When can one discontinue CPAP useage

Julie wrote:It IS possible you have something called Positional Sleep Apnea, which would mean that depending on how you react to e.g. sleeping on your side vs your back (the latter provokes apneas), you might not need Cpap... but you cannot properly test this yourself and need a lab study... figure out some way to get one (and take it easy on the workouts, they may not be the nth answer to everything).

Yes it is underlined on my test

Mild positional obstructive sleep apnea

If you can keep yourself from sleeping on your back (they sell long foam wedges for that) you may just be fine!

djhall wrote:

Stuey wrote:Far too many of you are too cynical about this, I fully understand that some people may have sleep apnea for the rest of their life but you can make that change and make it now. You really can live a long and healthy life without sleep apnea

Perhaps so, but one experience isn't necessarily representative of the majority. The question isn't if you should try, or if it is possible, but rather what you should expect and what your motivations should be for long term success. If you diet and exercise for the health benefits and you turn out to be one of the people who can also discontinue treatment then you win on both counts. If you fixate on not using a machine long-term and use discontinuation as the motivation to diet and exercise, the failure of diet and exercise to produce the expected benefit means the most likely outcome is discontinuing both the machine and the diet and exercise plan. That is especially true for the significant number of people whose OSA actually gets worse when they lose weight. Why set people up for the probability of encountering a lose-lose outcome when a simple change of expectations going in would have set them up for a win from the health benefits alone or even a win-win if they get the health benefits and the bonus of ditching the machine?

Also, when people assume that weight loss will achieve success in getting rid of sleep apnea, many people just figure they will skip cpap and lose weight. We all know it is difficult to lose weight, so really, what they end up doing is nothing. And the effects of sleep apnea get worse.

I have a narrow airway, small mouth, small chin. I have the perfect recipe for sleep apnea, regardless of weight. I have no idea when my symptoms started. I know I have had sleep apnea for at least 12 years. But I also know that I had some (then rare) choking gasping fits back in the 90s. I spent the night in the hospital once when I had a bad one. At the time, I was told in inhaled acid reflux and take a zantac. But I know now that those choking fits are apnea events.

I have allergies. I have asthma. They can be reduced, treated, and improved. I doubt there will ever be a cure for me. How do you make an airway larger? I was diagnosed with a small airway when I was 19. Medications can reduce inflammation, but they can't make the structure larger. Even my dentist has trouble. They use the kid size xray things for the back of my mouth.

For me, sleep apnea is like asthma and allergies. They are all part of a narrow airway system, so I will take use the treatments available to make the best of it. I still work to lose weight as that will improve my health too. But I have no false hope about getting off the cpap machine. My cpap machine has done great things for me already, so I am grateful for it and don't want to create a mindset of hating it and wanting to get rid of it.

Day_Dreamer wrote:Yes it is underlined on my test

Mild positional obstructive sleep apnea

Okay, well, taking everything you've said together and at face value, you appear to be something of a unique/marginal case. Most of us here suffer from traditional obstructive sleep apnea. Simply put, when we sleep our airway collapses and we suffocate until our O2 saturation drops significantly, our body panics, and we wake up enough to re-open the airway. That typically happens more severely during REM stage sleep and when we sleep on our backs, but for most of us it happens anyway even if we are side or stomach sleeping. This is a very serious condition and moderate to severe cases (which are the ones that typically seek diagnosis and treatment) are typically associated with genetic factors that influence the nerve wiring to the throat and/or the structure of the airway.

Now, you appear to have something of a different situation. On the good side, your O2 saturation numbers aren't as low as would be expected for clinically significant obstructive sleep apnea and an AHI of 3 doesn't fall into the problem range for OSA. On the bad side, an RDI of 16 is more than you want, your study results indicate mild positional obstructive sleep apnea, and you have symptoms of disturbed sleep. I am not very familiar with this mild of a case, but my suspicion is that the AHI of 3 and diagnosis of mild positional OSA probably comes from partial (50%+) collapse of the airway while sleeping on your back (possibly only during REM stage sleep). Subtracting the AHI of 3 from the RDI of 16 leaves us with and average of 13 RERA events per hour. RERA events are events severe enough to cause sleep disruption and arousal, but mild enough that they don't meet the criteria for a hypopnea. These are counted in RDI but not in AHI.

