Does Relieving Sleep Apnea Achieve Anything Useful?
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snoremonger
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I've seen lists like that before. Forgive me, but it's just this sort of, 'it's the cause and cure of almost everything' that makes sleep apnea have the ring of snake oil.neversleeps wrote:Cardiovascular consequences of OSA*
hypertension (high blood pressure)
heart failure
atherosclerosis (heart attacks, angina)
atherosclerosis (stroke)
atrial fibrillation
ventricular arrhythmias
pulmonary hypertension
Other consequences of OSA:
trauma (traffic accidents)
glaucoma
snoring spouse syndrome
diminished libido
in children: illness like attention deficit hyperactivity disorder (ADHD)
in children: slowed growth
Other associations with OSA:
obesity
obesity syndromes, such as Prader-Willi syndrome
polycystic ovary disease
renal failure
hypothyroidism
Marfan syndrome
Charcot-Marie-Tooth disease
post-polio syndrome
gastro-esophageal reflux
worsening of epilepsy
Just to be sure I leave no one unoffended, I didn't make up that list. The diseases I listed are from an early "study" by one of the fathers of chiropractic combined with some modern claims for it. These bogus claims sound much like your list of ailments associated with sleep apnea, and it’s one of the things that make me leery of the whole area. It makes sense that sleep disturbances would make you sleepy during the day, or that lowered oxygen levels in the blood would have an immediate effect of causing autonomic functions to become disrupted at the time. But the OP list sounds like the kind of thing that happens in a new and not well understood area where uncertainty (mystery) allows hucksters and well intentioned but emotionally blinded authorities to make exaggerated claims. Even the title of probably the most read book on the subject suggests the mystical, the occult – “The Phantom of the Night.”Step right up ladies and gentlemen, Dr. Hadley's elixir will cure your stomach problems, lung ailments, liver disease, gallstones, pancreas disease, spleen, kidney trouble, prostate and bladder diseases, conditions of the uterus, conditions of heart and pericardium, cancer, asthma, hypertension, rheumatoid arthritis, hyperactivity, sinusitis, colds, and emotional, neurological, gastrointestinal, and skin disorders.
Looking at this chart you linked to
. . . . . . . . . . . . . . .
I had to wonder how studies establishing this were done. Apparently obesity commonly causes sleep apnea, and obesity also causes the problems cited in the chart. So, are the effects shown in the chart a result of obesity or sleep apnea?
In reading posts in apnea discussion groups the majority of the anecdotal reasons people give for the benefits of treatment are things like “I feel better,” “I’m not as stressed out,” “I’m happier and more content,” “My life is better/improved,” etc. These are the kinds of things people say about a wide array of pseudo medicines and quackery. They’re called by medical science the placebo effect. The feelings are real, but are a psychological effect of expectation and desire for the benefit.
My brother-in-law began using a CPAP about 5 months ago and, much like me, says he sees no benefit other than his wife’s glad he’s stopped snoring.
By all the above I don’t mean there’s nothing to the major claims. But given all this, and given the fact that I’ve lived with a relatively severe case of the disorder for 50 years, yet none of the dire consequences have come to pass, and given that after using the remedy for a month it isn’t obvious anything other than the immediate and temporal effects of the disorder have been mitigated, I have to wonder how much of the claims are real. It’s certainly clear why getting long term compliance is difficult.
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snoremonger
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- Location: Enid, Oklahoma
I'm not sure about "overly," but if one must have the "right attitude" for the treatment to work it sounds like the concern I'm expressing, not science.snoremonger wrote:Many things in life do not work for the overly skeptic. Guess I'm glad I'm a little optimistic.
ResMed airsense10 w/integrated Humidifier
ResMed Mirage Swift Lt Pillow System
ResMed Mirage Swift Lt Pillow System
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Guest
IllinoisRRT here,derek wrote:jim,
(Edit) I see in your Introduction that you quote your PO2's in the low 80%s. That is your oxygen saturation level.
Oxygen desaturation in the blood occurs while you are not breathing, and is one of the long-term life threatening aspects of OSA. To measure the desaturation you need a recording oximeter, which clips on the finger while you sleep. You probably had this done during your sleep study, and your doc would know how bad your situation was at that time.
