Positive airway pressure therapy, or PAP, is the most commonly used treatment for sleep apnea. A PAP machine is typically the size of a shoebox, but it can be smaller. The machine is linked to a mask or other interface device worn over the nose and/or mouth by a flexible tubing. PAP works by forcing air into the airway channel at a high enough pressure to avoid apneas and can be used to treat both obstructive and central sleep apnea. The pressure is adjusted based on the patient’s sleep apnea.

Because PAP is a medical device, all PAP units must be approved by the Food and Drug Administration (FDA) before being sold. For the same reason, a physician’s prescription is required to receive a PAP. (In this article, “PAP” refers to any positive pressure device because it is a general phrase rather than a brand name.)

There are multiple PAP manufacturers who offer several sorts of machines with varying characteristics. After being diagnosed with sleep apnea and prescribed PAP therapy, you may be able to select one machine from among the numerous available. A PAP is often rented or acquired through a home health care firm, sometimes known as a durable medical equipment company, and is typically covered by insurance as a durable medical equipment benefit. PAPs are also available for purchase on the Internet. However, before purchasing a machine, it is often a good idea to rent one for several weeks first (on a rent-to-own option if available) to ensure that the machine has all of the capabilities you require and to evaluate if PAP is running properly.

Consult your doctor and a representative from a home care business to determine which machine is appropriate for you and your lifestyle. Keep in mind any cost and/or provider limits that your insurance company may impose. Certain types of PAP devices are only covered by some insurance carriers. Consider what features you want or need when choosing a PAP machine. A carrying case, the ability to convert to foreign currents (automatically or with additional equipment), the ability to adjust for different altitudes, an attached heated humidifier, ramping (which allows for a gradual increase in pressure), DC (direct current) operations via a car or boat battery, and bright colors are available as options. There are also bi-level devices with two different pressures–one for inhalation and one for expiration. Furthermore, the Food and Drug Administration has approved various auto-adjusting devices for the market; these machines are meant to detect varying pressure needs while you sleep and automatically adjust the pressure as needed. The most recent FDA-approved equipment is similar to a PAP in terms of continuous or constant inhalation pressure, but it offers adjustable lower exhalation levels. The exhale pressure is determined in part by the machine, which reacts to the user’s exhalation patterns, and in part by the user, who chooses one of three settings.

More complex machines, which are more expensive, are not typically covered by insurance, but they may be reimbursed with a specific physician prescription and documented failure to respond to basic PAP treatment.

Some equipment can track how frequently you use the PAP, while others can record whether or not you experienced any apneas while using the machine (this can indicate a need to adjust the pressure). Your doctor may wish to download this data on a regular basis to ensure that your treatment is effective, and the compliance monitor can be useful if you require objective proof that you are getting enough rest. You may need to take the machine to a sleep center or home care provider in order for the data to be downloaded. You may be able to take or send the card to the sleep center or home care company if the data is included in a compact, thin card. You might be possible to send the data using a telephone modem (included with the machine) rather than an Internet connection.

A mask or some form of interface will be required in addition to the machine. The mask’s fit is also important to you. Again, consult with your doctor and a representative from your home care business about your interface options, and keep in mind that the mask may be manufactured by one manufacturer while the PAP is manufactured by another. Participation in an A.W.A.K.E. support group for people with sleep apnea, as well as their friends and family, may also be beneficial in adjusting to the PAP and mask. To find out whether there is a group meeting in your region, call the ASAA at 888-293-3650 or send an email to asaa@sleephealth.org.