long-term home therapy. The commercial availability of a suitable system from Respironics in the United States was in 1985. This allowed many groups to begin using nasal CPAP and undoubtedly had a major impact in the development of sleep clinics and laboratories. A second key advance was the invention of the self-sealing mask (the “bubble mask”) in 1990 that greatly enhances a patient’s comfort and use. There have been many other developments including the introduction of BiLevel CPAP, autosetting CPAP systems and numerous nasal pillows that have greatly added to the area.
Nasal CPAP use is now so common that I have to make myself go back to the beginning to answer this question. At the time of the first experiment, nasal CPAP as a treatment looked like a useful rescue therapy to give us time to find a surgical cure. So, yes I must say that I am indeed surprised that nasal CPAP is now the front-line therapy for sleep apnea. I recall that in the early days,patients would use the treatment as it had such a dramatic effect on their daytime function – their personal feedback was the key to CPAP’s continuing acceptance. We now know sleep apnea can cause all of the common vascular diseases, so we are asking people with less severe symptoms to use CPAP to prevent having a heart attack or stroke. However, the comfort of the systems has improved. I often ask my patients to think of CPAP like reading glasses. They are a nuisance but you can’t do without them. Unlike other therapies, they don’t have to worry about drug side effects.
I think we will be more effective at prevention. Many of us think that children who snore are the group in whom adult sleep apnea will develop, and that appropriate orthodontic treatment to promote the growth of a larger upper airway will play an important role in prevention. However, I am sure that nasal CPAP will remain a front-line