Can CPAP cause atrophy?

Assuming weight gain was the trigger for your OSA, is it possible that using a CPAP can cause your airway muscles to atrophy thus requiring CPAP even after weight loss?

davelikesbeer wrote:Assuming weight gain was the trigger for your OSA, is it possible that using a CPAP can cause your airway muscles to atrophy thus requiring CPAP even after weight loss?

Often weight gain is caused by OSA.

Your muscles are not the problem, you use them all day you are awake to chatter to your friends. It is the combination of throat structure, sleep effects and weight (for some people).

Others have found that after weight loss they required MORE pressure.

BlackSpinner wrote:

davelikesbeer wrote:Assuming weight gain was the trigger for your OSA, is it possible that using a CPAP can cause your airway muscles to atrophy thus requiring CPAP even after weight loss?

Often weight gain is caused by OSA.

Your muscles are not the problem, you use them all day you are awake to chatter to your friends. It is the combination of throat structure, sleep effects and weight (for some people).

Others have found that after weight loss they required MORE pressure.

Honestly, I'm not a firm believer of the OSA causes weight gain theory. While I do agree that it *can* cause weight gain, I suspect the cause/affect is reversed in a majority of cases. Just look at the various polls asking people how much weight they have lost since going on CPAP and you'll see that most people do not lose weight.

Actually, I believe more that weight gain causes OSA which can cause more weight gain than simply the second half. (Please, among the anal retentive of the bunch, I am NOT saying all OSA is caused by weight gain.) Basically, I think OSA can be a weight gain accelerator for most people with OSA.

Looking at what changed in one's life can help determine what factor was most significant in driving OSA. For me, my genetics didn't change when I got older, as I still have the same genes. My bones and jaw line didn't change. Aside from excess fatty tissue, my throat structure didn't change either. My weight did change. I suspect a fair percentage, a plurality if not majority, of people who developed OSA can say the same.

Reading this forum, I think a disproportionate amount of people jump on the "weight gain is not the cause of OSA" boat when the research do *not* support that. And again for the anal retentive among us, yes, OSA can cause weight gain and not all people with OSA are overweight and not all people who are overweight have OSA. This whole attitude here reminds me of the polls that most people think they are above average drivers when just about half are below average.

In any case, I didn't want to start a religious war. In my original post, I stated "Assuming weight gain was the trigger ... " can CPAP cause atrophy?

The official answer seems to be "no, CPAP doesn't make you dependent on CPAP."

If you do CPAP for a while and then stop, you will tend to feel worse than you did before you started CPAP. In theory, your apnea is no worse, but your brain is no longer used to being strangled periodically throughout the night.

Also, if you do CPAP for a long period of time, if you quit, you will be older, other contributing factors may be worse, etc. Your apnea may very well be worse, but not due to the apnea.

As to the "truth" as to whether CPAP is "addictive," you can't really expect truth from the medical establishment about the possible disadvantages of their treatments. Well, at least not unless there's money to be made by disparaging one form of treatment vs. another. Maybe if someone invents some sort of therapy that's more profitable than CPAP, there will be some studies done that will show CPAP is addictive or otherwise harmful and everyone needs to switch to the new treatment.

I'll also say that this sounds like the usual overweight patient response to being told they have a weight related problem. "Being overweight is causing medical problem X. I don't want treatment Y. I'll just lose weight instead." Sounds good, but the weight loss usually doesn't happen.

CPAP 'dependency" would be a difficult study to do. Are you going to take apneacs on CPAP and stop treating them at random? It would be very difficult to do a double blind study. It's going to be pretty hard to convince someone who isn't getting CPAP that they are. What about the medical ethics of withholding treatment for apneacs? You might try studying people who quit doing CPAP voluntarily, but that would impose a bias on the results. Those people who quit CPAP may either have not needed CPAP to begin with, or have other health problems.

In summary, I don't think CPAP does any such harm. I don't think you'll find any medical studies showing it does. If you've got apnea, the danger of not treating it is much higher than the potential unknown dangers of CPAP.

CPAP causes atrophy that makes apnea worse sounds an awful lot like one of those rationales we all give ourselves in the beginning because we really don't want to use CPAP.

Just saying . . .

archangle wrote:The official answer seems to be "no, CPAP doesn't make you dependent on CPAP."

If you do CPAP for a while and then stop, you will tend to feel worse than you did before you started CPAP. In theory, your apnea is no worse, but your brain is no longer used to being strangled periodically throughout the night.

Also, if you do CPAP for a long period of time, if you quit, you will be older, other contributing factors may be worse, etc. Your apnea may very well be worse, but not due to the apnea.

As to the "truth" as to whether CPAP is "addictive," you can't really expect truth from the medical establishment about the possible disadvantages of their treatments. Well, at least not unless there's money to be made by disparaging one form of treatment vs. another. Maybe if someone invents some sort of therapy that's more profitable than CPAP, there will be some studies done that will show CPAP is addictive or otherwise harmful and everyone needs to switch to the new treatment.

