Speculations about CPAP-dependency.

[kteague]

"spiel
/spēl,SHpēl/
INFORMAL
noun
1.
a long or fast speech or story, typically one intended as a means of persuasion or as an excuse but regarded with skepticism or contempt by those who hear it.
"he delivers a breathless and effortless spiel in promotion of his new novel"
synonyms: speech, line, patter, pitch, sales pitch; "

The so-called "article" is laughable - a not-at-all-veiled sales pitch written by an ENT surgeon to scare CPAP users into having surgery. As to the claim "Brainstem activity for respiratory drive is taken over by CPAP leading to no spontaneous neuromuscular drive. As a result, these patients cannot breathe spontaneously.", I defer to common sense, for which there is none being used in that claim.

Now if we are talking about some people who are susceptible to pressure induced centrals, when they are using the CPAP this could loosely apply to them. However, when not using the CPAP their respiratory drive returns to normal. Other wise, CPAP users would have to use it 24/7 even while awake. I'm pretty sure those who died while sleeping without their CPAP died due to obstructive events that stressed their cardiovascular system, not from lack of respiratory drive. But who am I to say? I'm just a 13 year CPAP user whose respiratory drive is still intact, yet would likely die of a heart attack if I subjected myself to the assault of untreated obstructive sleep apnea.

[chunkyfrog]

In skimming over the misinformation, I missed this line:
"One SURGEON, Dr. Paulose, implies that the causes are neurological"
one more QUACK who ought to be exposed!
My bad.

[jnk...]

OF COURSE I'm dependent on CPAP. Like all living humans, I need air and sleep to live. Is that somehow newsworthy enough to spark some kind of study?

[SDBud]

Although I am not medically qualified,

THAT is abundantly clear.

[camper]

Come on guys! Common sense isn't libel.

Common sense general principles, for solutions to any problem:
1. Always look for side effects.
2. Always look at failure modes.
3. Always look for better alternatives.

You don't need a degree to understand these principles. Nor do you need a degree, or the requisite training for a degree, to recognize those needs.

Many science and technology papers, including medical studies, can be understood if you read carefully, and look up what you don't know. In the modern scientific world, the old divisions have substantially broken down. Math and statistics underlie physics and engineering, physics underlies chemistry, chemistry underlies biology, and all of these underlie medicine and medical technology. If you understand one field, you can understand a lot within the others, regardless of more specific training. Of course area-specific training does help assess the applicable literature - though that is what reviewers for refereed journals are supposed to be for - and does help assess possible solutions.

So, following common sense, when a quick search of the literature pertaining to surgery and CPAP-dependency

https://scholar.google.com/scholar?hl=e ... gery&btnG=

shows that many surgeons frequently deal with CPAP-dependency, in that severe side effects often occur, post-surgery, if CPAP isn't withdrawn gradually, then it is just common sense to look if there have been refereed journal articles establishing or denying a causal link between CPAP-use and CPAP-dependency - the kind of study that should have been done when looking at any treatment - then there should be such studies.

Of course it is possible I don't know how to look for such studies. If any of you know of such literature, please reference it, rather than screaming libel.

(Please note that I did NOT say there was a causal link - in fact I very carefully said several times I found no definitive evidence of same. Nor did I suggest that other people should discontinue CPAP, and move to other treatments. There isn't sufficient evidence at this time to support that contention.)

[jnk...]

You are failing to understand what you read.

"Dependence" in a medical context can mean "continuing to benefit from."

I continue to benefit from breathing and sleeping. Therefore I am dependent on them.

I also depend on my glasses to see. That does not mean my glasses have side-effects that damage me. It means I should not drive a car without gaining the benefit they provide for my safety and the safety of others.

Same with the importance of my not driving while sleepy. Fortunately properly optimized CPAP solves that issue with no damaging effects to my health in the way drugs or surgery have effects that damage health.

And THAT is not speculation. THAT is common sense. Drawing strange conclusions by misunderstanding medical papers, on the other hand, would show a lack of common sense.

[TropicalDiver]

OK, thinking about study design.
a) It is not possible to do a double blind study with a control group. Patients will know whether they are using xpap or not.
b) So you are left with population comparison studies.

You could assign patients diagnosed with apnea to one of two groups -- 1) active xpap users; 2) users who used xpap for some period and subsequently became not compliant. The problem is that would not answer the question posed by the OP. What study design does the OP suggest?

