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Can someone build up a CPAP "Tolerance" like the tolerance that someone builds up to alcohol, nicotine -- so that it takes more and more of the thing to get the desired effect? I only ask because Carla mentioned something in another thread that caught my eye:

"My understanding is that CPAP can fail, eventually, as well. I know several folks who use it and they continually need their pressure raised. My brother in law is at the highest setting and although he had initial success years ago with the CPAP, he feels he is back to square one."

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This will be a good question for the gurus around here. I wouldn't think your pressure needs would increase unless other factors are present -- but hey what do I know?
Actually, I think of it more as a case of the OSA worsening. Weight gain, for example, can make your apnea worse, and thus cause you to require re-titration, and possible increase in pressure. You should be checked regularly as your health condition changes.
I was diagnosed at the age of 56. Once educated on the symptoms of sleep apnea, I recognized that it was already present when I was in my twenties. I am sure over the years it gradually became more severe. I can also imagine that the CPAP pressure requirement became higher over the years.

It would be interesting to compare the brother-in-law's weight now with years back when the pressure was lower.

But OSA is not just about flabby throat tissues. Usually there is also a weakening of the nerve signal that causes the airway muscles to flex open.

As an aside, I am the same weight today at the age of 60 as when I graduated from high school. BMI is about 23.

If you have a machine that you can put in "auto" mode - give yourself a higher pressure range. Download your smart card and see what your average 90% pressure reading is . . . . if it at or lower than your treatment pressure - you have your answer.
My experience after 3 years is that the pressure has been the same and I really feel the benefit. How long has your in law used the machine and approximately when, he needed to change the setting?
interesting. my wife has told me sometimes with my mask on i still stop breathing and then " MAKE NOISE". My Cpap adjust automatically , it has been Even til the last several weeks,my lifestyle has not changed, noise level has. Cpap has changed(increased pressure) also to QUIET ME. in my limited time w/ c-pap (1 1/4 yr) i went from total silence at sleep time to waking my wife once again from time to time. if you change i would suggest getting a machine that will change with you like the one I have.
I haven't encountered "tolerance" in the literature or in practice. Overwhelmingly most, but certainly not all, OSA is related to obesity or advancing age. I see pressures rise w/ weight gain & drop w/ weight loss. Meds and comorbidities can also contribute to increased pressure needs.
I have only seen CPAP pressures vary in my family and friends due to weight changes -- gains mean more pressure, and losses meant less.

If there was a disease of the nerves (i.e. diabetes or Parkinsons') perhaps there'd be a change as the years and the disease progresses; my opinion only.

My husband has just read over my shoulder and stated that his pressure had to be increased despite weight loss, but I pointed out that he went from a CPAP to a BPAP, then back to a CPAP due to insurance coverage changes...which meant that his apnea was not efficiantly treated! Then with new coverage he just went back two days ago for a 24-hr. sleep study -- he is still waiting for the test results. Combined with his bad allergies and apnea, I think they'll again give him a BPAP. We'll see what pressure or other stuff is recommended.

Thanks for the good question and discussions!
The answer is "No." Tolerance refers to the diminution of the body's response to a drug after continued use. The best examples are alcohol, nicotine and pain killers. The problem with CPAP is that the machine has a set air pressure measured in centimeters of H2O and does not change unless you return for a repeat PSG and undergo a "titration" in order to determine the appropriate current pressure.

The upper airway is not a static passageway, but a dynamic opening made of muscles, mucous membranes, nerves, blood vessels (and fat pads beneath the side walls) that are subject to change, causing the opening to vary in size. Weight gain or loss has a major influence on the size of the vertical slit-like opening. Age alone has a considerable influence because tissues tend to sag or become more flabby. Colds, flu, allergies can change the dynamics of the airway. Acid reflux can play a role. Even body position or head and neck position can change the amount of air pressure required to maintain an open airway. For this reason a person can get caught in what I call the "CPAP trap", meaning that the pressure set in your machine is no longer maintaining an open airway, but you don't know it and neither does your doctor until you return to the sleep lab for a repeat PSA and "re-titration" to establish your current pressure needs. All the while you are mounting up the apneas at your peril.

Having to go back to the sleep lab every three to six months is very good for the sleep lab, but very bad for the patient. A better option is an APAP or auto-titrating PAP machine.(Some with congestive heart failure and chronic obstructive pulmonary disease may have to stick with CPAP). The computer chip is programmed to adjust the pressure with each and every breath. It's like having an in-lab titration , but in this case it's with each breath you take. And you don't have to go back the the $leep lab every three to $ix months for titration$.
It took me a while to understand that the machine adapts to my behavior. It comes on at a high pressure and then will decrease to match my breathing. When I first got the machine I did not know this and simply was trying to match it which caused me to hyperventilate. Once I learned to make it slow down I was a much happier camper.

I think the answer to your question is then yes for at least lowering the pressure. It may be true for raising the pressure too. But it may not be only the maximum pressure that needs to be adjusted but also the amount that it will reduce because of the users patterns of behavior.
THANK YOU, Dr Jones!!! I've advocated since starting CPAP in Oct 2006 that patients should be provided AT THE VERY LEAST w/a fully data capable CPAP. For some the constant pressure changes of APAP can be disconcerting and they sleep better w/straight CPAP which is another WONDERFUL feature of APAPs - they can be run in straight CPAP mode as well.

I insisted that any device I was provided w/be fully data capable and was started on a Resmed S8 Elite w/EPR. I have COPD and didn't sleep for beans during my titration study, two pressure changes by guess and by gosh and a loaner autoPAP brought another pressure change, so it didn't take me long, when my sleep doctor wouldn't re-write my script for an APAP, to purchase a Resmed S8 AutoSet Vantage out of pocket. When 17 months later I was re-titrated w/a bi-level and switched to a bi-level I INSISTED on the new Resmed VPAP Auto. By this time I had gotten thru to the sleep doctor AND my local DME supplier that I WOULD be provided w/the bi-level "I" wanted.
My weight fluctuates a lot over time, and i certainly don't feel much benefit from my untitrated CPAP treatment. I cannot afford a new study. Is there any way for me to get an Auotmated CPAP machine? No insurance (i am an American, after all) part time job that doesn't keep all the bills paid. I can tell my machine helps, because i cannot sleep for even 10 minutes without it. I am alone, so i can't tell from noise factors.

Shouldn't APAP machines be the standard? Why would anyone want their titration locked off at some rate that was helpful one night, long ago?

When i first got my machine (November 1999) i had that wonderful "REM Rebound" where i felt like a buh-Zillion dollars for about two weeks. Maybe an APAP machine could help me to feel like 20 US dollars, once in a great while??

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