Does CPAP usage make you dependent on or addicted to the therapy?

[G. Szabo]

I encountered an opinion saying that the CPAP, and especially the bilevel treatment, partially overtakes the functions of the muscles responsible for maintaining normal breathing. Hence, your breathing capability eventually decreases, and you will be more and more dependent on the therapy. 

Is there any merit to the above point? Should it be considered a side effect of therapy?

[Sleeprider]

If you're using a spontaneous triggered bilevel or CPAP, dependency is unlikely, however there are some individuals that will increase pressure support beyond their medical need, and that is a risk. We try to resolve upper airway flow limitation with tools like EPR and pressure support, but the levels needed to do that do not replace spontaneous respiratory effort. Instead, it replaces the abnormal effort needed to maintain airway flow and volume in a resistant airway. At a certain point, around 8-cm of pressure support (varies individually), the mechanical assistance starts to replace normal muscular effort needed, and we start to see abnormal tidal volume and respiratory abnormalities. These levels of pressure support rarely come from prescribed pressure, but from in individual seeking abnormally easy breathing effort. Certainly, anyone that has obstructive sleep apnea or upper airway resistance becomes dependent on their therapy for something resembling normal respiration without respiratory effort related arousals, hypopnea oxyegyn desaturation and obstructive cessation of breathing. If that is dependency, count me in, but the problem has been long before CPAP/BPAP therapy started.

[Jay51]

Good question, G. Szabo.  I can back up what Sleeprider has said by my personal experience using the Evo ventilator.  I have noticed no change to my daytime (awake) breathing from using the ventilator.  

Actually, I have noticed 3 positive things from using it and 1 negative.  Positives:  1.  I feel better on average and a bit more energy.  2.  Before I started using the ventilator, I would stop breathing before I fell asleep.  Using the vent for awhile now, my pattern has changed a little bit for the better in this area.  My brain has learned to breathe a little bit faster and deeper just before I fall asleep (it learned that it now has to do this in order to stay in sync with my ventilator).  3.  Surprisingly, the longer I have used the ventilator, the better each of my capnography (tests for hypoventilation) are each year.  

Negatives:  some aerophagia.  It is manageable though.  

One major thing that is overlooked in becoming "dependent" on pap, ventilator, etc. is the progression of a disease in the person during the same time period that is contributing to the decrease in respiratory output.  I noticed this when reading some studies on the subject.  What if the person's disease is the contributor to the decreased respiratory function and not the pap or ventilator?  This was not singled out in some studies.  What if the disease was 100% responsible?  

I just wanted to share my personal experience regarding this.

[volty]

I have read that opinion several times on specialist sites too. I am worried about it, especially by the claims that it can favour the onset of central sleep apnea - or at the very least to the weakening of the autonomous drive to breathe. That is the main reason I switched from my Resmed from ASVauto to CPAP at the lowest pressure level. Another thing I do is to remove my CPAP after about 5 hrs of sleep if I am awake at that moment. That way I can sleep another hour or two without the CPAP (but keeping my oximeter on, to see if there are any desaturation events).

The good news is that since I have learned to nose breathe 100% of the time, and especially during aerobic exercise - at both low and high intensity - these new habits seem to have helped improve my condition. Mouth taping might have also played a key role in this too. I am glad to feel that I am in control of my destiny here.

[brokensleep57]

I have never heard of this dependency in the way you describe.

I'm with sleeprider.  I'm dependent on my therapy so I don't suffocate all night.

I've heard of folks having issues with central apneas when first beginning CPAP therapy.  however, that usually resolves over time.

[SarcasticDave94]

...
I switched from my Resmed from ASVauto to CPAP at the lowest pressure level. Another thing I do is to remove my CPAP after about 5 hrs of sleep if I am awake at that moment. That way I can sleep another hour or two without the CPAP (but keeping my oximeter on, to see if there are any desaturation events).
...

Even the ASV will not promote dependence. ASV, yes V for ventilator, but not like life support. You mention treatment emergent Central Apnea as a concern, yet you could be using ASV in ASV or ASV Auto modes to prevent all Central Apnea. This change to CPAP mode will diminish your therapy intentionally. Then you further reduce therapy by sleeping for hours without it. I'll comment about this, you're not doing this correctly at all. These intentional diminishing actions will all hinder therapy, and I don't suggest following this idea for yourself or others reading this.

[therhile]

I encountered an opinion saying that the CPAP, and especially the bilevel treatment, partially overtakes the functions of the muscles responsible for maintaining normal breathing. Hence, your breathing capability eventually decreases, and you will be more and more dependent on the therapy. 

Is there any merit to the above point? Should it be considered a side effect of therapy?

I certainly can't sleep without my mask on anymore. Only been a few months too.

[BobinHI]

I can find no published literature that suggests CPAP causes some sort of respiratory dependence, or an increase in central apnea. I have used CPAP every night for 25 years and have no central apnea.

Without some link to a source for these claims, it is hard to evaluate them. But the general literature does not seem to support this as a recognized contraindication or complication. Here is a general overview from the National Library of Medicine. It mentions nothing of the sort. --

https://www.ncbi.nlm.nih.gov/books/NBK482178/

[ubersteiny]

Even the ASV will not promote dependence. ...

I have been curious on that. I'm just getting back into my ASV therapy after being off any machine for a few years. Since I believe my central apneas are "mild" I was worrying that I might be doing more harm than good using the ASV.

[SarcasticDave94]

I have used ASV for 2 years with great results until my COPD/Asthma increased and disturbed my breath sync with the ASV. I've been off unfortunately 4 years, but breathing wasn't hindered other than the disease itself.