Poll - Which OSA treatment would you try?

[ResMedUser]

I am skeptical that any of these really work all that well. The gold standard treatments for OSA in evidence based medicine are 1) CPAP and 2) weight loss, if weight loss is needed...which it usually is.

Mikey

Mikey,

According to my sleep doctor's PA some 40% of sleep apnea patients are NORMAL weight or UNDERWEIGHT. I'm one of them.

And of the 60% of apnea patients who are overweight, the vast majority of them will NOT be able cure their apnea even if they did lose ALL their excess weight. Why? Most OSA is caused by structural problems in the throat. In many (not all, but many) of the overweight apnea patients the connection between the apnea and the weight is far more subtle than your statement implies: For many overweight patients with OSA, the OSA lead to metabolic changes which lead to weight gain in the first place or which made it all but impossible to lose the weight until and unless the OSA is properly treated by CPAP (or an oral device---if the apnea is mild). The additional weight clearly stresses an already compromised upper airway system and may increase the severity of the apnea. But it seldom actually is the sole cause of OSA.

A lucky few overweight OSA patients are able to lose weight while NOT treating their apnea by CPAP and eliminate the apnea by weight loss alone. But they are very few and very far between.

A few more lucky overweight OSA patients are able to lose weight while ON CPAP and subsequently manage to demonstrate through a PSG that they no longer need CPAP therapy. But these people are also few and far between.

The vast majority of overweight OSA patients who manage to lose all their excess weight do NOT manage to free themselves of apnea. And they continue to need CPAP to properly treat their apnea. In many cases, the pressure needed to keep the airway does go down with weight loss, but even here it is an individual thing: Some folks find they need a pressure INCREASE after losing weight in order to keep the apnea under control.

SO: Please do NOT promulgate the myth that weight loss is a gold standard treatment for OSA. It most certainly is not. The ONLY gold standard treatment at present is xPAP therapy.

And please do NOT promulgate the myth that MOST OSA patients could cure ---or even substantially improve--- their sleep apnea by losing weight. First of all that completely ignores the 40% of us who do NOT need to lose weight. And second of all, it sends a message that the other 60% are somehow responsible for creating their problem by being overweight. And nothing could be farther from the truth.

I agree that some cases of sleep apnea are due to the structural abnormalities. I have some excess tissue in the back of my throat and also a deviated nasal septum from a broken nose. That being said, of the 60% (or more?) of the OSA sufferers who are overweight, many of them are significantly overweight. When dieted/exercised down from 225 to 204 lbs, my OSA improved and my pressures dropped some. If I could drop from 204 to say, 185 I would really be skeptical if my pressures did not drop a lot.

I have noticed when I lose weight and my neck circumference goes under 17" I particularly begin feeling better.

Mikey

[donnafowler]

Some that lose weight can use a lower pressure. But not always.

I lost thirty-five pounds last year, and am in a good weight range for me. I started at a pressure of 11, and it increased--it is now 14. I have an APAP, and I let it do its thing, my AHI is generally around .5, so I am doing well. My sleep doctor told me that I could lose 100 pounds it would still need CPAP because my bottom jaw is so tiny. The dentist gives me child sized toothbrushes! So, I do think one should be careful making generalizations. Each case is different. Each case is very personal. Each case changes over time.

To answer the original question--I would not try any of the choices. I get along very well with my APAP. But that is what is right for ME, not necessarily for anyone else.

[john_dozer]

My sleep doctor is useless so I don't know what exactly collapses, but since I've always been a mouth breather I have to assume my throat collapses during an OSA event. So the nasal stent option offered is really meaningless for me.

I would entertain a permanent or semi-permanent stent. Although I'm pretty good at turning off my body's autonomic reactions. I tried contacts once and by the second day I could freely touch my eyeball with my finger if I so choose without any sign of squinting. And that's stayed with me years later. I can choose not to sneeze. etc.

So I probably could learn to surpress gaging on a throat based stent if I thought it would work.

