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Re: Long term CPAP make you addicted?

Posted by SGS on November 26, 2002 at 12:41:27:

In Reply to: Re: Long term CPAP make you addicted? posted by Phil Stocker on November 26, 2002 at 11:30:12:

Hi Phil

Couple of points I'd like to make in this discussion.

1. CPAP is not addictive in the way that say Sleeping tablets are addictive. There is no chemical interaction between a person and their CPAP machine (although their are chemical interactions changed by the action of CPAP). I think it may be psychologically addictive in an entirely beneficial way. For the CPAP success story people we love to hear from on this forum CPAP affords them the best night's sleep they can remember and changes their lives. They might be extremely uneasy about sleeping without CPAP because they don't want to go back to feeling grotty all the time.

2. Changing CPAP pressure. In carefully prepared studies they have found that CPAP pressure can often be adjusted DOWNWARD after some time. The reason for this, as I understand it, is that the action of snoring plus the apnoea/hypopnoea cycle induces swelling of the soft tissure in the airway (this may be vibration induced edema???). Once CPAP has been working for some time this swelling goes down reducing the pressure need.

4. Why would somebody need a pressure increase? Weight gain is a big one. Change in the responsiveness of the brain to the occluded airway MIGHT be another (highly speculative). People have noticed the latest edition of the American Journal of Respiratory and Critical Care Medicine (AJRCCM) after the news agencies picked up the story. Chicken and egg arguements about whether apnoea changes the brain or the brain causes apnoea. Both probably. Remember the airway doesn't collapse during wake in people with OSA, only during sleep- The brain has to have something to do with this.
- the other reason pressure may be too low is that polysom is only a one night sample of the pressure you need, perhaps that particular night it was 2cm lower than the night sampled 1 year later.

3. OSA is not only found in people with weight problems. It's just that the clinical stereotype for a person with OSA is somebody who is overweight and somnolent. Non-Sleep doctors are more likely to refer somebody who is an overweight middle aged male for a sleep study than a 25 year old standard weight female. Hence it is these people you tend to see more often in clinical practice. The brain plays part of the role in the collapse of the upper airway as does the the shape of the airway and any abnormalities in it. Weight gain will probably make OSA worse for most people.

4. Doctors don't prescribe exercise and diet because they basically get ignored by the patients- hence telling people to go away and lose weight is an ineffective treatment. It's also because their is increasing demand (especially in american health but increasingly everywhere else to) that the doctor DO SOMETHING. Hence the rise and rise of direct to consumer advertising in the USA and NZ.

5. Diabetes and OSA. The obesity epidemic continues to grow. What doesn't seem to be understood is that their is a strong connection between Diabetes and OSA. I don't understand this bit well yet but it seems that Diabetes (and/or the metabolic syndrome) OSA and Obesity are involved in a nasty biochemical feedback loop. This may be a very good reason why so many report weight loss after going on CPAP. CPAP may somehow reduce some of the problems of Diabetes (this is probably also highly speculative).

6. I agree sometimes CPAP can't be tolerated. We all want to find a better way of treating OSA. But it is still the best treatment available. Some people love it, some utterly detest it. I can empathise with this. There has to be a better way.

7. A lot of the compliants people express here are symtoms of the American Health care system. They aren't really problems in Sleep medicine anywhere else. i guess citizens have to start electing people who actually want a health care system that is affordable and efficient. (sorry just my own political rant).

Have a nice day everybody!

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