube may be secured in place by a collar or a balloon cuff around your neck.

If a collar is used to secure the tube, keep this area clean and dry to avoid skin irritation or an infection.

If a balloon cuff is used to secure the tube, air may need to be added to the cuff from time to time. Your physician or nurse will show you how to do this.

If you develop skin irritation or an infection, contact your physician or the nurses at your hospital. They will instruct you on whether you need to see them immediately or if you can follow a treatment plan at home.

Cleaning the Skin

The skin that surrounds your tube site must be kept clean and dry. Ask your doctor or nurse how often you should wash this area. You may need to do this several times a day. Proper cleaning helps prevent infection and allows excess secretions to exit the body.

Washing with Soap and Water: Clean the skin that is exposed by the tracheostomy tube once or twice a day with warm water and a gentle, antibacterial soap. Pat—do not rub—the area dry with a clean towel.

Keeping the Area Dry: The skin that surrounds your tracheostomy tube is more delicate than other areas of your body that have skin. Keeping this area dry helps prevent infection and skin breakdown.

Important: If you have a tracheostomy in your neck to help you breath, you will need to keep this skin area dry. If it gets wet (with saliva, sputum or water) it can cause irritation or an infection. If you are having swallowing problems, a suction device may help remove excess secretions from your throat. It is very important to keep the skin area around your tracheostomy dry.

Removing Mucus: The following are ways to help remove excess mucus from the area around your tracheostomy tube or your stomach:

Suction: A small device called a suction catheter attaches to the opening of your tracheostomy tube. This can remove secretions from your throat.

Breathe low: Your family, caregiver or nurse can show you how to take quick, shallow breaths to help move secretions up and out of the trachea.

Use a technique called “coughing it out”: When you feel that a lot of mucus has built up in your throat, take a deep breath and try to cough it out.

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