Minimum CPAP hours and increased diabetes

[SleepyCPAP]

I stumbled across a NYT article from a few months ago. Perhaps it was discussed here before, but if so I missed that thread. After reading the Times I linked to the study abstract (I didn't register to get the full study though), and then I looked at the reply/comment to the study (see all links below).

What I take away from this is
*effective PAP treatment during REM sleep could mean the body is then less resistant to insulin, leading to better A1C.
*Taking off your mask in the middle of the night and ruining the final REM stage is not so good.

If the Chicago people take the critical response seriously and do a full study (with more real data to point to and less positing) we may have a shift in attitude where this leads to doctors wanting to see detailed data. (I like that).

--SleepyCPAP

well.blogs.nytimes.com/2014/02/21/sleep-apnea-may-worsen-diabetes/

"Most REM sleep occurs in the early morning hours before waking. But research shows that many patients remove their CPAP, or continuous positive airway pressure, mask in the middle of the night because it can feel uncomfortable, said Dr. Babak Mokhlesi, an author of the new study and the director of the sleep disorders center at the University of Chicago.
As a result, their apnea is more likely to go untreated during REM sleep, a time that may be particularly important for anyone with diabetes, Dr. Mokhlesi said."

http://care.diabetesjournals.org/content/37/3/e59.full
Association of Obstructive Sleep Apnea in Rapid Eye Movement Sleep With Reduced Glycemic Control in Type 2 Diabetes: Therapeutic Implications
by: Daniela Grimaldi1, Guglielmo Beccuti1, Carol Touma1, Eve Van Cauter, Babak Mokhlesi1

"Our model predicts that 4 h of continuous positive airway pressure (CPAP) use would leave 60% of REM sleep untreated… In contrast, 7 h of CPAP use would cover more than 85% of REM sleep and would be associated with a decrease in HbA1c by as much as 1%."
"CONCLUSIONS In type 2 diabetes, OSA during REM sleep may influence long-term glycemic control. The metabolic benefits of CPAP therapy may not be achieved"

http://care.diabetesjournals.org/content/37/3/e59.full
comment by Simone Scarlata and Raffaele Antonelli-Incalzi

"…In conclusion, we believe that the conclusions of Grimaldi et al. should be considered merely provisional and are worthy of confirmation in a real-life dimension."

[Goofproof]

Most studies are flawed, and not worth the paper they are written on, and debunked every five years or so. Jim

[kteague]

Another motivator to not cheat and get the last bit of sleep without the mask. I don't do that anyway, but I know some who do. Will mention this to them.

[purple]

My Primary Care Practitioner, who is a diabetic guru, because he can successfully help diabetes patients do better, (small town - we gossip about our docs) says my better A1C is because I am getting better sleep after change made to sleep treatment. So some thing the opposite is true. Better sleep, better A1C without eating less or exercising more.

[munkyBeatz]

For most OSA patients, the frequency of sleep apnea obstructions is elevated in REM sleep. Sleep apnea causes fluctuations with many systems, blood pressure and insulin being big ones for diabetics. So the previous the study mentioned in the OP, isn't a new topic per say; but it is one that the researchers need/want quantifiable data to support previous assertions. So ya, better sleep = better control of diabetes. What they're really trying to address with this study is the 'recommended' minimum time they suggest a patient wear their PAP. Currently, medicare says as long as a patient uses their equipment for 4hrs a night they are considered as compliant with therapy. This is the bare minimum that physicians want a patient to use their PAP when getting used to the therapy. They are using this study to try and increase the minimum recommendation to 7hrs, to show you get more out of 7hrs then you do out of 4hrs.