No one with obstructive sleep apnea who visits my office ever asks, “What continuous positive airway pressure mask do I get?” What I usually hear is, “I’m not wearing one of those things!”
Patients usually describe using CPAP as a love-hate relationship. Although they hate having to wear a mask to bed every night, they love how much better they feel in the morning compared with how they felt before visiting the office.
I am often reminded of how rapidly CPAP technology has evolved. When I show veteran CPAP users the newest machines, they can’t believe how small the units have become and how quiet. Patients occasionally bring in machines that are 10 to 15 years old, and I am always amazed about the difference in size. They are huge!
Patients often ask if they will be “hooked up to a machine” for the rest of their lives. When I explain that CPAP is relatively new technology, and explain the changes that have occurred since the development of CPAP, they are amazed. After all, the first CPAP machine was a vacuum cleaner motor!
One momentous night in June 1980, CPAP inventor Colin Sullivan, PhD, tested an idea. Before CPAP technology, patients with severe OSA had to have a tracheostomy to control their disease. Sullivan had a 43-year-old male patient who needed the surgery but refused to have it. The patient, however, did volunteer to be part of an experiment using plastic tubing and a vacuum cleaner motor.
Sullivan inserted plastic tubing, and rapid sealing silicone to seal the nasal airway. Then using a vacuum cleaner motor in the reverse mode he applied the positive pressure. The patient went into REM sleep very quickly and his apnea disappeared. He stopped the pressure and the apnea reappeared. He repeated the process multiple times and realized this was a treatment that worked.
CPAP therapy has come a long way since 1980. Now, there are multiple companies who produce CPAP machines, as well as bilevel positive airway pressure (BiPAP) and adaptive servoventilation (ASV) machines. There are also multiple variations of the three basic nasal, nasal pillow and full-face masks.
Sullivan made a huge discovery with CPAP. Today, there are other alternatives including dental appliances that show promise for treating mild disease, but CPAP remains the gold standard for moderate to severe disease. Knowing that CPAP is a relatively new technology means that there are likely to be more advances in the future.
Next time a patient asks about using a CPAP machine and mask give them the history. They will be fascinated and may take comfort in the fact that there is plenty of room for technological improvements to CPAP machines.
Sharon M. O’Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.