improvements in treatment with improvements of machines

[space45]

has the machines evolution and improvements made a real improvement in treatments, would like to hear from the ones that went through the development changes of the machine and how that impacted them

also the same with mask tech, how has it change over the years, has the improvements been large or mostly unchanged?

wow, short and sweet, did not know I had it in me

[TheDuke]

I first began apnea treatment about 28 years ago, in the real infancy of CPAP treatment. Since then I have had a total of four machines, and though I enjoy having the present generation readout data I do not feel that the actual treatment experience has improved a bit.

My first "Healthdyne" machine didn't even have an hours use meter, the pressure was selected by a little screwdriver turn pointer and there were absolutely no electronics to it. In that era, there were no machine humidifiers, no heated hoses, no BiPAP, APAP, etc. The machine was reasonably quiet and neat, AND importantly it really did help my condition. I will comment that the mask choice has genuinely improved-I had a bad time with masks for a long time ( blisters, discomfort, strap lines, etc. But I have been using the Red-Med Mirage Activa masks for over 8 years now and am quite comfortable with this design. I have found the heated, machine integrated vaporizer is a big plus as regards comfort, but I do think that a lot of the present refinements to even humidification represent overkill.

I am very glad we have XPAP treatment, and I certainly appreciate my very first sleep medicine doctor who quickly diagnosed and treated a very serious condition. I am a retired physicist-worked 42 years in the nuclear industry and am accustomed to instrumentation. Maybe I have veered toward becoming a bit of a Luddite, But from my personal perspective, I would quite readily go back to my first Healthdyne manual set CPAP and be glad to have the relief it afforded me so long ago.

[SuddenlyWornOut45]

No, I do not see much if any improvement in the technology of sleep disordered breathing. In fact, I liked the older CPAP and APAP technology, better. It worked better. The stuff they come out with now is designed to improve compliance, not improve effectiveness of the actual treatment. As an example, with the older machines if you had an APAP or autoBipap and set the thing "wide open" and slept with it that way, it would give you a TRUE AHI the following morning...normally awful.

the modern machines are DESIGNED to give you an under 4 AHI just about no matter what you do. No matter how the machines are set up, the AHI will be under 4. This is a scam. Also, another thing Ive observed is the newer machines are poorly calibrated. Ive got two machines that are "off" by at least .5 centimeters of water pressure. My original APAP was pretty close to being dead on accurate as far as calibration.

The masks keep getting flimsier and flimsier.

So to answer your question, no I think the improvements in treatment with "improvements" in the machines is not happening. If anything its going backwards to water things down so more people can tolerate CPAP and be compliant, that way they sell more machines even if the machines are less effective.

Eric

[Todzo]

As I read the research years ago I noted that pure CPAP had consistently the fewest arousals during use. Since I believe that indicates the best quality sleep I decided to do what I needed to do to continue with CPAP.

Well, learn to walk a lot (82% of 10,000 steps a day over all last month), do some strength training. Work with a personal trainer. Work with a dietitian. Learn to live in a way that better facilitates metabolism.

And so drop CPAP pressure in half. And continue to loose 10-12 pounds a year.

But I have been on CPAP for over ten years now. New machine had data, that is good.

However part of metabolistic health for me is re-learning to breath eucapnicly. I do believe this is best if guided by pulse oximetry. The process tends to increase CO2 reserve since the cells are in general more “fed” (i.e. do not need oxygen since they are already “full”). One thing that changes is the length of a long pause in breathing. To put it simply ten seconds of breathing pause is not a long time for me and results in no noticeable air hunger.

But the modern CPAP with data machine wants to send you a “clear airway sensing / pacing” pulse after only about seven seconds. I believe this results in many unnecessary arousals and awakenings for me.

Adding some compressible air space made me aware of how much the pressure tends to spike upon exhale, which is not a natural feel and seems to be fought by many. I now much prefer the much more natural feel that a bit of compressible airspace adds as well as the less noise and vibration it facilitates.

I find myself pursuing pure CPAP with even more passion than when I was reading about the arousal numbers. I think that the “play with the pressure to make things better” road is one that will prove less effective in the long run. But of course as it is right now not so many make it to the one year mark and there are plenty who think that they want to try the silly machines.

[SuddenlyWornOut45]

You sound like "I went insane and became a doctor."


