Why is CPAP the Gold Standard for Sleep Apnea Treatment?

CPAP. Not the most sophisticated medical treatment in the 21st century-- would you agree? So why is it the gold standard treatment for sleep apnea? 

When I look at a person's sleep apnea being treated with CPAP during an overnight stay in the sleep lab, I see the effects in real time. The pressure setting starts low and is increased very slowly by the sleep technician until the airway support is sufficient for the airway to be open. This is called a titration. 

As the pressure is increased, the airway obstructions, the drops in blood oxygen, and the sleep disruption go away. As I interpret the study, I am looking for the air pressure level that allows the patient to breathe normally. I watch a cure take place. At the therapeutic pressure, the blood oxygen levels are normal and stable. The EEG brain wave tracings show normal sleep and normal sleep cycling. The movement in bed quiets as the patient sleeps peacefully. Beautiful. This is one of the most rewarding parts of my job, and this scenario is common. The first reason that CPAP is the gold standard for sleep apnea treatment is: CPAP reliably works to fix sleep apnea. 

Second reason: CPAP offers multilevel airway support. The alternative treatments to CPAP may address only one level of airway obstruction from the nasopharynx to the epiglottis. This is an important distinction, especially for those who have severe sleep apnea (and even moderate sleep apnea), since the airway collapse can span a larger area that alternative treatments may not be able to overcome. 

Third reason: CPAP is non invasive. You may chuckle a bit at this one since using CPAP can certainly feel invasive, but I'm comparing it to surgery here. Unfortunately, in addition to being invasive, some surgical procedures intended to help sleep apnea can make the condition worse due to scaring and tissue contraction. Still, there is a lot of motivation to improve surgical procedures so they more reliably give good results. 

Fourth reason: CPAP can be customized. It's important to consider this with the inevitability of change in our lives. We lose and gain weight. We grow older. We acquire health conditions that affect the character or the severity of our sleep apnea. CPAP can adjust so our sleep stays healthy. 

Another way to describe CPAP is that it is the first-line treatment for sleep apnea. This rightfully implies that there are more choices after the first option is explored. If you choose CPAP, it is worthwhile to give it a sincere and diligent effort before moving on.