Can you try CPAP without becoming dependent on it?

[Sugarlips]

I've been singing the praises of CPAP to some of my clients (I'm a relationship counselor and sex therapist), and one person said he was concerned that, if he tried CPAP, he'd have to continue using it, even if he hated it.

This sounds dubious to me, but I thought I'd check it out. If someone uses CPAP for, say, six weeks and then stops, is there any risk that they would then have, or develop, *worse* health issues than if they'd never used CPAP?

Thanks!

-- Eric

[The Latinist]

One thing to keep in mind is that if you are a commercial driver there may be licensing issues with ceasing CPAP therapy once begun. We've had several people here complaining about starting CPAP for mild apnea that the DOT did not require treatment for only to find that, once they began, compliance was mandatory and CPAP could not be stopped without losing their license.

[Bons]

Cpap is not a drug, so there is no real "addiction". One can become an "air junky" and appreciate the flow of air, but it certainly isn't something that is going to harm you, other than some air in your tummy (which can be very uncomfortable) or central apnea events if you end up with pressure induced apneas. Obviously, those of us who us cpap for sleep apnea are on it for life, unless something else miraculously comes along. We continue using it because we like being alive, not because of some thrill.

Seems very bizarre for a relaitonship/sex therapist to recommend cpap - it would probably be better to refer to a sleep doc or even their GP for a referral for a sleep study......

[JDS74]

The treatment that CPAP therapy provides is an opening of the airway so that breathing can continue when, under normal circumstances for the patient, breathing will be interrupted. It does not cure anything except the symptoms that arise from these interruptions in breathing.

So, to the extent that the patient is correctly treated by this therapy, their overall health will improve and they will feel better. Stopping will send them back to their pre-treatment status and they'll feel worse but not worse than before treatment began. That kind of dependency is psychological and not physical.

I can't imagine the mindset that says just because adapting to this therapy mode is difficult or uncomfortable, I'll just risk serious long-term health consequences including death to avoid the difficulty. I do know there are folks out there who do just that but I don't understand the thinking.

As my neurologist at Mayo in Rochester, Minn. said to me on several occasions, "Untreated sleep apnea will kill you."

[Julie]

You cannot become 'dependent' on Cpap - it's just air being blown in to help keep your airway more open than it otherwise would be. That's all! But trying it out for six wks (knowing ahead of time you've given yourself permission to quit after that time) is pointless because it can take that long to adjust - to various issues with the machine, the mask, etc. etc. And all of that just misses the point - you're doing it to stay alive. To keep from having a stroke, either in your sleep or otherwise. To keep from having cardiac problems (worse than whatever you might have now that you know about or don't yet know about).
To keep from running over a child because you're asleep at the wheel, or killing the father/mother of your own children - yourself. To feel like a human being again, not just a lump who falls into the recliner after work and can't pursue things you used to. So cpap is not something you try out, it's something you commit to because you want to live and you want to feel like a human being again.

[Nick Danger]

Hi, Sugarlips,

We're in similar businesses (I'm a counselor and all but dissertation for a PhD in psychology). I suspect, as I think you do, that this is a rationalization and not a real argument. Sure, anything could conceivably develop into a process dependency; however, CPAP does not seem to me one of the more likely candidates for that (there is a lot of inconvenience associated with it and little in terms of immediate reinforcement). The only thing I've heard that remotely supports the client's argument is the issue with the DOT requiring someone who attempted CPAP to remain on CPAP to keep his commercial license (and I suspect we heard only one side of the story in that situation) .

For those criticizing Sugarlips for practicing outside his area - he did NOT state that he diagnosed or prescribed CPAP. He said "I've been singing the praises of CPAP to some of my clients." I suspect some of those are clients who may have undertaken a sleep study or who have had one recommended by a physician. As a therapist, I've on several occasions found that a couple is not sleeping together due to the snoring of one of the partners. If I hear that and I also hear that the snorer complains about being tired, it doesn't take long for the light bulb to turn on and for me to ask if that person has ever had a sleep study (and if not, to strongly encourage them to discuss the symptoms with their doctor and ask their doctor about OSA). Also, don't forget many of my clients are dealing with symptoms of depression - another marker for OSA.

Julie, with respect to "you cannot become 'dependent' on Cpap" - I've found that people can become dependent on a wide variety of things (if you ever watch a baseball game, just watch all the motions the batter repeats between every single pitch - I suspect that if the batter was told not to do even one of those motions that it would cause severe discomfort and would significantly affect his performance).

