Devices for positive pressure breathing with various technical principles, such as CPAP, also commonly known as PAP devices, are considered the gold standard in the therapy of obstructive sleep apnea syndrome. The abbreviation CPAP stands for “Continuous Positive Airway Pressure”. With this technique, a compressor produces compressed air. Via a hose and a face mask connected to it, this air is fed continuously into the upper airways with the same intensity. There, a positive air pressure (PEEP) is established, which is permanently directed, like a pillar, against slack tissue (air splinting). This is intended to expand the airways and support the patient’s own breathing.
No healing through symptomatic CPAP therapy
Is “gold standard” the right term for a method that merely suppresses symptoms and cannot correct the root cause of the disorder? Considering the benefits of the method on the part of industry and therapists alone, the term seems certainly to be correctly applied. From patients view, however, causal treatments are always the first choice and thus the real “gold standard”. Nevertheless, symptomatic therapies dominate the field and usually create lifelong dependencies on drugs or assistive devices. Taking into account the verbal semantics, such therapies are far away from “gold” ( valuable) and belong to the category “alternative treatments”.
All hyperbaric treatments have a “crutch function”, their effect is solely focused on the symptom and which will only occur in moments of current application. If the patient does not find new ways, there is a lifelong dependency on the use of an elaborate “crutch” from the beginning of the device therapy.There is no chance that positive pressure treatments will ever provide a natural breathing pattern independently from the device.
Positive pressure breathing – Most expensive medical technology supply
The first CPAP supplies began in 1983 and since then a large number of sleep laboratories have been established and with them the use of positive pressure breathing with technical equipment has spread rapidly. Every year, about 45 000 people join the lifelong community of users. The costs for a device range from 1.500,00 € to more than 5000,00 €. Added to this are expenses for masks, regular examinations, stays in sleep laboratories, maintenance and replacement of equipment and masks, etc. It is therefore not surprising that the method has long since reached the 1st place on the cost hit list of all medical-technical supplies.
CPAP – Often not accepted
The willingness of patients to use CPAP therapy (compliance) varies greatly. Many have the respiratory aid, but do not use it because they find the application unbearable or annoying. Allegedly, a maximum of 50% of the prescribed devices are used regularly.
Prospect of success from a single point of view
The chances of success of CPAP therapy are often given as 97 %. Obviously, patients who own a device and do not use it are not considered. In addition, only parameters that are directly related to respiratory effects are considered. For example, fewer breathing stops, better oxygen supply, change in sleep architecture, reduced daytime tiredness. Other associated promises such as preventive effects against cardiovascular diseases, strokes and heart attacks cannot be proven to date. On the contrary, international studies from the year 2017 even show an increase in the mortality rate of patients who use positive pressure breathing for such pre-existing conditions. Side effects have also hardly been mentioned or investigated so far. This is due on the one hand to the large number of possible initial and boundary conditions, interactions, influences and comparisons. On the other hand, the method objective alone distorts such efforts. After all, it is aimed at reducing breathing stops and if this is successful, it must be beneficial to health even if this is achieved by positive pressure breathing. The fact that positive pressure breathing cannot exist without side effects is discussed in the following sections.
However, application disorders are described under the exclusion of health side effects:
- Sleep disturbances due to noises from the CPAP compressor
- Skin irritations, pressure points and feelings of oppression caused by the breathing mask
- Dry mouth, feeling of pressure in the middle ear, headaches, impaired hearing
- Necessary increase of the mechanical breathing pressure
CPAP – Help with increased risk of death?
Statements that early PAP therapies protect against life-threatening diseases of the heart, circulation and brain are derived from less potent studies, apparently plausible explanations, manufacturer-funded publications, as well as acclamations from uncritical experts and users. These statements lack relevant scientific evidence. They only follow an apparent logic: Those who breathe too little at night without being observed and do not supply their organs with sufficient oxygen must be nearing the end! Woe to those who do not believe this or who contradict it!
