Sleep Care

History of CPAP

Charles Dickens First to Recognize OSA

Many people may not realize it but author Charles Dickens played an instrumental role in defining what is now known today as Obstructive Sleep Apnea (OSA). In fact, in Dickens’ 1836 novel The Pickwick Papers there is a character called Joe, who is a “fat boy” who eats a lot and falls asleep in almost any situation. It is Dickens’ description of Joe’s sleep disorder that caught the eye of future doctors and researchers.

In 1918, Sir William Olser coined the term “Pickwickian” to describe patients who were not only obese but were sleepy all the time, sometimes napping involuntarily. And, in 1956, Dr. C.S. Burwell was treating patients who had congestive heart failure, extreme sleepiness or fatigue and improper airflow to the lungs. He began labeling these symptoms in patients as having Pickwickian Syndrome.

Originally, it was thought that the sleepiness was a combination of excess weight and abnormally high levels of carbon dioxide in the blood. Then, in 1965 a group of French and German doctors lead by Dr. Henri Gastaut started doing research on patients with Pickwickian Syndrome. They recorded breathing and sleeping patterns and discovered distinctively unique patterns of apneas.

Their research, along with future studies, eventually demonstrated that Pickwikian Syndrome is actually a breathing disorder caused by the position of the tongue and the tissues in the throat. As more information became available about the condition, Pickwickian Syndrome was later renamed Obstructive Sleep Apnea (OSA). They used the word apnea, which is a Greek word for breathless.

Doctors recognized that breathing was so difficult during sleep for patients with OSA that it could lead to death

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in some patients. At first, they weren’t sure how to treat the life-threatening aspects of OSA. But by 1969, doctors were treating severe cases of OSA with a tracheotomy to prevent people from dying while trying to sleep,.

This surgery allowed air to bypass the upper air passage altogether by creating an incision or opening in the trachea or windpipe and inserting a breathing tube. This practice continued for more than a decade. It wasn’t until 1981 that a less-invasive procedure became available for treating OSA.

An Australian researcher, Dr. Colin Sullivan, developed the first CPAP (Continuous Positive Airway Pressure) machine. This invention was a landmark development in the treatment of sleep apnea.

The original machine contained a reversed vacuum cleaner motor that blew air into the affected person’s nasal passage using tubing to keep the airway open. Although the first CPAP machines were big, bulky and loud, by the late 1980s many improvements had been made to the machine and masks. It wasn’t long until the CPAP became the preferred treatment method for people with OSA.

Since then, there have been steady technological improvements in the CPAP machine. For instance, the machines have become much smaller and quieter. And, the masks and straps are far more comfortable than the original machines. Additional features have been added to CPAP such as humidification to keep the airway from drying out, and self-adjusting air pressure levels that keeps pressures low early on to allow users to fall asleep and then adjust to the prescribed level during deep

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sleep. BPAP is a model of PAP therapy that uses two different pressure settings, a higher pressure for inhalation and a lower pressure for exhalation.

Today, the nasal CPAP is the “gold standard” for treating OSA. But to be effective, research shows the CPAP must be used every night for at least 4.5 hours on a routine basis. And yet one study showed that 50 percent of patients quit using the CPAP within the first year. Meanwhile another study found that patients only wear their masks about 40 percent of the time.

While the reasons vary from person to person, most people still complain about inconvenience and discomfort. But finding a mask that fits properly can solve these problems. In the years that CPAP has become readily available numerous manufacturers and products has sprung up to accommodate different preferences, as well as CPAP care products such as mask gels and CPAP cleaners. It’s also a good idea for married couples to find a machine with an acceptable noise level.

If you are having issues with your CPAP machine contact your doctor. It is better to resolve the issues and use the machine than it is to stop using it altogether. After all, your life could depend on it.