Nick

[mecheng]

I have lost 40lb with regular exercise and not much in the way of dietary change. During that journey my AHI and required pressure on my APAP machine fell until a new sleep test was called for. This sleep test showed that I no longer require the therapy that is provided by these machines. I was advised to come off the machine and being under the NHS the sleep clinic wished to retain my machine there and then. I did not wish to part with my machine with immediate effect and requested retention of the machine while I tried coming off the machine.
I tried to come off the machine but found that I could not get to sleep. I remained awake for hours unable to fall asleep. I did manage eventually to get to sleep but the same thing happened on the next two nights. By now lack of sleep was catching up with me in exactly the same way as the sleep apnoea did so I have reverted back to my machine. Addicted maybe, Dependent maybe, feeling better definitely. I will give breaking away from the machine another go as I have been advised by the clinic that the unnecessary therapy my now be more detrimental to my health than continuing.

[The Latinist]

I don't think Sugarlips was really asking about physical addiction or even psychological dependence. I think he was asking if use of CPAP could worsen the underlying cause of a person's apnea such that stopping CPAP would result in worse apnea than if the patient had never started.

I've seen others express similar concerns before. Does anyone know if there've been any studies on the topic?

[Nick Danger]

I think Sugarlips wants to challenge the argument, but wants to make sure that the argument is really fallacious before he does so.

[Nick Danger]

Latinist, I searched for articles related to getting off of CPAP - lots of articles about how to increase adherence and compliance, but the only ones I could find that related to quitting CPAP were methods for weaning premature babies from CPAP.

[Sugarlips]

Yes, Latinist has it right -- I'm trying to find out if there are any medical consequences to using CPAP for a while and then stopping, not asking about psychological dependence. (Sorry I wasn't clearer.)

And Nick Danger (long live Firesign Theater!) is right that I'm hoping to tell my client that there's no (or little) risk to trying CPAP, to remove one obstacle from his path.

More later, but thanks to everyone so far -- I really appreciate the quick and thoughtful responses!

-- Eric

[Wulfman...]

I've been singing the praises of CPAP to some of my clients (I'm a relationship counselor and sex therapist), and one person said he was concerned that, if he tried CPAP, he'd have to continue using it, even if he hated it.

This sounds dubious to me, but I thought I'd check it out. If someone uses CPAP for, say, six weeks and then stops, is there any risk that they would then have, or develop, *worse* health issues than if they'd never used CPAP?

Thanks!

-- Eric

Sounds to me like this person has been listening to too many "snake oil" advertisements on TV.
I agree with some of the others.......if you NEED it and don't use it, you're going to die sooner (of something).

Does a double amputee ask if using prosthetics could become addictive?
Does a person with COPD and needs oxygen ask if THAT could be addictive/
Same question for a person with a cane or walker.

It didn't take me long to decide that using this therapy was much better for my sleep than NOT using it.


Den

.

[BlackSpinner]

If you need cpap to keep your SpO2 up then stopping cpap therapy will feel horrible because you will lose your adaptation to low O2 when you use cpap therapy.

[The Latinist]

If you need cpap to keep your SpO2 up then stopping cpap therapy will feel horrible because you will lose your adaptation to low O2 when you use cpap therapy.

True. When I have a bad night on CPAP I feel it and notice it more because I'm not constantly in a state of chronic sleep deprivation. But I don't think that's really a good reason not to use a CPAP; even on those days, I'm better off from a health perspective than I was when I was adapted to oxygen deprivation.

[hyperlexis]

This is an interesting topic -- I think a psychologist should be asking another PsyD this or perhaps a physician, for better, more clinically based input, however. That said, for me I would say that yes, there is something of an addiction. A psychological addiction, not a physical addition (which I do not know how it would be possible, although perhaps one could have a situation where an obese individual would justify not losing weight because CPAP would compensate). For me there is now a rather strong fear of not sleeping with the machine on. I very often do fall asleep accidentally without it, which I regret when it happens, but the thought of not having the machine at all does make me afraid of waking up choking/having apneas, which is what prompted me to start CPAP in the first place. I cannot imagine traveling somewhere without the machine unless an emergency. So yes, perhaps this could be considered something of an addiction. Waking up more refreshed also helps. Absolutely should not preclude an individual from starting xPAP, however. The benefits of the treatment far outweigh any phobias that could result. And at the end of the day the result is simply an issue of cost, or hassle of using a machine. Possibly bedroom embarrassment, etc. The machine really cant harm you per se, even if an 'addicted' person used it who didn't need it or who outgrew the need.