Why is 'effort' not considered an alternate?

[Goofproof]

Why is 'effort' not considered an alternate?

It is in certain snowflake leagues. Everyone gets a trophy.

Best laugh I've had all day. I have got to join one of those leagues.

Many here are honorary member, some are founders... I was hoping Global Warming would solve our Snowflake problem in the U.S., turning them back into Flakes, their major component. Jim

[FrederickRose]

With weight loss and exercise you may be able to reduce pressure settings...
Dideridoo may do the same... Neither have been shown on a significant basis to "reduce apneas".

I don't know about Dideridoo, but weight loss certainly has been shown to significantly reduce apneas in people who are obese to begin with.

Recent review: https://www.ncbi.nlm.nih.gov/pubmed/28185772

In summary, medical weight loss optimistically achieves about 14 kg of weight loss (106 to 92 kg) with an AHI fall from 23 to 12 eph, and bariatric surgical weight loss achieves about a 53-kg loss (154 to 101 kg) with an AHI fall from 54 to 19 eph. In both groups, about 70% to 90% of patients will have an AHI that remains > 5 eph.

[FrederickRose]

No!, Because XPAP is the "Gold Standard", You may Swim in De-Nile, playing games, but it's your health and life you are playing with. What's it worth to your Family and friends, even yourself. These are things you must decide for yourself for you must live with the choices.

PAP as a gold standard leaves a lot to be desired. For example, we know that people with severe sleep apnea have a higher risk of death than people who don't, and yet no high quality study to date has proven that PAP reverses those odds. Maybe that it because the studies weren't done well and/or included people on the wrong PAP settings or poor PAP adherence. But whatever the reason, we don't have glowing evidence that PAP is the be all end all for the millions of us who have sleep apnea.

I say all of this as someone who is using PAP all night, every night myself. But I think it's absolutely reasonable to look at complementary and alternative treatments. For example, some people who start out obese have a lot of weight loss can, in fact, cure their apnea. Such people are few in number, but there isn't any reason to not aspire to healthy weight loss with that hope. In the meanwhile, continue PAP until a repeat sleep study shows it isn't necessary.

As a physician, when someone says to me, "I'm gonna eat healthy, exercise, and lose weight so I don't have to take blood pressure medication", I say "That sounds great, and I fully support that plan. In the meanwhile, take your blood pressure medication until we can see that those efforts have made the medication unnecessary".

Most people who make those efforts will still need the blood pressure medication, but there's a lot of good in trying. I see weight loss with a goal of getting off PAP the same way. Unlikely but not impossible to work. And healthy to do regardless (just stay on PAP in the meanwhile).

[jnk...]

Try not to confuse a proven successful treatment (PAP) with a generalized recommendation based on a stastical association ('maybe you should try losing weight just to see if maybe that may help you'). That kind of confusion kills people. So I try not to perpetuate it or spread it.

Dieting has recently been scientifically proved ineffective. No dietary approach has a 10-year success rate. The body adapts to caloric restrictions. Meanwhile people die from not being helped to make their PAP use a success.

Help people make a success of what works to help them save their lives, and stop blaming the victims in order to delay providing them a real medical therapy.

[FrederickRose]

The reason The Gold Standard only treats 50 percent of diagnosed sleep apnea patients, is because only 50% of them have the intestinal fortitude to succeed at many things they need to do. It's strange as lots of us end up overweight
you would think we had more Guts, at least in size if not length. Jim

Can't's are born quitters.......

This exact same mentality could be used to say that we all ought to simply eat less to the extent required to have normal weight. Regardless of how limited our exercise due to joint pains, etc, it is always possible to eat even less if you have the "intestinal fortitude" to do so.

We can look around and call everyone who is overweight or obese (I am in that category) "weak" or "lacking intestinal fortitude", or we can try to help with the problems that weight causes, by offering things like PAP. And I am not saying that all sleep apnea is from obesity, but a LOT of it is.

And by the way, the reason so few obese people achieve an AHI < 5 with weight loss is that so few people achieve and sustain a normal weight with weight loss.

