Immediate Management of Central Sleep Apnea When CPAP Machine is Broken
For a patient with central sleep apnea whose CPAP machine is broken, immediate alternative interventions should be implemented, with priority given to obtaining a replacement CPAP device as soon as possible. 1
Emergency Alternatives to CPAP
Positional Therapy
- Use the bed wedge to maintain an elevated head position (30-45 degrees) to help reduce central apneas during sleep 1
- Though positional therapy is clearly inferior to CPAP and has poor long-term compliance, it can serve as a temporary measure 1
Oxygen Therapy
- Supplemental oxygen (2-4 liters per minute) can be considered as a temporary emergency measure to decrease the apnea-hypopnea index (AHI) 1, 2
- Oxygen therapy has been shown to reduce AHI from 49 to 29 events/hour in patients with central sleep apnea, though it does not address the underlying mechanism 1
Medication Considerations
- Avoid sedatives and alcohol as they can worsen central sleep apnea 1
- While benzodiazepines have been tried to reduce arousability, they should not be prescribed for long-term management of central sleep apnea 1
Urgent CPAP Replacement Strategy
Contact Options for Replacement
- Contact the equipment provider immediately for an emergency replacement CPAP machine 1
- If covered by insurance, contact the insurance company to expedite approval for a replacement device 1
- Consider rental options from medical supply companies while waiting for a permanent replacement 1
CPAP Settings for Central Sleep Apnea
- When the replacement CPAP is obtained, ensure it is set at the previously effective pressure 3, 4
- Higher CPAP pressures (often 9.0-16.5 cmH2O) may be needed for central sleep apnea compared to obstructive sleep apnea 4
Alternative PAP Therapies to Consider
Bi-level Positive Airway Pressure (BiPAP)
- If available, BiPAP with a backup rate can improve AHI to approximately 15 events per hour in central sleep apnea patients 5
- BiPAP in spontaneous-timed (ST) mode may be considered if CPAP is unavailable 6
Adaptive Servo-Ventilation (ASV)
- ASV is highly effective for central sleep apnea, dramatically improving AHI to approximately 5 events per hour 5
- However, ASV should be used with caution in patients with heart failure with reduced ejection fraction as it may increase mortality in this specific population 1
Follow-up Recommendations
- Schedule an urgent follow-up appointment with a sleep specialist to reassess therapy 1
- Once a replacement CPAP is obtained, monitor adherence and efficacy using the device's tracking system 1
- Evaluate for residual sleep-disordered breathing, hours of CPAP use, and mask leak with the new device 1
Pitfalls to Avoid
- Do not delay obtaining replacement therapy, as even one night without CPAP can result in return of symptoms and impairments 1
- Avoid using damaged equipment that may deliver inconsistent pressure or have electrical hazards 1
- Remember that partial use of appropriate therapy is better than no use at all 1
- Do not rely solely on the bed wedge as a long-term solution, as it is significantly less effective than CPAP therapy 1