Obstructive sleep apnoea and CPAP

What is obstructive sleep apnoea?

Obstructive sleep apnoea (OSA) is a condition that affects the airway and how we breathe. Usually, each time we breathe in, air passes through the nose, where it is filtered, warmed and moistened. It then travels down the upper airway to the lungs. The oxygen in the air is soaked up into the bloodstream in the lungs. It is then moved around the body.

When we are asleep, the muscles in the body naturally relax and become floppy. In some people this can make the upper airway fall in on itself, making breathing difficult. This can lead to more and more effort to breathe, which can narrow the airway further. At this stage, your body senses the airway problem and you wake up briefly.

This returns the airway to normal again, allowing you to breathe, and go back to sleep. This process of periods of struggling to breathe, followed by waking briefly, may happen many times during the night. Generally people do not remember this in the morning. This condition is called obstructive sleep apnoea (OSA).

What are the symptoms of obstructive sleep apnoea?

The first symptom most parents notice is snoring. Snoring is the sound made by the airway vibrating as it opens after it has partially collapsed. Parents may also notice children sleeping in unusual body positions that make it easier for them to breathe. Breathing problems can cause a lot of brief waking up throughout the night.

This interrupted sleep can make your child sleepy during the day. Younger children who suffer from sleep deprivation may actually be hyperactive or aggressive, whereas older children may feel tired. A child with sleep apnoea may:

• have difficulty concentrating
• behave differently
• wake up feeling tired and unhappy
• wake up with a headache
• not want breakfast
• have poor growth and weight gain

What causes obstructive sleep apnoea?

Sleep apnoea can happen for many reasons, both in adults and in children. In children, the most common causes are enlarged tonsils and adenoids, which can partially block the airway. Sleep apnoea affects the quality of sleep in both children and adults. It affects how your child feels during the day, but most importantly, it can be treated.

How common is it and who does it affect?

Obstructive sleep apnoea is common in both adults and children. People with some conditions may have a higher likelihood of obstructive sleep apnoea. These conditions include:

• obesity
• sickle cell disease
• Down’s syndrome

What treatments are available?

Your child’s doctor decided that continuous positive airway pressure (CPAP) is the best treatment.

Another option for treating sleep apnoea can be an ear, nose and throat (ENT) review. Your child may have an appointment with an ENT surgeon to see if there are any problems with the airway that can be corrected with an operation.

What happens with treatment?

If your child follows the treatment plan, there will be an improvement in the quality of their sleep. The benefits associated with this are:

• reduced tiredness during the day
• better school performance
• better growth and development

What is CPAP?

CPAP means continuous positive airway pressure’. It is a machine that gives continuous flow of air is given to your child via a mask. It helps your child’s airway and helps them breathe better at night. When used properly every night, your child’s sleep quality and daytime symptoms should improve.

What do I tell my child about CPAP?

Explain to your child that they are using their machine to help them to breathe at night so that they will feel better during the day. Your child must get into a routine of using their equipment all night, every night and be encouraged by those around them. Support from parents and carers is the most important part of making sure this treatment works. At first, CPAP can be frightening for children but hopefully they will have had a good experience in hospital and feel confident about using it at home.

Different methods may be needed for different age groups

• Babies will not understand what CPAP is, so you can put the mask on your child at bedtime.
• Infants will probably be more difficult and refuse to wear their mask or be frightened by it. If they are frightened when the pressure starts, you can help by letting them fall asleep with the mask on first and then start the pressure when they are asleep.
• CPAP can be explained to older children, and it is important that those around them are helpful and encouraging.
• Teenagers may become ‘fed up’ at times with their treatment. They may be embarrassed by having to use their equipment when staying over with friends. Depending on medical advice, your child may be allowed to have an occasional night off their treatment.

Making sure their mask fits well and stopping mouth leaks can resolve many issues.

What if the CPAP machine or supplies break or malfunction?

Most children will not suffer from one night without CPAP treatment; however, some children with rare conditions need CPAP every night. Your doctor will tell you if this is the case with your child.

If you notice something out of order during office hours, please contact us immediately. It is possible that the problem can be solved before bedtime.

If a problem happens outside of office hours, please call in the morning to tell us about the problem. We will help fix the machine or replace supplies as soon as possible. Telephone contact numbers are at the bottom of this page.

How do I look after the CPAP equipment?

CPAP machine

Please do not change the settings on the machine. A qualified member of the sleep team will make any necessary adjustments. Please bring the machine to be serviced when you come for future sleep studies. To clean the machine, wipe with a clean damp cloth and let air-dry.

Air filter

The air filter at the back of the machine should be replaced around every six months, and more often if needed.

Do not wash or recycle used air filters.

Dust filters (spaceship filters at front of machine) are usually changed monthly, or more frequently if needed.

CPAP mask, headgear and tubing

The mask and tubing should be disconnected and aired out daily.

They should also be washed regularly (once a week or more often if necessary). To do this you will need to take the mask apart. Separate the headgear parts, mask frame and soft cushion. Then fold over the Velcro ends on the headgear so that they do not become frayed. Hand-wash these in warm soapy water, making sure that the tubing is completely under the water. When finished, rinse all the parts well and allow to dry in the air, away from direct sunlight.

Follow-up appointments

Your child will need follow-up appointments and studies to see how treatment is progressing. When you come for a follow-up appointment and study, please bring all of your child’s equipment, including mask, machine, tubing, leads and so on, so that we can check and clean them. We will be able to decide whether any equipment needs replacing and also whether it is being used properly.