Just to clarify, PO2 is not a saturation level, it is the partial pressure of oxygen that is dissolved in the blood, normally 80-100 mm Hg (may be a lot more if you are on supplemental oxygen). The oxygen saturation would be listed on a blood gas as SaO2 or via pulse oximetry as SpO2; this is normally above 90 (but often not), and would be listed as a percentage. There is definitely a difference! A PO2 of 80 is within normal limits; an SaO2 or SpO2 of 80 is low. This concludes your RT lesson for the day!
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neversleeps
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Following are excerpts from i_am_jim's previous post:
May I suggest you start with this from Pulmonary and Critical Care Update:
Cardiovascular Abnormalities in Sleep-Disordered Breathing
Here is an excerpt:
Acute Cardiovascular Changes in Apnea
In patients with SDB, repetitive upper airway obstruction during sleep leads to cyclic decrements in airflow (apneas and hypopneas), which are terminated by cyclic brief arousals that lead to transient resumption of airflow. The apnea-recovery-apnea cycle may occur hundreds of times over the night. Varying levels of cyclic oxygen desaturation are associated with respiratory events, with the oxygen desaturation nadir occurring at the termination of the event. The severity of oxygen desaturation depends upon the length of the respiratory events, the completeness of airway obstruction (apnea vs hypopnea), the frequency of respiratory events, and the oxygen stores in the lung, which, in turn, depend upon body weight, body position, and the presence or absence of respiratory disorders. In addition, other factors that affect oxygen delivery and consumption are likely to be important. Because of the normal motor atonia of REM sleep, individuals are more at risk for the development of apnea during REM sleep than NREM sleep. Oxygen desaturation also tends to be more prominent in REM sleep.
In association with recurrent apneas, there are cyclic changes in blood pressure, heart rate, and central hemodynamics, which may have acute effects (Table 2). Blood pressure is lowest at the start of the apnea, increases gradually during the event, and rises markedly at apnea termination coincident with arousal, the nadir of oxygen saturation, and the release of negative intrathoracic pressure and resumption of airflow. The normal dipping pattern of blood pressure during sleep may disappear and be replaced by a pattern such as the one shown in Figure 1. Heart rate decreases during apnea, particularly just before apnea termination, and accelerates with arousal. Pulmonary artery pressure increases with apnea, with the greatest increments during REM sleep in patients with daytime pulmonary hypertension. Reductions in stroke volume and cardiac output, most marked at apnea termination, have been reported in humans, although more recent animal data suggest that stroke volume declines during apnea and returns to normal at apnea termination. Cerebral autoregulation is insufficient to protect the brain from these hemodynamic changes and cerebral perfusion pressure declines, particularly early in apnea when increased intrathoracic pressure is associated with a fall in systemic blood pressure and a rise in central venous pressure with a concomitant increase in intracerebral pressure. Continuous positive airway pressure (CPAP) therapy of SDB has been shown to improve many of these transient hemodynamic changes.
Table 2—Acute Cardiovascular Changes in Apnea Parameters Altered During Recurrent Apneas
Heart rate
Blood pressure
Central venous pressure
Pulmonary artery pressure
Cardiac output
Stroke volume
Cerebral perfusion pressure
Potential Acute Effects
Arrhythmias
Myocardial ischemia
Cerebral ischemia
Nocturnal pulmonary edema
--------------------------------------------------------------------------------
Figure 1. A 9-min polysomnographic segment from a patient with SDB. Note the elevations in systemic blood pressure following apnea termination as well as the transient decreases in systolic blood pressure (arrows) when inspiratory efforts were made during the obstructive portion of the mixed apnea. Reprinted with permission from Shepard.
--------------------------------------------------------------------------------
The acute consequences of SDB during the night may include arrhythmias and conduction disturbances, cardiac and cerebral ischemia, and nocturnal pulmonary edema. Tachy-brady arrhythmia is the most common arrhythmia associated with SDB, but sinus pauses, heart block, and ventricular ectopy have all been described. Owing to an imbalance in oxygen delivery and consumption, acute cardiac and cerebral ischemia may occur in patients with preexisting vascular disease, but this has been less well characterized. Nocturnal pulmonary edema has been described in humans and in animal models of obstructive sleep apnea.
