Sleep Apnea Makes Quick Comeback When Breathing Treatment Stops

Aug 15, 2011
Originally published on August 16, 2011 10:18 am

If you use a breathing machine to treat your sleep apnea, it's probably a bit clunky. But it's also probably doing you a lot of good.

In a small study, researchers at the University Hospital in Zurich, Switzerland report that when patients stopped using continuous positive airway pressure machines, or CPAP, for one night or more, not only were they sleepy the next day, but a flood of related health problems returned.

The findings appear online in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

Those findings make a lot of sense, says Dr. Nancy Collop, medical director of the Emory Sleep Center in Atlanta. She likens the CPAP machine to blood pressure medication. If you stop taking your medication, your blood pressure rises. If you forget to use your CPAP, your sleep apnea will return.

Patients with sleep apnea can awake hundreds of times during a night, gasping for breath and never really getting a good night sleep. The breathing machine helps patients by pumping air directly into their obstructed airway, essentially forcing them to breathe regularly.

What was surprising in the study was just how quickly problems returned when patients went off the machine. Researchers divided patients into two groups. One used their breathing machines as usual. The other was taken off their regular machine and given another one that pumped less air, making it ineffective. After two weeks, the group on the ineffective breathing machine experienced a return of a number of health problems related to apnea.

Researchers found a marked increase in blood pressure and heart rate, as well as increased dysfunction of blood vessels inside the heart and certain hormones related to heart disease. CPAP withdrawal leads to a return of obstructive sleep apnea within the first night off CPAP, researchers say.

Dr. Collop says that because the CPAP machine can be cumbersome, most patients at one time or another will ask her if they really need to wear it every night. But over the years, the machine — which was once the size of a suitcase — has been re-designed and is now about the size of a square box of tissue.

Even so, "CPAP is a treatment, not a cure," she says. "Unless it's on your nose or over your face, it's not going to be helping you when you're sleeping."

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MELISSA BLOCK, host: People with sleep apnea have trouble breathing during the night. The most common treatment is a machine that keeps them breathing regularly. And it turns out they have to use it every night. As NPR's Patti Neighmond reports, researchers from Switzerland find that just one night off the machine brings the symptoms rushing back.

PATTI NEIGHMOND: For Bill Peters, being diagnosed with sleep apnea was a good thing. A self-described obnoxious snorer, his wife couldn't get a good night's sleep even if she slept on another floor of their home. As a lawyer and lobbyist, Peters had to get all his work done in the morning. By the afternoon, he was too tired.

BILL PETERS: I could not sit down to read a newspaper in the evening without falling asleep. I could fall asleep in almost any movie; for sure, any concert; at any event that I wasn't standing.

NEIGHMOND: The breathing machine changed all that. It pumps air directly into Peters' nose and mouth, forcing him to breathe regularly. He no longer wakes up at night gasping for breath, and he doesn't snore. He gets a good night's sleep and can work without fear of napping.

PETERS: I've even gotten used to sitting through operas.

NEIGHMOND: For two decades, Peters has been faithful to his breathing machine, except for two times. Once, he forgot it when he went on a road trip. He felt so sleepy the next day, he turned around and came home. The next time, a blizzard knocked out electricity in Lincoln, Nebraska, where he lives. At the time, no electricity meant no breathing machine.

PETERS: By the second full day without electricity, I was tired. The headaches had returned - just very intense headaches.

NEIGHMOND: Typical symptoms for people with sleep apnea, who are also at high risk of high blood pressure, irregular heartbeat, diabetes and depression. What researchers wanted to find out was how quickly symptoms like these returned if patients stopped using the machine. They divided patients into two groups. One used their breathing machines as usual. The other was taken off their regular machine and given another one that pumped less air, making it ineffective. After two weeks, that group not only got really sleepy, they experienced other bad reactions very quickly. Dr. David Rapoport is a sleep specialist at New York University.

Dr. DAVID RAPOPORT: Your blood pressure goes up, and certain hormones in your blood change. And there's a test that we use to measure your predisposition to things we think cause heart disease in the long term, and those change almost immediately.

NEIGHMOND: Like heart rate, and the function of blood vessels in the heart.

RAPOPORT: Raising your blood pressure a little may not do anything to you today. But over many years, it's been shown that that has an effect on your chances of having a heart attack, a stroke or even of dying.

NEIGHMOND: Dr. Nancy Collop, who directs the Emory Sleep Center in Atlanta, says the findings are a reminder that the breathing machine is a treatment, not a cure.

Dr. NANCY COLLOP: It's like if you forget to take your blood pressure pill, your blood pressure will go up.

NEIGHMOND: The breathing machine can be cumbersome. Patients wear a mask to deliver the air. And often, they ask Dr. Collop if they really need it every night.

COLLOP: What I tell them is whenever they go to sleep, they have sleep apnea. So they're always better off wearing the machine when they're sleeping than not wearing it.

NEIGHMOND: Bill Peters says he really has no choice. The machine comes with him everywhere.

PETERS: It's an automatic. It's the first thing I pack.

NEIGHMOND: Over the years, the machine, which was once the size of a suitcase, has been redesigned and is now about the size of a square box of tissue. Peters' machine also sports an alarm clock and humidifier. And since that electrical blackout years ago when Peters couldn't use his machine, he now has a battery-operated backup.

Patti Neighmond, NPR News. Transcript provided by NPR, Copyright NPR.