How do I know if I don't need CPAP anymore?

hello,

I've used CPAP since 2004 (currently Auto Adjust for the last couple of years) and recently had weight loss surgery. So I've lost almost 70 lbs now, and am down from a BMI of 42 to 33.

Originally, I was diagnosed with severe sleep apnea - somewhere around 45-50 apneas per hour as I recall, its kind of fuzzy now. My APAP range has been 11-18, and my CPAP prior has been set between 12-14 for years.

I've been beginning to feel like it was too much pressure, so I did an experiment last week and took the low end of my APAP range down to 6. I've been checking my stats (I have a devilbiss autoadjust intellipap) and my 95th percentile pressure has been running 6-6.5 most nights.

My questions -- should I keep lowering the bottom end of the range to see where I end up, or should I put it back where it should be and ask for a new sleep study?

Second, my ENT told me because i have a severely deviated septum, the apnea and snoring may remain. Any experience? The surgery sounds horribly painful, but if it would help me completely get rid of needing to use a CPAP, I would consider it.

Final question. I've faithfully used CPAP for 8 years, and I am almost wondering if I will be able to sleep without it now...if that makes any sense. Putting on the mask and the airflow is a major sleep cue for me. Anyone have to adjust to life WITHOUT CPAP? Odd question, I know. Since most newbies can't figure out how to adjust to life with it. I never really had many problems getting used to it.

Thanks in advance!

glassjules wrote:My questions -- should I keep lowering the bottom end of the range to see where I end up, or should I put it back where it should be and ask for a new sleep study?

I would have another sleep study. That is the only way to know if you still need CPAP.

Second, my ENT told me because i have a severely deviated septum, the apnea and snoring may remain. Any experience? The surgery sounds horribly painful, but if it would help me completely get rid of needing to use a CPAP, I would consider it.

You're still snoring? If you can have two sleep studies, you could have one before doing surgery and only consider it if you still have OSA or otherwise would benefit from having it.

Final question. I've faithfully used CPAP for 8 years, and I am almost wondering if I will be able to sleep without it now...if that makes any sense. Putting on the mask and the airflow is a major sleep cue for me. Anyone have to adjust to life WITHOUT CPAP? Odd question, I know. Since most newbies can't figure out how to adjust to life with it. I never really had many problems getting used to it.

*IF* you don't need it anymore, I have confidence you will adjust to life without it!

Hi - don't keep lowering the pressure - all that will happen is that you'll find it harder and harder to get any air to breathe.

The way to tell if you still have apnea is to have consistently almost no events at all as per results from a data capable Cpap machine over a relatively long time while also wearing an oximeter with an alarm on it, OR by having another sleep study...

Never assume that because things are going well, weight loss or not, that you can just quit... maybe you can, but don't guess at it - it doesn't happen that often at all.

I completely agree with SU.....get another sleep study

I called and setup a consult with the sleep doc. So that's all good -- its in two weeks, and they will decide then whether they want me to come in for a study or do a home study, she said.

So, though, my question is, if my pressure is running at 6-6.5 (as opposed to 12-14 where it used to stay while on an autoadjust with range set from 11-18) and I'm having no apneas according to the nightly data for the last two weeks, wouldn't that be an indicator that things are getting better, that its running at the bottom of the range and I'm not having apneas? If the top of my range is where its always been, could the machine not theoretically adjust up to where it needs to be (as an autoadjusting machine) to stop any apneas, in order to prevent myself from doing any harm to myself?

I have the wheels in motion on doing this through the proper channels, but the scientifically curious in me is wondering about how the auto adjust works and if I'm misunderstanding how it works...I would think that the idea of it is that it will adjust to the level it needs to in order to stop apneas, and if its running at the bottom of my range without any apneas, that perhaps I could try an experiment to keep lowering the bottom, it would still run at the level it needs to in order to prevent apneas? Or is there an issue if you make the range too wide, it won't adjust effectively?

Thanks, you guys are so smart!

Jump overboard, beware the water in DeNile is cold. Jim

After all the years he's still treading, amazing.

glassjules wrote:I would think that the idea of it is that it will adjust to the level it needs to in order to stop apneas, and if its running at the bottom of my range without any apneas, that perhaps I could try an experiment to keep lowering the bottom, it would still run at the level it needs to in order to prevent apneas? Or is there an issue if you make the range too wide, it won't adjust effectively?

It's true that if the range is too wide, it will tend to go to lower pressures. That said, I wouldn't expect you to have zero respiratory events and be running a 95th % pressure of 6, with a range of 6 to 18, if you still had significant obstructive apneas. But do you have data to see what your flow limitations are like? Personally, I have run 4cm of pressure just to collect data and see what comes of it. I don't think it's a substitute for a sleep study, though. It could be that your pressure needs have changed markedly, but that doesn't mean you need 0cm of pressure.

Goofproof wrote:Jump overboard, beware the water in DeNile is cold. Jim

After all the years he's still treading, amazing.

