CPAP vs. APAP

Automatic positive airway pressure systems deliver continuous air pressure to the nose or mouth to help people diagnosed with sleep apnea get extended periods of deep sleep. The air pressure is automatically adjusted to keep the throat from collapsing or closing, enabling a clean passageway for breathing and sleeping.

APAP machines measure breath-by-breath resistance, detect slight decreases in pressure and accommodate for them. As resistance changes, the computerized machine adjusts its pressure up or down, ensuring appropriate pressure throughout various sleep stages.

The ability of APAP machines to differentiate pressure make them more comfortable for people who need them. Automatic pressure adjustments ensure that users won’t wake up gasping for air or feeling out of breath.

Because APAP systems adjust automatically, they stay in tune with an individual’s day-to-day health, such as when you have the flu, are exhausted physically or have another condition that reduces or increases your respiratory rate.

While APAP machines automatically adjust pressure, continuous positive airway pressure machines deliver one steady pressure throughout a sleep period. Doctors can adjust a CPAP machine’s pressure settings, but the setting remains unchanged until the doctor adjusts it again. This can make CPAPs less comfortable — and potentially less effective — than APAPs over extended use.

APAP machines are well-suited to treat sleep disordered breathing, thus making them an ideal choice if the individual experiences multiple changes in breathing patterns during sleep. Conversely, people with an established pattern of continuous events may find a CPAP device to be more effective.

Neurologists, the physicians who usually diagnose sleep disorders, prescribe both APAP systems and CPAP systems to treat apnea. Both types of devices provide external pressurized air to make long, peaceful rest periods possible, but the flexibility with APAPs come with a price: APAPs cost a little bit more (about 20%) than CPAPs.

While doctors can prescribe either one — and both are readily available in the U.S. market — physicians more often set up their patients with CPAPs. Many insurance companies include CPAPs in their coverage plans but do not include APAPs. Some insurers may require you to use a CPAP first before they will approve coverage of an APAP.

More Data is Available for CPAPs

CPAP machines have proven well-tolerated and effective for most patients, while APAP machines are still relatively new. Scientists and sleep specialists have more available data about the effectiveness of CPAPs than they do of APAPs. So far, there isn’t a sufficient body of research comparing the two.

One study found that CPAP systems have a 56% success rate for people with non-severe obstructions and a 75% success rate for people who have severe obstructions. But because of APAP machines’ ability to adjust pressures when in use, people who are actively losing (or gaining) weight might find them preferable.

Ultimately, the effectiveness of APAPs and CPAPs depends on using a system best suited to treat the individual’s specific respiratory conditions, breathing patterns and desired comfort. While there are inherent side effects to both systems, both are reportedly effective at helping users achieve a better night’s rest.

How Much Do APAP Machines Cost?

Cost is always a consideration when it comes to medical care. APAP systems typically range from $400 to $1,000, while CPAP systems can range from $300 to $800.

Most medical insurance providers recognize the seriousness of sleep disorder and the benefits of CPAPs. Insurance coverage for the devices is grouped with regular healthcare coverage and is subject to the same annual deductible and out-of-pocket maximum coverages.

However, not many insurers cover APAP systems in the same way. Medicare covers CPAPs (typically at 80%) but that is not yet so for APAPs. Neurologists are hopeful this will change with more extensive record of APAP machines’ effectiveness and greater adoption.

Philips CPAP Recall

In June 2021, Philips Respironics recalled several million CPAP machines because of an incorporation of a PE-PUR sound abatement foam that degrades over time. Most of the recalled CPAP devices are in the DreamStation line manufactured between 2009 and 2021.

As foam within the CPAP degrades, it can release particles and toxic gases into the airstream, which are then inhaled or swallowed. This design defect is potentially linked to significant negative health outcomes, raising concerns about a possible CPAP cancer risk.

The U.S. Food and Drug Administration (FDA) identified this device problem as a Class I recall, the most serious type of recall, in July 2021 because of the potential for serious injury or death the use of one of the defective devices potentially posed.

The known health hazards inhalation or ingestion of Pe-PUR foam can cause resulted in multiple class-action lawsuits against Philips Respironics. Plaintiffs claim in court filings that the devices have caused significant personal injuries, wrongful deaths and other adverse health effects. Depending on the Philips CPAP lawsuit, plaintiffs are seeking compensation for personal injuries, wrongful death, as well as the cost of replacing their CPAP machine with a safer alternative.

According to a 2022 study evaluating 2,571 patient injuries associated with CPAP between 2014 and 2021, 4.62% of patients reported cancer development after use, the second most commonly documented issue. As of December 31, 2022, the FDA received more than 98,000 medical device reports of side effects linked to PE-PUR foam. There have also been reports of 346 related deaths.

APAP or CPAP? Individuals who require continuous pressure may choose a CPAP machine. Individuals whose breathing patterns change throughout the night may find APAP machines more comfortable and effective because of their ability to automatically adjust the pressure the machine applies.

CPAP machines have a proven track record of effectiveness, while APAP machines are relatively new and their full advantages and benefits are still under evaluation. Available data, however, indicates that both APAP and CPAP machines are effective at helping individuals achieve a better night’s rest. Both provide reliable respiratory support.

Because of their ability to adjust pressure settings mid-sleep, APAP systems are sometimes considered the better option for people who tend to toss and turn at night. People who move around while sleeping have periods when they need more air pressure. But not everyone may qualify for an APAP system. People who are diagnosed with chronic heart failure or obesity hypoventilation syndrome may not be considered for APAP therapy.

Consult with your physician to determine which system is right for you based on your overall health, your sleep patterns and the type of respiratory support you require throughout the night.