Is it posible to become dependent on CPAP?

For some reason or other, naturists are rarely depicted skiing.

chunkyfrog wrote:For some reason or other, naturists are rarely depicted skiing.

Have you ever noticed that those "Get one with nature" posts always show nice weather without any black flies or mosquitoes? They never show people wading through the mud, in a fine drizzle, while filtering a cloud of black flies through their teeth or trying to cook while the sleet and snow is hitting them in the face.

I composed a very long reply and accidentally deleted it. I don't have time to start over, so I will just summarize. Weight loss and diet are rarely an effective cure for OSA, and OSA is rarely a result of weight gain alone. That is a common and dangerous misconception among the general public and even many in the medical community, and it contributes to people avoiding treatment for a life threatening medical condition most commonly related to genetic factors related to the neurology and structure of the upper airway rather than their weight. Since we know this, most of us are extremely reluctant to lend any support or credibility to claims that people with OSA should expect to be able to discontinue treatment if they diet and exercise. The mismatch between the misconceptions and reality is particularly brutal for those who encounter the common experience of working hard to lose weight and finding their OSA symptoms getting WORSE and requiring MORE CPAP pressure as a result of the weight loss!

If you are one of the rare exceptions and are able to eliminate your OSA through weight loss and diet then we will all cheer and be happy for you. But you won't find anyone here encouraging you to plan your treatment with that expectation any more than we would encourage you to plan your retirement with the expectation that you will win the lottery. We wouldn't be helping you or anyone else that reads these forums if we encouraged that kind of misinformation.

rkuntz wrote:To help here are some answers to help put the Topic in context and answer some of the honest questions raised.

My Doc wants me off CPAP because happily is one of those who is an advocate of minimal intervention.

Sleep Lab result was +30 AHI baseline.

Did your doctor tell you that 30 is considered severe? I don't know if your events are short or long, or how bad your desaturations are, but even of those two are low, the number of events is high enough to be severe. Even surgery has a low level of success for people with severe sleep apnea.

It made my Doc's day, I mean he was really happy when he was able to halve my BP Meds, and eliminate the Statin after I lost 30 lbs. Additionally my 30 day AHI avg. has dropped from 5.5 to 3.5 with that weight loss and he's talking about lowering pressures.

It sounds like your cpap treatment is working great! But keep in mind that, like medication, cpap is a daily therapy, it is does not cure. Your ahi *with cpap* is NOT the same as your ahi *without* cpap. The only way to know if your untreated ahi has improved is to get a new sleep study. If you quit cpap at some point without a new sleep study, you could go right back to severe sleep apnea without knowing it. Lowering pressures is great as that can be more comfortable, and monitoring your data will help you stay on track and keep you from cutting back too much.

My response to those with the snarky comments is that denial and fear of sleeping without out mechanical ventilation can be, in and of themselves, signs of dependency. If you need to and can, loss some weight, explore Ketogenic diets, get on your feet and Sing. Can't hurt, might help.

Very few people here use a machine with ventilator ability. We have the regular cpap and apap machines that simply splint the airway open for us. We do all the work ourselves. I don't mind being dependent on a machine to help me sleep better. It's better than the crappy sleep I got without it. It's no worse than needing a rescue inhaler for my asthma in case I encounter a bad allergy that sets me off. Or taking blood pressure medication., Though I probably could have avoided those medications had I not spent 10 years in denial, refusing to address my sleep apnea. Instead, I waited until it got severe and made my blood pressure pretty severe too. That was my fault.


I know it is hard to adjust to cpap, and we want to find any way possible to get off the machine, but you experience good sleep with it, then you can really see how bad the old sleep was, and how much it is worth it to keep at it. It is so nice to finally feel good.

OSA can be as a result of weight gain... but common sense tells me that sagging skin can occur anywhere in the body and at any time; from gaining weight or because of whatever. Whether it is from weight gain or not doesn't matter. It's not going to get better once the muscles in your throat begin to droop, even with enormous weight loss.

I really don't understand your doctor and wonder if he/she knows anything about sleep apnea. It can be controlled but once your throat muscles (if that's the reason you have SA in the first place) start to sag, not a thing is going to stop it from continuing to droop. Maybe surgery but there are many cons to that. Hence the CPAP or BPAP... to help keep those airways open so that you can breath.

ems wrote: It [OSA] can be controlled but once your throat muscles (if that's the reason you have SA in the first place) start to sag, not a thing is going to stop it from continuing to droop.