I don't know why people on CPAP have a tough time accepting that someone can be "cured" or that they'd want to find out if they are. The OP is going to follow proper channels to see if CPAP is still needed, so what's the problem here?

[quote="SleepingUgly"]I don't know why people on CPAP have a tough time accepting that someone can be "cured" or that they'd want to find out if they are. [quote]



I completely agree. I think after so many years on CPAP and significant weight loss, it would be a natural thing to think about.

Great on the weight loss. You're doing the right thing following up with a sleep study or at least seeing the doc.
I'll bet after a night or two you won't have any trouble sleeping without that mask.

see the doctor to see if you need a new study. remember the apap info is a one dimensional picture while the sleep study is a truer more accurate multi-dimensional picture.

don't get your hopes up about ever getting off the machine.

Granted, many of us understand there is a connection between obesity and apnea,
albeit not the convenient one to one, cause and effect relationship so prevalent among the lazy and ignorant.
It is not to hard to see the cause and effect seems to be more often the other way around--apnea leading to obesity, but this does not rule out
the possibility that the common belief may actually not be 100% erroneous.
How about that! If one person can be cured of apnea by losing weight, it still does not mean it will work for any other person.
Probably not. But if the OP's sleep study confirms no further need for CPAP, lucky, lucky,--and congratulations!!!

Glassjules,

I went to a class on sleep apnea/CPAP that was put on by my sleep doctor. The same question came up, namely, after loosing weight/having surgery can people with a history of sleep apnea stop using the CPAP machine?

The answer that he gave us was that as we age, our tissue in our throats/noses that caused the obstruction tends to get looser and sag. Surgery may temporarily fix the problem and allow us to stop CPAP for some years. We then may go back into sleep apnea due to the looser tissue, but if we're not using the CPAP machine with it's data, we might not pick up on the sleep apnea episodes until it's too late and cardiac/brain/immune stress damage has taken place. As we age we are potentially more fragile, so not a good scenario to potentially go back into untreated sleep apnea as we age. Perhaps if you kept your machine and slept with it for a few nights each month to get some data on how many episodes you may be having?

I wish you the best of luck, Happy Sleeper

I'm not holding any illusions, and i had typed out a response earlier which I discarded, lets just say that its not very helpful to throw out pithy little comments, unless you've walked a mile in my shoes --- sour grapes much? I've been a faithful cpap user for 8 years, and have found helpful information here over the years.

Now back to the real topics. Thanks for some of the thoughts, sleepingugly and others, I'm looking forward to my followup sleep study.

My data definitely has shown no apneas at the new levels for the last couple of weeks, so if there is no harm experimenting until I get in to see the doc, and I continue to see no apneas on my machine, that is the data I'm interested in. my data reports don't show flow limitations, they show the percentile pressures, apnea events, exhale puff index, and maybe one more, but nothing called flow limitations. Its all interesting, and good to know that the APAPS start to lose their ability to adjust well if the range is too wide. its a question of "how low can I go?" or is it possible for it to be gone?

I'm already off diabetes and high blood pressure medications, all of those things are now normal, which blows me away, so its natural to wonder about the apnea. My neck circumference is down 3 inches, the pressure is just too much for me anymore at the setting I used to run, it blows me away now, when I never used to notice it.

My bariatric doc sees in the neighborhood of 60-80% of his patients who have lost 50% or more of their excess weight (not total weight loss, but the excess amount you need to lose get back to normal) have their apnea resolve. its no guarantee of course but I don't think I'm crazy given the changes I'm experiencing to want to check it out. A helpful research article is available at Chest research journal (which I can't link to but you can google) -- while the method of weight loss surgery I had was vertical sleeve gastrectomy, its fairly hopeful/optimistic for greatly reduced severity or return to normal breathing while sleeping. So I'm ok with being a little hopeful

happysleeper, that is very good info. Darn it, why does everything have to sag? If I could get some time without it, though, it would be great. I travel a lot, and while I have a fun little travel CPAP, would still be nice to not have to take it at all. Your suggestion of using it occasionally if I do end up getting off it now, is a good idea!

Glassjules

Just a thought....Do you use a recording pulse oximeter at night sometimes?

You might want to record a couple of nights using your CPAP and then if you decide go without the CPAP for a couple of days record it then and check to see if there are differences?

While going the Sleep Study route is definitely better, this might give you some clues as to where you stand/lay in regards to the effectiveness of your CPAP therapy.

-BIll

"I travel a lot, and while I have a fun little travel CPAP, would still be nice to not have to take it at all."

Hello glassjules
Could you please name your travel CPAP machine and give some detail about it? (Weight, battery requirements etc.). I am desperately looking for information on one that is light weight with low battery power requirements. Humidifier not required.
Also - good luck with your investigations. I have also noticed that after 5 yrs on CPAP, my AHI index has dropped alot over the past year. Some weight gained, not lost, however, over this past year.
Thanks!
jandi