Cease CPAP Use Two Weeks before Sleep Study?

[ChicagoGranny]

Is this a good practice backed up by evidence?

I'm calling bullshit on the idea that follow-up sleep studies of CPAP-compliant patients should include a withdrawal period. "Withdrawal period" means the patient would discountinue the use of CPAP for a period of some nights before the follow-up study.

The confusion in the medical profession might possibly have come from this study ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803046/ ) published in the Journal of Thoracic Disease. The purpose of this study was NOT to determine how quickly obstructive sleep apnea returns upon cessation of CPAP.

From the study,

Withdrawal of CPAP resulted in an increased apnoea-hypopnoea-index (AHI) at 1 and 2 weeks to a comparable degree (mean increase in AHI +31.9 (95% CI: +20.1 to +43.7) and +33.5 (95% CI: +22.4 to +44.6), respectively; P<0.001 for both comparisons) compared to continuation of CPAP

Note that the AHI was only measured after one week and two weeks of CPAP cessation. It was NOT measured on any of the first through sixth nights of cessation.

As many of you can testify, your OSA returns with one night of CPAP cessation. Hell, it even returns within one hour. Actually, it never goes away.

Repeating myself, the purpose of the study was NOT to see determine how quickly OSA returns, nor was this studied. The purpose of the study was to determine the impact on the downstream effects such as deterioration of daytime symptoms and psychomotor performance; increases in blood pressure, heart rate, and urinary catecholamines; peripheral endothelial dysfunction; disturbances of cardiac repolarisation; changes in the metabolic breath profile; etc. These impacts were measured at one and two weeks.

Sleep medical professionals prescribing withdrawals by compliant CPAPers are misinformed and practicing bad medicine. I'm so mad I could spit.

[Pugsy]

As many of you can testify, your OSA returns with one night of CPAP cessation.

Mine certainly did return significantly the one night I had to do without CPAP because some dumbass went on a trip and didn't bring the long hose and didn't realize it until about 11 PM.
Horrible sleep and all my pre cpap symptoms returned in full bloom.

I don't know how much I believe this hold over crap or not. BUT I sure wouldn't want to have a negative test because of it...and the potential is there. Though when I used to hang around the RT forum...they were talking that 1 to 3 nights without cpap was more than enough to eliminate that potential.

[ChicagoGranny]

I don't know how much I believe this hold over crap or not.

Barring some solid evidence otherwise, I will continue to believe that this one statement from the study,

In the CPAP withdrawal model, patients previously diagnosed with OSA, and effectively treated and compliant with CPAP, are randomised to either continue therapeutic CPAP or to withdraw it by using a subtherapeutic sham-CPAP device, for a short period (e.g., 2 weeks).

taken out of context, caused the entire confusion.

[Pugsy]

Where's Dave aka Morbius aka Rubicon now...when we need him?
He reads or has read a lot more studies than I have ever thought about reading.

[ChicagoGranny]

Yes, and the study cites a lot of other studies that I am not willing to wade through.

[zonker]

As many of you can testify, your OSA returns with one night of CPAP cessation. Hell, it even returns within one hour. Actually, it never goes away.

testify, sister!

on a trip last year, we were in a rental house. the power went out at 4 am. of course, it woke me up. there wasn't any "one night" about it. it returned IMMEDIATELY. tried napping sitting up, which is a ridiculous concept. dozed fitfully until power came back an hour later.

i just thank heavens that so far (fingers crossed) i've had no reason to do another sleep study if the prevalent attitude among the docs is to cease cpap before another study.

[Julie]

Just to be ornery - everyone's different!

[Dog Slobber]

Just to be ornery - everyone's different!

Which is accommodated for in well designed studies.

[dataq1]

Is this a good practice backed up by evidence?

I'm calling bullshit on the idea that follow-up sleep studies of CPAP-compliant patients should include a withdrawal period.

WOW, Pretty strong reaction!

First I had to wonder what prompted this, and what "practice" you referred to in the beginning of this thread. Maybe it was from another thread that was titled " Anyone managed to get a prescription...."

In that thread Pugsey had written:

Don't use your current machine for 4 or 5 nights prior to the sleep study just in case there is some hold over effect from using the cpap. May or may not happen but you don't want to risk going through a sleep study and have it come up and say you don't have OSA just because you used the machine right up to the sleep study and there was a bit of a hold over effect.

I'm inclined to agree with Pugsey on that .......with the caveat: unless not using your current machine causes you extreme discomfort.

In my household my wife has no problem with not masking up, no tiredness, no headaches, no rashes or slurred speech. That's her. However, without my cpap I (apparently) seem to sleep just fine, no wake ups, not particularily tired or drowsey, but I am more apt to wakeup with a headache. That's me.

The point is we are all a bit different, sometimes more than a bit.

If @sarahcovenant's doctor or sleep study practitioner tells her to hold her therapy for a few days prior to testing (assuming she can tolerate it), How are you qualified to advise her in contradiction. ?

[Dog Slobber]

If @sarahcovenant's doctor or sleep study practitioner tells her to hold her therapy for a few days prior to testing (assuming she can tolerate it), How are you qualified to advise her in contradiction. ?

Where did ChicagoGranny give sarahcovenant advice such as this?

[zonker]

"

In that thread Pugsey had written:

Don't use your current machine for 4 or 5 nights prior to the sleep study just in case there is some hold over effect from using the cpap. May or may not happen but you don't want to risk going through a sleep study and have it come up and say you don't have OSA just because you used the machine right up to the sleep study and there was a bit of a hold over effect.

just a tip: it's considered good manners to post the thread link when pulling a quote from it.

[dataq1]

@DogSlobber,
In the prior thread (Anyone managed to get a prescription.....) saracovenant wrote:

Thank you for the advice! This is a bit tough for me because I find it hard to do my job while sleepy, but maybe I can try to schedule the sleep study during the weekend when I can skip using my CPAP on say Fri and Sat night.

- On Wednesday 4/20 sarah was expecting to be told to skip her Cpap treatment for a couple of nights (based on advice from the forum)
- On Saturday 4/23 granny begins a new thread that suggests that holding treatment in preparation for sleep study is "bullshit".

What is saracovenant supposed to think?

My only point here is that sara should follow the directions of her doctor and/or the operator of the sleep study.
If she can not comply - she should tell her doctor or sleep study operator.
Simple as that

(if there is another thread that proposed a two week hiatus (that Granny seems to be reacting to), it would be helpful if Granny would reply in that thread or at least provide a link to the thread.

[zonker]

(if there is another thread that proposed a two week hiatus (that Granny seems to be reacting to), it would be helpful if Granny would reply in that thread or at least provide a link to the thread.

be nice if YOU would provide a link as well.

or is it beyond you?

[chunkyfrog]

When we had a power outage, I waited hours until the power came back on,
before lying down--I am not crazy!
I remember the morning apnea headaches all too well.
My mental state before cpap was inches away from suicidal.
Where do these idiots get that half-assed idea anyway?
Insurance companies trying to kill off costly patients?
Disturbingly believable.

[dataq1]

just a tip: it's considered good manners to post the thread link when pulling a quote from it.

No problem: https://www.cpaptalk.com/viewtopic/t184 ... erate.html