Eric

As I read the research years ago I noted that pure CPAP had consistently the fewest arousals during use. Since I believe that indicates the best quality sleep I decided to do what I needed to do to continue with CPAP.

Well, learn to walk a lot (82% of 10,000 steps a day over all last month), do some strength training. Work with a personal trainer. Work with a dietitian. Learn to live in a way that better facilitates metabolism.

And so drop CPAP pressure in half. And continue to loose 10-12 pounds a year.

But I have been on CPAP for over ten years now. New machine had data, that is good.

However part of metabolistic health for me is re-learning to breath eucapnicly. I do believe this is best if guided by pulse oximetry. The process tends to increase CO2 reserve since the cells are in general more “fed” (i.e. do not need oxygen since they are already “full”). One thing that changes is the length of a long pause in breathing. To put it simply ten seconds of breathing pause is not a long time for me and results in no noticeable air hunger.

But the modern CPAP with data machine wants to send you a “clear airway sensing / pacing” pulse after only about seven seconds. I believe this results in many unnecessary arousals and awakenings for me.

Adding some compressible air space made me aware of how much the pressure tends to spike upon exhale, which is not a natural feel and seems to be fought by many. I now much prefer the much more natural feel that a bit of compressible airspace adds as well as the less noise and vibration it facilitates.

I find myself pursuing pure CPAP with even more passion than when I was reading about the arousal numbers. I think that the “play with the pressure to make things better” road is one that will prove less effective in the long run. But of course as it is right now not so many make it to the one year mark and there are plenty who think that they want to try the silly machines.

[70sSanO]

I'm a relative newcomer as I have only been on CPAP for 13 years. I think there has been a tremendous improvement in equipment. Mind you I have only had a S6 and a S9.

The S6 was a big, heavy, loud wind tunnel. I will say that it will probably outlast anything on the market today, but so will a 35 year old Kenmore.

The other area of even more improvement are the masks, especially FFM. it used to be here is choice A that will leak around your mouth or choice B that will leak around your nose. Masks are so much better now.

But the biggest improvement is the data. Being able to actually monitor what is going on is the key to being able to make necessary adjustments to getting the best therapy. I can't imagine ever going back.

John

[robysue]

the modern machines are DESIGNED to give you an under 4 AHI just about no matter what you do. No matter how the machines are set up, the AHI will be under 4. This is a scam.

There are plenty of folks here posting data with AHI >> 4 and asking questions about what the heck is wrong.

Also, another thing Ive observed is the newer machines are poorly calibrated. Ive got two machines that are "off" by at least .5 centimeters of water pressure. My original APAP was pretty close to being dead on accurate as far as calibration.

I have no idea what the specs on the older machines were. But on page 29 of the S9 AutoSet Clinical Guide there is this chart about Pressure Accuracy:



Interestingly enough, the pressure accuracy depends on the breaths per minute as well as the pressure used and whether the humidifier is being used. But at any rate: If your S9 machines are verifiably off by "at least .5 cm," then it's worth taking them back to the DME and asking for a warranty return if they're still under warranty. If they aren't, it may be worth asking what you can do since the machine's don't meet the advertised accuracy.

The masks keep getting flimsier and flimsier.

A lot of this is really driven by COMFORT. PAPers by an large are voting with their noses and choosing to use masks that are both lighter and smaller. It's not a big surprise that they also are flimsier than the older, much heavier and much more difficult to get used to masks.

So to answer your question, no I think the improvements in treatment with "improvements" in the machines is not happening. If anything its going backwards to water things down so more people can tolerate CPAP and be compliant, that way they sell more machines even if the machines are less effective.

Getting more people to use and tolerate CPAP is the name of the game. If a machine is fantastic at controlling OSA, but large numbers of people simply cannot or will not use it, then that machine is of no use to them.

And that's actually where space45 is going with this thread: Have there been any improvements in the last 10-20 years that have made it easier for a typical person with OSA to use and tolerate the machine? And the short answer is YES.

Twenty years ago, the machines and masks were uncomfortable enough and unwieldy enough that the only patients who were told they really needed to try to make PAP work were the folks with SEVERE OSA---the ones most at danger of having severe health consequences if they were unable to become compliant PAPers. The focus of treating OSA was no so much on relieving the daytime symptoms of excess sleepiness, brain fog, and fatigue, as it was in trying to prevent the comorbidities from becoming even more serious than they already were for the patient.

