How effective is CPAP?

Real help or eternal crutch therapy

Who lends us crutches does not help us

Devices for positive pressure ventilation quickly conquered the cost hit list of medical devices and the trend is unbroken. CPAP ventilation, BIPAP and ASV are forms of positive pressure ventilation that are considered the gold standard in the treatment of obstructive sleep apnea syndrome. But:

Does CPAP and other pressure ventilation really help against heart attacks and strokes?

Because these are purely symptomatic treatments, patients must use their “crutches” every day until they are stretchered off if they want to reduce their nocturnal breathing problems. Regular checks on their sleep, hygiene and technique go hand in hand with this. No wonder that many users give up at some point: After all, nothing changes in the causes and every night without “crutches” makes them aware of this again.

This article was written in response to an article in the Ärztezeitung:
Schlafapnoe: Schützt Beatmung doch vor Herzinfarkt?
(Sleep apnea: Does ventilation protect against heart attacks after all?)

New scientific findings put the promises of CPAP therapy into perspective

Scientific evidence for the numerous positive effects with regard to the preventive effects of PAP therapy is significantly relativized by new, international studies. Statements that early PAP therapies protect against life-threatening diseases of the heart and brain are mainly derived from less potent studies, seemingly plausible explanations, manufacturer-financed documentation and acclamations by experts and users. The core statements implicit in the study results fulfill the criteria of linear logic: anyone who breathes too little at night unobserved and does not supply their organs with sufficient oxygen must be close to the end! Woe betide anyone who disagrees!

Discussion

Medical applications must primarily focus on the treatments of causes. Only in this way does the patient have the prospect of a healthy, independent life.
Continuous long-term symptomatic supply with devices (crutches) should not become the standard. Often their use has a spontaneous positive effect on the symptom. Negative changes that come along with it are usually introduced later and are not assigned to the primordial application. Long-term applications of “crutches” are never without consequences. At the very least, they cause compensatory changes of movement and function patterns. Neurophysiological changes affect the parasympathetic nervous system and organ activities.

This and more are the consequences of long-term pressure breathing. However, the authors do not want to question their application in principle. If it is important to optimize night-time breathing spontaneously, PAP methods are recommended. Previously or in parallel, however, additional procedures should be taken which also address the cause of the existing breathing problem. Thus, a lifelong and possibly negative device dependency may be avoided. In obstructive sleep apnea, tissue and muscles in the mouth and throat are relaxed. They constrict and obstruct the airways. Therefore, it is obvious to correct these underlying problems. As a rule, this can not be done surgically, but only by training of muscles and developing physiological patterns of movement and functions.

We are not helped by those who lend us crutches, but by those who teach us to walk.

Charles Tschopp

The importance of muscles and function has long been recognized in the treatment of the “No. 1 widespread disease” – back pain. In the past, spinal problems were usually treated by bracing and immobilization in order to reduce supposedly harmful movements. This was later followed by operations using various techniques. For some years now, however, far more successful training methods for back problems have become the “standard of art”. Those affected are mobilized. Muscles and posture are trained to stabilize the back.

For problems in the mouth, throat and breathing the treatment is still reduced to the approaches:

Crutches, supports and cutting.

In most cases, training is not on the agenda, although the mouth, throat, face, and head have as many muscles and the finest muscle chain functions as there is nowhere else in the human body. If functional and muscular deviations disrupt this fine-tuned system, a neurophysiological training is required for correction.

The evil at the root only can be combated in this way. The causes of narrowed or obstructed airways are to be treated with corrective exercises. As with the example of the back, consistent training is required.

In the case of obstructive sleep apnea, relaxed tissue in the pharynx causes a recurring occlusion of the airways.

FaceFormer® Therapy method tackles the causes

For example, with FaceFormer Therapy, an easy-to-perform but complex exercise program is available to the practitioner and the patient. It aims at treating the causes of snoring and sleep apnea. Slackened muscles are trained, incorrect movement patterns and malfunctions are corrected.

Further scientific information

CPAP erhöht das Sterberisiko (CPAP increases the risk of death)
InFo Neurologie 17, 26 (2015). https://doi.org/10.1007/s15005-015-1527-1

Association of Positive Airway Pressure With Cardiovascular Events and Death in Adults With Sleep Apnea
A Systematic Review and Meta-analysis
JAMA. 2017;318(2):156-166. doi:10.1001/jama.2017.7967

Does Obstructive Sleep Apnea Treatment Reduce Cardiovascular Risk?
It Is Far Too Soon to Say
JAMA. 2017;318(2):128-130. doi:10.1001/jama.2017.7966

Learn more about CPAP respiration

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How effective is CPAP?

Who lends us crutches does not help us

Does CPAP and other pressure ventilation really help against heart attacks and strokes?

Discussion

We are not helped by those who lend us crutches, but by those who teach us to walk.

FaceFormer® Therapy method tackles the causes

Further scientific information

Learn more about CPAP respiration

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Gefährliche Beatmungsgeräte – Größter Medizinprodukt Rückruf und Endstation Schlafapnoe-Therapie

Due to significant safety risks: recall of CPAP and respiratory devices

CPAP ventilation – Real help or eternal crutch therapy?

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