Citations?

As one who for most of his life was a couch potato but is now moving toward an active lifestyle I see many droopy things firming up! It is a wonderful thing!

The Sleep Tech was good and he told me that +30 was severe, the Doc was a no show (sleeping?). Had the decimal points in the wrong places earlier, actually my treated AHI has dropped from .55 to .35 with weight loss. Regarding weight gain caused by Apnea vs. Apnea caused by weight gain, to me it sounds like a metabolic linkage exists so you need to treat both if you have both.

Dependency is a complicated issue physical vs psychological vs malignant vs benign vs many other characteristics. My Wife thinks I'm dependent because she's seen the fear I experience if I don't have my machine. Objective evidence of this is that I panicked and drove home for hours in a life threatening zero visibility blizzard this winter rather than overnight in a Hotel without my beloved CPAP machine.

I'm not in denial about my need for therapy, hell I'm probably far enough along the dependency curve that I'm addicted. Note: I'm not about to drop CPAP therapy until I've self titrated down to a level (if possible - crossed fingers) that warrants another lab visit with a satisfactory result and a cancellation of the Script by my Doc.

Thanks for the comment that something like -50% of people who loss weight go off CPAP, that's good, it gives me a goal. However the statement that the level of intervention required can go up over time, is not good and that rise could be a direct result of physical dependency and nothing else. Apparently no around here knows if a physical dependency on CPAP therapy, which could make things worse can develop, so that is a partial answer in itself for my original question.

Psychologically speaking, in all probability fear of dependency is one of the major reasons why compliance levels are so low for CPAP and this group as a whole doesn't seem to recognize that. This fear of dependency can be a bad thing in and of itself. I know because I delayed therapy for years and I have a dear friend who's machine sits idle as he sacrifices both the quantity and quality of the balance of his life.

You can't roll back the clock, but you can Loss weight (if needed), get on your feet and Sing. It can't hurt and might help.

I don't know if you deliberately chose (and limited yourself to) the word 'dependency' rather than 'addiction', but Cpap clearly cannot be called addictive as there is no chemical interaction going on, though your brain might put out (or hold onto) some chemical or other in the process of recovering from OSA to a manageable level. Any dependency is going to be psychological and that's all... maybe just clarifying for anyone who's confused the terms.

@rkuntz: from personal experience your last post sounds like you may be suffering from some form of anxiety. Have you considered talking with a psychologist about these concerns you have regarding CPAP dependence? I ask as you appear to be focusing on a concern with CPAP that is not generally accepted within the CPAP community as being something to be concerned about.

rkuntz wrote:
Dependency is a complicated issue physical vs psychological vs malignant vs benign vs many other characteristics. My Wife thinks I'm dependent because she's seen the fear I experience if I don't have my machine. Objective evidence of this is that I panicked and drove home for hours in a life threatening zero visibility blizzard this winter rather than overnight in a Hotel without my beloved CPAP machine.

Your definition of dependency is wrong. It is a layman's misconception. With severe OSA you need a cpap machine to function or even stay alive. That you are concerned about this is natural. Your wife is wrong. Any one who has their air cut off will become anxious, any first aid course will tell you that. The reason for this is that humans are completely dependent on air in order to live. Should we try to over come that "dependency" or "addiction" to O2 because "dependency is wrong"?

What you really need is some therapy to come to terms with the reality of your life. And you wife needs a swift dose of reality - just put you hand over her mouth & nose for more the 10 seconds 33 times in one hour and ask how anxious she feels about that.

Think of it this way... you'd better be dependent on Cpap, just as diabetics need to depend on insulin!

rkuntz wrote:The Sleep Tech was good and he told me that +30 was severe, the Doc was a no show (sleeping?).

Yes those “Sleep Doctors” often seem to be doing that.

rkuntz wrote: Had the decimal points in the wrong places earlier, actually my treated AHI has dropped from .55 to .35 with weight loss.

I am running near those numbers myself. Sounds like you are doing with CPAP about as good as can be currently done with CPAP.

rkuntz wrote: Regarding weight gain caused by Apnea vs. Apnea caused by weight gain, to me it sounds like a metabolic linkage exists so you need to treat both if you have both.