Now? The current guidelines for treating OSA put out by the American College of Physicians are available at http://annals.org/article.aspx?articleid=1742606. Those guidelines suggest putting ALL OSA patients (including those with mild-to-moderate OSA) on CPAP to see if they can adjust because CPAP has a better record than anything else for properly managing OSA and relieving the symptoms of OSA. And while a large number of new PAPers never make it, the comfort features now available do allow people (like me) who would never have been able to tolerate a heavy, unyielding mask with no humidification to use PAP with enough comfort to remain compliant over the long run.

[robysue]

Please note:

As I read the research years ago I noted that pure CPAP had consistently the fewest arousals during use. Since I believe that indicates the best quality sleep I decided to do what I needed to do to continue with CPAP.

Well, learn to walk a lot (82% of 10,000 steps a day over all last month), do some strength training. Work with a personal trainer. Work with a dietitian. Learn to live in a way that better facilitates metabolism.

And so drop CPAP pressure in half. And continue to loose 10-12 pounds a year.

Most of us are not in a financial position to work with a personal trainer and a personal dietician.

And losing weight may or may not allow an overweight OSA patient to drop their CPAP pressure in half.

And not all OSA patients are overweight to begin with. (If I tried "to lose 10-12 pounds a year", I'd disappear completely by year 10.)

However part of metabolistic health for me is re-learning to breath eucapnicly. I do believe this is best if guided by pulse oximetry. The process tends to increase CO2 reserve since the cells are in general more “fed” (i.e. do not need oxygen since they are already “full”). One thing that changes is the length of a long pause in breathing. To put it simply ten seconds of breathing pause is not a long time for me and results in no noticeable air hunger.

Todzo is in a very small minority when he expresses these thoughts.

But the modern CPAP with data machine wants to send you a “clear airway sensing / pacing” pulse after only about seven seconds. I believe this results in many unnecessary arousals and awakenings for me.

Most of us appreciate the ability for the machine to distinguish between OAs and CAs and respond appropriately. But Resmed's FOTs and PR's PP do indeed cause problems for a small number of patients.

But of course as it is right now not so many make it to the one year mark and there are plenty who think that they want to try the silly machines.

It's true that way too many new PAPers give up way too soon.

But I don't think there are "plenty who think they want to try the silly machines." Indeed, I think the problem of denial about OSA is largely because too few people are willing to try the silly machines.

Case in point: Hubby got a sleep test in July 2013. It should mild sleep apnea, and mainly when he was on his back. But he was VERY symptomatic: Could not stay awake in front of TV shows that he wanted to watch; found himself napping a lot; his snoring would wake him up sometimes; exhausted all the time; and getting crankier by the day. Back in July, Hubby even went for the titration study back in July and sailed through it with flying colors: He slept for 96% of the time in bed and woke up at the ungodly hour of 5:30am and had the energy to go all day without a nap and didn't fall asleep in front of the TV that night But Hubby still hemmed and hawed about whether he really needed to treat the OSA with CPAP and whether it would be enough to just sleep on his stomach---he was doing that most of the time, but was still waking up exhausted. I didn't nag (too much), but finally got him to agree that if he couldn't figure out a way of making stomach sleeping work in the sense of him feeling better during the daytime, that he'd consider PAP after New Years. It still took him another three months of dithering before finally asking his PCP for the script. He's now 2 weeks into PAPing and he actually is feeling better and wondering why he didn't do this a long time ago.

Next case in point: Hubby has two twin brothers---one identical with him and one fraternal. Both have clear symptoms of OSA. When hubby went to NJ last week (right after starting PAP), he could not get either brother interested in even talking about whether they should be tested and how PAP might help them. All because: "I don't want to sleep with a damned machine".

[Todzo]

Most of us are not in a financial position to work with a personal trainer and a personal dietician.

And losing weight may or may not allow an overweight OSA patient to drop their CPAP pressure in half.

And not all OSA patients are overweight to begin with. (If I tried "to lose 10-12 pounds a year", I'd disappear completely by year 10.)

Weight as BMI is not a measure of metabolic health by itself. For example 20% of those with OSA are of normal or less BMI and 20% of those with fatty liver disease are of normal or less BMI.

There are many programs out there which provide these services gratis. In my case I simply make it a priority. I sacrifice cable, for example, to pay for the gym. That way my love of tv drives me to the gym where they have tv and I can also afford the gym.

