Bunch of CAs

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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robysue
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Re: Bunch of CAs

Post by robysue » Wed Jul 12, 2017 4:22 pm

ONE SIZE FITS NOBODY
cpaps are cheap and some people can do well on them but they should not force aspirin on all of us with cancer to save money on those with headaches
A ludicrous analogy if ever I saw one.

But let's continue with your headache analogy, since headaches are something I am way, way too familiar with.

So let's talk about the medical treatment of headaches. It's fine for a person who gets one or two headaches a month to treat them with aspirin, ibuprofen, or tylenol. Most of the time, the headache will get better faster with the OTC medication and, just as important, if you only have occasional headaches, the OTC stuff is all you need.

But if you are someone like me, a chronic headache sufferer who has multiple types of headaches, OTC medication is not going to work, and it can, in fact make the headaches worse over time. So when someone presents with a chronic headache problem (like mine), the first task that has to be done is to figure out whether the headaches are tension headaches, cluster headaches, migraines, related to TMJ problems, sinus headaches, etc., or some combination of them. Because the fix for each type of headache is different.

Once the the type(s) of headaches have been identified, then the real fun begins: Finding an effective treatment. This usually means finding a prescription drug that effectively deals with the headaches, but does not cause unacceptable side effects. Let's narrow our discussion down to one of the most common kinds of serious headaches, namely migraines.

When a patient is diagnosed with migraines, treatment depends on both the severity and the frequency of the migraines. If the migraines are neither too severe nor too frequent, guess what, plain old OTC ibuprofen or ibuprofen combined with caffeine is likely to be as effective as anything at dealing with the infrequent, mild-to-moderate migraines. And mild-to-moderate, infrequent migraines really is the most common kind of migraine.

Once the pain gets to be in the moderate-to-severe range OR if there are a lot of nausea with the migraines, OTC pain medication is not going to do diddly squat to treat the pain. Patients with severe episodic migraines are prescribed so-called "rescue" meds designed to be taken at the first sign of pain. One problem, however, is no medicine seems to work for everybody, and all the medicines have side effects, and some of them are both scary and serious. Serious side effects of the rescue drug prescribed to me include chest pain and serious numbness/tingling on one side of the body. (I've been fortunate not to have experienced any side affects of my rescue drug.) It's common that people who suffer from severe migraines may have to try several different medications before finding one that is both effective (in terms of minimizing the pain) and tolerable (in terms of side effects). So between the expense of the drugs, the need to trial different drugs at different doses, and the serious side effects, it's not reasonable to prescribe these rescue meds to every person who has migraines: People with mild-to-moderate episodic migraines won't have their headaches better treated with the more expensive medication AND they may be subjected unnecessarily to serious side effects.

But there's more: Some migraine sufferers (including yours truly) wind up having chronic migraines. Meaning that they have a migraine headache on at least 3-4 days every week. Many chronic migraine sufferers have migraines almost every single day. Chronic migraines are seldom as painful as severe episodic migraines, but because they are chronic, they really mess with the quality of your life as much, or more, than episodic ones do.

The thing is: The rescue meds that work so well for episodic migraines cannot be taken on a daily basis: The potential for side effects is too great and one of those side effects is a nasty thing called rebound headaches. In other words, treating chronic migraines with the standard rescue meds can make a bad situation worse by adding another type of headache to the mix.

So when a person's episodic mild-to-moderate migraines become chronic, there's a need to treat them to improve the quality of life, but neither the OTC stuff nor the prescription rescue meds can be used on a daily basis. So that starts another round of experimentation and multiple doctor appointments. There are literally dozens of drugs that are used off-label to treat chronic migraines, and nothing that's specifically been developed for them. It's a matter of trying a drug, seeing if it works and if you can tolerate the side effects, and if not, moving to the next suggested drug. And the prophylactic drugs can take 3-6 weeks before they start reining in the frequent migraines. And some of them have to be "titrated up" to an effective dose, and that takes time. And the ones that have to be titrated up, sometimes have to be titrated down if the side effects are not tolerable. And then finally add in this: Over time a particular medication may lose its effectiveness for a particular patient. Once that happens, it's back to the same old grind as before: Try a new dose of the old med. Try a new med, see if it works. If not, try yet another one.

Now to tie this all back to your analogy of CPAPs/APAPs and ASV machines:

The average OSA sufferer is like the average migraine sufferer with moderate episodic headaches: Plain CPAP or APAP is going to take care of their OSA the same way that OTC ibuprofen will take care of mild-to-moderate episodic migraines. There's no real need to go to the fancier machines for a run of the mill OSA patient any more than there's a need to prescribe a triptan to a person with mild episodic migraines.

But you are right: SOME people with sleep apnea have additional problems, including the problem of pressure induced centrals. And these people do need fancier equipment just the way people with severe episodic migraines and/or chronic migraines need prescription medication rather than OTC pain relievers.

But there's no easy way to tell which new PAPers are going to do well on CPAP/APAP and which are not. That's a process, and it's rather like the process of figuring out which migraine medication will be the best at addressing a particular migraine suffer's headaches. If a new PAPer is compliant but is still not feeling well after a month or so, that warrants further investigation. If CAs are a problem, then the doc ought to be willing to investigate whether a switch to an ASV machine is warranted.

But unfortunately, cost is part of puzzle, whether we're talking prescription drugs or medical equipment. There are far more people, including a lot of people with cancer, who struggle each day with the question of how to pay for their prescription medication than how to pay for xPAP equipment. Insurance companies are quite happy to tell people with cancer, "No we won't pay for drug X because it's not on the formulary." Or tell people, "Drug X is on the formulary, but not for your diagnosis, so we won't pay for it." Or tell people, "Drug Y works just as well as Drug X and is substantially cheaper, so we only pay for Drug Y for treating your condition."

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