So about 20% of those with OSA are of normal body weight. And about 20% of those with fatty liver disease are of normal body weight. I have become suspicious that there is ALWAYS a metabolic connection.

Part of the reason that our current “disease care system” cannot cure disease (they only “care” for it) is that they lack interdisciplinarity. They have become so many “specialists” who cannot work with one another let alone those who can teach us to eat well and move well. They need to learn to respect the value of other contributors I really do believe.

rkuntz wrote:Apparently no around here knows if a physical dependency on CPAP therapy, which could make things worse can develop, so that is a partial answer in itself for my original question.

I don't think the problem is that we don't know. The problem is the question itself doesn't really make sense to most of us. Dependent just means relying on something else, which is kind of assumed when talking about life saving medical treatments. We would all prefer to breathe regularly on our own at night without artificial assistance. Unfortunately, we can't. For most people there is no effective cure, as most OSA is NOT primarily caused by being overweight and surgeries have a very low success rate. Therefore, we have a choice. We can live a shorter life with impaired quality, increased blood pressure, raised risk of heart attack and stroke, depression, memory loss, daytime fatigue, brain damage, impaired concentration, poor work performance, and changes in the concentration of leptin, the hormone that affects appetite and metabolism (yes, the OSA often starts first and causes the weight gain instead of the weight gain causing the OSA as most people assume). Or we can live longer and healthier with improved quality of life by using a medical device to alleviate the symptoms of the generally incurable condition. Most of us are here because we strongly prefer the second option. And because the machine alleviates the symptoms rather than fixing the root causes, we are dependent on continued use of the machine to continue reaping the benefits it delivers. We are all dependent on the machine. But the machine didn't make us dependent.

This is rather normal in the world of assistive medical devices. If you are practically blind without eyeglasses then you are dependent on them to see, you will always be dependent on them to see, and we don't generally try to convince people to stop using their glasses. People who have heart attacks without pacemakers are dependent on them to keep their heart beating normally, will always be dependent on them if they want their heart to continue beating normally, and we don't generally try to convince people to have their pacemakers removed. Even simple toothbrushes and toothpaste aren't natural and we are dependent on them to keep our teeth healthy.

Since it would be downright strange for you to ask about dependency on eyeglasses or pacemakers or toothbrushes, the real question is, "Why are you asking this question and what is motivating you to do so?" I can only think of two plausible reasons. One possibility is that you are really asking a slightly different question that is alluded to when you say, "physical dependency on CPAP therapy, which could make things worse." Perhaps the real question you have is if xPAP therapy can make OSA degenerative... in other words, does long term use of a PAP machine make the body less capable of mitigating the effects of OSA on its own? I don't think it does, but I don't know of any scientific studies that addressed that question. Ultimately I doubt it matters.... the natural response to OSA is a shorter life with impaired quality, increased blood pressure, raised risk of heart attack and stroke, depression, memory loss, daytime fatigue, brain damage, impaired concentration, poor work performance, and changes in the concentration of leptin, the hormone that affects appetite and metabolism. Who in their right mind would ever want to go BACK to that, even if the alternative is being dependent on a machine for the rest of your life?!?!

The other plausible reason for you asking this question is the one most of us have assumed in our answers... You don't really understand the fundamental causes of OSA and believe it can often be effectively mitigated with weight loss, diet, exercise, or other forms of "getting healthier". That is the overwhelming belief among most people who aren't in the medical community and even a large number of people in the medical community who really should know better. It wouldn't be so bad if it didn't have an incredibly detrimental effect on the health of so many people who percieve a stimga attached to PAP therapy and avoid seeking treatment, discontinue treatment, or are unsupportive of their partner's long-term prognosis as a result, because in the back of their mind is the notion that you are choosing the easy route of being dependent on a machine rather than doing the hard work of exercising and losing weight. To quote a recent National Institute of Health research paper, "most of the risk factors involved in the pathogenesis of OSAS are largely genetically determined. ... It is likely that genetic factors associated with craniofacial structure, body fat distribution and neural control of the upper airway muscles interact to produce the OSAS phenotype." This is NOT to say there is no relationship between OSA and obesity, as there obviously is. OSA symptoms cause physiological changes that increase the propensity for weight gain, and weight gain worsens the symptoms of OSA, which worsens the propensity for weight gain, etc., in a self reinforcing feedback loop between OSA and obesity. The mistake most people make is to assume that the weight gain came first and the symptoms of OSA started as a result, so weight loss should logically be able to eliminate the symptoms of OSA. In most cases this is backwards. The unnoticed symptoms of OSA most likely contributed to the weight gain, which made the OSA worsen to the point where the patient sought diagnosis and treatment, and treating the OSA helps the patient achieve and/or maintain weight loss. However, that doesn't cure the underlying causes of the OSA!

