Muscles of exhalation compromised with CPAP

[lovehatemyCPAP]

I am writing this post to see if anyone has any feedback or is having the same experience with general breathing as I am.

I have been using my CPAP for 2 years consistently now. I am a 39 yr old relatively athletic male dentist. I have not fully accepted that I will be using CPAP for the rest of my life so I am always looking for the reasons why I have it (I have a few theories) and any possible ways to fix it naturally. Using the mask does help me feel and sleep better with room for improvement.

I notice that my breathing during the day is not great. I take shorter breaths or forget to breathe all together. It seems that I do not exhale fully and to empty my lungs I have to consciously contract my diaphragm. I theorize that the CPAP could be detrimental to our overall breathing. Due to the constant pressure emitted by the CPAP, inhalation is never an issue. However, as we have to push/exhale against the pressure of the CPAP we are giving a shortened exhalation thus not utilizing are expiratory muscles and weakening them. After this short exhalation we switch over to a larger inhalation which is again easy due to the outward pressure of the CPAP. Thus with weakened muscles of exhalation our overall breathing will be negatively affected during the day as well.

Opinions.. Thoughts?

[Julie]

Yes - which model of what machine do you use? And what mask? Pressure settings? Depending on the first question, you likely have a feature that can lower the exhale pressure on your machine - needing to use it is fairly common. It may raise your AHI by a small amount, but if the relief works, then the difference will be worth it... and you set the level of relief.

We need more info though to help, so come back to this thread with it.

[Pugsy]

Thus with weakened muscles of exhalation our overall breathing will be negatively affected during the day as well.

Might be true if you were on a ventilator 24/7 for 7 days a week for the last 2 years you have been using cpap.
It is not true for cpap use just during the night for 6 to 8 hours.

You need to find another reason for what you feel are breathing irregularities during the day.
I strongly urge you to see a pulmologist or lung specialist doctor to ease your mind or figure out what is going on.

Using cpap at night doesn't weaken your lungs or chest wall muscles. It has been discussed often here. It will NOT affect your daytime breathing.

[Dog Slobber]

Rule of thumb with most muscles is by giving them a little extra work, they get stronger, not weaker.

If your theory had any merit, then millions of CPAP users would have compromised exhalation muscles. We don't.

[chunkyfrog]

Rule of thumb with most muscles is by giving them a little extra work, they get stronger, not weaker.

If your theory had any merit, then millions of CPAP users would have compromised exhalation muscles. We don't.

+ a million!
The OP's username says it all . . .
Only one post, too.
Physical fitness does not guarantee health.
My uncle died at 40--doing a treadmill stress test.
[I would never use HIS doctor.]

[ChicagoGranny]

My uncle died at 40--doing a treadmill stress test.

A doctor once told me that he didn't use treadmill tests because the only time they revealed anything useful was when the patient had a heart attack on the treadmill.

I once knew a guy who had a heart attack doing a treadmill test. The doctor kept him alive, he was transported to a hospital and was saved.

[Julie]

What I remember most about the stress (t-mill) test I had 15 yrs ago was that my hands hurt from holding the grab bar for the time... early arthritis, no respiratory/cardiac trouble.

[lovehatemyCPAP]

Yes - which model of what machine do you use? And what mask? Pressure settings? Depending on the first question, you likely have a feature that can lower the exhale pressure on your machine - needing to use it is fairly common. It may raise your AHI by a small amount, but if the relief works, then the difference will be worth it... and you set the level of relief.

We need more info though to help, so come back to this thread with it.

Hi Julie - thank you for the response. I have a ResMed - AirSense 10 Autoset. I just updated my profile to include it. I have not been back to the ENT for a while but last I went I believe they set minimum pressure to 8. I am having issues finding that info on the menu options. I was trying to adjust the minimum and maximum and could not find that either. How do I lower the exhale pressure? I didn't know you could do that with CPAP. Would a BiPAP be better for me since I have this issue with making full and complete exhalations?

States from last nights use are: Pressure: 9.4 AHI: 1 Events per hour: 1.4
Other settings:
Ramp time off, Humidity level 4, nasal pillows, Pressure relief on.

Thank you!

[LSAT]

Yes - which model of what machine do you use? And what mask? Pressure settings? Depending on the first question, you likely have a feature that can lower the exhale pressure on your machine - needing to use it is fairly common. It may raise your AHI by a small amount, but if the relief works, then the difference will be worth it... and you set the level of relief.

We need more info though to help, so come back to this thread with it.