Pathophysiologic Mechanisms of Acute Cardiovascular Changes in Apnea
As detailed in a recent review, the proposed pathophysiologic mechanisms for the acute cardiovascular changes that accompany the apnea-recovery-apnea cycle include (1) negative intrathoracic pressure, (2) hypoxia, and (3) arousals. Negative intrathoracic pressure resulting from upper airway obstruction is associated with increased left ventricular transmural pressure with resultant increased left ventricular afterload and increased venous return to the right heart, leftward shift of the interventricular septum, and resultant decreased preload of the left ventricle. The combination of increased afterload and decreased preload leads to a decrease in stroke volume during apnea and an initial fall in blood pressure. Aortic baroreceptors are activated by the increased transmural intrathoracic aortic pressure, but carotid baroreceptors are inhibited because of the fall in blood pressure related to the decreased cardiac output. Sympathetic nerve activity is initially suppressed because the effect of aortic baroreceptors predominates. As the apnea continues, hypoxia may occur, with or without hypercapnia, and this, in turn, stimulates sympathetic output via peripheral chemoreceptors. Sympathetic activity increases peripheral vascular resistance through a-adrenergic receptors in the peripheral vasculature and increases heart rate and cardiac output through cardiac receptors. Thus, as shown in Figure 2, cyclic changes in blood pressure and heart rate mirror the changes in sympathetic tone. Arousals also contribute to the sympathetic activation at the termination of the apnea.
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As you can plainly see, from just this one article, this is not snake oil, pseudo medicine, or quackery.
You wrote:
There are many studies and much evidence regarding SDB and the link to the above listed health issues. Instead of pouring your efforts into questioning the fact that sleep apnea causes many health problems, and instead of asking members of this forum to provide you with the proof, perhaps you should take the time to research the evidence yourself.i_am_jim wrote:I've seen lists like that before. Forgive me, but it's just this sort of, 'it's the cause and cure of almost everything' that makes sleep apnea have the ring of snake oil.
These bogus claims sound much like your list of ailments associated with sleep apnea, and it’s one of the things that make me leery of the whole area.
In reading posts in apnea discussion groups the majority of the anecdotal reasons people give for the benefits of treatment are things like “I feel better,” “I’m not as stressed out,” “I’m happier and more content,” “My life is better/improved,” etc. These are the kinds of things people say about a wide array of pseudo medicines and quackery.
May I suggest you start with this from Pulmonary and Critical Care Update:
Cardiovascular Abnormalities in Sleep-Disordered Breathing
Here is an excerpt:
Acute Cardiovascular Changes in Apnea
In patients with SDB, repetitive upper airway obstruction during sleep leads to cyclic decrements in airflow (apneas and hypopneas), which are terminated by cyclic brief arousals that lead to transient resumption of airflow. The apnea-recovery-apnea cycle may occur hundreds of times over the night. Varying levels of cyclic oxygen desaturation are associated with respiratory events, with the oxygen desaturation nadir occurring at the termination of the event. The severity of oxygen desaturation depends upon the length of the respiratory events, the completeness of airway obstruction (apnea vs hypopnea), the frequency of respiratory events, and the oxygen stores in the lung, which, in turn, depend upon body weight, body position, and the presence or absence of respiratory disorders. In addition, other factors that affect oxygen delivery and consumption are likely to be important. Because of the normal motor atonia of REM sleep, individuals are more at risk for the development of apnea during REM sleep than NREM sleep. Oxygen desaturation also tends to be more prominent in REM sleep.
