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CPAP - Medical Directive vs Sleep Apnea

Question #: 406

Question:

What is the difference between home CPAP for sleep apnea and CPAP we carry/our medical directive? Why can people with sleep apnea can use CPAP while sleeping (not sitting upright) and our medical directive doesn't allow (contraindication if patient cannot sleep upright)?

Answer:

The discussion surrounding sleep apnea indications and the ALS PCS indications has roots in acuity. Patients in respiratory distress do not tolerate lying down. Sitting up allows for more diaphragm movement, therefore improving compliance/ventilation/oxygenation, especially when in respiratory distress. Patients with sleep apnea are not in respiratory distress and therefore are not required to sit upright to facilitate optimum movement of the diaphragm. In addition, a GCS of three carries the risk of not being able to communicate complications (ie worsening s/s, possible pneumothroax etc).

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