I'll also say that this sounds like the usual overweight patient response to being told they have a weight related problem. "Being overweight is causing medical problem X. I don't want treatment Y. I'll just lose weight instead." Sounds good, but the weight loss usually doesn't happen.

CPAP 'dependency" would be a difficult study to do. Are you going to take apneacs on CPAP and stop treating them at random? It would be very difficult to do a double blind study. It's going to be pretty hard to convince someone who isn't getting CPAP that they are. What about the medical ethics of withholding treatment for apneacs? You might try studying people who quit doing CPAP voluntarily, but that would impose a bias on the results. Those people who quit CPAP may either have not needed CPAP to begin with, or have other health problems.

In summary, I don't think CPAP does any such harm. I don't think you'll find any medical studies showing it does. If you've got apnea, the danger of not treating it is much higher than the potential unknown dangers of CPAP.

I totally agree with everything you said, especially the last sentence. What I'm most curious about is weight loss. If weight caused my apnea and I lost weight, is it then possible the I would still require CPAP after the weight loss. As far as I can tell, it looks like that is a very real possibility.

"What I'm most curious about is weight loss. If weight caused my apnea and I lost weight, is it then possible the I would still require CPAP after the weight loss. As far as I can tell, it looks like that is a very real possibility."


Well, are we talking 15 pounds or 115 pounds? I need to lose 15-20 pounds. Somehow I don't think that I would be able to stop CPAP.

Janknitz wrote:CPAP causes atrophy that makes apnea worse sounds an awful lot like one of those rationales we all give ourselves in the beginning because we really don't want to use CPAP.

Just saying . . .

So far, I'm a believer in CPAP, although I've not been on it for too long, my first night was May 25. Since then I've not used it two nights, once by choice early on because I could not get the nasal mask to seal, and once while camping when my fuse blew on the DC connector.

Since using it, I have not woken up with a headache once. For me that is proof enough that it works to my benefit.

I remember reading somewhere that cpap can actually strengthen muscles because we are breathing deeper while using it.

I'm one of the gang that actually gained weight on xpap. Thanks to starting xpap and menopause at the same time I'm buying a whole new fall wardrobe......

Janknitz wrote:CPAP causes atrophy that makes apnea worse sounds an awful lot like one of those rationales we all give ourselves in the beginning because we really don't want to use CPAP.

Just saying . . .

That sounds like my husband's lame excuse for not wearing glasses--it will make him dependent on glasses. Instead, he's dependent on me to read him the menu at the restaurant. oh brother!

You might be interested to read through this PPT presentation - http://www.stanford.edu/~davesv/Weight%20&%20OSA.ppt

most people do not lose weight.

Don't forget that most people overeat whether they are using CPAP or not, have OSA or not. It is not just fast food. In fact, the typical meal in full service restaurants is very high calore/high carb. The average American consumes 49 lbs of sugars annually that have been added to food and drink. This does not include sugars occurring naturally in fruits, dairy products, etc.

We also overeat at home. Plates are larger and recipes are larger. Also think about 2-liter sugared drinks in refrigerators.

Also don't forget that most people are generally physically inactive in our times whether they are using CPAP or not, have OSA or not. Think office jobs, TV viewing hours, "playing" at computer, taking the car everywhere and riding around to find a park near the door, etc.

Overeating + physical inactivity = yeah, it is going to be hard to lose weight with or without CPAP.

Can CPAP cause atrophy?

Blockages are caused by some combination of tongue and soft palate. What mechanism of CPAP could possibly cause enlargement of the tongue and/or soft palate?

Dave, I think alot of things probably come into play and are never considered. Modern medicine doesn't pay much attention to cause and effect relationship. It's all about treating symptoms. That which is billable.
I know that my O2 drops as soon as I lay down now.
If I fall asleep without my mask I feel noticeably worse than I remember ever feeling after a nap before cpap. The first symptom upon awakening is blurred/double vision.

I started xpap in December and didn't lose any weight until I went low carb (thanks to info on this site) January 21st of this year.

Factors that I think probably come into play:
Living alone - not chattering with friends all day.
Retirement - not chattering wth co-workers all day.
Sedentary lifestyle - less exercise for the respiratory system.
Too much time on the computer- posture, focus, not breathing naturally.
Over stimulation of electronics - My stats are noticeably better if I turn off the tv and the computer an hour or so before going to bed.
They are also better if I get out, get a life, visit with friends, talk and laugh.

Then there are genetics, because I tend to think I have a family history of sleep apnea but there is no way of knowing since this is fairly new.
I also wonder about head injuries- what part of the brain governs breathing, awake or asleep.

There is alot we don't know...

An interesting idea, but, no, I don't think Cpap treatment makes you dependant on Cpap in any addictive sense. I've been reading everything that comes my way on sleep apnea for years, and I have not come across anything suggesting that Cpap treatment causes atrophy in the muscles holding the airways open. As pointed out above, the problem is not atrophy of the muscles.