Now, this isn't ALWAYS the case. In SOME cases the OSA is only present because of weight gain and the person can successfully discontinue PAP therapy following weight loss. Unfortunately, for most people that isn't the case, and for a fair number of people the opposite happens and losing weight worsens their OSA symptoms. Therefore, we strongly encourage people to pursue weight loss, diet, and exercise for the intrinsic health benefits while strongly discouraging any expectation that doing so is likely to eliminate the need for xPAP therapy. It might, but it isn't probable, so encouraging people to think that it is only sets them up for failure and encourages people to believe the fundamental misconception that OSA is "treatable" with diet, exercise, and weight loss. If you pursue health for its own sake and find you are able to discontinue xPAP therapy then you win on all counts. If you fixate on the idea that xPAP is temporary and the goal of getting healthy is to eliminate the xPAP, but your OSA stays the same or gets worse as you get healthier, the odds are much higher that you will "fail" and discontinue both the quest to get healthier and the xPAP, and then you lose on all counts.

All humans are born totally dependent on breathing and sleeping, much as we are dependent on food and water.

Good breathing and good sleeping are a large part of good health for any human, much as is the case with good food and good water.

Optimized CPAP for those who need it to breathe well and sleep well is the best thing going for that sort of thing.

So the point is that if you need CPAP to sleep and breathe well, but you choose NOT to become "dependent" on it, you are, to use a scientific expression, headed for a world of hurt.

I am not ashamed of being totally dependent on food, water, air, and sleep. That would be being ashamed of being human. And yes, it can at times require gadgets and devices to get the food, water, air, and sleep we need to stay alive.

I am deeply thankful to the human beings who were smart enough to come up with this handy little gadget that has brought me back to life and given me much better quality of life. I wish it worked as well for everyone.

rkuntz wrote:Psychologically speaking, in all probability fear of dependency is one of the major reasons why compliance levels are so low for CPAP...

In the sense that fear tends to lower the arousal threshold and also to raise the ventilatory control system gain and since low arousal threshold and high ventilatory control system gain are two nonanatomic features which cause OSA[1] I can easily agree.

However I think it is also worth mentioning that CPAP tends to exacerbate high ventilatory control system gain (the pressure is a “plus” factor for ventilatory gain) and that the extra breathing (respiratory effort) will result in more arousals especially in those with low arousal threshold. In other words many find they have intrinsic characteristics which tend to make CPAP unusable for them.

I think that what drives many people away from seeking help for Sleep Apnea is simply that they often see those who have tried and did not have success. Honestly if we had people able to do an Amazon style review what would the numbers look like. Would we even see three stars?? Since those who have a very negative or very positive experience are most likely to review I think the result would be considerably less than three stars indeed!

rkuntz wrote: ...and this group as a whole doesn't seem to recognize that. This fear of dependency can be a bad thing in and of itself. I know because I delayed therapy for years and I have a dear friend who's machine sits idle as he sacrifices both the quantity and quality of the balance of his life.

Please do not be too hard on your friend. As explained above many many people find CPAP unusable. What bothers me about this group is that when you bring up the reasons why CPAP is unusable for many many people they head for denial or attack you (as one in denial might).

We need to face reality if we wish to change it.

[1] Danny J. Eckert, David P. White, Amy S. Jordan, Atul Malhotra, and Andrew Wellman "Defining Phenotypic Causes of Obstructive Sleep Apnea. Identification of Novel Therapeutic Targets", American Journal of Respiratory and Critical Care Medicine, Vol. 188, No. 8 (2013), pp. 996-1004. doi: 10.1164/rccm.201303-0448OC