In association with recurrent apneas, there are cyclic changes in blood pressure, heart rate, and central hemodynamics, which may have acute effects (Table 2). Blood pressure is lowest at the start of the apnea, increases gradually during the event, and rises markedly at apnea termination coincident with arousal, the nadir of oxygen saturation, and the release of negative intrathoracic pressure and resumption of airflow. The normal dipping pattern of blood pressure during sleep may disappear and be replaced by a pattern such as the one shown in Figure 1. Heart rate decreases during apnea, particularly just before apnea termination, and accelerates with arousal. Pulmonary artery pressure increases with apnea, with the greatest increments during REM sleep in patients with daytime pulmonary hypertension. Reductions in stroke volume and cardiac output, most marked at apnea termination, have been reported in humans, although more recent animal data suggest that stroke volume declines during apnea and returns to normal at apnea termination. Cerebral autoregulation is insufficient to protect the brain from these hemodynamic changes and cerebral perfusion pressure declines, particularly early in apnea when increased intrathoracic pressure is associated with a fall in systemic blood pressure and a rise in central venous pressure with a concomitant increase in intracerebral pressure. Continuous positive airway pressure (CPAP) therapy of SDB has been shown to improve many of these transient hemodynamic changes.
Table 2—Acute Cardiovascular Changes in Apnea Parameters Altered During Recurrent Apneas
Heart rate
Blood pressure
Central venous pressure
Pulmonary artery pressure
Cardiac output
Stroke volume
Cerebral perfusion pressure
Potential Acute Effects
Arrhythmias
Myocardial ischemia
Cerebral ischemia
Nocturnal pulmonary edema
--------------------------------------------------------------------------------
Figure 1. A 9-min polysomnographic segment from a patient with SDB. Note the elevations in systemic blood pressure following apnea termination as well as the transient decreases in systolic blood pressure (arrows) when inspiratory efforts were made during the obstructive portion of the mixed apnea. Reprinted with permission from Shepard.
--------------------------------------------------------------------------------
The acute consequences of SDB during the night may include arrhythmias and conduction disturbances, cardiac and cerebral ischemia, and nocturnal pulmonary edema. Tachy-brady arrhythmia is the most common arrhythmia associated with SDB, but sinus pauses, heart block, and ventricular ectopy have all been described. Owing to an imbalance in oxygen delivery and consumption, acute cardiac and cerebral ischemia may occur in patients with preexisting vascular disease, but this has been less well characterized. Nocturnal pulmonary edema has been described in humans and in animal models of obstructive sleep apnea.
Pathophysiologic Mechanisms of Acute Cardiovascular Changes in Apnea
As detailed in a recent review, the proposed pathophysiologic mechanisms for the acute cardiovascular changes that accompany the apnea-recovery-apnea cycle include (1) negative intrathoracic pressure, (2) hypoxia, and (3) arousals. Negative intrathoracic pressure resulting from upper airway obstruction is associated with increased left ventricular transmural pressure with resultant increased left ventricular afterload and increased venous return to the right heart, leftward shift of the interventricular septum, and resultant decreased preload of the left ventricle. The combination of increased afterload and decreased preload leads to a decrease in stroke volume during apnea and an initial fall in blood pressure. Aortic baroreceptors are activated by the increased transmural intrathoracic aortic pressure, but carotid baroreceptors are inhibited because of the fall in blood pressure related to the decreased cardiac output. Sympathetic nerve activity is initially suppressed because the effect of aortic baroreceptors predominates. As the apnea continues, hypoxia may occur, with or without hypercapnia, and this, in turn, stimulates sympathetic output via peripheral chemoreceptors. Sympathetic activity increases peripheral vascular resistance through a-adrenergic receptors in the peripheral vasculature and increases heart rate and cardiac output through cardiac receptors. Thus, as shown in Figure 2, cyclic changes in blood pressure and heart rate mirror the changes in sympathetic tone. Arousals also contribute to the sympathetic activation at the termination of the apnea.
_______________________________________________________________________
As you can plainly see, from just this one article, this is not snake oil, pseudo medicine, or quackery.
You wrote:
but you also wrote:i_am_jim wrote:But given all this, and given the fact that I’ve lived with a relatively severe case of the disorder for 50 years, yet none of the dire consequences have come to pass, and given that after using the remedy for a month it isn’t obvious anything other than the immediate and temporal effects of the disorder have been mitigated, I have to wonder how much of the claims are real.