When a treatment is difficult for millions of people - whether that treatment is eating less or that treatment is PAP - it is reasonable to look at alternative and complementary treatment options.

[JimW159]

Are drugs and surgery the only alternatives for these people?
Is there no other alternative that warrants mentioning?

If you identify the alternatives and propose their respective benefits relative to the existing PAP "Gold Standard," I am certain many here will share their thoughts on the matter.

[FrederickRose]

Try not to confuse a proven successful treatment (PAP) with a generalized recommendation based on a stastical association ('maybe you should try losing weight just to see if maybe that may help you'). That kind of confusion kills people. So I try not to perpetuate it or spread it.

Dieting has recently been scientifically proved ineffective. No dietary approach has a 10-year success rate. The body adapts to caloric restrictions. Meanwhile people die from not being helped to make their PAP use a success.

Help people make a success of what works to help them save their lives, and stop blaming the victims in order to delay providing them a real medical therapy.

Even temporary weight loss has long term health benefits, and weight loss efforts which result in neutral weight or small weight gains are much more healthy than the alternative of progressive weight gain. For example, weight loss surgery results in longer lifespans with less heart attack, stroke, and some types of cancer, despite the fact that people eventually regain weight.


"Dieting has recently been scientifically proved ineffective."

This is incorrect. I read the studies every day, and no recent study has proved what you say.


"The body adapts to caloric restrictions."

The body has a limited ability to adapt to caloric restriction. Energy still has to come from somewhere. You cannot continue bodily processes without using calories. Yes, weight loss gets harder over time, and the body defends against weight loss to an extent, but people still have success through effort, and some people have a lot more success than others.


"stop blaming the victims in order to delay providing them a real medical therapy"

No one here is doing that. Everyone here is pro-PAP. But trying to lose weight is a healthy thing to do, complementary to PAP. And for some people, the resulting weight loss is highly effective in treating their sleep apnea.

[Mogy]

Try not to confuse a proven successful treatment (PAP) with a generalized recommendation based on a stastical association ('maybe you should try losing weight just to see if maybe that may help you'). That kind of confusion kills people. So I try not to perpetuate it or spread it.

Dieting has recently been scientifically proved ineffective. No dietary approach has a 10-year success rate. The body adapts to caloric restrictions. Meanwhile people die from not being helped to make their PAP use a success.

Help people make a success of what works to help them save their lives, and stop blaming the victims in order to delay providing them a real medical therapy.

I not sure who you are directing this to but as late as 2015 Havard Medical was recommending weight loss.

https://www.health.harvard.edu/blog/wei ... 1310026713

Breathing devices do not treat 100 percent of people effectively.
Alternatives are needed and should be discussed, even if they are not a cure.

[jnk...]

I take no issue with statements reminding doctors to remind fellow humans, with or without any given disease state, of the importance of healthy eating and exercise. But I take strong issue with doctors or patients misreading those statements to mean that diets preclude the need for treatment. In my opinion, that is what your statements imply. I apologize if I'm misreading them.

Losing weight can temporarily lower AHI. So it is always worth mentioning. But diets have NOT been established as a successful long-term approach for treating moderate-to-severe OSA. Implying otherwise is irresponsible. I aim those words at you, Harvard, doctors, and patients alike.

No study has established the efficacy of saying "go on a diet." Science has no effective long-term diet to offer. So those words are little more than a copout. Scientifically speaking, those words are useless at best and damaging at worst, especially when some uneducated doctors interpret those words to mean that diets are established as better than or equal to PAP therapy in treatment for OSA.

[Wulfman...]

Try not to confuse a proven successful treatment (PAP) with a generalized recommendation based on a stastical association ('maybe you should try losing weight just to see if maybe that may help you'). That kind of confusion kills people. So I try not to perpetuate it or spread it.

Dieting has recently been scientifically proved ineffective. No dietary approach has a 10-year success rate. The body adapts to caloric restrictions. Meanwhile people die from not being helped to make their PAP use a success.

