• Max Hirshkowitz and Amir Sharafkhaneh.
• Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA. maxh@bcm.tmc.edu
• Semin Respir Crit Care Med. 2005 Feb 1;26(1):68-79.

AbstractPositive airway pressure is standard therapy for patients with obstructive sleep apnea. It comes in three basic varieties: (1) continuous positive airway pressure (CPAP), (2) bilevel positive airway pressure (BPAP), and (3) autotitrating positive airway pressure (APAP). When properly titrated, positive airway pressure devices minimize the number of sleep-related breathing disorder events, often producing dramatic results. Sleep-related breathing may completely normalize, specific stages of sleep may selectively rebound due to having been chronically suppressed, sleep microstructure may improve, and the patient may awaken feeling refreshed for the first time in years. The specific indications and criteria for recommending APAP, BPAP, and CPAP therapy are reviewed. The titration process is presented in a step-by-step manner and titration grading is explained. Issues surrounding the interface, acceptance, utilization, and side-effects are discussed. Finally, we present an assortment of approaches for troubleshooting clinical problems commonly encountered among patients being treated with positive airway pressure therapy.

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