I guess we'll never know what caused your hypertension. But 50 years of sleep apnea is a likely contributing factor based on the proven scientific medical evidence.i_am_jim wrote:So, I’ve lived with this condition constantly all this time and of the defined side effects, the only major one that could be associated with it is hypertension. But, for many reasons I do not think my hypertension is caused by sleep apnea.
i_am_jim,
I have been crossing streets for most of my 65 years of life. I have NEVER been hit by a bus before. No need to start worrying about it now. Que sera, sera.
Clif
I have been crossing streets for most of my 65 years of life. I have NEVER been hit by a bus before. No need to start worrying about it now. Que sera, sera.
Clif
_________________
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xpap helpful?
Only you can answer your question. After a trial period of xpap do you feel better? Is your BP lower? Is your energy level increased? Is your nasal stuffiness cleared? Does your wife feel safer knowing that you are breathing regularly and not missing inhalations? (She might enjoy your snoring but I am sure she would not relish finding you blue next to her).
It sounds to me like the xpap is causing you more stress/anxiety than it is medical benefit. If it is not beneficial in your mind than stop doing something simply because your doctor said so. No need to follow doctor's orders blindly. We are all our own "healthcare providers" in the true sense of the words.
In this website I have found genuine, thoughtful folks who think and act in their best interests. That is a crowd I am proud to be in. I applaud your willingness to try xpap for the second time, given your upfront skepticism.
I must report to you that I had an immediate drop in my BP since starting xpap. The fact that I have a tangible number makes compliance easy for me. It is objective data and hard to ignore. Good Luck with your decision.
It sounds to me like the xpap is causing you more stress/anxiety than it is medical benefit. If it is not beneficial in your mind than stop doing something simply because your doctor said so. No need to follow doctor's orders blindly. We are all our own "healthcare providers" in the true sense of the words.
In this website I have found genuine, thoughtful folks who think and act in their best interests. That is a crowd I am proud to be in. I applaud your willingness to try xpap for the second time, given your upfront skepticism.
I must report to you that I had an immediate drop in my BP since starting xpap. The fact that I have a tangible number makes compliance easy for me. It is objective data and hard to ignore. Good Luck with your decision.
Nice post barbyann. Very well said.
I really don't have any information to add to this thread except my own personal thoughts and experiences. Of course that's never stopped me from opening my mouth before. (Of course the J&J tape I use at night does).
I've got some of the feelings that i_am_jim has too. I'm sticking with the CPAP because it does fix my snoring and my wife gets a better night's sleep too. (both from no snoring and not worrying about my gasping for air). But I've been on it for 4+ months now and it doesn't seem to have had any real big impact on my life. I didn't have daytime sleepiness before and well, I still don't. My BP seems to be about the same and my weight is completely steady. (FYI, the sleep study said I had severe apnea (90 events an hour) and a desat to 80% in the one hour of sleep I managed)
But it is frustrating. I don't like taping my mouth shut but I dislike mouth breathing or a FF mask even more. And tape is the only solution I've found that works for me. I don't like having the "love sick octopus" stuck on my nose each night either. But I'm lucky, I can sleep through the night with this contraption on and I don't seem to have any leaks and I don't get sore spots (well mostly anyway). But honestly, if it were more difficult I might not be able to keep going with it.
So maybe OSA does cause all those bad things, I'm not sure. There's risk factors to everything we do or do not do. At the end of the day, we all do the best we can with the info. we've got. And decide how accurate that info. is as well.
But the whole "positive attitude" to make it work does kind of stick in my craw a bit. Yeah, and sugar pills work great in pain relief if the patient believes it will help. And every self-help book out there will say "just believe in it and it can work for you..."
I will try my best to make CPAP work for me, and that is where my "positive attitude" ends. I have to be objective as I can in regarding whether it is helping or not. So for me the positives are ...
1. No snoring.
2. Wife gets a better night's sleep.
3. My acid reflux (which was minor) seems to have mostly cleared up
And that's as far as it goes for tangible "good results" for me. And that's enough, I guess, for me to keep doing it. All the "it's bad for my heart, causes brain damage, and makes me fat" I'll have to just accept on faith.
