CPAP the cornerstone of OSA treatment

[DrJim]

There is no better treatment for OSA than a properly adjusted and fitted PAP device.
CPAP maintains an open airway during sleep that mimics the open airway we experience when we are awake.
The use of CPAP NEVER weakens our breathing muscles with use, but enables easy breathing during light and deep sleep (REM- when only our diaphragm is working to breath).
There is no cut off or minimal RDI that is necessary for CPAP to be an effective treatment choice. In fact CPAP has been successfully used to treat patients with the Upper Airway Resistance Syndrome ( UARS)....a condition that features nonrestoraive sleep, excessive daytime sleepiness and no apneas or hypopneas, during a sleep study or polysomnogram!!
Certainly a sleepy patient with an RDI of under 20 events/hour can benefit from appropriate CPAP pressures that enable sleep without respiratory related arousals or an increased work of breathing while asleep..
Properly adjusted CPAP pressures do not become dangerous over time, if they continue to alleviate the upper airway obstructions, prevent arousals and any oxygen desaturations that occur in patients with untreated sleep apnea.

Chronic CPAP use will not result in any damage to anyone who uses it for the purpose of eliminating upper airway obstruction or increased upper airway resistance during sleep. Any reduction in normal breathing or increased effort to breath during sleep wil be alleviated with CPAP therapy night after night after night.. That will always be a GOOD thing forever.

Sweet Dreams!

[Tracy]

Thank you Dr. Jim for setting the record straight regarding not only the importance of cpap use but confirming most of our beliefs that there is no downside to long term cpap use.

As a 16 year "hosehead" I truly feel that my overall health has improved thanks to bipap use. As for being addicted to it, I can only say I am addicted to "feeling great" and waking refreshed!

Tracy

[Justme2]

Ten years on the pap and the only side effect I have experianced is being awake and alert most days. I know I would be dead if not for the pap.

[SleepyTexan01]

Although I have been diagnosed with IH, I believe I have Upper AirWay Resistance syndrome.

Tracy,
How long did it take for you to become comfortable wearing using cpap/bipap? I tried it for two weeks and I would always end f taking it off the bipap mask some time during the night. The incoming air would raise my pulse, thus making it difficult to go sleep. Did you use a ramp, to slowy raise the pressure? Does you nose ever become congested making it impossible to wear bipap? I Think I might try bipap again.

Dr. Jim,

Is there a method to determine the optimal pressure for bipap? I just had a lot of problems with my sleep technologist. I am going to see an ENT doctor to determine if there if I have any anotomical obstructions.

I'd appreciate any advice .

[Guest]

Assuming proper humidification, which means that between 1/4 to 3/4 of a distilled water filled heated humidifier container is used up each night of use, the presence of nasal stuffiness usually means that the pressure is too low for normal breathing.
This of course assumes that you are able to breath through your nose while awake, seated with you mouth closed for several minutes without any difficulty. If you are not able to do this, you may have significant intranasal obstruction that would make the use of a nasal interface very difficult if not impossible.

BiLevel devices can produce easy breathing through the nose during inhalation, but a stuffy nose during exhalation usually means that the minimum pressure is set too low.

[FloridaBums]

[rested gal]

Very good post, Floridabums. Understandable, given the timing of what has been going on recently in this thread:

Post subject: Had pillar today

You said:

[Tracy]

When I was dx in 1989 and delivered a cpap and mask, no one sat me down and explained how cpap worked, mask problems to watch for etc. "here's your equipment, see ya, goodbye"
I was a cpap failure for almost a year with the addition of oxygen because by sats were 50%. I had difficulty exhaling over the constant pressure of cpap (at that time set at only 7). The mask hurt my face, back then they were heavy and mostly hard plastic.
I also had UPPP, which upon recovery sent me back to the sleep lab to see if it "cured" and we discovered it made the apnea worse. Now I needed a pressure of 10.
I had a bad attitude that first year, a lot I think because of my ignorance about what apnea was, its dangers if left untreated and no instruction on how to use the equipment or what the equipment did.
It was not until my doctor said "trach or die" that I went for a second opinion and the nex doc confirmed the severity of my apnea and introduced me to BiLevel which was fairly new on the market. It was an instant success for me because it allowed for a relaxation upon delivery of exhalation pressure. I felt a remarkable difference within one week and almost complete benefit after 2 eeeks. I had a lot of sleep deprivation to make up for.
I think education is key and that is what these boards help with. I know not everyone will experience the same thing once the dx and treatment begins. I do think xpap will work for most people. Often the hard task is finding the right pressure and mask. It is important for us patients to understand apnea and how the equipment works. It helps to have a caring sleep doctor to work with us but I also believe we must become prepared patients to better help our docs help us. For most, apnea is for life.
I eventually worked my way up to a BiLevel pressure of 20-11 - I think due to the failed UPPP surgery.
I am now using an Autopap - but that's another story!

