Expert David Rapoport Gives Advice on Sleep Apnea, CPAP, and Alternative Therapies

"I have seen 500-pound patients drop down to 450 pounds and notice significant improvements in their symptoms."
David Rapoport, MD, is director of the Sleep Medicine Program at the NYU School of Medicine and director of research at the NYU Sleep Disorders Center at Bellevue Hospital. He is the founder and president of the Foundation for Research in Sleep Disorders, and a editorial adviser.

Q: I just started using my CPAP machine and have noticed a big improvement in my sleep. Do I need to use it every night?

A: Absolutely. Studies have shown that the moment you remove your continuous positive airway pressure (CPAP) mask, obstructive sleep apnea returns. While you may be able to get away with one or two nights without the machine, the symptoms will eventually come back. It's simple: If you don't wear the mask, you will have sleep apnea episodes.

Q: But I don't want to depend on a machine for the rest of my life. Are there any lifestyle changes I can make?

A: Studies show that sleep apnea is associated with a person's weight. For overweight people, especially those with mild cases of sleep apnea, losing weight may reduce sleep apnea symptoms and, in some cases, the symptoms may completely disappear.

It's not necessarily about getting back to a 'normal' weight. I have seen 500-pound patients drop down to 450 pounds and notice significant improvements in their symptoms. Overall, 100% improvement is very rare, but losing weight is definitely worth trying.

Apneas also tend to be worse when sleeping on the back, since gravity makes it more likely for the tongue to fall back over the airway and for the airway muscles and other tissues to collapse and block the airway. Sleeping on your side may reduce the frequency of apneas.

If you're looking for less conventional treatment options, you may be interested in a study published in 2006: Swiss researchers suggested that playing a didgeridoo, an Aboriginal instrument, improves (but doesn't cure) sleep apnea symptoms. While the study was quite small and more investigation is needed, it does suggest that exercising the upper airways may help relieve apnea.

Q: I use my CPAP at night but have trouble falling asleep. Is it safe to take sleeping pills?

A: If you're using your CPAP, taking a mild sleeping pill to deal with mask discomfort and help you fall asleep is safe, as long as you keep the mask on. However, if you remove the mask—say, you get up in the middle of the night and, because you've taken a sleeping pill, you're groggy and inadvertently forget to put the mask back on—your sleep apnea will worsen.

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Interview by: Heather Lee
Last Updated: April 15, 2008

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