My several years meeting about every six weeks with a dietitian was provided by medicade/medicare.

My income is very modest.

But of course as it is right now not so many make it to the one year mark and there are plenty who think that they want to try the silly machines.

It's true that way too many new PAPers give up way too soon.

What I really do believe is that if they eliminated the expiratory pressure rise, if they resolved the noise problems, if they eliminated the airway sensing / pacing pulses and provided instead honest strait CPAP as a good first choice that many many more would be enabled to use CPAP rather than finding it unusable.

But I don't think there are "plenty who think they want to try the silly machines." Indeed, I think the problem of denial about OSA is largely because too few people are willing to try the silly machines.

In Amazon when I see three or less stars...

The machines have built for themselves a reputation. That is the real problem. That is why people would rather not try. So many have tried and failed!!!

The medical community can stop research from being done which looks at usability and they indeed seem to have done that. But they cannot stop word of mouth.

Case in point: Hubby got a sleep test in July 2013. It should mild sleep apnea, and mainly when he was on his back. But he was VERY symptomatic: ... He's now 2 weeks into PAPing and he actually is feeling better and wondering why he didn't do this a long time ago.

Next case in point: Hubby has two twin brothers---... All because: "I don't want to sleep with a damned machine".

Lets just fix the !@#$ machines!

[chunkyfrog]

Nothing wrong with my machine!
I was so relieved that there actually was a reason why I was feeling so horrible.
Cpap was the solution; and still is.

[49er]

Todzo,

Can you provide a citation that shows that improving metabolic health enables one to lower the pressure on their machine and/or cure sleep apnea? Out of curiosity, I just did a search and all the links I came up with were suggesting that pap therapy improves metabolic conditions but nothing like what you have inferred.

49er

Most of us are not in a financial position to work with a personal trainer and a personal dietician.

And losing weight may or may not allow an overweight OSA patient to drop their CPAP pressure in half.

And not all OSA patients are overweight to begin with. (If I tried "to lose 10-12 pounds a year", I'd disappear completely by year 10.)

Weight as BMI is not a measure of metabolic health by itself. For example 20% of those with OSA are of normal or less BMI and 20% of those with fatty liver disease are of normal or less BMI.

There are many programs out there which provide these services gratis. In my case I simply make it a priority. I sacrifice cable, for example, to pay for the gym. That way my love of tv drives me to the gym where they have tv and I can also afford the gym.

My several years meeting about every six weeks with a dietitian was provided by medicade/medicare.

My income is very modest.

But of course as it is right now not so many make it to the one year mark and there are plenty who think that they want to try the silly machines.

It's true that way too many new PAPers give up way too soon.

What I really do believe is that if they eliminated the expiratory pressure rise, if they resolved the noise problems, if they eliminated the airway sensing / pacing pulses and provided instead honest strait CPAP as a good first choice that many many more would be enabled to use CPAP rather than finding it unusable.

But I don't think there are "plenty who think they want to try the silly machines." Indeed, I think the problem of denial about OSA is largely because too few people are willing to try the silly machines.

In Amazon when I see three or less stars...

The machines have built for themselves a reputation. That is the real problem. That is why people would rather not try. So many have tried and failed!!!

The medical community can stop research from being done which looks at usability and they indeed seem to have done that. But they cannot stop word of mouth.

Case in point: Hubby got a sleep test in July 2013. It should mild sleep apnea, and mainly when he was on his back. But he was VERY symptomatic: ... He's now 2 weeks into PAPing and he actually is feeling better and wondering why he didn't do this a long time ago.

Next case in point: Hubby has two twin brothers---... All because: "I don't want to sleep with a damned machine".

Lets just fix the !@#$ machines!

[Bama Rambler]

Nothing wrong with my machine!
I was so relieved that there actually was a reason why I was feeling so horrible.
Cpap was the solution; and still is.

I fully agree with this.
There is nothing wrong with my machine either. Looking at the designs of machines several years ago and machines today I'd say that vast improvements have been made.

I would be a lot more hesitant to do this if my machine didn't provide data. Data lets me know that it's working and it's not just something hung on my face.