Summarized evaluations of recent scientific studies, in which for the first time several thousand patients (approx. 10,000 in total) participated and which were conducted in various countries under the direction of renowned scientists, cannot confirm the apparently plausible, beneficial effects of positive pressure breathing. The study involved 2717 patients from 89 research centres in seven countries. All of them had sleep apnoea syndrome and pre-existing conditions such as coronary heart disease, stroke or other cerebrovascular pathologies. It was shown that the frequency of heart attacks, cerebral infarctions, heart failure and deaths in the groups using the positive pressure breathing devices did not decrease, but even increased.
The use of a device for adaptive servo ventilation, which is mainly used in patients with Cheyne-Stokes respiration and is considered a technical optimization of the PAP devices, significantly increased the death rate, although the device had drastically reduced the number of breathing interruptions. As a possible cause, the researchers (Ulysses Magalang of Wexner Medical Center, Columbus and Allan Pack of the Perelman Scool of Medicine in Philadelphia and others) weigh components of ventilation, for example the constant positive airway pressure that the device generates. Also the authors of the Jama study (2017), which is based on 7266 patients, could not find any reduction of risk and death in cardiovascular diseases, regardless of whether the patients were treated with PAP devices or not (Study – JAMA July 11, 2017 Volume 318, Number 2).
Danger to life for artificially ventilated patients is known
Patients with Acute Respiratory Distress Syndrome (ARDS) are given artificial respiration because they cannot breathe sufficiently and would die. The decision to take this intervention is always associated with a conflict: On the one hand, there is a positive effect because the airways and lungs dilate due to increased breathing pressure. This creates the conditions for the vital exchange of oxygen and carbon dioxide. On the other hand, the ventilation pressure damages the lungs and the lung tissue reacts with inflammation as a defensive reaction. The application therefore often ends fatally and even survivors do not remain without serious consequential damage.
The same is not true for positive pressure breathing. In artificial respiration, the machine takes over the breathing activity. For this purpose a tube is inserted directly into the trachea. With positive pressure breathing, on the other hand, the patient can breathe on his own. During sleep, however, the airway passages are repeatedly constricted by slack tissue in the throat area. The permanently applied air pressure is intended to push the tissue out of the airways (air splinting), thus avoiding obstructions and allowing the user to breathe freely.
The human respiration regulates the gas exchange in the lungs. From there the oxygen is transferred to the blood and transported to the body cells. There is a mutual communication between the brain and the respiratory organs via neuronal and endocrine mechanisms, generated by a self-regulating “pulse generator” in the brain stem and other interacting brain regions, which check the mixing ratio of the air breathed and coordinate and adjust rhythms. These mechanisms react to both physical and mental load changes and regulate the tension activity of the impulse-controlled respiratory muscles, such as scale muscles (large respiratory assist muscles), intercostal muscles and diaphragm. During inhalation, the respiratory muscles coordinate and tense and expand a vacuum space surrounding the lungs inside the body. This creates a suction on the lung tissue and the lung unfolds. Inside the lung, a negative pressure is created which affects the upper airways and sucks the air into the lungs (inspiration).
During exhalation (expiration), elastic fibres of the lung parenchyma (breathing space of the lung) contract the lung – again passively – as soon as the breathing muscles relax. The used up breathing air is thus expelled from the lungs and exhaled (expiration).
Side effects of positive pressure breathing
In the global study on the effects of PAP therapies described above, the researchers found that in the group of patients treated with PAP devices, the death rate increased despite a reduction in the number of breathing stops. The scientists assume that the reason for this is the influence of device ventilation, for example the constant positive airway pressure.
We take up such assumptions and try to scientifically consider facts and connections so far with reason and logic that have rarely been discussed.
The lung consists of soft, sponge-like tissue types. The reactions between its tissue, air currents and fluid are sensitive and complicated. To date, there is no measuring method to trace processes that occur at the lung micro level.
