CIPAP-therapy: the principle of action, indications and contraindications

CIPAP-therapy is non-invasive and at the same time not a medical treatment for snoring, often conjugate with the syndrome of obstructive sleep apnea (OSAS) and a number of other pathological conditions. It was proposed in 1981 by the Australian physician K. Sullivan and quickly found recognition among somnologov, neurologists and doctors of a number of other specialties. Currently, CIPAP therapy is considered to be the main and most effective method of treatment of moderate to severe cases of OSAS. And the testimony to the application of this technique is gradually expanding.

What is CIPAP therapy?

The CPAP device prevents the sleep during the sleep of the tissues of the nasopharynx and the soft palate, which is the prevention of sleep apnea

SRAP - Russified name of the original CPAP methodology. In fact, this is an abbreviation of the English-language "Constant Positive Airway Pressure", which translates as a constant positive air pressure in the airways. And it is created with the help of a special device, the key structural components of which are a compressor, a face mask (nasal or nasooral) and a connecting hose on the face. Also in most modern models there is a unit for moistening and multistage filtration of the supplied air.

The principle of CIPAP is the creation in the upper respiratory tract of an additional dosed positive air pressure, supporting in a certain position the tissues of the soft palate and nasopharynx. This prevents their sleep during sleep and thus serves as a prophylaxis of temporary obstruction with a short-term stop of breathing - the so-called sleep apnea. It was for the treatment of this condition that the SRAP therapy was invented. But at the present time it is quite successfully used for other disorders as part of complex therapeutic regimens.

When recommend CIPAP-therapy

The main indications for CPAP therapy are:

• The syndrome of obstructive sleep apnea is the main indication for CIPAP. Therapy is prescribed in severe and moderately severe forms with an apnea / hypopnea index (IAG) of 15 or more per hour. For mild forms (IAG 5-14 per hour), CIPAP is recommended in case of clinical signs of functional disorders of the brain and a significant deterioration in the daily activity of the patient.
• Arterial hypertension, while the CIPAP is used as part of complex treatment. Helps control blood pressure in the early morning hours due to improved oxygen saturation of the subcortical structures of the brain.
• Chronic cardiovascular diseases with a high risk of stroke and / or myocardial infarction.
• Some forms of impotence.
• Endocrine disorders, obesity.

CIPAP-therapy not only improves the quality of night sleep, but also significantly reduces the manifestations of chronic hypoxia of vital organs. And now it is recognized as the best method of correcting the syndrome of obstructive sleep apnea, being the prevention of sudden death from stopping breathing at night.

Syndrome of obstructive sleep apnea: why it occurs

In recent years, SRAP therapy has been used not only in the syndrome of obstructive sleep apnea, but also for treatment of some other diseases, in particular, chronic heart diseases, obesity and impotence.

The syndrome of obstructive sleep apnea develops with the temporary collapse of the soft tissues of the upper respiratory tract. This usually occurs during the phase of creating a negative pressure at the beginning of the inspiration and is accompanied by snoring at the time of resumption of breathing.

The development of OSAS is facilitated by a decrease in the tone of the soft tissues of the upper respiratory tract. Normally, even during deep sleep, they remain completely passable, regardless of the position of the body and head of a person. And with obstructive sleep apnea, they periodically subside, blocking the flow of air. The resulting hypoxia is accompanied by characteristic changes in the ratio of oxygen and carbon dioxide in the blood, which leads to the activation of brain structures and incomplete awakening. At this point, muscle tone rises, the airway opens, the person takes a deep breath with a loud snort. After a while, the apnea repeats.

Development of this state is facilitated by:

• obesity;
• short neck syndrome;
• ENT pathology (pronounced curvature of the nasal septum, polyposis of the nose and adenoiditis, chronic rhinopharyngitis with hyperplastic changes in the soft tissues of the nasopharynx);
• neurological pathology with the development of bulbar syndrome;
• reception of sedative drugs, which have some muscle relaxant effect, chronic alcoholization.

According to statistics, men are more likely to develop OSAS, especially after 60 years.

What is dangerous OSAS?

Although obstruction during sleep is temporary, a brief discontinuity that occurs regularly during the night the intake of oxygen with the development of hypoxia adversely affects the condition of vital organs. Therefore, OSA is considered as a factor that significantly increases the likelihood of many pathological conditions. It can be a variety of chronic progressive disorders of the internal organs and brain, acute cardiovascular disasters (strokes, heart attacks), functional disorders of the genitourinary, vascular and endocrine systems.