[Blackjackcat]

Out of those choices, I will stick with cpap. Also, I am in good shape yet have Sleep apnea. I have friends, that are clueless to the cause of SA, say "your not overweight, how can you have sleep apnea"? I wish it was just a weight issue. : (

[Goofproof]

Thank goodness "The Gold Standard", (XPAP) treatment works and I don't have to swim in DeNile, and can get along with my sleep, without useless pain. jim

[mars]

Hi All

It is good that solutions are still being looked for.

I know Cpap is currently the best option, but Cpap is not a belief system, and, I hope, not a cult. So if something else comes along, then I will check it out.

I stick by the saying - the good is often the enemy of the best. So lets keep on experimenting, and not get complacent or think the problem is dealt with.

Cpap is good, as most of us will agree on this Forum. But until I find something that allows me to go where I want, when I want, and sleep where I want (think overnight Greyhound Bus for example, or the beach, or under a tree, etc), I will be looking for something better.

And the fact is that Cpap does not work (no matter why) for about 50% of OSA sufferers. Lets not consign them to the rubbish heap.

cheers

Mars

[sydneybird]

Finally an article with a sleep doctor's analysis providing some realistic (in my opinion) effectiveness and side effects for:

1. losing weight - the sleep doc treats OSA first and weight loss will come naturally. OSA is the cause of weight gain is the thinking here (how refreshing).
2. UPPP surgery - uvulopalatopharyngoplasty - low success rate and high complication rate
3. Pillar procedure - considered appropriate for people who have only snoring and no OSA on their sleep study
4. maxillo-mandibular advancement - jaw breaking and extension - most successful OSA surgery, and the one with the lowest complication rate, invasive, technically challenging and has a long recovery period. It involves bisecting the upper and lower jaw and extending them forward with titanium plates.
5. Provent - Nose valves http://www.proventtherapy.com Effectiveness rates are low, but it is relatively non-invasive and less cumbersome at first glance, it can lower the number of apneas per hour by 50%. Many patients find it so difficult to exhale that they cannot tolerate the therapy, not covered by insurance. (sydneybird comment - if stuffing your nose with a one way valve is supposed to put enough back-pressure in your throat to keep it open, then why don't people with very stuffy, but not completely clogged, noses stop snoring and have a lower AHI? Seems the opposite happens for me. The doc's patients simply start mouth breathing to overcome the valve back-pressure. )
6. manidibular advancing device oral appliance - She calls this a rich man’s bite guard. Excessive salivation, jaw pain, teeth shift and/or change in bite, we are now starting to see some long-term consequences.

http://pagingdrgupta.blogs.cnn.com/2011 ... es-a-cpap/

I would go to this sleep doctor in a heartbeat.

[jbn3boys]

...And the fact is that Cpap does not work (no matter why) for about 50% of OSA sufferers. Lets not consign them to the rubbish heap...

Could I ask where you got this information? I was under the impression that it was more like 85-90% that CPAP worked for, with the remaining 10-15% being able to use another machine, such as Bi-level or an ASV.

Or do you mean that only 50% of OSA sufferers are willing to do the work to use their CPAP machines, and give up with it's "too hard"?

[mars]

Hi jbn3boys

...And the fact is that Cpap does not work (no matter why) for about 50% of OSA sufferers. Lets not consign them to the rubbish heap...

Or do you mean that only 50% of OSA sufferers are willing to do the work to use their CPAP machines, and give up with it's "too hard"?

Actually, I meant what I said.

You are welcome to your interpretation, but I wonder how helpful that is to those who are still suffering. But I guess I covered your thoughts on the subject with -

Lets not consign them to the rubbish heap.

Those who fail at Cpap (for whatever reason) do not deserve our condemnation.

cheers

Mars

[Goofproof]

Of the 50% of failed XPAP users, probably 90% of those can be blamed on incorrect equiptment, lack of personal will, and failed support from providers. 10% left for failing. (A large number) may be due to XPAP not being the correct solution for the patient. My thoughts on the failure rate..... Jim

[robysue]

Of the 50% of failed XPAP users, probably 90% of those can be blamed on incorrect equiptment, lack of personal will, and failed support from providers. 10% left for failing. (A large number) may be due to XPAP not being the correct solution for the patient. My thoughts on the failure rate..... Jim

Idle speculation on my part, but I think far more than 10% of those 50% of xPAP users who just give up are giving it up because of very real side effects of CPAP therapy which they find unacceptable---particularly if the side effects are also accompanied by a seeming lack of effectiveness in improving their OSA symptoms. And after several painful months of therapy, they come to a conclusion that the side effects and lack of apparent effectivesness of CPAP (for their particular case) outweigh the non-apparent benefits of continuing treatment.

