SimSportPlyr wrote:robysue, thanks for the reply.
I'm clearly not doing a great job of articulating what I meant by 'success', but I don't want to waste folks' time by attempting to clarify further.
Why not? We're a relatively friendly bunch and the most important definition of "success"
for you is the one that is most meaningful to you.
You write:
In my mind mind, success is, "use of the CPAP machine significantly increases sleep quality'".
That's a decent beginning. But what does it mean to "significantly increase sleep quality'"? Consider the following things concerning "sleep quality":
1) As Pugsy points out CPAP fixes
one problem with troubled sleep---namely
sleep disordered breathing where the problem lies in an airway that is too prone to collapse. In other words CPAP fixes the problems caused by OSA and UARS. And it does a remarkably good job in preventing airway collapses and hence eliminates the respiratory effort related arousals and O2 desats. And doing that does result in an objective improvement of sleep quality. In other words,
if OSA is your only sleep disorder, then with a proper titration and the appropriate patient education and follow-up, CPAP will make a significant difference in the objective quality of the paitent's sleep and it should (in time) make a difference in the subjective quality of the patient's sleep.
2) There are numerous other sleep disorders that can cause serious problems with both the objective and subjective quality of one's sleep. CPAP does not directly address these other sleep disorders, and if a particular person's sleep problems do not include sleep disordered breathing, a CPAP is unlikely to help. But many of these other disorders can occur in a person who also has OSA. In that case, all the CPAP can do is treat the OSA; it cannot and will not effectively treat the other sleep disorders. And while the CPAP will effectively eliminate the respiratory effort related arousals and O2 desats associated OSA, the objective and subjective sleep quality of the person will likely remain suboptimal until
all of the sleep problems have been effectively treated. In this case CPAP will be a critical
part of the overall treatment plan, but it should not be the whole of the treatment plan.
3) Adjusting to CPAP requires time, patience, and often some hard work on the patient's part because sleeping with a six foot hose attached to your nose is NOT natural. (But neither are the therapies prescribed for a great many other chronic medical conditions.) It would help if struggling newbies were routinely given the kind of in-depth education and follow-up that retrodave15 talks about in his post. All too often, however, newbies are simply given the machine (which is usually a brick), shown how to turn it on, and told to keep tightening the straps to eliminate leaks. This sets the patient up for failure: At the first sign of trouble, many a newbie decides that it's too much trouble to try to make this therapy work and they just abandon it.
4) For a not insignificant group of new PAPers, the
subjective quality of their sleep goes down---perhaps even plummets precariously---shortly after starting CPAP therapy. I have direct first hand experience with this: My first three months were hellish, and the next six to eight months involved a long, slow slog to merely get back to feeling about as good as my pre-PAP self---one where the subjective quality of my sleep really was best describes as "fair"---as in "not really good, but not bad enough to be poor." But by the time I'd been I'd been a hosehead for 18 months I had to admit that I was (finally) sleeping better
with CPAP than I had during the last two or three years prior to CPAP. (But there is still more room for improvement.) Now it could be argued that I should have just given up---and in fact, a PA in my first sleep doc's office even told me as much about 8 months after I started therapy---just before he fired me as a patient. Given my exceptionally long and difficult battle to adjust to PAP, I really do wish that there was some real interest on the part of the sleep medicine community in studying folks who don't start feeling better in the standard "2 weeks to a couple of months" timeframe the sleep docs think it should take to adjust.
5) Finally, like many other medical therapies for chronic diseases, the real point behind CPAP is not (just) to address the patient's obvious symptoms, but rather, the point of CPAP is to prevent further damage to the body and to minimize the physical effects of the disease on multiple systems throughout the body. OSA damages the body through the repeated apneic episodes each and every night and the damage is cumulative and leaves one at significantly higher risks for a whole host of nasty medical problems. The doctor's focus on using CPAP to prevent further damage damage to the OSA patient's body is what underlies the sentiment that "CPAP is almost 100% effective---if used as directed" and the subsequent focus of defining "CPAP success" in terms of "CPAP use". But it also leads to a major disconnect with a patient's definition of "CPAP success" which is usually defined in terms of "I am feeling and sleeping better NOW."
