[Mod Note] Prevention rather than Cure ? - Thread Closed

[Micheal.M]

Been on a CPAP machine for several years but I feel a bit trapped. When I can’t use my machine I have a horrible night and the next day is a blur.
 I’ve got a theory that my respiratory muscles aren’t working too hard at night and I’m over 60 and not exactly an athlete.
 So should I be doing more respiratory training during the day to offset the muscular ‘downtime’ at night ?
 And If I consistently worked on those muscles would I be able to get off cpap or is it a totally different thing ?

[upsman]

Obstructive apnea is when the muscles controlling the soft tissues of the palate and tongue relax and allow the airway to become blocked. 

You could definitely benefit from exercising your breathing muscles and diaphragm, but it's not likely to eliminate the need for PAP therapy. Sometimes losing weight helps sleep apnea if the loss occurs in the neck area, but again it's not likely to eliminate the need for treatment.

[Micheal.M]

Thanks UPSMAN, I want to build my breathing muscles back up so I’m not completely dependant on the machine. I’m not raging against the machine, just looking at reversing any muscle loss.

[Dog Slobber]

Many have suggested that improved upper airway muscle tone can help with OSA. To date I haven't seen this supported by any reliable studies. In fact the following linked study supports as much:

https://pubmed.ncbi.nlm.nih.gov/20563659/

Conclusions: There is no accepted scientific evidence that methods aiming to increase muscle tonus of the stomatognathic system are effective in reducing AHI to below five events per hour. Well-designed randomized controlled trials are needed to assess the efficacy of such methods.

Your post seems to suggest that using CPAP has resulted in lessa of a need to use one's respiratory muscles to breathe. And no, that's not the case. CPAP does not breathe for you and doesn't require less respiratory effort  because of the pressure. In fact I would argue that while pressure does help with inhalation, the pressure also requires more effort during expiration. Using CPAP adds to respiratory effort.

I doubt CPAP has caused any kind of measurable muscle loss. With millions of CPAPs users world wide any trend in muscle loss amongst CPAP user would be very noticable.

[clownbell]

Agree with Dog Slobber (what a screen name!!!). Most regular CPAP and APAP machines don't breathe "for" you. They provide air to splint your airway open so that "you" can breathe. There are a few advanced machines that will breathe for you by providing a puff of air when you don't breathe (central apnea) but those machines are in the definite minority.

And it is worth noting that CPAP machines "treat" you but don't "cure" you. Think of this analogy - if your vision needs correction, you get eyeglasses; wearing them doesn't mean you are "cured." Taking them off doesn't mean you are "cured." The vision defect is simply treated by the eyeglasses' the underlying condition didn't magically go away.

[Micheal.M]

I wasn’t interested in the upper airway, more about the muscles around the rib cage.
 I had a Central apnoea moment when I wasn’t using any muscles to breath while the machine piped air  into me. That lead me to consider that the body and brain will allow the CPAP machine to replace the effort usually involved with breathing, especially inspiration as exhaling is more of an elastic muscle contraction.
The air pressure of the machine would certainly take away some of the resistance involved with muscles  of inspiration and over a long time those muscles would degrade. If the internal lung pressure is higher than normal because of the machine, the muscles will have less work to do.  Possibly to a small degree, maybe much more. Unless you’re an athelete during the day of course.

 I lead a fairly regular life so if I’m getting little active/strenuous exercise during the day and even less with a machine at night, I’m not putting myself in the best position should I fall ill and need all of my body to function at a high degree.
That’s why I asked if I should be doing more respiratory training during the day to offset the muscular downtime at night.

[upsman]

You have to realize that PAP machines don't "pipe air" into your lungs. A very small amount of pressure is supplied to open your airway to remove the obstruction. YOU then breathe using your muscles as normal. During a central event, there is no CO2 trigger to tell your brain to breathe. This can be caused by many different things. 

If you were on some type of ventilator, I suppose your breathing muscles could get lazy, but CPAP or APAP therapy does not breathe for you. Everyone would benefit from strengthening their respiratory muscles, but the use of PAP therapy doesn't weaken these muscles.

[Dog Slobber]

If the internal lung pressure is higher than normal because of the machine, the muscles will have less work to do.  Possibly to a small degree, maybe much more. 

Then, when exhaling those same muscles will have *more* work to do.

[Micheal.M]

I apologise for saying CPAP ‘pipes air’. English isn’t my first language and sometimes I can be inelegant with English.
 I meant to explain that if a machine creates any pressurised air flow it would always be at a higher value than the ambient air pressure therefore your lungs wouldn’t need to work as hard to draw air in because the pressure from the machine is already higher than normal.
 If the pressure is adjusted to be slightly or substantially higher than normal then it’s clear the muscles of inspiration would do less work, slightly or substantially.
 Inspiration is the work phase of breathing, I’ve seen many people with Cheyenne-Stokes breathing, the effort is in the lifting and expanding of the rib cage against the body weight, composition, gravity and muscle condition.
 Exhaling is never a problem as the body weight, gravity and the muscle elasticity naturally contracts the thorax. 
With positive air pressure the brain wouldn’t recognise the need to exhale as the air supply is constant so the muscles wouldn’t necessarily engage fully or at all, leading to central apnea or failure to breathe independently.
 I apologise if my English is poor but I hope you can see the physiology of how it might be working.
Even if I’m incorrect, every discussion is worth thought to improve understanding.

[Gideon]

Do not confuse CSR with Periodic Breathing. ResMed calls ALL Periodic Breathing CSR. CSR and Complex Apnea or Treatment-Emergent Central Apnea look very similar the difference in appearance is that CSR last for considerably longer periods but the cause is typically Congestive Heart Failure (CHF). Both are the result of a CO2 imbalance in our system. With too little CO2 no signal to breathe is sent. CPAP in general causes us to breathe better, and with proper optimization nearly eliminates resistance from passage narrowing.

Following your logic, we would want to maximize flow limitations or resistance to strengthen our "breathing" muscles, in other words, make it harder to breathe and thus to lower our O2 SATs. I assure you that, in general, this is not a good direction.