Help people make a success of what works to help them save their lives, and stop blaming the victims in order to delay providing them a real medical therapy.

I not sure who you are directing this to but as late as 2015 Havard Medical was recommending weight loss.

https://www.health.harvard.edu/blog/wei ... 1310026713

Breathing devices do not treat 100 percent of people effectively.
Alternatives are needed and should be discussed, even if they are not a cure.

Harvard Medical is full of "excrement"!

"The only sure way to rid yourself of the condition for good is to either lose weight or have surgery to remove excess tissue from the palate or throat."

They neglect to mention that the benefits from "surgery" (removing excess tissue from the palate or throat.....UPPP) is only temporary and that the patient will eventually have to use a CPAP/Bi-Level device in the future.

But, they do get some of it right.

"The ACP also strongly recommends continuous positive airway pressure, or CPAP. This is typically the first-line treatment for people with sleep apnea, because weight loss can be so hard to achieve. CPAP is a mask or device that fits over the nose and mouth. It blows air into the airways to keep them open at night."

And, again, they never mention that weight gain can be the result of OSA and losing weight doesn't get rid of OSA.


Den

.

[chunkyfrog]

EFFORT requires ENERGY.
When we are totally worn out from apnea, where do we find the energy?

[jnk...]

If only more docs had enough time to read the science to keep up to date so they could get rid of their old assumption-based misunderstandings:

The interaction between obesity and OSA is complex. Although it is often assumed that obesity is the major cause of OSA, and that treatment of the OSA might mitigate further weight gain, new evidence is emerging that suggests this may not be the case. . . . Unfortunately, weight loss by either medical or surgical techniques, which often cures type 2 diabetes, has a beneficial effect on sleep apnea in only a minority of patients.-- Chest Journal, July 2017, Volume 152, Issue 1, Pages 194–203, "Impact of Weight Loss Management in OSA," Simon A. Joosten, MBBS, PhD, et al. http://journal.chestnet.org/article/S00 ... 5/fulltext

Color added by me.

And that statement about helping that minority of patients is only about it having a "beneficial effect on" the sleep apnea, NOT that it alone is an "effective treatment for" many patients. It was based on treating patients with very low AHI and, for example, lowering AHI from less than 10 to less than 5. This is not information that is applicable to an assumption of any success in using this method to treat moderate-to-severe OSA patients in any form or fashion.

[mrcrayola]

I do have a friend who went the surgery route and his apneas are gone. He has lost and kept off weight as well. Perhaps an outlier. Then again, do some of us use the PAP as an excuse not to "exercise" restraint in food consumption, i.e., viewing it as the easier alternative? I, for one, am overweight. Not quite considered obese, but dang close. I am heading into semi-retirement next month, which will give me more time and fewer excuses not to exercise more regularly. Plus, I have a very active granddaughter whom I will be watching once a week on average. That will also help with the weight loss and maybe even with sleep!

Happy 2018!

Cheers,

mc

[jnk...]

. . . his apneas are gone. . . .

Any chance you can post the results of the before and after PSGs proving that statement?

[Goofproof]

I do have a friend who went the surgery route and his apneas are gone. He has lost and kept off weight as well. Perhaps an outlier. Then again, do some of us use the PAP as an excuse not to "exercise" restraint in food consumption, i.e., viewing it as the easier alternative? I, for one, am overweight. Not quite considered obese, but dang close. I am heading into semi-retirement next month, which will give me more time and fewer excuses not to exercise more regularly. Plus, I have a very active granddaughter whom I will be watching once a week on average. That will also help with the weight loss and maybe even with sleep!

Happy 2018!

Cheers,

mc

I've ate food for 72 years, before and after XPAP, I use it for air supply while sleeping not for food control. 12 years on XPAP, I have gained 100 pounds in those years, while cutting my cal intake over 50%. Due to health problems I can't exercise or even hardly move. I'd love to have a alternate , but they don't have one to replace 1/3 heart function, XPAP allows me to live.

Annoying as blowing on a wooden pogo stick is, it won't solve my problem. Jim