CPAP (continuous positive airway pressure) is considered the frontline, gold standard treatment for sleep apnea. In fact, for many doctors, it’s the only treatment. However, some doctors are noting that CPAP fails to treat some of the serious consequences of sleep apnea, leaving patients with ongoing health problems. Doctors are now struggling to explain why CPAP can’t reverse these serious and potentially deadly effects of sleep apnea.

man laying in bed with CPAP mask on to help treat sleep apnea

Metabolic Consequences of Sleep Apnea

Sleep apnea disrupts many body functions that are supposed to take place during sleep. One of these is regulating your body’s hormones that control the use and storage of energy.

The effects of this include greater weight gain, but also less ability to dispose of blood sugar (glucose), and a lower release of insulin. The relationship between the two conditions even seemed to be dose-dependent: the more severe your sleep apnea, the worse your ability to regulate your blood sugar.

The result is that people with sleep apnea are more likely to experience elevated levels of blood sugar and develop diabetes. Since diabetes is linked to many secondary health conditions, including heart attack, stroke, neurological damage, and blindness, it’s important to control blood sugar.

Unfortunately, CPAP doesn’t seem to be capable of helping this for many patients. 

Although there are decades of research into the effectiveness of CPAP, including numerous randomized controlled trials, there is not enough evidence to suggest that CPAP is effective at helping people control their blood sugar.

What makes this baffling to scientists is that animal models predict that CPAP should work. When they look at animal models, they find that hypoxia–low oxygen levels, as experienced by people with sleep apnea–leads to elevated blood sugar levels. However, when the normal levels of oxygen are restored in animals, blood sugar levels go back to normal.

To try and explain why this doesn’t happen for humans, researchers propose three possible solutions:

  • There’s a problem with the experiments
  • People don’t comply with CPAP
  • Sleep apnea causes permanent damage to the metabolism

Right now, they don’t know which of these factors is responsible for the seeming disconnect or if it’s a mix of all three. 

Experimental Problems

First, researchers think their experiments  might not be designed well enough to show the impact of CPAP on blood sugar. Most of their studies on CPAP treatment are short–3-6 months. This might not be long enough to show the difference that CPAP is making. It might take longer for the effects of hypoxia to reverse.

Or it could be that they’re not measuring the right things. They rely extensively on measuring blood sugar levels. However, other measurements, like insulin secretion, might either show the benefit or give more insight into why it’s not helping.

Compliance Problems

The big obstacle with CPAP has always been compliance. Although CPAP is theoretically 100% effective at controlling sleep apnea when you use it, many people don’t use it. There are many different estimates of how many people don’t use their CPAP machines or don’t use them enough. However, based on numerous studies, it’s likely that at least a third to a half of people prescribed CPAP don’t use their machine enough to comply with the standard.

However, the compliance standard might also be the problem. Currently, the compliance standard is often defined as using CPAP for at least four hours a night on 70% of nights. In other words, a person in compliance is only using their CPAP for 35% of their sleeping hours, if they sleep a standard 8 hours. This might not be enough time to reverse the metabolic effects of sleep apnea.

Permanent Metabolic Disruption

Another explanation researchers propose is that sleep apnea actually causes some kind of permanent disruption to the body’s metabolism. In other words, if you have sleep apnea, and you don’t get it treated right away, you might lose the ability to properly regulate your blood sugar levels. That would mean that you should try to get your sleep apnea diagnosed and treated as soon as possible.

Sleep Apnea Treatment in the Detroit Area

If you have sleep apnea and are looking for effective treatment in the Detroit area, let the Michigan Center for TMJ & Sleep Wellness help you find a solution that really works for you.

If your CPAP isn’t giving you the results you want, or you’re not able to use it as much as your doctor recommends, it might be time to switch to a different treatment. Oral appliance therapy is much easier to use. It’s comfortable, and it’s convenient. Studies of compliance rates show that almost all people use it for most if not all of the night. This might help it to be effective where CPAP was not.

We can also help if you only suspect sleep apnea. We can help you get a home sleep study to determine if you truly have sleep apnea or merely another condition with similar symptoms.

To learn more about how the Michigan Center for TMJ & Sleep Wellness can help, please call (248) 480-0085 or use our online form to schedule an appointment with sleep dentist Dr. Jeffrey S. Haddad.