CPAP Dependence

I don't doubt that CPAP is beneficial for short term sleep and daytime benefits and the evidence seems irrefutable that it helps prevent or delay long term illnesses associated with apnea so what is my problem? (Be nice now)

All of the research seems designed to sell the benefits of CPAP or just the usual research into research or research into the methods employed by other researchers etc.

Some research compares different treatments like CPAP and dentistry (which is a clear winner in the moderate range) but there appears to be no research into the impact of assisted breathing on each aspect and function of the airways and lungs if the treatment is discontinued. (for obvious reasons)

It seems that the whole dependence issue is ignored because the therapy is viewed as perpetual and inescapable so why would it matter but this isn't necessarily true of those suffering from moderate apnea.

What I would like to know is what outcomes would be achieved if you took 100 subjects with OSA between 5 and 15 and treated half of them with CPAP for 6 months (while the other half had no treatment) then took their machines away and waited a few weeks before running all the tests again. Would the CPAP group be better or worse than the non CPAP group in OSA events and lung function?

I would also like to see more emphasis on how to prevent or significantly delay the transition to therapy and some more sensible approaches to the assessment and treatment of moderate apnea.

Ideally this would involve education and public awareness campaigns related to apnea and fitness as well as alternate or multi staged treatment methods.

Be careful what you ask for!

Physiological consequences of CPAP therapy withdrawal in patients with obstructive sleep apnoea

"In conclusion, the findings from the CPAP withdrawal RCTs have provided robust evidence for increased sympathetic activity in OSA associated with a considerable blood pressure increase, relevant cerebral hypoxia, and disturbed cardiac repolarisation. Furthermore, the blood pressure lowering effect of CPAP was further proven. Additionally, the findings of these trials have challenged previous hypotheses on the role of intermittent hypoxia in oxidative stress and vascular inflammation, and have suggested a so far unconfirmed mechanism of hypoxic preconditioning in OSA."

My layman translation: CPAP works, has benefits, and those benefits are reversed when you discontinue use.

As an Australian, you might find this article interesting. If nothing else it may be a sure fire way to treat insomnia, as it is 64 pages long. It is about the history of ResMed, and Colin Sullivan who I believe are credited with inventing CPAP therapy. The journey started not that long ago in 1981 with the use of a vacuum cleaner motor and fan to supply pressure for OSA treatment. What is surprising about it is that much of the effort was not in the technical development of the product, but in getting acceptance that OSA was a legitimate problem and could be treated. They also spent a lot of time in court fighting over patents. I believe if I recall correctly that Respironics (now owned by Phillips and use the DreamStation brand name) actually beat them to the market, and at one point they were very close to merging.

Perhaps their biggest issue was in convincing medical professionals of the time that CPAP worked and OSA was worth treating. I think you are basically questioning the same thing. I would be easy to say it is a big conspiracy as the demand for the product was created by the inventor of the product. It started our as the solution in search of a problem.

Origins of ResMed

You bring up the dental appliance solution. The basic issue with it is cost. If done right, it is not inexpensive. My preliminary research on it in Canada put it in the range of $3000-4000. Kind of high compared to a CPAP system at about $850. I think where a dental appliance solution comes into its own is when low pressure causes excessive central apnea. It should provide a unique way of correcting lower levels of OSA without increasing CSA -- because it uses no pressure.

I am a dentist working in dental sleep medicine. I work in the USA, so that I am not familiar with market pricing in Canada, but, on the face of it, your pricing seems high. I am actually going to cite the prices that I charge every day. In all fairness, I think I am on the low side, but in the ballpark. Most likely, the prices others may charge in the USA may be $500-$800 more than mine, but nowhere near what you are talking about. I charge $1,450 for a Tap3 or a DreamTap. I charge $1,650 for a Prosomnus IA or CA. My most expensive is $1,750 for a Luco Hybrid. I can do an in office MyTap for as little as $650. This is a legitimate OSA appliance, although, admittedly, rather light duty. My sense of it is that pricing for OA's WAS much higher maybe ten years ago when very few dentists did them, but increased market competition has steadily driven the prices down to where they are now very competitive with CPAP, especially since you do not have the recurring bills for CPAP consumables. Arthur B. Luisi, Jr., D.M.D., The Naples Center For Dental Sleep Medicine.

I agree Gremlin, current research is slow and not always in areas we need. One thing I have found out--research takes money. The people who make CPAP machines and appliances seem to have the money to afford research. Which is good as we benefit from better technology. The bad part is that research like the one you described is seldom funded. Sucks, doesn't it? That's why it is important to have the patient voice heard so all in the sleep field know what we need. Will we get it? Maybe. But the squeaky wheel sometimes does get the grease.

It seems that more and more research is being done on the approach to treating apnea. Here is an example of a technology which does an auto titration test of a MAD device similar to a home sleep test.

MATRx plus

And for a deeper dive into the technology:

A Feedback-Controlled Mandibular Positioner

Sounds interesting, but the overnight test itself does not look all that comfortable of an affair with that thing and motor sticking out of your mouth!

This is not necessarily positive or constructive and it does not address the specifications that I raised above but it is of concern to all of us.

CPAP Doesn't Cut Risks

This research flies in the face of most other conclusions so there is cause for skepticism or at least caution.

The aspects that concern me the most are the number of events within a relatively short period and the disparity in expected outcomes.

Some good points Sierra but you cannot dismiss it so lightly.

Your approach might be justified if it had been a more limited experiment or merely delivered a diminished outcome but it was on a massive scale and the outcome was less than zero and it is not the only research that has shown these results.

By normal reckoning any hours of therapy on such a scale should have shown a benefit.

It doesn't effect the outcome and the lessons we need to learn if the condition was preexisting or not as long as both groups were the same.

Most of the people who visit this forum would have qualified for this study, depending on what definition they used for CVD.

You and I might use cpap 8 hours a night 100% of the nights but when the definition for full compliance is 4 hours per night 70% of the nights we are obviously not average users.

Perhaps I should have pasted this link instead of the one above because it explains the parameters more effectively

Treating Sleep Apnea Save Results

The real issue is that Apnea sufferers have been led to believe that CPAP will reduce the risk of cardiac events and in all likelihood that is simply not true.

We would need to eliminate the causes of apnea to get those benefits but cpap only eliminates some of the symptoms of apnea.

Don't get me started on climate change! CPAP adherence and use is another issue for me. From what I am learning lately, my Type II diabetes and my afib could have been caused by undiagnosed sleep apnea as well as weight gain. Maybe my hearing loss too? What about the wrinkles that seem to be multiplying daily? Although I am being facetious, it does make you wonder. Science and research have made great strides but it seems the more we learn the less we know. Have people had undiagnosed sleep apnea for years or is this something newer? Has it caused other health issues all along? I get confused about who to listen to, who to go to for good information and what is the best course for me. About the time I think I have it figured out, it all changes again.