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Is this possible?
I have now been on a cpap machine 15 months and during that time I have lost 100 pounds. I am now getting ready to have another sleep test to see if I can get off the machine but it seems like I am struggling to breathe whenever I lay down without the mask. I just want to see how it feels.
So my question is, is it possible that my throat muscles have become to weak to hold my throat open in a supine position because of the fact that the CPAP held it open for 15 months. In other words the throat muscles had nothing to do so they became weak from lack of use.
Sorry if this is a stupid question, and Hello to everyone.
Views: 50
Replies to This Discussion
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Permalink Reply by Mary Z on
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There are no stupid questions, Joe. Unfortunately I don't know the answer and wait with you for some wisdom from other forum members. It does seem as though those muscles and your tongue have plenty to do during the daytime. Your apnea may have not been caused by excess weight. I was skinny when diagnosed, though have sense gained weight and my apnea has worsened. Good Luck with the sleep study.
Congratulations on that great weight loss.
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Permalink Reply by Mike on
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Tremendous question. I know there haven't been any studies on this but I am sure the answer is "yes." use it or lose it is a rule that seems to hold true for muscles throughout the body. Why would the muscles in the airway be any different.
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Permalink Reply by RockRpsgt on
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I am no MD, but I would say no. Using CPAP actually strengthens your airway and has a residual effect. Every case is unique. I have seen many people get so used to having the machine that they have trouble not having it. One person recently quoted his therapy as an addiction. Any learned action can and will become a habit.
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Permalink Reply by Joe Jones on
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Is there a study out there that I can read that proves using CPAP actually strengthens your airways. It seems so odd to me that I want to know how that works. Thanks
RockHinkleRPSGT said:I am no MD, but I would say no. Using CPAP actually strengthens your airway and has a residual effect. Every case is unique. I have seen many people get so used to having the machine that they have trouble not having it. One person recently quoted his therapy as an addiction. Any learned action can and will become a habit.
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Joe, I'm a layperson, so if you don't think much of what someone without letters after their name has to say, tune out now. That caveat said, I respectfully disagree with Rock's statement that CPAP actually strengthens one's airways. My understanding of the scientific literature (as conveyed to me in prior conversations with a leading Sleep MD -- Dr. David Rapoport) is that the residual positive effects of CPAP are minimal to zero.... i.e., you need to use CPAP every time you sleep -- the fact that you had been using CPAP does not give you any "runway" for smooth sailing without it. does that make sense? in fact, i personally think it's quite the opposite: the more you use CPAP, the more "lazy" your airway gets, and the more important it is to stay on CPAP. I back that up with anecdotal evidence from my own experience: i never got morning headaches before being diagnosed with OSA and using a CPAP. now, if i don't use it even for a little nap, I get a pretty big headache. does that mean don't use CPAP? Of course not. Does that mean use CPAP every night: Clearly Yes.
Joe Jones said:Is there a study out there that I can read that proves using CPAP actually strengthens your airways. It seems so odd to me that I want to know how that works. Thanks
RockHinkleRPSGT said:I am no MD, but I would say no. Using CPAP actually strengthens your airway and has a residual effect. Every case is unique. I have seen many people get so used to having the machine that they have trouble not having it. One person recently quoted his therapy as an addiction. Any learned action can and will become a habit.
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Thanks Mike, I think I have figured out what the problem is and the answer means I need to visit an ENT guy before I go any further. However I did needed the suggestions from you guys to help me see what was bassically right in front of my face. So I have cancelled the Sleep test for now and I am going to go in that direction. Thanks everyone.
Mike said:Joe, I'm a layperson, so if you don't think much of what someone without letters after their name has to say, tune out now. That caveat said, I respectfully disagree with Rock's statement that CPAP actually strengthens one's airways. My understanding of the scientific literature (as conveyed to me in prior conversations with a leading Sleep MD -- Dr. David Rapoport) is that the residual positive effects of CPAP are minimal to zero.... i.e., you need to use CPAP every time you sleep -- the fact that you had been using CPAP does not give you any "runway" for smooth sailing without it. does that make sense? in fact, i personally think it's quite the opposite: the more you use CPAP, the more "lazy" your airway gets, and the more important it is to stay on CPAP. I back that up with anecdotal evidence from my own experience: i never got morning headaches before being diagnosed with OSA and using a CPAP. now, if i don't use it even for a little nap, I get a pretty big headache. does that mean don't use CPAP? Of course not. Does that mean use CPAP every night: Clearly Yes.
Joe Jones said:Is there a study out there that I can read that proves using CPAP actually strengthens your airways. It seems so odd to me that I want to know how that works. Thanks
RockHinkleRPSGT said:I am no MD, but I would say no. Using CPAP actually strengthens your airway and has a residual effect. Every case is unique. I have seen many people get so used to having the machine that they have trouble not having it. One person recently quoted his therapy as an addiction. Any learned action can and will become a habit.
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Well I can't find the studies at this moment. I will though. You should always use you PAP device. It is not as much about strenthening muscles as it is muscle memory. The residual effects may be minute but they are there.
If you are having breathing problems when you are sleeping than that is one thing. If you are having breathing problems while you are awake then that is a different problem.
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What do you think the problem is?
Joe Jones said:Thanks Mike, I think I have figured out what the problem is and the answer means I need to visit an ENT guy before I go any further. However I did needed the suggestions from you guys to help me see what was bassically right in front of my face. So I have cancelled the Sleep test for now and I am going to go in that direction. Thanks everyone.