Bottom line... you appear to have enough respiratory effort related arousal events to disrupt your sleep but not enough severe ones to qualify as a fully developed case of clinical obstructive sleep apnea. So what can you do? Preventing yourself from rolling onto your back may help. Loosing weight and improving your metabolism and overall fitness may help. But they also might not. If you have a fully data capable machine you can learn to download the data from your machine to your computer and interpret the results. If your diet and exercise plan is enough then you may get to the point where you have low RDI at the minimum pressure setting of 4cm. If you get to that situation you have a bit of a dilemma. 4cm can still provide significant improvement in borderline cases, but the machine cannot give you any data on how you sleep completely without it. At that point you would have to either discontinue and see if symptoms return or do a full sleep study in a clinical setting to determine how much residual sleep disruption still exists with no machine assistance at all. If you don't get to the point where symptoms are eliminated at minimal pressure, but the machine improves the quality of your sleep and quality of life, then you may end up being one of the many who accept life with the machine for the improved sleep and daily life it enables.

djhall wrote:

Day_Dreamer wrote:Yes it is underlined on my test

Mild positional obstructive sleep apnea

Okay, well, taking everything you've said together and at face value, you appear to be something of a unique/marginal case. Most of us here suffer from traditional obstructive sleep apnea. Simply put, when we sleep our airway collapses and we suffocate until our O2 saturation drops significantly, our body panics, and we wake up enough to re-open the airway. That typically happens more severely during REM stage sleep and when we sleep on our backs, but for most of us it happens anyway even if we are side or stomach sleeping. This is a very serious condition and moderate to severe cases (which are the ones that typically seek diagnosis and treatment) are typically associated with genetic factors that influence the nerve wiring to the throat and/or the structure of the airway.

Now, you appear to have something of a different situation. On the good side, your O2 saturation numbers aren't as low as would be expected for clinically significant obstructive sleep apnea and an AHI of 3 doesn't fall into the problem range for OSA. On the bad side, an RDI of 16 is more than you want, your study results indicate mild positional obstructive sleep apnea, and you have symptoms of disturbed sleep. I am not very familiar with this mild of a case, but my suspicion is that the AHI of 3 and diagnosis of mild positional OSA probably comes from partial (50%+) collapse of the airway while sleeping on your back (possibly only during REM stage sleep). Subtracting the AHI of 3 from the RDI of 16 leaves us with and average of 13 RERA events per hour. RERA events are events severe enough to cause sleep disruption and arousal, but mild enough that they don't meet the criteria for a hypopnea. These are counted in RDI but not in AHI.

Bottom line... you appear to have enough respiratory effort related arousal events to disrupt your sleep but not enough severe ones to qualify as a fully developed case of clinical obstructive sleep apnea. So what can you do? Preventing yourself from rolling onto your back may help. Loosing weight and improving your metabolism and overall fitness may help. But they also might not. If you have a fully data capable machine you can learn to download the data from your machine to your computer and interpret the results. If your diet and exercise plan is enough then you may get to the point where you have low RDI at the minimum pressure setting of 4cm. If you get to that situation you have a bit of a dilemma. 4cm can still provide significant improvement in borderline cases, but the machine cannot give you any data on how you sleep completely without it. At that point you would have to either discontinue and see if symptoms return or do a full sleep study in a clinical setting to determine how much residual sleep disruption still exists with no machine assistance at all. If you don't get to the point where symptoms are eliminated at minimal pressure, but the machine improves the quality of your sleep and quality of life, then you may end up being one of the many who accept life with the machine for the improved sleep and daily life it enables.

Thank you for taking the time to fully understand my situation. ( I get the feeling many just read the title and posted their standard response)

I am going to make an appointment with a Dr that someone recommended in another post

I'll post more when known

Not sure if I should continue the CPAP therapy in the mean time

Did not sleep a wink and I have meetings all day.....

This has been a very stressful situation. Thanks to all the positive and informative people who posted.

I found this regarding the treatment of Mild to moderate Sleep apnea

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564770/

It states no benefit from CPAP usage for individuals with my levels

No increased mortality rates either

"In summary, the benefits of CPAP compared to usual care with respect to daytime sleepiness, symptoms, cardiovascular risk, quality of life and mortality are minimal or nonexistent in patients with mild obstructive sleep apnea and the adherence to PAP at three months appears inadequate."

"I conclude that first line treatment of mild obstructive sleep apnea should be medical. CPAP and other modalities such as a dental appliance or surgery should be reserved for failed treatment in highly selected cases."

Has anyone pointed out that there are two different causes or types of sleep apnea? One is obstructive sleep apnea, in which some floppy part of your mouth/throat intermittently blocks the air passage. The other, rarer, is neurological, in which your brain or nervous system occasionally stops sending the signal to breathe. Weight has nothing to do with the neurological type.

btm1 wrote:Has anyone pointed out that there are two different causes or types of sleep apnea? One is obstructive sleep apnea, in which some floppy part of your mouth/throat intermittently blocks the air passage. The other, rarer, is neurological, in which your brain or nervous system occasionally stops sending the signal to breathe. Weight has nothing to do with the neurological type.