A person suffering from sleep apnea has disturbances in night sleep in the form of a decrease in its quality and depth, changes in the natural rhythm of the cycles. And he himself does not notice it, often does not even remember the night awakenings. With the total seemingly sufficient duration of sleep, a person with OSAS on awakening feels not rested, broken, often feels a headache, palpitations and a slight increase in blood pressure.

Such people are reduced working capacity and ability to concentrate, the productivity of cognitive activity, which often leads to complaints of memory loss with its objective preservation.

Also, the OSA significantly increases the risk of injuries in production and accidents on the roads. After all, a person with such a frustration often suffers from an insufficient speed of reaction to changes in the external situation. In addition, against the background of OSA because of a significant deterioration in the quality of night sleep, he often noted during the day increased drowsiness and spontaneous falling asleep. They practically can not be consciously controlled, and the reception of tonic drinks is of little help.

How is CIPAP-therapy performed?

CIPAP-therapy is appointed by a doctor-somnologist. It requires a preliminary examination of the patient to clarify the severity of the OSA and the reasons for its development.

The first treatment session is performed at the Sleep Center (separation of the somnology), the patient's condition is monitored by polysomnography. This allows you to choose the optimal mode of operation of the CIPAP device, to evaluate the prospects for therapy.

The subsequent sessions are conducted by the patient independently, at home, in accordance with the recommendations of the doctor. To do this, you only need to put on the mask before going to sleep at night and turn on the device. It is usually recommended to use the device in at least 70% of nights, for 4 or more hours per day.

Do not be afraid that an unplanned shutdown of the device (for example, when the power supply is cut off) will lead to suffocation of the patient. Masks have so-called security ports that open when the airflow is interrupted. Their holes have a sufficient diameter for unobstructed breathing of a person. In addition, the termination of the device in most cases wakes up the patient, so that he has the opportunity to personally monitor the condition of the device.

Adverse Events

Initially, the patient will be unaccustomed and not very comfortable to sleep in a mask, but eventually everything is normalized

CIPAP therapy is almost always accompanied by a period of adaptation. After all, the patient must get used to the constant sound of the working apparatus, the presence on the face of the mask, the change in the character of inspiration and exhalation, new sensations in the nasopharynx. Sometimes, to increase comfort, it is necessary to select another type of mask and even a device.

Possible side effects of CIPAP therapy include:

• irritation of the facial skin in the area of ​​the mask;
• drying of the nasal mucosa and pharynx (usually with simple models of the apparatus, without the function of full hydration and filtration);
• irritation of the conjunctiva, which in most cases is associated with a loose fit of the mask and the entry of exhaled air to the lower eyelids;
• the tendency to recurrent rhinitis and rhinosinusitis, usually in patients with previous relevant chronic ENT pathology.

Contraindications

There are no absolute contraindications for conducting the CIPAP therapy. But some diseases of the patient require special attention from the doctor with careful selection of the treatment regimen and systematic checkups. Such tactics are necessary for the following states:

• expressed violations of the heart rhythm;
• chronic ophthalmic and ENT diseases;
• severe heart failure;
• patient's propensity to nosebleeds;
• the presence in the anamnesis of indications on the transferred operations on a brain, organs of a thorax and a mediastinum;
• arterial hypotension.

In these cases, the decision to perform a CPAP therapy is usually taken after consultation of the relevant specialist (cardiologist, neurologist, ENT doctor), which, if necessary, corrects the received therapy.

What can I expect from CIPAP therapy

The result of CPAP therapy is often seen after the first session. Due to the elimination of episodes of apnea, a person wakes up more alert and active. He usually notes the disappearance or significant reduction of the headache in the morning. It should be understood that such treatment does not relieve the patient of the preconditions for the development of sleep apnea, and is not the prevention of repeated episodes. But CIPPA helps effectively prevent breathing stops even with a severe degree of OSA. True, this technique has no cumulative effect, the result will only be with a regular and sufficient duration of sessions.

The result of systematic application of the technique will not only improve the quality of night sleep and well-being of the patient, but also stabilize his somatic state. In many cases, it is possible to reduce the dosage of antihypertensive and anti-anginal drugs, better control the weight. Increased mental and physical performance. In the future, the risk of cerebral and cardiac vascular accidents, the development of vascular dementia, is reduced.

CIPAP is a non-invasive, home-made and effective method for treating obstructive sleep apnea syndrome and associated various pathological conditions. At the present stage of the development of medicine, it is considered to be the best way to prevent sudden nighttime death caused by stopping breathing.