The idea that, "Brainstem activity for respiratory drive is taken over by CPAP leading to no spontaneous neuromuscular drive" is just plain silly. First, a CPAP is not a vent -- it does not initiate breathing (yes, a sub-type of xpap will, but not cpap). Second, how would his surgery cure apnea in patients who previously used cpap if their respiratory drive was somehow disabled (by prior CPAP use)?

[billbolton]

Common sense general principles, for solutions to any problem:

Wild conspiracy theories from vested interests are never a solution to any problem.

[TropicalDiver]

So, following common sense, when a quick search of the literature pertaining to surgery and CPAP-dependency

https://scholar.google.com/scholar?hl=e ... gery&btnG=

shows that many surgeons frequently deal with CPAP-dependency, in that severe side effects often occur, post-surgery, if CPAP isn't withdrawn gradually, then it is just common sense to look if there have been refereed journal articles establishing or denying a causal link between CPAP-use and CPAP-dependency - the kind of study that should have been done when looking at any treatment - then there should be such studies.

Yes, people undergoing sedation are more likely to have apnea (and/or the apnea more severe) that those who don't undergo sedation. In this context, the articles are mostly referring to the fact that some of the patients required cpap to maintain respiratory sufficiency at rest. None suggest that the use of XPAP causes one to need XPAP when that would not otherwise be the case....

[TropicalDiver]

Of course it is possible I don't know how to look for such studies. If any of you know of such literature, please reference it, rather than screaming libel.

Who accused you of libel?

[zoocrewphoto]

shows that many surgeons frequently deal with CPAP-dependency, in that severe side effects often occur, post-surgery, if CPAP isn't withdrawn gradually, then it is just common sense to look if there have been refereed journal articles establishing or denying a causal link between CPAP-use and CPAP-dependency - the kind of study that should have been done when looking at any treatment - then there should be such studies.

Please be aware that surgeons consider their surgery to be a success ifthere is a 50% reduction in apnea events. Since most people don't feel truly well unless they get below an ahi of 2, they would need to be at 4 or less to feel true success with surgery.

The truth is that a surgeon would love to take my money, and then consider me a success with an ahi of 40 (still severe) since that is half of my untreated ahi of 80. They also claim to have a 50% success rate. So, 50% of people getting the sugery have a reduction of 50%. Not many get down below 2, and even those tend to get worse after a year or so.

For most of us, this is simply not worth the permanent damage caused by the surgery. With cpap, there really aren't any side effects, other than possibly swallowing air, which is usually fairly easily to correct. We accept that currently there is no cure, but continued use does keep us in good condition despite the fact that over time, we would have gotten worse. (I didn't become severe over night, that took years of getting older).

Idon't know ifyou are somebody new to cpap and hoping to find a better alternative, or if you are trying to push surgery. But most of us here have learned that cpap is the gold standard. It does NOT make us worse over time. It keeps us alive and fairly healthy. Since we see no reason to attempt the surgery, there is also no reason to discontinue cpap. Perhaps in the future if something better comes along. But I would want REAL success defined as less than 2 ahi and a high likelihood of attaining that.

[Julie]

+1

[Jack Burton]

Last month I slept without my machine, first time in ~5 years.
Finally got to sleep but several times as I drifted off I felt my heart race and got an Adrenalin bump.
The next day felt like an all day hangover.
I won't be doing that again if I can help it.

[camper]

Who accused you of libel?

Someone who changed or deleted their remarks after I made that reply. They said Internet anonymity could be breached (which is true), and that I could be sued for libel for saying negative things about CPAP.

BTW, I'm not advocating surgery - and wouldn't consider it for my mild case, and neither did my ENT. That is to say, if my OSA is real - the extreme discomfort, atypical sleep position, and lack of sleep created by those during my sleep studies makes me think those results may have been atypical.

If anything, I tend to prefer athletic training techniques to medical procedures. I may well attempt some of those alternatives - though I got almost as strident remarks in another thread when I mentioned that.

And as I'm about to post in another thread, using a fan last night made much more difference to the soundness of my sleep than the CPAP machine has. Though that might be because I'm new to CPAP, and started out with the wrong masks (at least for me) and possibly the wrong machine (for me). I may decide I like CPAP if results keep improving.

[jnk...]

. . . using a fan last night made much more difference to the soundness of my sleep than the CPAP machine has . . .

It may have made more of a difference in your PERCEPTION of the soundness of your sleep. But that does not necessarily mean it is comparable in preventing medically significant sleep disturbances that destroy sleep-stage continuity and insidiously destroy the benefits of sleep in ways we do not always sense in the short term.