Treatment making apnea worse?

[izzyb]

I have been thinking about this on and off for a while. When I was first diagnosed with sleep apnea in 2006, I went for testing because I wasn't sleeping well and I had about 3 episodes when I woke up gasping. Of course, I didn't know what this was but when I told a friend she said it sounded like sleep apnea. Fast forward to 7 years later. A couple of times over the last few years I decided to see if I really needed to hose up to sleep. (Wishful thinking.) Of course, I did. I had to put my mask on because of almost constant episodes of gasping. Also the few times I have tried to have a normal nap on the couch (oh, to be normal again) and the same thing - constant apneas. Compared to pre-diagnosis, the episodes are horrible.

The question I have is why in the beginning my apneas seemed to be less severe and less often than they are now. (I initially tested at 31 apneas an hour but, as I said, I only had a few episodes previously at home that were bad enough to wake me.) This may be a crazy thought, but I was wondering if using a X-Pap could cause a person to become dependent upon it. Maybe, causing the problem to be even worse somehow.

[nanwilson]

I have been thinking about this on and off for a while. When I was first diagnosed with sleep apnea in 2006, I went for testing because I wasn't sleeping well and I had about 3 episodes when I woke up gasping. Of course, I didn't know what this was but when I told a friend she said it sounded like sleep apnea. Fast forward to 7 years later. A couple of times over the last few years I decided to see if I really needed to hose up to sleep. (Wishful thinking.) Of course, I did. I had to put my mask on because of almost constant episodes of gasping. Also the few times I have tried to have a normal nap on the couch (oh, to be normal again) and the same thing - constant apneas. Compared to pre-diagnosis, the episodes are horrible.

The question I have is why in the beginning my apneas seemed to be less severe and less often than they are now. (I initially tested at 31 apneas an hour but, as I said, I only had a few episodes previously at home that were bad enough to wake me.) This may be a crazy thought, but I was wondering if using a X-Pap could cause a person to become dependent upon it. Maybe, causing the problem to be even worse somehow.

You WERE having more apneas that you think.... gasping were the bad ones, the others were there but not bad enough to make you have a big gasp. Read up on apnea and you will get the gist of the problem you didn't think you were having.... but WERE.

[Pugsy]

Back in the pre cpap days your body slowly adjusted to the apnea events and the side effects...sort of learned to compensate for them in various ways.

Then you started cpap..and it worked and with time the body again adjusted to the "pleasant" absence of side effects.

So now it doesn't have any coping mechanism in place..the body is no longer "used" to having all those unpleasant side effects...and when you take a nap you get the full effect of the side effects because they are no longer a "normal"thing the body accepts...they are abnormal.

So we really don't come to depend on the machine in the sense that the apnea events are actually worse when we don't used the machine...they are most likely the same in terms of duration and severity..but our body likes to depend on not having to go through all those ugly side effects.
So our sleep apnea isn't really "worse" but it sure seems worse when compared to sleep with proper therapy.

If you were to blow off therapy for a prolonged bit of time...eventually the body would tend to compensate and the apnea events would become the new "normal" way for the body to feel.

[chunkyfrog]

Maybe you have gotten older. (unlikely, yes, but possible)
Had you not been sleeping with cpap, lo these many years, you could
be well into the "long quiet sleep" (the dirt nap)
Isn't it great to be alive?

[izzyb]

Pugsy, your explanation sounds good. I just feel like I have gotten worse over the years. I have never felt a difference in all these years. My doctor said that I would "feel like a new person." Not.

And I don't understand how people who have sleep apnea can "sleep" without it. (I still don't sleep well, even if I take something to sleep but at least I'm breathing.) My father and brother both have severe sleep apnea and neither are compliant. When my dad has nodded off in the chair and the one time I spent the night, I could not believe how horrible it is. Constant not breathing and then gasping. (I can only imagine my brother is the same.) It is horrifying to listen to. And knowing how it actually feels from the times that I have tried sleeping without mine makes me even more aware of how horrifying it is. I really don't see how they do it.

[izzyb]

chunkyfrogg - sometimes I wonder.

[Pugsy]

Well..don't know about you but it seems like as I have gotten older everything has started to sag more.
It wouldn't be impossible for the airway tissues to sag more or maybe if we have wintered too well for a few winters (few extra pounds each winter) for there to maybe either more collapses or more severe collapses if we nap without the machine.

Like you I never felt like "a new person". Too many other things also affect how well I sleep or feel in general.
But I just tell people that while I still don't wake up wanting to run a marathon...at least I don't wake up like I just ran a marathon and got run over by a bus at the end of it.

My brother also has sleep apnea. I realized this last fall when he was in the hospital and I was watching him sleep.
He absolutely refuses to do anything about it.
They cope, they make excuses and all the while keep paddling of the De-Nile river.

[Captain_Midnight]

Izzy asks...The question I have is why in the beginning my apneas seemed to be less severe and less often than they are now?

Quite possibly, if one of your many involuntary responses to (untreated) OSA was to avoid the more relaxed, "dipping" sleep.

Then, through successful xpap therapy, over time, you might have experienced successively greater dipping levels (lower bp) and in generally, a progressively more relaxed sleep. All good.

This is why I think that after a few months, successful xpap therapy will often require slightly higher pressures from the originally titrated pressure.

And then, sleeping w no xpap would find you with OSA occlusions but in a deeper sleep from when you were originally titrated. Not good.

You can google "dipping", it's a good thing; but many of us apneics unfortunately lose the nocturnal dipping ability, at least before dx and therapy. Losing dipping, for example, can lead to higher daytime bp.

.

[izzyb]

Captain_Midnight, thanks for the info. I googled. Makes sense. Just one more piece of bad news related to sleep apnea.

Pugsy, everything is definitely sagging more. And even though I am overweight, I weight a little less than I did when first diagnosed. I was just kind of thinking that like a muscle that is never used and atrophies, then the muscle tone in the throat, uvula, etc. might decrease after the airway pressure starts doing the job for it. I don't really know what I'm talking about - just musing.

[Pugsy]

the muscle tone in the throat, uvula, etc. might decrease after the airway pressure starts doing the job for it.

You know if you were on a real ventilator 24/7..yeah maybe a good chance of that happening but remember...our pressures aren't ventilator pressures and we only use cpap maybe 1/3 the night.
We still have 2/3 of the day where we are exercising those things all day long.

[izzyb]

Now if only I would exercise the rest of my things!

[newpapper]

It's turning out that sleep apnea is responsible for just about every bad medical thing that can happen to a person.

[Pugsy]

It's turning out that sleep apnea is responsible for just about every bad medical thing that can happen to a person.

Ain't that the truth....sagging boobs, my white hair that I have to color way too often, ingrown toenails, bad eye sight, and what sleep apnea doesn't cause...using a cpap machine will.

[izzyb]

And if sleep apnea doesn't get you, menopause will.

[DoriC]

It's been 7yrs since your last sleep study, maybe things have changed . You don't mention having software to analyze your machine data, that's important so you can tweak your pressure settings if necessary and see if your leaks are interfering with good sleep. How about a different mask? If you're still using the same model there have been many improvements in designs. You also might be interested in an ugraded machine especially if your insurance will approve one after all these years. Lots of things to think about and they all will contribute to better therapy. Good luck and keep us updated.