Tracy

[Tracy]

[Mr Mango]

We see the world through our own eyes and through the experience of life.

What Dr Jim has forgotten to mention was that it is his experience.

Resmed has indicated through their News Letter that compliance is still below 50%.

I do thnk that companies who make the machines Dr Jim is pleased with have a broader understanding of the difficulties of compliance of their products.

But we are all glad for you Dr Jim and hope that your relationship with postive pressure therapy remains good.

One thing Jim (if I may) ask. Therapy that you speak of seems to be more sustaining with those who comply with its treatment. Those who have dental treatment are in fact so much better as their sleep is not affected or intruded upon by positive pressure.

Positive pressure is an active process where the body is constantly resisting pressure. Absolutely cannot be refuted as that is how it works. Body tension is always there.

The body is not relaxed but constantly making adjustments. Unlike other OSA treatments where the body is free to relax.

Sometimes Jim our opinion can cut us from somethng that is better for us. Always keep your door open for a better way, for adaption is not always a succesful solution long term.

You dont have to convince us that you are better off but have you considered moving away from positive pressure to allow your body to relax fully.

Tracy and I hope you are the lady that had the banding done on your stomach.

How is it going. Its stepping up to be a treatment for OSA for some in Australia and to be done at no cost to help those with OSA. Just like to hear some OSA positive feedback about this treatment. I am sure Jim wont mind sharing the topic with you.

[Mr Mango]

Sorry Tracy I drifted off while reading your last reply and thought it was part of my thought. ( a narcolepsy symptom ) Great news about your health and bad luck about the apnea.

What is life like for you now socially.

[Mr Mango]

Just to be clear Dr Jim. OSA treatment is making some real changes and the opitiions beyond positive pressure are looking so much better.

This is fantastic news. Better health for more. I wasnt trying to burst your bubble or be critical of you but curious to your opinion.

Tracy. I would answer questions in class as if had this unbelieveable breakthrough when indeed it had been a collation of what others answers had been.

People with narcolepsy can hear what is being said when they are asleep.

Just making sure you dont think I am being smart with you.

[Less Sleepy]

My belief is that compliance with xPAP is so poor because of the impersonal, one-size-fits-all, save-all-the-dollars-you-can, ignorant care many patients get from sleep professionals. As I said in another post, if xPAP patients were properly fitted with equipment with the same care and attention currently given to patients receiving dental devices, xPAP compliance might approach the 80% we see with patients on dental devices.

[DrJim]

It is good to read all the responses and realize the large and diverse audience out there.
I do believe that CPAP is a cornerstone treatment for sleep related breathing disturbances, but there usually are 4 cornerstones so lets name them: CPAP, Upper airway surgery, oral appliances and changes in certain sleep hygiene measures that involve alcohol, benzo's, narcotic analgesics all of which can can lower the threshold or aggravate an already significant apnea condition.

Despite the Positive airway pressure derived from CPAP therapy, there is far more tension generated from attempting to breath against a narrow or closed upper airway.
None of these therapies are perfect, but each offers a way to breath more easily during sleep and that is the goal of OSA treatment.

I have thought about CPAP therapy and likened it to contact lenses---
----if you have the right fit (interface) and the wrong pressure you won't benefit from the treatment
----if you have the correct pressure and the wrong interface you'll hate wearing it and be non compliant.

Just like contact lenses you need to have BOTH the correct pressure prescription and best fit to work.

[HH]

I think Less Sleepy hit the spot - the poor efforts a lot of people get in started with xpap will lead to a low compliance level. Insurance companies are a big problem in this area as they want to deliver the cheapest "solution" possible. DMEs (especially the chains) want minimum wage employees whenever possible. Most doctors get hit from a hundred directions - reps wanting to show them the newest drug or machine, a mountain of pubs each month, etc. Small wonder that a lot of patients are left hanging.

I do agree with DrJim, though, in feeling that pap treatment is the foundation of addressing OSA. While there are options, from surgery, strips of plastic, dental options, etc. pap is the only one that addresses the full airway. My preference is the autopap for comfort and long time pressure adjustments, but I'm a pap supporter. I simply don't believe that there will be an option that will last the patient for a long term solution.