Thanks
more reading to do

Day_Dreamer wrote:I found this regarding the treatment of Mild to moderate Sleep apnea

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564770/

You are aware this paper is seven years old? And its conclusions represent the opinion of just the author, and not the wider medical community?

And you are also aware that the American College of Physicians (ACP) released new recommendations concerning the treatment of OSA in September 2013?

The ACP's new recommendations say that CPAP should be the first line of treatment for all OSA patients, and overweight and obese OSA patients should also be encouraged to lose weight as well as be started on CPAP. Deep in the recommendations there is a long discussion about weight loss and whether it can be effective at managing OSA (It can be for some, but not all obese OSA patients.) But in that discussion the authors also noted that the amount of weight that needs to be lost is usually significant and that keeping the weight off usually requires continuing on a pretty low calorie diet more or less permanently.

You can find the meta-study that includes the new recommendations at http://annals.org/article.aspx?articleid=1742606

It states no benefit from CPAP usage for individuals with my levels

No increased mortality rates either

One thing that is noted in the new recommendations is that there are no studies at all that look CPAP use for more than 24 months, and hence there is simply NO data at all that says anything at all about whether genuine long term CPAP use can be demonstrated to reduce long term mortality rates in any OSA patient. Out of the numerous CPAP studies the authors went through and studied, almost all of them were limited to considering what happened to the OSA patients during the first three months (or less) of CPAP use. A handful looked at what happened after six to twelve months of CPAP use, and one looked at results after 24 months of CPAPing. No study looked at the affects of CPAP use for a period of time any longer than 24 months.

And CPAP is intended as a very long term (permanent) therapy for treating OSA in the same way that insulin is intended as a very long term (permanent) therapy for treating Type I diabetes. So there just isn't any data out there that even looks at very long term mortality rates and whether long term use of CPAP will reduce them.

To be clear: Because no study has considered more than 24 months of CPAP use, the the very long term data simply do not exist: With today's (lack of long term) data, you can't prove anything either way about whether using CPAP for the long haul will reduce the probability of your dying of congestive heart failure or a stroke in 10 or 15 years down the line.

robysue wrote:

Day_Dreamer wrote:I found this regarding the treatment of Mild to moderate Sleep apnea

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564770/

You are aware this paper is seven years old? And its conclusions represent the opinion of just the author, and not the wider medical community?

And you are also aware that the American College of Physicians (ACP) released new recommendations concerning the treatment of OSA in September 2013?

The ACP's new recommendations say that CPAP should be the first line of treatment for all OSA patients, and overweight and obese OSA patients should also be encouraged to lose weight as well as be started on CPAP. Deep in the recommendations there is a long discussion about weight loss and whether it can be effective at managing OSA (It can be for some, but not all obese OSA patients.) But in that discussion the authors also noted that the amount of weight that needs to be lost is usually significant and that keeping the weight off usually requires continuing on a pretty low calorie diet more or less permanently.

You can find the meta-study that includes the new recommendations at http://annals.org/article.aspx?articleid=1742606

It states no benefit from CPAP usage for individuals with my levels

No increased mortality rates either

One thing that is noted in the new recommendations is that there are no studies at all that look CPAP use for more than 24 months, and hence there is simply NO data at all that says anything at all about whether genuine long term CPAP use can be demonstrated to reduce long term mortality rates in any OSA patient. Out of the numerous CPAP studies the authors went through and studied, almost all of them were limited to considering what happened to the OSA patients during the first three months (or less) of CPAP use. A handful looked at what happened after six to twelve months of CPAP use, and one looked at results after 24 months of CPAPing. No study looked at the affects of CPAP use for a period of time any longer than 24 months.

And CPAP is intended as a very long term (permanent) therapy for treating OSA in the same way that insulin is intended as a very long term (permanent) therapy for treating Type I diabetes. So there just isn't any data out there that even looks at very long term mortality rates and whether long term use of CPAP will reduce them.

To be clear: Because no study has considered more than 24 months of CPAP use, the the very long term data simply do not exist: With today's (lack of long term) data, you can't prove anything either way about whether using CPAP for the long haul will reduce the probability of your dying of congestive heart failure or a stroke in 10 or 15 years down the line.[/quote

Thanks for the help. I'll read this when I get home. I could not find anything more recent
Thanks again

btm1 wrote:Has anyone pointed out that there are two different causes or types of sleep apnea? One is obstructive sleep apnea, in which some floppy part of your mouth/throat intermittently blocks the air passage. The other, rarer, is neurological, in which your brain or nervous system occasionally stops sending the signal to breathe. Weight has nothing to do with the neurological type.

