Normal person breathing through CPAP

[napstress]

Did you google what oxygen deprivation does to your body?

And that is exactly what sleep apnea is: it is a respiratory problem where a person doesn't breath during their sleep.

So when someone wonders if staying on CPAP and breathing the entire night to provide life giving oxygen to their body is worth it, I've got to wonder what they're thinking?

This is the thing: The contradictory wording in my sleep study and titration reports had me confused for most of these 3 months as to whether I actually even have apnea or not. Finally cornering my sleep doctor, I now know that I don't have sleep apnea; but I did have an average RDI of 45 events/hour during my sleep study. The lowest fall in oxygen saturation was 95%. During my titration my RDI was 27 and my oxygen saturation was 88%. From the looks of it, CPAP therapy didn't do a specatcular job of helping me breathe better (at least on that night), and it actually made my AHI go up and my oxygen saturation worse. Moreover, I feel worse on CPAP therapy than I did before starting it. The absence of both definitive numbers and the experience of feeling well-rested leaves me doubtful about my diagnosis and treatment.

I've learned here at this forum about UARS, something my doctor has never mentioned, but seems very likely to be what I have, and which does not cause the oxygen level to drop. I will ask her about it tomorrow at my appointment, and whether a lifetime of obstructions and arousals without the apneas could result in the same serious health issues as those of sleep apnea. Either way, CPAP therapy is the treatment for both conditions, but I wonder if there is the same degree of urgency. For you, ameriken, it's crystal clear that CPAP therapy is a lifesaver, and I'm glad it's working for you.

Also, the sleep doctor never went into the negative consequences of not treating whatever it is I do or do not have. I learned that here. I originally went to her because of chronic insomnia (which not only remains untreated but is actually worse), and have entered into this whole strange universe. So the alternatives do not look to me like CPAP therapy vs. stroke, heart disease, etc.; they look like the possible long-term side-effects I've been wondering about vs. possible stroke, heart disease, etc. (due to my not knowing what I have or the consequences of leaving it untreated). Both choices seem like "what ifs," not certainties, and they are about as equally appealing to me.

Nonsense, my dear, you're 5 levels on the arrogance scale below what's required to qualify as a troll.

>*Whew!*< Thanks, archangle! Thank you, also, for explaining why you choose CPAP therapy, in spite of the possible problems that have crossed your mind. The perspective helps.

[rested gal]

I have a PR System One REMstar BiPAP Auto with Bi-Flex on the way. I got tested for sleep apnea and did not get a diagnosis. Had an AHI of 2.1. Still have all of the horrible symptoms of sleep apnea so I bought a CPAP regardless. Maybe I could be your guinea pig for this...

I'm sorry, but we'll have to exclude you from our study of "normals". Normal people with an AHI of 2.1 don't order a bipap. j/k

Maybe "normal" people should, anyway...

"THE APNEA-HYPOPNEA INDEX: USEFUL OR USELESS?"
http://www.respiratoryreviews.com/sep02 ... Index.html

[SleepingUgly]

I have a PR System One REMstar BiPAP Auto with Bi-Flex on the way. I got tested for sleep apnea and did not get a diagnosis. Had an AHI of 2.1. Still have all of the horrible symptoms of sleep apnea so I bought a CPAP regardless. Maybe I could be your guinea pig for this...

I'm sorry, but we'll have to exclude you from our study of "normals". Normal people with an AHI of 2.1 don't order a bipap. j/k

Maybe "normal" people should, anyway...

"THE APNEA-HYPOPNEA INDEX: USEFUL OR USELESS?"
http://www.respiratoryreviews.com/sep02 ... Index.html

Saltyk9, I hope you know I was kidding. No one more than I knows that you can't trust sleep study results. There is so much variability in how they do it, how they score it, etc., that one lab's positive finding is another lab's negative finding. Good luck with the bipap!

