All three breathing masks offer universal compatibility, meaning they can be used with any APAP machine. It’s important to note that the APAP machine, humidifier, and breathing mask each require a doctor’s prescription. A machine may be sold with a built-in humidifier or the humidifier may be sold separately; breathing masks are always sold separately. For more information on this topic, please see our ‘APAP Prescription Requirements’ section below.
Operating an APAP machine is fairly straightforward. For most devices, the process is as follows:
1. Position the APAP machine on a flat, even surface that can support its weight. APAP machines always have flat bases.
2. Connect the machine’s power cord to an outlet or power strip.
3. If the humidifier is integrated, fill the reservoir with distilled water using a pitcher; if it is detachable, fill the reservoir with distilled water using a faucet and then attach to the machine.
4. Check to make sure the connective hose is secure between the airflow generator and the breathing mask.
5. Put on the face mask and adjust to a comfortable position.
6. Turn on the machine.
CPAP machines typically need a few minutes to reach the prescribed pressure setting; this is known as ramp time. Because they don’t have a fixed setting, APAP machines do not need as much ramp time – though sleepers that initially need a high-pressure setting may need to wait a few minutes.
Pros and Cons of APAP Machines
Advantages of using an APAP machine include:
- More comfortable breathing: Because APAP machines automatically adjust pressure settings based on breathing patterns, many sleepers find APAP therapy more comfortable than CPAP or BiPAP therapy (both of which involve fixed pressure settings). This is especially true during exhalation, when most sleepers prefer lower pressure settings.
- Easy to use: Even advanced APAP machines with cutting-edge features are fairly user-friendly and easy to operate.
- Compact size: With few exceptions, APAP machines are small, lightweight devices that don’t take up much space and can be used on any bedside table, nightstand, or other flat surface. Some models are suitable for travel due to their exceptionally small size.
Disadvantages of using an APAP machine include:
- Noise potential: Some APAP machines are quieter than others, but most produce whirring sounds that reach between 26 and 32 decibels (dB). At this volume, those who have a hard time falling asleep and/or awaken easily due to noise may experience sleep disruptions.
- Facial discomfort: Each breathing mask is associated with certain comfort issues. Full face masks can be heavy and bulky, and also restrict mobility in bed (especially for side sleepers). Nasal cradles can be problematic for those who prefer breathing through their mouth, as well as people with allergies. Nasal pillows share the same issues as nasal cradles; additionally, many users develop irritation and sores around their nares, or nostril openings.
- High price-point: Even the cheapest APAP machines cost hundreds of dollars, and these devices do not include breathing masks (or, in some cases, the humidifier).
Important Considerations for APAP Machine Shoppers
Sleep apnea type is not a major concern when choosing a new APAP machine, since these devices can effectively treat both OSA and CSA. However, APAP machine shoppers should take the following factors into account:
- Size/weight: Generally, APAP machines are compact, lightweight, and easy to lift. However, those with limited space on their bedside surfaces may want to opt for a smaller model. The same is true for frequent travelers.
- Pressure range: Most people with OSA or CSA require air pressure settings between 6 cmH20 and 14 cmH20. The vast majority of APAP machines offer a range of 4 cmH20 to 20 cmH20, making them suitable for most users, but those with pressure needs outside this range should consult with their physician about other options.
- Humidifier: Most APAP machines have humidifiers with reservoir volumes ranging from 300 to 450 milliliters (mL). The larger the reservoir, the longer the machine will operate before more water needs to be added. Additionally, some sleepers breathe more easily using machines with humidifiers that heat the water.
- Noise potential: All APAP machines produce noticeable noise, but some models are quieter and less disruptive than others. If noise potential is a concern, sleepers should shop for devices that produce between 26 and 28 dB.
- Connective hose: With rare exceptions, the standard connective hose issued with an APAP machine will measure six feet in length. Many brands offer longer hoses, which are sold separately if needed.
- Power requirements: Most APAP machines operate on a voltage range of 100 to 240 volts. Be sure to read the owner’s manual before powering up the machine for the first time. Many machines are also battery-powered, and can be used with backup batteries if power is unavailable.
- Operating altitude: Most APAP machines have a maximum operating altitude; exceeding this elevation can compromise the device’s ability to pressurize air correctly. Most machines operate up to at least 5,000 feet, and some operate up to as much as 9,000 feet.
- Alerts: Some APAP machines issue helpful alerts when problems arise, often in the form of loud beeps and/or LCD backlighting. These problems include air leaks in the connective hose; the mask falling out of position on the sleeper’s face; and loss of pressure due to power outage or dead batteries.
- Sleep data: Some more advanced APAP machines track time asleep, time awake, nocturnal breathing patterns and heart rates, and other helpful sleep data. In most cases, owners can access this data using a wireless app.
