Is there an end to CPAP therapy?

[robysue]

Is there an end to CPAP therapy?

It really depends on whether your OSA 100% caused by being overweight. If the weight problem is the only cause of the OSA, then losing the weight and keeping it off forever can cure OSA.

But if the problem is a structural problem with your upper airway, (a too long palate, an over large tongue, an exceptionally small airway, an over large uvula, etc.), then losing weight probably won't be enough to cure the OSA.

There are plenty of folks who have moderate-to-severe OSA who are and always have been in the normal weight range. (I'm 5'1" and weigh about 110 lbs and my diagnostic sleep test had an AHI = 23.something or other.) For those of us who are normal weight OSA sufferers, the problem is most likely caused by a structural problem in our upper airway. And there is some evidence that if you develop OSA while at normal weight, you are at a much higher risk of long term weight gain, along with having a higher chance for it to be very difficult to gain weight once you have gained it.

So if you are pretty sure that your OSA is 100% caused by a weight problem and you are successful at losing a large amount of weight and getting in shape, then it is worth having another CPAP-less sleep test to confirm whether your OSA is indeed cured by the weight loss.

[JLHighstreet]

CPAP therapy expires when you do.

Well, I thought that was funny...

[CPAPAmma]

At my most recent check-in with the sleep doctor, after 9 months of CPAP usage, he said I was doing well. My AHI is average 0.3 so obviously the machine is working. My energy levels are up and my blood work is much improved. He told me to work on losing weight and to check in with him in a year. He said at that check-up, he would probably tell me to just use the CPAP "as needed." REALLY? I love my CPAP and I "need" it to sleep and feel rested everyday! I experimented by taking a little nap without it the other day and my snoring kept waking me up! CPAP FOREVER for me!

[Sleepster]

He told me to work on losing weight and to check in with him in a year. He said at that check-up, he would probably tell me to just use the CPAP "as needed." 

I would write to him (most doctors have a portal where you do things like check test results, make and confirm appointments, and leave messages for your doctor) and ask why he said that.

Weight loss doesn't necessarily cure obstructive sleep apnea, and when it does there's no "as needed" usage as a cure means no usage.

I don't know if sleep apnea can be so borderline that there are some nights when CPAP therapy is needed and others when it isn't. I've never before even considered that as a possibility. But even if that were possible, how would one know in advance that the upcoming night is going to be one when it is needed?

I just can't imagine a scenario where CPAP therapy can be used on an "as needed" basis. You either need it all the time or you need it none of the time, as far as I know.

By the way, Amma, have you checked your leak rate graph to make sure all is well? That's often overlooked by both doctors and patients. Just because the leak statistics look good doesn't mean all is well. There can still be significant chunks of time when the leak rate is elevated enough to cause problems. But if you feel well rested it's likely that it's not.

[CPAPAmma]

He told me to work on losing weight and to check in with him in a year. He said at that check-up, he would probably tell me to just use the CPAP "as needed." 

I would write to him (most doctors have a portal where you do things like check test results, make and confirm appointments, and leave messages for your doctor) and ask why he said that.

Weight loss doesn't necessarily cure obstructive sleep apnea, and when it does there's no "as needed" usage as a cure means no usage.

I don't know if sleep apnea can be so borderline that there are some nights when CPAP therapy is needed and others when it isn't. I've never before even considered that as a possibility. But even if that were possible, how would one know in advance that the upcoming night is going to be one when it is needed?

I just can't imagine a scenario where CPAP therapy can be used on an "as needed" basis. You either need it all the time or you need it none of the time, as far as I know.

By the way, Amma, have you checked your leak rate graph to make sure all is well? That's often overlooked by both doctors and patients. Just because the leak statistics look good doesn't mean all is well. There can still be significant chunks of time when the leak rate is elevated enough to cause problems. But if you feel well rested it's likely that it's not.

Sleepster,
You sound as puzzled by my doctor's words as I was! How will I know in advance that I could have apnea during my upcoming sleep? 

Thanks for mentioning the leak rate though. I initially had some leakage, but once I switched to the correct sized nasal pillows, that leak rate has dropped to 0.00 (median leak rate) and the 95% is under 1.0. I give no credit to the DME who sent me on my way with 2 small size pillows, taking the extra small and the medium from the kit because "you won't need them." I wish I had been on the Apnea Board before that encounter. It would have ended differently.

[lab rat]

The stupidest Sleep Apnea remark a GP ever said to me was a year after I started therapy and had a cold (which of course blocks your nose and makes using a machine impossible) which I thoght perhaps he could do something about.

He said


sleep apnea doesn't exist.



Back then a patient had to sign a piece of paper after the visit to authorise Medicare to pay a GP for the consultation. I was so angry when he slid it across the desk at me that I stood up to leave and tore it up into tiny pieces saying something to the effect "how are you allowed to practice?"