[McSleepy]

[...]
Aerophagia, gas, and stomach problems are side effects with serious quality of life implications and have the potential to be implicated in a CPAPer's developing GERD or LPR, both of which are real medical conditions that cause real damage to the body. And the connections between GERD/LPR and aerophagia don't seem to be that well understood. There's an underlying assumption (here at least) that somehow pre-exisiting GERD/LPR causes or leaves one prone to aerophagia problems when you start xPAP, but as someone who NEVER had GERD type problems and who had no real chronic symptoms of LPR before starting xPAP, but who has had and continues to have real problems with aerophagia, I can't help but wonder if I'm going to develop GERD or LPR because the xPAP's pressurized air makes it harder for those sphincters of the esophagus to stay shut the way they are supposed to stay shut at night, all night long. And if it's possible that xPAP can lead to GERD or LPR, it would be nice to be made aware of that fact by the docs who prescribe the treatment. It may be that I've just had bad luck with sleep docs and their PAs, but in 10 months of seeing these folks and complaining of aerophagia, not a one of them has bothered to suggest that I get tested for GERD/LPR. No---that idea has come only from listening to others here at cpaptalk.com.

There are a lot of factors involved in GERD and one can have some of the underlying causes, making it difficult to predict whether a full-blown GERD will be developed/experienced or it will stay dormant and only exhibit partial symptoms. There really isn't a clear cut-off threshold between a person with GERD and one considered "healthy". After all, every person has sporadic reflux symptoms after that hearty meal. Some doctors say if you have symptoms "too often" (3-4 times a week?), then that makes it GERD, otherwise, you don't. You see how shaky that is.

One important reason for GERD is hiatal hernia - a condition that most adults have (again, in some degree). Unless the weakness/size of the opening of your diaphragm is too large, you are unlikely to experience GERD symptoms, but add 15cm H2O pressure to that and you can see how the condition can be exacerbated. Obviously, only your doctor can tell you what your situation is (after an endoscopy) but if you have, say, medium-grade hiatal hernia, you wouldn't normally experience a clearly defined GERD... until you added high pressure. Now, although I don't believe the pressure will actually make your hernia worse (i.e., stretch your diaphragm), but age will certainly do that, to the point where one day your GERD/LPR symptoms will climb over that threshold where you would be diagnosed with it.

Luckily, the treatment is very easy. The diaphragm cannot be easily repaired (complex surgery with variable success) but you wouldn't want to, considering how simple the alternatives are. They address the symptoms of GERD and they are not invasive. The simplest (and very effective) is: avoid acidic foods or drinks before bedtime and raise your bed at the head to cause some incline downwards to your feet. That's a safe "treatment" as it can get, yet might be all you need to alleviate your problem. I have it much worse - some years ago, I actually developed an ulcer and had to eventually get on proton pump blockers (over-the-counter Omeprazole), which is as safe as any medication you could be taking continuously, but you might not need to do that (at least for now).

In other words, this should not be a concern for you as the problem can be taken care of rather easily, if it develops. I hope this helped you feel better.
McSleepy

[McSleepy]

I think people who defend each side of the big issue of benefits/downsides of CPAP are... all correct. The truth is, life is the deadliest disease there is - no one has come alive out of it In other words, whatever you do, it has the potential to do harm. The difficult part is to weigh the pluses and minuses, for each particular case. The trouble is, sleep disorders are not well understood and there is vast incompetency among doctors who venture into that area. I am speaking strong words but frankly, since I was a child, I have always viewed doctors as some sort of super-humans who know what we need and can do what it takes to make us feel better. The truth is, sadly, they are humans just like us, some are competent, some are not. And the sleep field is one of the most complicated - the need has become quite clear lately and demand has risen, yet little good knowledge has been accumulated to give doctors the tools to address the troubles. It is sad that one has a better chance of getting quality help with OSA from an Internet forum than from a licensed physician.

