CPAP/BiPAP Desensitization and Management

Introduction to Desensitization Therapy

The American Academy of Sleep Medicine recommends performing mask refit, adjustment, or changing mask type whenever significant unintentional leak is observed or the patient complains of discomfort, and considering an oronasal mask or chin strap if mouth leak is causing significant symptoms 1
The American Academy of Sleep Medicine suggests decreasing pressure to a comfortable level that allows return to sleep if the patient complains that the pressure is too high, and considering pressure relief during EPAP (flexible PAP) to improve comfort if the patient has difficulty exhaling 2

The American Academy of Sleep Medicine recommends performing mask refit, adjustment, or changing mask type whenever significant unintentional leak is observed or the patient complains of discomfort, and considering an oronasal mask or chin strap if mouth leak is causing significant symptoms 1

The American Academy of Sleep Medicine suggests adjusting rise time (time duration for pressure change from EPAP to IPAP) for comfort, with shorter rise times (100-400 ms) for obstructive airway disease and longer rise times (300-600 ms) for restrictive disease 1
The American Academy of Sleep Medicine recommends decreasing pressure to a comfortable level that allows return to sleep if the patient complains that the pressure is too high, and considering pressure relief during EPAP (flexible PAP) to improve comfort if the patient has difficulty exhaling 2

The American Academy of Sleep Medicine suggests implementing a progressive desensitization approach, starting with minimal pressure settings (IPAP 8 cm H₂O, EPAP 4 cm H₂O) and gradually increasing duration of use during daytime 3

The American Journal of Respiratory and Critical Care Medicine recommends scheduling periodic reassessment as appropriate to the stage of disease, and performing regular skin assessments to prevent medical device-related pressure injuries 4
The American Academy of Sleep Medicine suggests monitoring for development of daytime hypoventilation, which may necessitate around-the-clock ventilation, and scheduling regular follow-up visits to adjust settings as the patient's condition changes 1
The American Academy of Sleep Medicine recommends beginning with minimum settings and gradually increasing; considering BiPAP if CPAP intolerance persists at 15 cm H₂O 2
The American Journal of Respiratory and Critical Care Medicine suggests adding heated humidification and considering nasal steroids for nasal/pharyngeal problems such as dryness, congestion, and irritation 4