Pulmonary hypertension (PH) can affect various aspects of your life, including your ability to get enough quality sleep each night. Around 20 percent of people who have sleep apnea, a sleep-related breathing disorder, also have PH, as reported in a review of past research. If you have PH and a condition like sleep apnea, you might benefit from using a continuous positive airway pressure (CPAP) machine to help you get the rest your mind and body vitally need.

Members of myPHteam have wondered about using CPAP machines. One member asked, “Anyone know or hear that using a CPAP machine helps pulmonary hypertension?”

Although there is a lot of evidence that CPAP machines can improve symptoms of sleep apnea, evidence is lacking for helping PH alone. When sleep apnea either causes PH or makes it worse, using a CPAP machine may help manage your PH symptoms.

What Is Sleep Apnea?

Sleep apnea is a common sleep condition that causes your breathing to stop and restart repeatedly while you sleep. A 2021 study found PH occurs in around 20 percent of people with sleep apnea, but others have reported a range between 17 percent and 70 percent.

There are two main types of sleep apnea — obstructive sleep apnea (OSA) and central sleep apnea. OSA is the most common type. In OSA, the muscles supporting the soft tissues at the back of your throat relax too much. This can cause your soft palate (the back of the roof of your mouth), tonsils, tongue, or uvula to block your airway.

Common risk factors for OSA include:

• Fat deposits around your upper airway
• Older age — Your risk of developing OSA increases with age, leveling off in your 60s and 70s.
• Sex — Men are two to three times as likely to have OSA as premenopausal women, according to Mayo Clinic.
• High blood pressure
• Diabetes
• Smoking
• Family history
• Chronic nasal congestion
• Asthma

In central sleep apnea, your airways aren’t blocked. Rather, your brain doesn’t properly signal the muscles that control your breathing. Common causes for central sleep apnea include congestive heart failure (CHF), stroke, or sleeping at high altitudes.

Complications of Sleep Apnea

When your brain and body sense that you’ve stopped breathing, you might suddenly wake up coughing or gasping for breath. You may or may not be aware of waking up. This process can repeat from five to 30-plus times per hour while you sleep, preventing you from getting a restful and restorative night’s sleep.

A lack of restful sleep can lead to a decreased quality of life by making you feel tired during the day. Additionally, sleep apnea is associated with a number of other health conditions, including pulmonary hypertension and pulmonary arterial hypertension (PAH).

Other potential complications associated with sleep apnea include:

• Cardiovascular diseases (heart disease), including heart failure, strokes, high blood pressure, heart attacks, and arrhythmias (abnormal heart rhythms)
• Eye diseases, such as glaucoma
• Surgery complications — Medications used to make you sleep during surgery can worsen OSA.

Sleep apnea may also be a cause of mild PH, may make existing PH from another cause worse, or may increase your risk of PH by causing heart disease.

How Can Sleep Apnea Cause PH?

Sleep apnea can cause PH by causing changes to blood vessels. During the time you stop breathing, your body doesn’t get enough oxygen. This is called intermittent hypoxia, meaning when you start breathing again, your oxygen level recovers.

While you aren’t breathing, your body also isn’t getting rid of carbon dioxide, causing it to build up — called hypercapnia.

Continual periods of hypoxia and hypercapnia over time can cause structural changes (remodeling) in the blood vessels of your lungs and heart, causing them to become more narrow.

The exact way that blood vessel remodeling happens isn’t yet known. Researchers think that chronic hypoxia may decrease levels of nitric oxide, which normally dilates (opens) blood vessels. Decreased nitric oxide levels may lead to narrower blood vessels.

There’s also evidence that OSA may decrease levels of an anti-inflammatory hormone called adiponectin, which may lead to more inflammation in the blood vessels.

When the blood vessels become narrower, your blood is squeezed into a smaller space. This increases the pressure on the walls of the blood vessels, causing increased pulmonary artery pressure.

How Can CPAP Treatment Help?

A CPAP machine is a noninvasive medical device that delivers a constant stream of air pressure to the airways to keep them open through the night. The machine uses a motor to take air from the room, filter it, then pressurize it according to your doctor’s prescription. The pressurized air is then delivered through a tube connected to a mask worn over your nose and/or mouth.

The constant airflow helps to keep the airways open by keeping your tongue, uvula, and soft palate from shifting into your airway, allowing you to get a full night of uninterrupted sleep.

Benefits of CPAP Machines for PH

Successful treatment with a CPAP machine can lead to the improvement of other health conditions, such as PH.

Two studies on people with OSA and PH found that pulmonary artery pressure measured by echocardiogram was significantly decreased after four months of CPAP therapy. However, more research is needed to find the benefit of CPAP treatment for people with PH. Many clinical trials on people with OSA will not include people with lung diseases like PH.

Using a CPAP machine to treat OSA has been associated with lower blood pressure, a decreased risk of heart attacks and strokes, and improved blood sugar management in people with diabetes.

A myPHteam member who uses a CPAP machine shared, “I view my CPAP as a preventative measure, not a cure. Sleep apnea can cause stress on the heart. Not using my CPAP is how I got PAH.”

Risks of CPAP Machines

CPAP machines are the preferred treatment for OSA, but studies show that only about 30 percent to 60 percent of people consistently use their prescribed treatment. Some people find CPAP machines difficult to use and uncomfortable. For most people, the discomfort goes away as they get used to their CPAP machine.

A myPHteam member shared, “I feel like I haven’t fully grasped exactly how to operate the CPAP machine.” Another member commented, “Definitely not liking this CPAP mask 😫. Going to take a while to get used to it.”

Other side effects of CPAP therapy include:

• Nasal congestion
• Dry mouth
• Nosebleeds
• Bloating
• Skin irritation around the mask

How Can You Get a CPAP Machine?

You need to get a prescription from a health care provider before you can buy a CPAP machine. You may need to participate in a sleep study to help diagnose sleep-disordered breathing before you get a prescription.

A sleep specialist or doctor has to prescribe the correct pressure setting for you, so you shouldn’t start using a CPAP machine without your doctor’s instructions. Many medical device companies will work with insurance to help cover the cost of a CPAP machine.

Talk to your doctor to find out if a CPAP machine can improve your quality of life with PH.

Talk With Others Who Understand

On myPHteam, the social network for people with PH and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with pulmonary hypertension and pulmonary arterial hypertension.

Have you used a CPAP machine? How has it affected your PH? Share your experience in the comments below, or start a conversation by posting on your Activities page.