It appears that most sleep disorders are caused by OSA and we know CPAP is very effective for that - when administered properly, which is, actually, a big consideration. Some disorders, though, are caused by other reasons and adding CPAP in such (possibly rare) cases might do harm because it would, on one hand, preclude identifying and applying the proper treatment, and, on the other, because of the side effects discussed earlier in this thread. Even in cases of clear OSA, prescribing the wrong machine/settings, instructing the patient poorly in how to use the equipment, etc., could make the treatment not only ineffective but actually detrimental. As a professional in a related area, I can also tell you that the equipment is not nearly as good as it could be. Part of it, I'm sure, is red tape, but a lot if it is a grave disconnect between the knowledge of the disease by the medical profession (and some lack thereof) and the technical side, which is charged with the development of the equipment, as well as the priorities of the latter. Some progress has been made in the last decade but starting from nothing makes that rather easy. We need much better attention paid to this issue as the prevalence of OSA is rather disconcerting. But as long as people are more concerned about how shiny their car is then their health, things are not going to be looking much brighter, I'm afraid.

McSleepy

[saltyk9]

I have a PR System One REMstar BiPAP Auto with Bi-Flex on the way. I got tested for sleep apnea and did not get a diagnosis. Had an AHI of 2.1. Still have all of the horrible symptoms of sleep apnea so I bought a CPAP regardless. Maybe I could be your guinea pig for this...

I'm sorry, but we'll have to exclude you from our study of "normals". Normal people with an AHI of 2.1 don't order a bipap. j/k

Maybe "normal" people should, anyway...

"THE APNEA-HYPOPNEA INDEX: USEFUL OR USELESS?"
http://www.respiratoryreviews.com/sep02 ... Index.html

Saltyk9, I hope you know I was kidding. No one more than I knows that you can't trust sleep study results. There is so much variability in how they do it, how they score it, etc., that one lab's positive finding is another lab's negative finding. Good luck with the bipap!

I knew you were kidding and I found it humorous My machine arrived last night...I just need to figure out which mask to buy now.

[rested gal]

I'm sorry, but we'll have to exclude you from our study of "normals". Normal people with an AHI of 2.1 don't order a bipap. j/k

I knew you were kidding and I found it humorous

I knew she was, too. And found it humorous.

My machine arrived last night...I just need to figure out which mask to buy now.

Cool! Yep, finding a mask that will actually let you sleep comfortably while using "cpap" is the most important piece of the puzzle to get in place right. A more important piece (in most cases) imho, than "which machine" to get.

I have a PR System One REMstar BiPAP Auto with Bi-Flex on the way.

You got yourself a good one, salty! Even though straight cpap treats me fine (and comfortably), I like the comfort of "bilevel" therapy.

Good luck, salty! Let us know how it goes, please.

[saltyk9]

Thank you for the support. I am going to look into getting the Swift FX nasal pillow mask.
Tough part now is finding a place to buy it without a prescription!

[archangle]

Thank you, also, for explaining why you choose CPAP therapy, in spite of the possible problems that have crossed your mind. The perspective helps.

I try to think of the downside of everything I choose to do. Driving a car can get you killed in a crash, costs you money, can get you carjacked, can make you not get enough exercise, etc. I choose to still drive a car, but I try to minimize the risks and other costs. It would be foolish to not consider or admit the risks.

[SleepingUgly]

saltyk9, I sent you a PM.

[napstress]

My sleep doctor said there is no downside to CPAP therapy when I asked her today about some specific concerns:

RE: becoming dependent: she said someone can only become psychologically, not physically, dependent on CPAP use.

RE: lung atrophy/weakening: no

RE: stretching of alveoli, lung tissue, esophagus, pharynx, etc.: they are elastic, so while they do stretch, they also go back to normal.

RE: pressure causing damage to eyes: not at all, though people who have just had cataract surgery must take care not to let air leak into their eyes.

RE: pressure causing damage to inner ears: possibly infection in Eustachian tube, if that has been a previous issue.

RE: vulnerability to infection: no

RE: polyps: no

She said that during the day we breathe in more air pressure just living our normal lives than we do through CPAP use. She went on to distinguish between regular breathing being negative air pressure and the CPAP being positive air pressure, but I didn't really understand it.

