CPAP ventilation – who lends us crutches does not help us

Does CPAP and other overpressure breathing actually help against myocardial infarction and stroke?

CPAP ventilation, BIPAP and ASV are forms of device-related overpressure breathing, which are regarded as gold standards in the therapy of obstructive sleep apnea syndrome. Because these are purely symptomatic treatments, patients have to use their “crutches” daily until to the grave, if they want to reduce their nighttime breathing problems. Regular checks of their sleep, hygiene and technology go nessecarily hand in hand. No wonder many users give up at any time: After all, the causes do not change, and every night without “crutches” makes this aware again.

Devices for overpressure breathing quickly captured the cost-hit list of medical supplies and the trend is unbroken.

Scientific evidence for the various positive primary effects, the preventive effects against life-threatening diseases of the heart and brain are mainly derived from poorly potent studies, seemingly plausible explanations, manufacturer-financed documentation, as well as acclamations from experts and users. The implicit core statements of study results fulfill the criteria of a linear logic: If you breathe too little at night and do not supply your organs with sufficient oxygen, you must be close to the end!
Woe to him who rebukes!

Based on a clientele of several thousand patients and carried out with international participation, the recent studies relativize the previous assumptions. Investigations were conducted on 2717 patients from 89 centers in seven countries. In all, there was a sleep apnea syndrome and at the same time coronary heart disease, stroke or other cerebrovascular disease. It was found that the incidence of heart attacks, cerebral infarctions, heart failure, and deaths in those groups, which applied the pressure breathing apparatus, was not reduced but even increased.

By using a device for adaptive servo evacuation, which is mainly used in patients with Cheyne-Stokes breathing and is considered as a technical optimization of the PAP devices, the death rate increased significantly, even though the device drastically reduced the number of respiratory traps. Ulysses Magalang from the Wexner Medical Center, Columbus and Allan Pack from the Perelman School of Medicine in Philadelphia, among others, consider the components of the ventilation, i.a. the continuous positive airway pressure that the device generates as a possible cause. Also, the authors of the Jama study (2017), which is based on 7266 patients, could not detect a reduction in risk and death occurence in cardiovascular diseases, regardless of whether patients were provided with PAP devices or not.

Diskussion

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.

In the treatment of the widespread disease no. 1 – back pain, the importance of musculature and function has long been recognized. In the past, spinal column problems were mostly treated by supports and immobilization in order to reduce supposedly harmful movements. Later, surgical operations followed in different techniques. For a few years now, however, the much more successful training methods for back pain have become the “state of art”. The patients are being mobilized. Muscles and posture are being trained to stabilize the back.

Consequences

Whoever lends us crutches does not help us, but who teaches us to walk.
(Charles Tschopp)

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.

Schema: Vollständiger Verschluss der Atemwege im Rachenbereich

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

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.

Face Former Therapy

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.

Dr. Klaus und Sabine Berndsen
(Rehabilitologists, ISST-Unna)

Die ursachenorientierte Face Former Therapie mit dem Dr. Berndsen FaceFormer kann eine wirksame Alternative zur CPAP Beatmung sein.

The FaceFormer is the patented training device for the effective, cause-oriented treatment of snoring and sleep apnea.