The Stanford Center for Sleep Sciences and Medicine

Positive Airway Pressure (PAP) Therapies


Positive airway pressure (PAP) Therapy is a generic term applied to all sleep apnea treatments that use a stream of compressed air to support the airway during sleep. With PAP therapy, you wear a mask during sleep. A portable machine gently blows pressurized room air from into your upper airway through a tube connected to the mask. This positive airflow helps keep the airway open, preventing the collapse that occurs during apnea, thus allowing normal breathing. For optimal improvement, itís important to use your PAP machine every time you sleep Ė including naps.

PAP therapy is a prescribed treatment because the air pressure required to stabilize the airway, known as the therapeutic pressure, is different for everyone. The treatment pressure is measured in centimeters of water (cm H2O) and most machines can be set by the provider to deliver pressures between 4 and 20cm H2O. The correct setting is critical because if the air pressure is set too low, the airway can still collapse. If itís set too high, you can become over-ventilated. Either scenario will have a negative impact on your sleep quality.

Several factors impact the therapeutic pressure, including severity of OSA and structure of the airway. An individualís therapeutic level is determined during a Continuous Positive Airway Pressure (CPAP) Titration sleep study. There are three main types of PAP treatment available, Continuous Positive Airway Pressure (CPAP), BiLevel, and Auto-Titrating Devices.

Overall PAP therapy is a safe and effective treatment, however there are a few counter-indications. Be sure to tell your doctor if you have bullous lung disease, pneumothorax, cerebrospinal fluid leak or severe epistaxis (nosebleeds).

Resources at Stanford:

CPAP Classes

Dr. Michelle Cao conducts a CPAP Class (PDF) for Stanford patients who are CPAP users on the first Monday of each month. Attend the class to learn about sleep apnea and discuss treatment options, review what is on downloaded data reports, how to troubleshoot device and mask problems and more. Please bring your CPAP device, mask, plug, and report of data download if available. Space is limited to 10 per class, so pre-registration is required. To participate, contact the front desk of the sleep clinic at (650) 723-6601.

AWAKE Meetings

Stanford hosts a monthly Alert, Well, and Keeping Energetic (AWAKE) Meeting. The AWAKE group provides information and support for sleep apnea patients and their families. To learn more about the AWAKE Group and for information about upcoming meetings, visit their website.

Dr. Imamura will present on Melatonin and its Effect on Circadian Rhythm and Sleep Regulation at the next meeting which will be held on Wednesday, October 5th at 7pm. Read the AWAKE eNewsletter for details about the meeting.

Stanford Medicine Resources:

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