I was relieved and grateful to hear this information.

[archangle]

I remember when official medical and US government authorities said that cocaine was not physically addictive, only psychologically addictive. All your doctor knows is that the current official medical dogma is that there's no dependency involved. Ask her if there's a long term, peer reviewed, double blind study.

However, CPAP is so much safer than apnea, that it's worth the risks for apenacs. If you actually have apena, you're already "addicted" to CPAP in some sense. Maybe you become more addicted after long period of use. Long periods of non-use can leave an apneac dead.

Ditto for most of the other risks. There are serious, well documented risks of untreated apnea. Whatever risks there are to CPAP are very iffy. We should watch out for them, and try to reduce the risk, but keep CPAPing. For instance, if there's no risk of infection, why bother cleaning the hose or mask? I'm going to keep cleaning mine, even if someone tells me there's no risk of infection. I'm going to leave my pressure at the lowest pressure that gives me good treatment, even if someone tells me higher pressure won't do any harm.

[McSleepy]

I remember when official medical and US government authorities said that cocaine was not physically addictive, only psychologically addictive.

If I may, apparently, digress from the main topic a bit (although we already have taken this thread way off-topic, anyway). I don't know what the official stance described above actually was, but I'd be thrilled if it was what it seems to be, as that would mean giving a lot of credit to the authorities. Because, in one broader sense of the work "addiction", it is true that no drug is addictive and substance dependencies are indeed rooted in the individual human psychology.

In the narrow, purely physiological sense, addiction would be the development of tolerance to a substance (meaning its effect diminishes as it is taken more and more) and, the most evident symptom, withdrawal - which is what causes the compulsion to keep taking the drug, often at great costs. However, the truth is that even the substances that have the strongest physical dependence effects on the human physiology (e.g., heroine) still have limited addiction effects. In other words, after some period of time of non-use, the dependence disappears. For someone who has developed a heavy dependence, this process could be extremely difficult, but there are effective rehabilitation procedures that can help anyone through such an ordeal. It all depends on the desire of that individual. The problem is that whatever made that person start taking the drugs is certainly not going to compel them to give them up. That is the psychological reason for the serious, long-lasting drug addiction. To illustrate the point I'm trying to make, let's take a hypothetical situation: a healthy person, one without any psychological disorders that would normally lead them to drugs, is forced to take heroin long enough to become dependent. Maybe a journalist is captured in a rogue state and subjected to some mental restructuring by the use of chemical substances. This goes on for months and the physiological dependence becomes strong. Then, one day that person is rescued and returned to his home and family. Most certainly they would seek help, get treated and overcome the dependency soon enough. Looking back, you could say that the drug by itself could not cause an addiction - a short-term chemical dependence, yes, but certainly not a long-lasting, insurmountable addiction.

This has little applicability to CPAP treatment as I don't even see how it could be construed as some sort of a "getaway from reality"; it's really a treatment of a serious medical condition. I take Omeprazole for my GERD every day - am I addicted? I could stop anytime, but why would I? Am I addicted to eating? (well, maybe a little, you know what I mean ) Breathing? Ah, yeah - this is the thing, if CPAP helps us breathe vs not so much, then it's part of our normal existence. Having said that, we should absolutely strive to improve the available treatment options: offer more data to improve the general knowledge of OSA and its treatment by CPAP, put pressure on doctors to have better knowledge of it, and on equipment manufacturers to produce better quality products. And if one day someone comes up with a way of curing OSA, I am very confident we will figure a way to wean ourselves off of our CPAP machines!

McSleepy

[McSleepy]

She said that during the day we breathe in more air pressure just living our normal lives than we do through CPAP use. She went on to distinguish between regular breathing being negative air pressure and the CPAP being positive air pressure, but I didn't really understand it.