It must be assumed that even slight deviations affect the lungs and the entire respiratory system. The anatomist and developmental biologist Wilhelm Roux (1895) explained such connections for all human systems: According to him, any functional influences, regardless of intensity and organ, always have qualitative and quantitative consequences.
Positive pressure breathing meets the innate vital basic pattern of breathing, which is maintained from the first to the last breath. When positive pressure breathing is used, the habitual breathing pattern is subordinated to the technique. This requires the following serious changes:
- The inhalation process is assisted by permanently applied air pressure and the exhalation is directed with increased effort against the artificially generated airflow. These altered unnatural pressure conditions can damage the delicate, sensitive tissue of the lungs. Self-active breathing becomes accustomed to the respiratory relief and reduces its activity. The technical breathing pressure must be increased accordingly. The danger of lung damage increases again.
- Inhalation and exhalation are exactly opposite to physiological breathing. During inhalation, the air is pressed into the airways instead of being sucked in and exhalation takes place against incoming air instead of flowing out without resistance.
- The change in the physiological respiratory process forms a new stimulus/reaction pattern and irritates the polysynaptic reflex events of the complex respiratory mechanism – including remote effects via receptors in the nose and the olfactory function.
- Functional processes in the brain change due to altered information stimuli to the respiratory system. Production and interaction of the neuromodulators and the receptors related to them change. It is unclear what effect this has. What is certain, however, is that respiration is the essential prerequisite for brain metabolism and maintains the formation of messenger substances. Stimulus changes depend on the degree of intensity and the associated reactive consequences. If they are too great, they can support the development of neurodegenerative diseases such as dementia, Alzheimer’s, Parkinson’s disease, etc.
Summary of the dangers of positive pressure breathing
The results of the largest studies to date (approx. 10,000 patients) show that the use of PAP devices can reduce breathing stops, but more PAP-supplied patients died than in the unsupported comparison groups. In this respect, more damaging than positive influences are to be assumed for the therapy. The assumption that people with respiratory failure improve their health through positive pressure breathing is reversed to its contrary. Taking into account the objective existing effects described by us as well as the known fatal reactions to artificial respiration, this is a logical consequence. The enormous number of device prescriptions is therefore not only unjustified, but even dangerous. However, it is to be expected that the puffed up lobby system of industry, sleep laboratories and epigones of therapy will prove resistant to such effects.
Causal treatment – Neurophysiological FaceFormer therapy
A biologically functioning breathing pattern (habitual nasal breathing instead of oral breathing), mouth closure, tongue tension, coordinated muscle tension and muscle chain functions in the nasal, oral and pharyngeal areas are prerequisites for unhindered healthy breathing day and night. Wrong behaviour in one or more segments can neither be changed positively by insight nor by good intentions. Even nasal sprays cannot change the wrong breathing behaviour, but they destroy the filigree defence system of the nasal mucous membrane permanently. Finally, surgical operations and auxiliary devices are also available. Surgical interventions, however, always involve additional risks, cannot change habitual incorrect behaviour and are without guarantee of success. Devices only have supporting properties. They thus impair the body’s own abilities and create a permanent dependency.
Disturbed respiratory functions, as well as nocturnal breathing stops, can only be corrected and stabilised in the long term by neurophysiological exercise treatments. Complicated coordination mechanisms are trained with elements such as posture, tension and movement patterns in the mouth/throat area and in the airways, balanced head posture and habitually correct breathing behaviour. The FaceFormer Training Therapy was developed for this purpose based on the findings of modern neuroscience. With FaceFormer, identical exercises are trained regularly over a limited period of time. As soon as resistance-free breathing through the nose is automated, the program can be completed. The newly learnt skills are preserved for a long time: The natural breathing through the nose is successful day and night. A successful recipe for the prevention and shielding of pathogens, against allergies, snoring, nocturnal breathing interruptions and much more.