- Price: The average APAP machine costs between $600 and $800, but some machines can cost $1,000 or more. Some sellers offer financing. Additionally, some patients may have insurance plans that reduce their out-of-pocket costs for buying an APAP machine.
- Product warranty: Most APAP machine manufacturers back offer a warranty, which covers the product for one to three years. Longer warranties are rare.
Lastly, APAP machine shoppers should consider their prescription. In the next section, we’ll cover the key prescription requirements for purchasing these devices.
APAP Prescription Requirements
Some of the most common prescription-related questions about APAP therapy are answered below.
Do I need a prescription to purchase an APAP machine?
Yes. A prescription is required for the APAP machine, humidifier, and breathing mask. The U.S. Food and Drug Administration (FDA) regulates the sale of these three components. Other APAP components, including the air filter and connective hose, do not require a prescription.
The FDA requires a prescription for two reasons. The first is medical liability. Doctors write PAP therapy prescriptions after evaluating the patient for sleep apnea symptoms. The prescription includes recommended air pressure levels, based on the patient’s results. APAP machines are calibrated for a certain pressure range, based on the lowest and highest optimal settings for the patient. Incorrect calibrations can actually worsen symptoms of sleep apnea, rather than alleviate them. For this reason, an APAP machine user should never attempt to recalibrate the machine themselves.
The second reason is related to insurance. Patients do not need medical insurance to purchase APAP machines, humidifiers, or breathing masks. However, insurance companies mandate the prescription because some buyers cannot afford to pay for these devices out-of-pocket.
Do I need a special APAP prescription?
No. Your doctor may write a prescription that specifically calls out APAP therapy, but you can also use a CPAP prescription to purchase FDA-regulated APAP hardware.
Is it illegal to buy APAP machines without a prescription?
Yes. The FDA categorizes APAP machines, humidifiers, and breathing masks as Class II medical devices. Those who sell Class II devices can only do so after receiving FDA approval, and they may only sell these devices to buyers with a prescription.
Technically, you can buy APAP machines, humidifiers, and masks without a prescription, but you are breaking the law and so is the seller. In addition to legal repercussions, transactions of this nature are also ill-advised. Most take place online on private sale websites, and involve machines that have been used, refurbished, and/or modified. Alterations to the APAP machine carry health risks, including complications due to using improperly calibrated equipment and exposure to germs and bacteria from previous owners. Furthermore, the buyer receives no guarantee the item is in working order and will not qualify for any sort of warranty coverage.
Bottom line: we highly discourage you from purchasing an APAP machine, humidifier, or breathing mask without a prescription; buying these items from an FDA-approved medical device seller is strongly recommended.
How do I get a prescription for APAP equipment?
A sleep apnea diagnosis is needed for an APAP prescription. You must consult with one of the following certified professionals in order to obtain this prescription:
- Medical physician or physician’s assistant
- Doctor of osteopathy
- Naturopathic physician
- Nurse practitioner
- M.D. psychiatrist
However, most APAP device sellers will not accept prescriptions from chiropractors, optometrists, or psychologists.
The prescribing physician may diagnose you with sleep apnea or issue a home sleep test (HST). Some may refer you to a sleep disorder specialist instead. These specialists also commonly issue HSTs; they may also conduct polysomnography sleep tests that record brain waves, blood oxygen levels, and eye movements. The HST is less invasive but results tend to be inconclusive; for this reason, many patients undergo the HST and polysomnography tests.
What does my APAP prescription need to say?
An APAP prescription must include the following:
- The full name, signature, and contact information of the prescribing professional
- The patient’s legal name
- The patient’s specific sleep apnea diagnosis and optimal pressure range
- At least one of the following terms verbatim: ‘APAP’; ‘AutoPAP’; ‘Auto adjusting PAP’; ‘CPAP’; or ‘continuous positive air pressure’
The prescription requirements for an APAP machine can be somewhat confusing. For a more detailed analysis, please visit our CPAP, BiPAP, and APAP Prescriptions guide.
Additional Strategies for People with Sleep Apnea
For some sleepers, APAP and other forms of PAP therapy may not be the most effective treatment method for sleep apnea symptoms. For others, additional measures are needed. Let’s look at some alternate devices and sleep strategies that can also benefit people experiencing OSA or CSA.
Other Medical Devices and Procedures
The following products help alleviate snoring, irregular breathing, and other apnea-related symptoms
Mandibular advancement devices (MADs): MADs are anti-snoring mouthpieces designed to fit inside the sleeper’s lower jaw (also known as the mandible). The device pushes the jaw forward, which expands the airway to help reduce snoring episodes. Some MADs are custom-molded; the sleeper bites into a malleable material, forming an impression, and then mails their mold to the manufacturer. Other MADs, known as ‘boil-and-bite’ models, become softer in hot water; this allows owners to create the impression themselves without custom fitting. A MAD may require a prescription, but many over-the-counter options are available.