For many of us with plain old OSA, weight has nothing to do with it either: We were diagnosed while weighing an appropriate amount for our height and body structure and we've maintained that weight even after diagnosis.

For some people, the untreated OSA came first, and the weight came later. For these folks, losing the weight won't make much of a difference in the untreated OSA, but it may change the pressure needed to splint the airway open.

And for a few people, the weight came first and the OSA developed after there was too much fatty tissue pressing against the airway. And if these people manage to lose enough weight and keep the weight off long term, then they may very well be lucky and find out that the OSA disappears along with the weight. But the key is keeping the weight off, and studies show that most folks who lose a lot of weight fail to keep it off for several years to several decades.

My humble guess is that the failure rate for eliminating OSA through long term weight management is at least as great as the failure rate for newbie CPAPers making it to long term compliant CPAPers.

Day_Dreamer wrote:I found this regarding the treatment of Mild to moderate Sleep apnea

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564770/

It states no benefit from CPAP usage for individuals with my levels

No increased mortality rates either

"In summary, the benefits of CPAP compared to usual care with respect to daytime sleepiness, symptoms, cardiovascular risk, quality of life and mortality are minimal or nonexistent in patients with mild obstructive sleep apnea and the adherence to PAP at three months appears inadequate."

"I conclude that first line treatment of mild obstructive sleep apnea should be medical. CPAP and other modalities such as a dental appliance or surgery should be reserved for failed treatment in highly selected cases."

As discussed in my last post, if your numbers are accurate you technically don't meet the criteria for OSA at all, even as a mild case... technically OSA is AHI > 5 and/or O2 < 90%. What you are actually trying to treat is poor sleep quality rather than true OSA, and the primary suspect is Respiratory Effort Related Arousals. For you, the hope is that CPAP will help you breathe easier, easier breathing will reduce Respiratory Effort Related Arousal, reduced RERA will enable you to get less fragmented and more restful sleep, and that in turn will help with your BP, frequent waking up, and morning headaches. This is a plausible scenario, but not nearly as straightforward as a typical OSA case. The only way you are going to know if this will help you is to establish a treatment that is effective at reducing your RDI, maintain that for several months, and then evaluate the effectiveness after you have had a chance for your body to adapt and heal.

Because this isn't a typical OSA case, I would think the exercise and reduced alcohol, anxiety medications, and sleeping pills are all potentially significant players in the outcome along with the CPAP treatment, but it will take much more than a few weeks before you know where this is all going to end up.

I've read this entire thread & my take on this is that you need another sleep Dr. One who will look at all aspects of this, read your data from your machine after at least a month of use. You don't meet the usual criteria for CPAP, but the original Dr. had some reason for trying this therapy, so I'd want another opinion, from a totally different Dr., one who is in no way associated with the first Dr.

You might be one of the really lucky few who gets to stop CPAP. Take that from me with a grain of salt. Usually CPAP is for life, but sounds to me like you may have been prescribed CPAP incorrectly in the first place. Maybe you could scan, cut & paste a copy of your report here, we could all glean more from the actual report.

I've been on CPAP 14 years & for me it is for life, I was diagnosed with severe OSA. My hubby has been on for just over a year & he will be a lifer as well. He lost weight prior to going on CPAP therapy and was diagnosed with mild OSA.

Post that report if you can, I'd really like to see it, that would perhaps give some of us a better picture of what your Dr. was thinking.

I've lost 48lbs. My blood pressure has gone from 158/108 to 117/77. Resting pulse 98 to 43. I started at 48AHI now under 1.0 sometimes 0.0 but I think that may
be a glitch. I turned down my pressure from 12 to 8 and my AHI shot up to 42, so I look at CPAP like eyeglasses I doubt you can ever go without it. Sure I'm going
to titrate as low as I can slowly. If I don't hit a wall maybe you can "cure" apnea. I really doubt it though.

It's important to remember that reading your stats of just 1-2 nights WITHOUT Cpap, after using it for a relatively long (at least months) time may look good - give you numbers close to what you've been used to seeing, that within a week or two, depending on your partic. variables, you could be right back in the soup, so along with overnight oximetry and data, as well as realizing you may not be so alert - it can be quite insidious (not necessarily talking about you Day Dreamer), it's important to get a new study before thinking you no longer need a machine.