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.