I'm not sure what she meant by saying "we breathe in more air pressure", if that is exactly what she said. I'm sure your doctor doesn't fully understand all those explanations she gave you, but she was probably trying to make a point on some widely accepted concepts, which should be all right. As to the specific statement I quoted above, what she probably meant is that when we breathe normally, we cause a negative pressure differential inside our lungs to cause air to enter them. That is, as we pull our diaphragm down and expand our rib cage, we enlarge the volume of our lungs (relative to the relaxed state), which causes the pressure inside to become lesser than the surrounding (atmospheric) pressure. If we pick the pressure inside the lungs as the reference and the atmospheric pressure as the target variable, then the differential would be negative. When we breathe using our CPAP, the external pressure is not the atmospheric pressure, it is higher by the amount the machine produces. The funny thing is that the pressure differential between your (reference) lungs and the air from the machine is still negative (it will only be positive when you're exhaling). The negative differential is what causes air to flow from the outside-in (inhalation). If the pressure is positive, you are exhaling. Thus, the difference when using CPAP is not in the sign of the differential pressure (it is always the same); in fact, we (at least the OSA sufferers) don't really care about anything else than the pressure at our larynx, relative to the body-tissue pressure (which depends a little on the atmospheric pressure) so it can keep our soft tissue from collapsing and blocking our airways. The only difference between the two scenarios is in the mass of air we could breathe in during a single inhalation, but our brains complex adjustment procedures vary that widely (by changing the intensity of the breathing), so it is very difficult to say if that has any effect on relevant factors such as our oxygen intake. A higher volume (actually, mass) of air entering our lungs due to the positive pressure, assuming we always open our lungs to the same volume (which couldn't be farther from the truth) would mean more oxygen available for consumption in our lings. That is akin to the concept of volumetric efficiency affected by forced induction in internal combustion engines (yeah, baby, us CPAP user are supercharged! ) but, I'm afraid, has zero relevance to the topic because of the wide adjustment abilities of our body.

Now, she might have been referring to the fact that without CPAP the pressure at the air inlet (our nostrils) and at our rib cage is the same without CPAP and higher at the inlet in the case of CPAP use, but a few cm H2O are not going to make any difference as far as that is concerned. That also reminds me to address the concerns about subjecting the internals of our lungs (e.g., alveolae) to a higher absolute pressure. First, the difference between sea-level pressures and, for example, where I live is 160 cm H2O (and I don't even live that high up) - that's enough to dwarf what any CPAP machine can do. Then, if you looked at the absolute pressure inside the lungs of a military diver at 50m underwater (pretty routine), you might be shocked to find it is over 6000 cm H2O! Of course, the external pressure (of the water) is nearly the same, thus preserving the habitual differential, but nonetheless, the tissues of your lungs are subjected to this enormous pressure, and they are taking it quite well.

So, I have no idea why your doctor brought up the fact that we process a higher volume of air off CPAP than on it, and that one is negative and the other - positive (in whatever aspect she had in mind). But she must have been trying to reassure you, one way or the other, which is not a bad thing.

McSleepy

[So Well]

Some excellent points have been made here to help quell the fear mongering.

She said that during the day we breathe in more air pressure just living our normal lives than we do through CPAP use.

That is so true and so easily overlooked. When I am running or doing pullups, barbell squats, deadlifts, etc., I am sure that pressures in my airways and lungs are a big multiple of the 10 cm CPAP pressure. Even for those who are relatively inactive bending over to pull on socks causes an increase in pressure much greater than that of CPAP.

I like your doc napstress!

I remember when official medical and US government authorities said that cocaine was not physically addictive, only psychologically addictive. All your doctor knows is that the current official medical dogma is that there's no dependency involved. Ask her if there's a long term, peer reviewed, double blind study.

Generally people do not know the difference between dependency and addiction. Plenty of good resources on the net and I suggest that you learn the difference.

Although I don't like the term "psychologically addictive", the officials you very loosely cite are correct that cocaine is not addictive.

The number of cocaine users in our country is likely hundreds of times higher than the number of cocaine addicts.

Just for the record, I don't use cocaine (or caffeine or soft drinks or hydrogenated oils or HFCS) and recommend against it.