Imagine you’ve just come home for a long day on the job. All you really want is to fall into bed and say goodnight to the world. You know you should muster the energy to prepare your CPAP machine, but it seems like a hassle. You’ve been good up to this point, so would taking just one night off really hurt? That question, of course, is testable, and it has been tested!
In this study, the sleepiness/vitality scores of 15 subjects with obstructive sleep apnea (OSA) were tested at three different time points. All subjects were tested before beginning CPAP treatment, after at least 30 days of CPAP treatment, and without just one night of CPAP use. Sleepiness was tested in many ways. Questionnaires were administered to gauge the subjective sleepiness of the subjects, a test called the Multiple Sleep Latency Test (often used for those with suspected narcolepsy) was used to see how easily subjects could fall asleep, and a psychomotor vigilance test (a basic reaction time test) was used to assess objective sleepiness. The overnight sleep apnea severity was also tested within this group.
Not surprisingly, the sleep apnea improved after CPAP initiation, and sleepiness scores were also reduced when compared with the before-treatment condition. After the night without CPAP, though, interestingly, sleep apnea severity was not as bad as it was prior to treatment. This phenomena has been reported before, but sleep apnea severity would likely return to baseline after a few days without CPAP. Importantly, however, after one night without CPAP, sleepiness (measured in multiple ways) returned to before-treatment levels.
So to answer the question of whether taking one night off does matter, it depends on what you think “matters.” If having apneas and hypopneas throughout the night is something you can deal with, then it does not matter. But if feeling revitalized and ready to go (which is how you should always feel after a night of sleep), then yes, it absolutely does matter. These vigilance/sleepiness levels may not seem like a huge deal, but they become a important when you need to spend all day staring at a computer screen, or when you need to stay awake during your child’s dance performance, or when you need to get behind the wheel of a car.
Kribbs NB, Pack AI, Kline LR, Getsy JE, Schuett JS, Henry JN, Maislin G, Dinges DF. Effects of one night without nasal CPAP treatment on sleep and sleepiness in patients with obstructive sleep apnea. Am Rev Respir Dis. 1993 May;147(5):1162-8.