[space45]

I first began apnea treatment about 28 years ago, in the real infancy of CPAP treatment. Since then I have had a total of four machines, and though I enjoy having the present generation readout data I do not feel that the actual treatment experience has improved a bit.

thanks for the feed back

My first "Healthdyne" machine didn't even have an hours use meter, the pressure was selected by a little screwdriver turn pointer and there were absolutely no electronics to it. In that era, there were no machine humidifiers, no heated hoses, no BiPAP, APAP, etc. The machine was reasonably quiet and neat, AND importantly it really did help my condition. I will comment that the mask choice has genuinely improved-I had a bad time with masks for a long time ( blisters, discomfort, strap lines, etc. But I have been using the Red-Med Mirage Activa masks for over 8 years now and am quite comfortable with this design. I have found the heated, machine integrated vaporizer is a big plus as regards comfort, but I do think that a lot of the present refinements to even humidification represent overkill.

I have got to try a unit like that, blower, dump valve flap, spring and a adjustment screw. who knew it could be that easy, that would be so cool to make and try. call me nuts (and I know allot of you do, wonder how many read my post just to see what the crazy is up to or will say next) but I have got to try that type of unit, but I will have to make a humidifier as I get horribly dry even with one, last nigh was the worst, trying out the heated hose, not good.

I will comment that the mask choice has genuinely improved-I had a bad time with masks for a long time ( blisters, discomfort, strap lines, etc. But I have been using the Red-Med Mirage Activa masks for over 8 years now and am quite comfortable with this design.

I had heard they were hell back in the day, so things have got better, I do think they can get better yet.

I have found the heated, machine integrated vaporizer is a big plus as regards comfort, but I do think that a lot of the present refinements to even humidification represent overkill.

I may try a night with the humidifier off and see just how bad that can be, as for the rest I can see them arguing that the new machine will help stop central apnea and help a larger group and give better over all results, will try doing a straight CPAP, turning off the extras and setting things up to see if that makes thing better, but not to many changes to fast. takes a bit to get a real feel of real change and improvement, so I am told at least. thanks for you input.

No, I do not see much if any improvement in the technology of sleep disordered breathing. In fact, I liked the older CPAP and APAP technology, better. It worked better. The stuff they come out with now is designed to improve compliance, not improve effectiveness of the actual treatment. As an example, with the older machines if you had an APAP or autoBipap and set the thing "wide open" and slept with it that way, it would give you a TRUE AHI the following morning...normally awful.

there could be a few reasons for that, the new machines maybe better at filtering out false triggers or events to give a more true reading. it would seem that there is a ton of opinions in this sleep apnea field, in doing my research I have found a large range of varying ideas and opinions from the sleep apnea docs. so one can deduce this is far from a exact science. as it is right now

the modern machines are DESIGNED to give you an under 4 AHI just about no matter what you do. No matter how the machines are set up, the AHI will be under 4. This is a scam. Also, another thing Ive observed is the newer machines are poorly calibrated. Ive got two machines that are "off" by at least .5 centimeters of water pressure. My original APAP was pretty close to being dead on accurate as far as calibration.

I have trouble getting down to the 4 AHI at times, most events are while I am awake and mess with the true sleep number, but the machine does report them and my numbers can really suck if I had trouble sleeping.
one could easily make a real accurate and reliable tester, I could make and sell one, easy do. just print it out. would also have the model for public download for the guys that have there own printer.
thanks for the input Eric

As I read the research years ago I noted that pure CPAP had consistently the fewest arousals during use. Since I believe that indicates the best quality sleep I decided to do what I needed to do to continue with CPAP.

will most defiantly be trying that out, you have said allot of wise things and gave some real good advice. will have to try them out, I am a tad on the heavy side, OK not just a tad, a vary big tad. lol

The other area of even more improvement are the masks, especially FFM. it used to be here is choice A that will leak around your mouth or choice B that will leak around your nose. Masks are so much better now.

But the biggest improvement is the data. Being able to actually monitor what is going on is the key to being able to make necessary adjustments to getting the best therapy. I can't imagine ever going back.

the mask thing does seem to be a agreed upon thing for the most part, would like to see it even better, and for the high pressure guys like me that is even more so, straps are to flimsy. the data thing sure in a big deal I would agree, very important, I would like even more data to look at and see whats up. thanks for the input John

Getting more people to use and tolerate CPAP is the name of the game. If a machine is fantastic at controlling OSA, but large numbers of people simply cannot or will not use it, then that machine is of no use to them.

And that's actually where space45 is going with this thread: Have there been any improvements in the last 10-20 years that have made it easier for a typical person with OSA to use and tolerate the machine? And the short answer is YES.