As for the weight-gain issue, sure, it is well known that obesity can cause OSA, as fat deposits make effective airways smaller. There are indeed a few people who can lose weight and eliminate OSA; but, they are in the extreme minority, I believe. That is because, regardless of one's weight, the main "trigger" for OSA is not obesity, it is age. The metabolism slows as glands no longer function as well as they once did, and there is a general deteriation of the nerve/muscle system. Snoring is a good marker for the condition for most (not all) people, and, at some point as susceptable people age, often as they push 40, the snoring becomes worse and OSA sets in. The sad fact is that biological evolution didn't care much what happened to us after we hit 20 or 30... My OSA hit big time while I was still close to my ideal weight. It's more recently that I have piled on the pounds, for a variety of reasons, the only one related to OSA probably being the continued slowing of the metabolism as I get older. Excercise is wonderful for slowing down the process (and even reversing it in the short term), but, alas, I don't get enough of that.

In one small way, I am actually less prone to OSA since beginning Cpap treatment. It used to be that if I reclined on a couch and fell into a doze, it was immediately marked with extreme snoring and the stops and starts typical of OSA (according to observers). I now sometimes doze lightly without that happening (generally, one should not do this--it's important to use Cpap for any nap). I'm not saying I'm "cured." I believe what is happening is that, not being so sleep deprived these days, I can more successfully stay on that edge between wakefulness and sleep, where my nerves/muscles are still holding the airways open.

Well, while it's an interesting debate, I'm afraid the bottom line is that it doesn't really matter. Untreated OSA does such terrible things to the body and its organs that even someone convinced that weight loss is the answer should use Cpap while working on the weight.

Lizzzabeth wrote:

Janknitz wrote:CPAP causes atrophy that makes apnea worse sounds an awful lot like one of those rationales we all give ourselves in the beginning because we really don't want to use CPAP.

Just saying . . .

That sounds like my husband's lame excuse for not wearing glasses--it will make him dependent on glasses. Instead, he's dependent on me to read him the menu at the restaurant. oh brother!

I and my husband are both severely near sighted, and we are highly dependent on those glasses: And like most severe myopes, our dependency is not only for the obvious things such as driving. (Heaven forbid I try to drive without my glasses on my nose.) For both hubby and I, the glasses come off our nose once we're in bed, and they go back on before we get out of bed in the morning. I'm comfortable enough navigating my way around the house without my glasses, but hubby is not. But I certainly can't cook a meal without them. And I could not navigate my way through an unknown supermarket very easily without my glasses on my nose. And when the cat knocks our glasses off the bedside table, we genuinely need help in finding them. It happened again to me yesterday morning. And it is very disturbing to realize (again) that you need the glasses to find the glasses and that you cannot get on with the rest of your day until you have found the glasses.

Moreover, I want to point out that in the 40 odd years I've been wearing glasses for nearsightedness, they have indeed changed the advice given to parents when their kid is given that first pair of glasses to correct nearsightedness: 40+ years ago parents were routinely told when their kid got their first set of glasses: Make sure the kid wears the glasses all the time so they don't have any eyestrain. Yes, they should have them on when they're reading too. And no, wearing the glasses won't cause the eyes to deteriorate at a faster rate. And back then, almost nobody thought anything at all about the potential risks associated with severe myopia.

But guess what: There is some sound scientific evidence that near sighted kids really shouldn't wear their glasses except when they can't see something clearly without them. And when kids with mild myopia are encouraged to wear their glasses when reading, their eyes often do deteriorate at a faster rate and sometimes they do develop quite severe myopia that is far worse than their parents' or siblings' myopia. And severe myopia is not as benign as many folks think it is: Severe myopia all by itself is a risk factor for a number of other eye diseases including glaucoma, retinal detachment, age-related macular degeneration, and cataracts.

By the time my kids were diagnosed as myopic, the standard advice for parents had changed. We were told: Have the kid only wear the glasses when they can't see the board or the tv or something else at a distance. Make sure they don't use the glasses when they are reading. Our daughter still wound up almost as blind as we are; but our son can pass a driver's test without his glasses and about the only time he needs them is if he's sitting in the back of a large lecture hall. Which may explain why he chose a small liberal arts school for college.

The point of my ramble? Comparing CPAP to glasses may or may not be a decent analogy in the first place. But carrying the analogy to the point of implying that you won't get dependent on CPAP by using it because you don't get dependent on glasses by wearing them just might not be in our best interests.

davelikesbeer wrote:
I totally agree with everything you said, especially the last sentence. What I'm most curious about is weight loss. If weight caused my apnea and I lost weight, is it then possible the I would still require CPAP after the weight loss. As far as I can tell, it looks like that is a very real possibility.

Why do you say that? There doesn't seem to be any evidence to support the idea that CPAP makes you dependent on CPAP if you later cure the underlying medical cause.

I suspect that weight may often be a convenient whipping boy for apnea, too. Doctors love to blame your health problems on bad patient behavior. If you're fat, every problem you have is caused by you being a lazy fat slob. Or diabetic, not having regular checkups, etc.

Don't assume that thin Dave would not have apnea. There are a lot of thin apneacs too.

It's sort of like a politician explaining why we're having a bad economy. "Yes, the unemployment rate is high, but if not for my administration's efforts over the past 4 years, unemployment would have been much higher."