Mike said:Joe, I'm a layperson, so if you don't think much of what someone without letters after their name has to say, tune out now. That caveat said, I respectfully disagree with Rock's statement that CPAP actually strengthens one's airways. My understanding of the scientific literature (as conveyed to me in prior conversations with a leading Sleep MD -- Dr. David Rapoport) is that the residual positive effects of CPAP are minimal to zero.... i.e., you need to use CPAP every time you sleep -- the fact that you had been using CPAP does not give you any "runway" for smooth sailing without it. does that make sense? in fact, i personally think it's quite the opposite: the more you use CPAP, the more "lazy" your airway gets, and the more important it is to stay on CPAP. I back that up with anecdotal evidence from my own experience: i never got morning headaches before being diagnosed with OSA and using a CPAP. now, if i don't use it even for a little nap, I get a pretty big headache. does that mean don't use CPAP? Of course not. Does that mean use CPAP every night: Clearly Yes.
Joe Jones said:Is there a study out there that I can read that proves using CPAP actually strengthens your airways. It seems so odd to me that I want to know how that works. Thanks
RockHinkleRPSGT said:I am no MD, but I would say no. Using CPAP actually strengthens your airway and has a residual effect. Every case is unique. I have seen many people get so used to having the machine that they have trouble not having it. One person recently quoted his therapy as an addiction. Any learned action can and will become a habit.
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Permalink Reply by D. W. Conn on
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When education our patietns we explain that weightloss and /or weight gain can increase the risk of sleep apnea.
The short answer is yes after weightloss you can have OSA. Think of the tissue around your mid-sectioin. with weightloss there can be sag. The same maybe true for the throat area.
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Permalink Reply by Banyon on
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Joe Jones said, "So my question is, is it possible that my throat muscles have become to weak to hold my throat open in a supine position because of the fact that the CPAP held it open for 15 months. In other words the throat muscles had nothing to do so they became weak from lack of use."
Everyone's tongue and soft palate muscles relax for much of the night. So no, they have not been missing nightly workouts in the gymn while CPAP was working. :)
I also don't believe there is any carryover improvement in muscle tone provided by the use of CPAP. I have never seen a study that showed that and intuitively can't think of a reason to believe it.
If I ever find out otherwise, I will buy fans and aim them at my biceps, pecs and abs while I sleep. :)
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I am going to mark the time and date for this one. :^)
Thanks jnk I could not find it for some reason.
j n k said:The residual effect of pressure in the airway is documented enough to be considered more than just probable, in my opinion, even if the exact mechanism of that phenomenon isn't locked down:
http://www.ersj.org.uk/cgi/reprint/10/5/973.pdf
Some labs ask patients to go off nCPAP for a few night before a follow-up diagnostic NPSG for that reason, I understand.
Thing is, airway patency is about much more than muscle tone. It is about nervous system interactions and sensitivities that are affected by, for example, edema (tissue swelling) and other related issues. According to some, once the syndrome is fully triggered and exists for years untreated, the sensitivity of the airway and the nervous-system response are forever effected in a way that cannot, with present medical knowledge anyway, be healed. It isn't simply a matter of the muscles becoming too weak, though. It is more a matter of the entire system not responding correctly.
Similarly, the residual effect, in my opinion, is not likely about mere muscle strength or tone either. When the airway has been splinted open during sleep for a long time, the body/brain has had no reason to actively ignore (in a sense) the messages from the airway for purposes of preserving sleep architecture. So in that sense, the airway may regain some sensitivity (in a good way) for a while if the person goes without nCPAP a few nights. [Dangerous move for someone with severe apnea, by the way.] But once the body/brain recognizes the pattern of what is happening again, it has to go back to ignoring the airway in its (flawed) attempt to opimize its own sleep. That is one of many unproved theories, anyway. One that makes sense to me.
Bottom line, as has been said, is for someone with moderate-to-severe apnea syndrome to use the machine for ALL sleeping, and not to imagine that losing weight will automatically cure moderate-to-severe sleep apnea. For some, it could be that not having gained the weight in the first place might have prevented the triggering of the syndrome. But once it is triggered, for most it remains triggered. That doesn't mean losing weight is a waste of time and energy, though. It may be absoluttly lifesaving on many levels and may reduce the adverse effects of the condition under discussion and improve a person's health in many untold ways profoundly. But losing weight is unlikely to change the body's already ingrained behavior it has developed for breathing during sleep, or to correct all of the factors that led to it.
So don't worry about gaining muscle and losing muscle in the throat. Lose weight, use the machine, be healthy, and get tested again if you gain a lot of weight or lose a lot of weight, especially if you don't have nightly data from your machine to tell you and your medical team what is going on with you breathing at night.
Be healthy. Sleep well. Breathe well. Stay alive. Enjoy life.
-jeff
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Regardless if the muscles weaken or strengthen, the fact that you lost 100 pounds may be significant to you. At the sleep center I am associated with, someone in your situation would come back into the lab for a sleep study to evaluate your status. We call it a baseline study. You would go to bed with out your PAP. We would evaluate your index at a predetermined time, usually about 2 hours of recorded sleep. If your index was greater than 5 after the predetermined time, you would be retitrated. That way your pressure would be adjusted to your current needs. In the event that your index was less than 5 at the predetermined time you would be allowed to continue to sleep without your PAP. When the study was scored, if your index for the night was greater than 5, you would be invited back for a retitration. If less than 5 for the night, you would discuss the situation with the doc and come to an agreement as to use/discontunuation and followup. Granted, there might be an extra study for those whose index was less than 5 at the predetermined time and greater than 5 for the entire night, but overall, people are getting checked that have a significant change in their status and their pressures adjusted accordingly.
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