Twenty years ago, the machines and masks were uncomfortable enough and unwieldy enough that the only patients who were told they really needed to try to make PAP work were the folks with SEVERE OSA---the ones most at danger of having severe health consequences if they were unable to become compliant PAPers. The focus of treating OSA was no so much on relieving the daytime symptoms of excess sleepiness, brain fog, and fatigue, as it was in trying to prevent the comorbidities from becoming even more serious than they already were for the patient.

that is very true, would be great if we can do even better. leaks, comfort, machine, price, there are lots of places to improve. not a easy nut to crack as we are all different. thanks for the reply

What I really do believe is that if they eliminated the expiratory pressure rise, if they resolved the noise problems, if they eliminated the airway sensing / pacing pulses and provided instead honest strait CPAP as a good first choice that many many more would be enabled to use CPAP rather than finding it unusable.

this is a big one, some times simple is better, some would say the extras are what it is all about, makes thing safer and better. the airway sensing / pacing pulses as I understand it, and correct me if I am wrong are to find central apnea events and to make sure it is not a obstructive event. so that could be a good thing, and if they could not detect it they could not report it in the data, loves me data, must have data lol . maybe with reading all I read now I would have been good with the brick they were wanting to sell me, but little data and we all know we likes our data. no one more then me. I bought the fancy high end one so I would have choice and thought it cheaper to get "the good one" over buying 2 or 3 as I find the one I had was not doing the job. plus who can say no to bells and whistles, I do loves the cool toys. anyway, hard for some to believe a plain CPAP could be better then our high tech Jim dandy extra crispy newfangled units. heck what could even be better then that. I know I would have been a skeptic, but will try it. turn off the extras and see whats up.

The machines have built for themselves a reputation. That is the real problem. That is why people would rather not try. So many have tried and failed!!!

The medical community can stop research from being done which looks at usability and they indeed seem to have done that. But they cannot stop word of mouth.

I agree fully, and so the search goes on, the system that works so hard and spends so much money to protect us, can really get in the way of finding a solution. try winning a race when your all warped up protective gear. your protected and feeling very safe, but your not going anywhere fast or very far. and the was the point of some of my earlier stuff. maybe the crazy one is not so crazy after all. I will have to watch out I will loose my crazy watching crowd, there goes 95% of my readers...lol

Nothing wrong with my machine!
I was so relieved that there actually was a reason why I was feeling so horrible.
Cpap was the solution; and still is.

also could not agree more, I am feeling great, I knew I was a bad sleeper, and I knew about sleep deprivation, what I did not know is one could sleep and still be sleep deprived, sure I was tiered but I was getting the recommended sleep so it must be something else. I now know about apnea and what it is and what it means, only the one that have felt the improvements can know for sure what it means.

Todzo,

Can you provide a citation that shows that improving metabolic health enables one to lower the pressure on their machine and/or cure sleep apnea? Out of curiosity, I just did a search and all the links I came up with were suggesting that pap therapy improves metabolic conditions but nothing like what you have inferred.

49er

I would think he is going on if your old and fat your more likely to have apnea and it gets worse, so loose fat and get in shape should make it better and need less pressure. make sense to me, but I am new here so what do I know, but it did seem to work for him.

Looking at the designs of machines several years ago and machines today I'd say that vast improvements have been made.

I would be a lot more hesitant to do this if my machine didn't provide data. Data lets me know that it's working and it's not just something hung on my face.

I would have to agree the machines are much better and nicer, but do they do the job better was the question, do they do more for the end user, and if so how much, was what I was asking. now the data thing,,WOW, yes that is for sure a big one, you can see whats up, whats changes, you have feedback as to what is happening, that is most definitely a big boost and one that keeps some using the machine. I know I am addicted to the data. like a addict I am hooked and looking for the hard stuff, EEG data and any other data I can get, never enough data.

[Todzo]

Todzo,

Can you provide a citation that shows that improving metabolic health enables one to lower the pressure on their machine and/or cure sleep apnea?

Can you provide a citation that shows that improving metabolic health disables one from lowering pressure on their machine or causes sleep apnea.

If you can it is contrary to my own experience and that of others I have seen post here regarding this issue.

Out of curiosity, I just did a search and all the links I came up with were suggesting that pap therapy improves metabolic conditions but nothing like what you have inferred.

49er

Honestly 49er, what kind of research do you expect our current disease care system to do anyway?!