Hi Julie - thank you for the response. I have a ResMed - AirSense 10 Autoset. I just updated my profile to include it. I have not been back to the ENT for a while but last I went I believe they set minimum pressure to 8. I am having issues finding that info on the menu options. I was trying to adjust the minimum and maximum and could not find that either. How do I lower the exhale pressure? I didn't know you could do that with CPAP. Would a BiPAP be better for me since I have this issue with making full and complete exhalations?

States from last nights use are: Pressure: 9.4 AHI: 1 Events per hour: 1.4
Other settings:
Ramp time off, Humidity level 4, nasal pillows, Pressure relief on.

Thank you!

When you turn on your machine, your pressure setting is on the screen

[lovehatemyCPAP]

Rule of thumb with most muscles is by giving them a little extra work, they get stronger, not weaker.

If your theory had any merit, then millions of CPAP users would have compromised exhalation muscles. We don't.

Yes that is true about muscles. I am not sure if my theory has merit which is why I posted. My intent was to get feedback regarding other people's experience and if they have thought about this topic before or if they have noticed the same. How do you know that millions of CPAP users don't have compromised muscles of exhalation? Have you asked this question before or have you seen any research studies?

Again I could be wrong but this is my theory and it makes sense to me. You are obviously welcome to argue against it.
If your CPAP air is pushing against your exhalation air while you are unconscious/sleeping and if the force of your CPAP is a greater force than your normal force of exhalation than the CPAP will win that battle. It takes conscious action to work out muscles. While you are sleeping because you are unconscious your force of exhalation is at the mercy of your CPAP pressure.

[Miss Emerita]

To enter the clinician's menu, press and hold the round knob and the home button simultaneously for several seconds. In the clinical menu, you can view and change your minimum and maximum pressures and change your EPR (expiratory pressure relief), if you don't find EPR on your main menu.

EPR drops the pressure by 1, 2, or 3 cm H2O when you exhale. To be sure you don't increase the numbers of obstructive events you have, you should increase your minimum setting by 1, 2, or 3 to compensate.

Of course, see your physician if you're concerned, but please be aware that (a) daytime exhalation is normally passive and does not involved muscular exertion and (b) normal daytime exhalation is incomplete, i.e., leaves an unexhaled residual volume in the lungs. In addition, daytime respiration is less regular that night-time respiration. We hold our breath when we're concentrating on something or exerting ourselves physically, and we sigh from time to time.

Using CPAP does mean a little bit of exertion on exhalation, and occasionally this give people some sore chest muscles at first as their muscles strengthen. I know of no reason to think this shortens the period of exhalation, or to think that CPAP weakens chest muscles.

[lovehatemyCPAP]

Rule of thumb with most muscles is by giving them a little extra work, they get stronger, not weaker.

If your theory had any merit, then millions of CPAP users would have compromised exhalation muscles. We don't.

+ a million!
The OP's username says it all . . .
Only one post, too.
Physical fitness does not guarantee health.
My uncle died at 40--doing a treadmill stress test.
[I would never use HIS doctor.]

Yes only one post. Remember when you only had one post? What is your point?

My username says it all? Yes I love my cpap because it helps me but I don't love that I have to depend on it for the rest of my life. I would venture to say that a large portion of people would agree. What is your point?

[chunkyfrog]

A dentist is not necessarily an MD, and certainly not a pulmonologist.
Accept the fact that you need help from another profession.
The internet does not know everything--and freedom of speech is no guarantee of veracity.

[Julie]

I think the point made re 'one' post was because we've had lots of trolls lately who post goofy things and then never return. Yours wasn't goofy, but we're all ready - too much maybe - to call people trolls if they don't come back soon to see responses.

[lovehatemyCPAP]

To enter the clinician's menu, press and hold the round knob and the home button simultaneously for several seconds. In the clinical menu, you can view and change your minimum and maximum pressures and change your EPR (expiratory pressure relief), if you don't find EPR on your main menu.

EPR drops the pressure by 1, 2, or 3 cm H2O when you exhale. To be sure you don't increase the numbers of obstructive events you have, you should increase your minimum setting by 1, 2, or 3 to compensate.

Of course, see your physician if you're concerned, but please be aware that (a) daytime exhalation is normally passive and does not involved muscular exertion and (b) normal daytime exhalation is incomplete, i.e., leaves an unexhaled residual volume in the lungs. In addition, daytime respiration is less regular that night-time respiration. We hold our breath when we're concentrating on something or exerting ourselves physically, and we sigh from time to time.

Using CPAP does mean a little bit of exertion on exhalation, and occasionally this give people some sore chest muscles at first as their muscles strengthen. I know of no reason to think this shortens the period of exhalation, or to think that CPAP weakens chest muscles.

Thank you for that! I guess I shouldn't be touching these settings myself? Although I did read another post stating that they got more help with their CPAP from these forums than they did from their own doctor. Do you adjust yours?