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Mike,
Pressure is not something that patients develop tolerance to like medications, such as narcotics. Nonetheless, there are many variables that affect the tone of the airway. Weight for sure is a biggie! Then there is age. With age EVERYTHING will sag a bit more and in patients with sleep apnea, age alone can affect their condition. Alcohol is also a big no, no for patients with OSA as that substance can also affect airway tone. In some cases, for whatever the reason, if patients reach a point where simply positive pressure does not resolve their problems, then a tracheostomy can become a last ditch effort. With a tracheostomy there is no longer a physical obstruction of the airway but with excessive weight still on the body, the body has to work harder to breathe just to move all the tissue on their chest and abdomen. The bigger you are the harder it is to breathe on your back or any recumbant position.
B. Robles MD
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