Tongue retaining devices (TRDs): TRDs, like MADs, are anti-snoring mouthguards, but they operate differently. Rather than repositioning the jaw, TRDs pull the tongue forward using a suction system; this widens the gap between the tongue and the airway. Many TRDs resemble baby pacifiers, and most are one-size-fits-all models that do not need to be custom-molded. TRDs rarely require a prescription.
Provent: Provent therapy is a recently developed apnea treatment that has been approved by the FDA. Provent therapy consists of two small valves with air filters; the valves are placed in each nostril using a non-toxic and hypoallergenic adhesive. The valves open to ease inhalations, then close during exhalation to build pressure in the breathing passages and keep the airway open. Provent can reduce apnea-related breathing episodes and cut down on snoring. A prescription is required.
Oral surgery: Sleep apnea patients with severe symptoms may be good candidates for oral surgery. A physician will make surgery recommendations based on the patient’s individual symptoms. Some of the most common procedures include: uvulopalatopharyngoplasty (UPPP), during which the uvula is removed to strengthen the soft palate; genioglossus advancement (GGA), during which tongue tendons are stretched away from the patient’s throat; and maxillomandibular advancement (MMA), during which the upper and lower jaw are permanently readjusted. Oral surgery can be very expensive, but it is also highly effective.
Sleep and lifestyle changes
In addition to the devices listed above, sleepers may be able to alleviate snoring and other apnea symptoms through the following measures:
Try side sleeping: Sleep position can affect sleep quality and duration for those with sleep apnea. Side sleeping is considered the best position for those with this condition, particularly the OSA type. Sleeping on one’s side causes the tongue to fall away from the throat, which allows the esophagus to expand. Comparatively, back sleeping is considered the worst position for those with sleep apnea because the tongue is much more likely to block the airway. Stomach sleeping, like side sleeping, may result in less airway blockage; however, most doctors discourage this position because it leaves sleepers more vulnerable to neck and shoulder pain.
Buy a thicker/thinner pillow: Pillow loft, or thickness, plays a significant role in sleep quality and duration for people with sleep apnea. Many people with this condition experience fewer shallow breathing and snoring episodes when their head and neck are elevated. This is especially true for those who insist on sleeping on their backs.
Pillow loft is divided into three general categories: low loft (thinner than 3″); medium loft (3″ to 5″); and high loft (thicker than 5″)
When choosing a pillow based on loft, consider the following:
- Head size: Those with larger heads usually prefer higher-loft pillows for sufficient padding and support. Those with smaller heads can often use medium- or low-loft pillows.
- Weight: Heavier people typically find that low-loft pillows are most comfortable; they do not sink into their mattress as much, requiring less space between their head and the mattress in order for their head to be properly elevated. For lighter people, the opposite is true; high-loft pillows provide more space, since they do not sink as deeply into their mattress surface.
- Shoulder length: Those with broader shoulders tend to prefer high-loft pillows because it creates more space between their head and the mattress. People with narrower shoulders may find a low-loft pillow elevates their head to the optimal level.
- Mattress firmness: Low-loft pillows are better for softer mattresses because sleepers tend to sink deeply; if the pillow is too thick, then the sleeper’s head will elevate too much. Alternatively, high-loft pillows are better for firmer mattresses because the sleeper does not sink as much (if at all).
To learn more about loft and other pillow selection factors, please visit our Pillow Buying Guide.
Consider an adjustable bed base: Adjustable beds can be raised at the head. This allows owners to sleep with their head and neck at an elevated angle, which can reduce snoring and apnea-related breathing episodes. Modern models offer a wide range of elevation angles, so most sleepers can find a setting that works best for them. Additionally, many adjustable beds are split down the middle, offering different elevation levels for couples.
Depending on the model, an adjustable bed may have manual, remote, and/or app-based controls. One thing to keep in mind: adjustable beds can be very expensive. The baseline for most models is about $1,000, but some cost more than $3,000. To learn more about these products, check out our Adjustable Bed Buying Guide.
Lifestyle changes: The Mayo Clinic recommends the following lifestyle changes for people with sleep apnea:
- Lose weight. For many, sleep apnea is linked to obesity or excess weight. Shedding extra pounds and achieving a healthy weight can alleviate snoring and apnea-related breathing episodes; furthermore, regaining that weight can cause the symptoms to resurface.
- Exercise regularly. This can alleviate apnea-related symptoms without serious weight loss. At least 30 minutes of moderate physical activity are recommended.
- Abstain from drinking excessive amounts of alcohol and/or taking tranquilizers and sleeping pills. All of these substances cause throat muscles to relax, which can affect breathing patterns.
- Quit smoking. According to the Mayo Clinic, smokers are three times more likely to develop sleep apnea symptoms than non-smokers.
To learn more about sleep apnea, PAP therapy, and other related topics, please visit the following pages on Tuck.com.
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