Choosing a PAP machine

The most common treatment for sleep apnea is positive airway pressure therapy, PAP.  A PAP machine is usually about the size of a shoebox but can be smaller.  A flexible tube connects the machine with a mask or other interface device that is worn over the nose and/or mouth. PAP works by pushing air through the airway passage at a pressure high enough to prevent apneas and can be prescribed for both obstructive and central sleep apnea. The pressure is set according to the patient’s sleep apnea.

Because PAP is a medical device, all PAP units must have Food and Drug Administration (FDA) approval before they can be sold. For the same reason, you must have a physician’s prescription in order to obtain a PAP. (In this publication, “PAP,” considered a generic term and not a brand name, can refer to any positive pressure device.)

There are several PAP manufacturers that offer different types of machines with different features. Once you have been diagnosed with sleep apnea and have been prescribed PAP therapy, you may be able to choose one machine among the many offered. A PAP, typically covered by insurance as a durable medical equipment benefit, is most often rented or purchased through a home health care company, also known as a durable medical equipment company. PAPs may also be purchased over the Internet. However, before buying a machine, it is generally a good idea to rent one first (on a rent-to-own plan if possible) for several weeks to make sure that the machine has all the features you need, and to determine if PAP is working as it should.

Talk to your doctor and your home care company representative about which machine is best for you and your lifestyle. Keep in mind the restrictions on cost and/or provider which your insurance company may impose. Some insurance companies will cover only certain types of PAP devices. In deciding which PAP machine to use, think about what features you want or need. Options include a carrying case, the ability to convert to foreign currents (automatically or with additional equipment), the capability 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. Bi-level devices with two different pressures–one for inhalation and a lower pressure for exhalation–are also available. In addition, the Food and Drug Administration has approved some auto-adjusting devices for the market; these machines are designed to sense varying pressure needs as you sleep and to change the pressure automatically as needed. The latest type of machine to receive FDA approval is equivalent to a PAP with continuous or constant pressure for inhalation, but it has flexible lower exhalation levels. The exhalation pressure is determined partly by the machine, which responds to the user’s exhalation patterns, and partly by the user, who selects one of three settings.

More sophisticated machines with higher costs are not always automatically covered by insurance but may be covered with a specific physician prescription and documented failure to respond to standard PAP treatment.

Some machines can monitor how often you use the PAP, while others can also record if you had any apneas while using the machine (this can indicate a need to adjust the pressure). Your doctor may want to download this data periodically to verify the adequacy of your treatment, and the compliance monitor can also be an important feature if you need an objective verification that you are obtaining sufficient amounts of sound sleep. For the data to be downloaded, you may have to take the machine in to the sleep center or home care company. If the data are imbedded in a small, thin card, you may be able to take or to mail the card to the sleep center or home care company. You may be able to send the data via a telephone modem (supplied with the machine) that does not require Internet access.

In addition to the machine, you will need a mask or some type of interface. The mask fit is also critical to you. Again, talk to your doctor and home care company representative about your choice of interfaces, and keep in mind that the mask may be manufactured by one company and the PAP by another. For more on this topic, read “Choosing a Mask.”  Participation in an A.W.A.K.E. support group for people with sleep apnea and their friends and family may also be helpful in adjusting to the PAP and mask. To learn if there is a group meeting in your area, contact the ASAA by calling 888-293-3650 or by sending an e-mail to asaa@sleepapnea.org.