So the question is: How long should a person with plain old uncomplicated OSA keep at using CPAP every night, all night long even though doing so has lead to a worsening of their daytime functioning, significant sleep deprivation due to CPAP related issues, and pain from side effects such as aerophagia and air in the eyes through the tear ducts? How long before they can "quit" and be part of the "10% CPAP failed them group" rather than "the 90% who didn't try hard enough group"?

As for mars's comment:

And the fact is that Cpap does not work (no matter why) for about 50% of OSA sufferers. Lets not consign them to the rubbish heap.

Until and unless some other way of treating OSA is found, it's a real shame that no money seems to be used for seriously studying the problems the folks who abandon or refuse to even start CPAP have with CPAP. Given the numerous posts from newbies with absolutely no support from either the sleep doctor's office or the DME when facing real problems of insomnia, aerophagia, congestion, a sense of feeling WORSE not better---sometimes for weeks---,etc. it's really no wonder people give up. I'll readily admit it: Had I not found cpaptalk.com and had I not had a full data machine (so I at least knew the S9 was at least treating the apneas well in spite of how it was making me feel back in October, November, and December), I seriously doubt I would have continued using the machine past the middle of October. The side effects were just too painful and I'd crashed and burned too extremely in terms of daytime functioning while on CPAP/APAP: At that point in time the rational part of my mind (what little there was) was saying it was time to carefully weigh the supposed benefits against the excessive costs of the side affects. And it was not at all clear that the benefits outweighed the side effects at the time.

[sleepyb]

The amount of support for people with OSA is amazing for its non existence. Without support and help and reinforcement it is completely understandable why people quit. Like the data. Why would you stick with something if you didn't see concrete results? If you wanted to loose weight you would start excercising every day but how long would you keep this up if you never looked at a scale or a mirror to see how you are progressing. Without feedback there is nothing to motivate you to continue. So, you have a sleep study because you are tired. Comes back with Moderate OSA. You get a machine and a mask. Two weeks later you don't feel much of anything better, in fact you are a little more tired because of leaks, rainout, etc. About 50% would probably just put it down as something tried and failed and toss it in a closet. That's where the data from the machine and support come in.

As for the poll,I would try the electrical treatment in a heartbeat if I could afford it and if they found that it will work for someone with severe OSA. I think the machine I have is wonderful. I can actually get a good night sleep more often than not. But then again, I have never been satisfied with good.

[jbn3boys]

Hi jbn3boys

Those who fail at Cpap (for whatever reason) do not deserve our condemnation.

cheers

Mars

I am SO far from condemning....I happen to BE one of those that cpap does not work for. I am 5 1/2 months into therapy, and am now working my way through proving that I will most likely fail bi-level as well.

But I still wonder where you get your statistic of 50%. You didn't answer that question.

But maybe we just have different ideas of what "doesn't work" and "failing" mean. Do they mean that the machine is incapable of addressing the issues, or do they mean that the patient is unwilling or unable to get the help that they need to find a solution that does work (compliance).

I'm really NOT trying to start an argument...just trying to get an understanding. (at 5 1/2 months, I'm still a newbie in many ways)

[Jade]

Just read about the New York Times article "Treating Sleep Apnea Without the Mask" by Anahad O'Connor. I'd trial these (provent nasal "plugs"), particularly since I'm one of those folks who experienced unacceptable and sustained side effects of CPAP therapy which I and my "sleep team" were unable to mitigate.

[chunkyfrog]

Anybody ever get the results of a PSG while wearing Provent only?
--Or dental devices?
--Or the pacemaker device?
Show me a spreadsheet, please.
I have to fight to get my darling to wear his machine every night.
If anything else works for him, I would consider it.
Me, I'm quite satisfied with APAP, except for the hassle with getting the right size mask (or 'close enough' ).