Doctor, do I have to wear this CPAP for the rest of my life?

Yes, you may just have to wear that CPAP for the rest of your life. Those are hard words to say and even harder words to hear. The fact is the more mild your sleep apnea and the less pressure you need to open your airway, the better chances you have of getting off of CPAP. It may take some life style changes or even undergoing surgery-- but it has been done. The problem is that not every one has mild sleep apnea. Allot of us take high CPAP pressures to hold open our airways.
Let me try to explain why everyone needs a different CPAP pressure to open their airway. Think of your airway as a balloon. Some balloons are hard to inflate and hurt your cheeks, others will inflate slightly easier. An airway that is obstructed may not even begin to inflate until you get into the upper pressure ranges. Your weight and the severity of your obstructive sleep apnea (OSA) are the two main factors that play a large part in how high of a pressure you may require for your CPAP machine. The pressure acts like a splint or cushion of air that holds open what gravity is trying to close. Yes gravity plays a large role in obstructing your airway. That is why most OSA patients have learned to sleep on their side rather than their back. Because of this, some mild OSA patients can be treated with positional therapy. This position allows the airway to stay open as long as they do not lay on their back. The more weight you carry the harder it is to keep your airway from collapsing under your own body weight because gravity is pulling down on it.
There are a number of reasons why you may have OSA. For example, when lying on your back gravity will pull your tongue back and obstruct your airway. Another contributor to OSA is the excess stomach weight that is pushing up against your diaphragm. Again it can be relieved by lying on your side. Gravity now will prevent it from pulling into your diaphragm. Instead the stomach lies to the side along with your tongue. Genetics also plays a role by the way it has shaped your jaw, the size of the airway opening, the size of your tonsils and adenoids. These are just a few of the reasons why a patient will be predisposed to having OSA.

As you can see it may not always be just one factor that will cause your sleep apnea. Weight reduction alone may only reduce your risk of OSA. Most people who have moderate to severe OSA have more them one problem going on. That is why correcting one problem through surgery or weight loss may lower the pressure you need, but not always fix the entire problem all together. This is not to say that for most moderate to severe apnea patients losing weight will not allow you to discontinue CPAP therapy. It may just get you into the realm of ‘Very Mild’ which can then be then treated by alternative measures such as the positional therapy, surgery or possibly even a dental appliance. Each person has there own combination of problems which they would need to discuss with there doctor.

The first thing you need to do to feel better is get on CPAP. Then when you feel better try exercise with a weight loss program, then go from there. There are a lucky few who everyone hears about who are able correct one problem and manage to reduce their pressure or eliminate CPAP altogether. Unfortunately most people don't fall into that category. My advice to you is that if you can correct something through surgery or weight loss, go back for a repeat sleep study to determine if you truly are with out OSA. You may think you’re cured only to find that you may still need CPAP therapy but
at a lower pressure.