I really don't have any information to add to this thread except my own personal thoughts and experiences. Of course that's never stopped me from opening my mouth before. (Of course the J&J tape I use at night does).
I've got some of the feelings that i_am_jim has too. I'm sticking with the CPAP because it does fix my snoring and my wife gets a better night's sleep too. (both from no snoring and not worrying about my gasping for air). But I've been on it for 4+ months now and it doesn't seem to have had any real big impact on my life. I didn't have daytime sleepiness before and well, I still don't. My BP seems to be about the same and my weight is completely steady. (FYI, the sleep study said I had severe apnea (90 events an hour) and a desat to 80% in the one hour of sleep I managed)
But it is frustrating. I don't like taping my mouth shut but I dislike mouth breathing or a FF mask even more. And tape is the only solution I've found that works for me. I don't like having the "love sick octopus" stuck on my nose each night either. But I'm lucky, I can sleep through the night with this contraption on and I don't seem to have any leaks and I don't get sore spots (well mostly anyway). But honestly, if it were more difficult I might not be able to keep going with it.
So maybe OSA does cause all those bad things, I'm not sure. There's risk factors to everything we do or do not do. At the end of the day, we all do the best we can with the info. we've got. And decide how accurate that info. is as well.
But the whole "positive attitude" to make it work does kind of stick in my craw a bit. Yeah, and sugar pills work great in pain relief if the patient believes it will help. And every self-help book out there will say "just believe in it and it can work for you..."
I will try my best to make CPAP work for me, and that is where my "positive attitude" ends. I have to be objective as I can in regarding whether it is helping or not. So for me the positives are ...
1. No snoring.
2. Wife gets a better night's sleep.
3. My acid reflux (which was minor) seems to have mostly cleared up
And that's as far as it goes for tangible "good results" for me. And that's enough, I guess, for me to keep doing it. All the "it's bad for my heart, causes brain damage, and makes me fat" I'll have to just accept on faith.
Have to admit, like jim I am extremely disappointed in CPAP. I mean it hasn't waxed my car, done the grocery shopping, cured baldness, enlarged anything, given me the winning lottery numbers, returned me to my 20s or any of the other grand claims. Don't even try to get me started on that world peace thing it offered.
Guess it is pretty worthless if all it can do is reduce my chance of stroke and give my wife some well deserved rest and maybe help me avoid some auto accident. Yep it just isn't worth it. Gonna take up smoking again atleast it will deliver the cancer it promises in addition to making me look cool.
Guess it is pretty worthless if all it can do is reduce my chance of stroke and give my wife some well deserved rest and maybe help me avoid some auto accident. Yep it just isn't worth it. Gonna take up smoking again atleast it will deliver the cancer it promises in addition to making me look cool.
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Jan in Colo.
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- Location: Colorado
Glanced over this thread and found several references to the idea that "if you have to have a good attitude to make this treatment work, then it smells like quackery". Not a direct quote of anybody, just the gist of a couple of statements I've read.
I've not seen anybody actually say a good attitude makes the treatment WORK, it is more that a good attitude makes the treatment PALATABLE. It helps with compliance, because yes...if you choose to dwell on it, CPAP is a pain in the rear. Absolutely. But a good attitude helps you put up with the inconvenience of it all and adjust to the mask and rushing air and noise and whatnot. Compliance makes the treatment work. A good attitude makes the patient more easily compliant.
Yep, MikeMoran, the smoking comparison occurred to me also. Might as well start smoking again because after all, I haven't keeled over yet from it. I haven't seen anybody walking down the street with a cigarette falling down dead either. How do I know smoking is harmful? But not much humor in that for me right now. A good friend of ours now has head and neck cancer directly resulting from his smoking habit...the habit he was sure wouldn't hurt HIM....58 years old.
Jan in Colo.
I've not seen anybody actually say a good attitude makes the treatment WORK, it is more that a good attitude makes the treatment PALATABLE. It helps with compliance, because yes...if you choose to dwell on it, CPAP is a pain in the rear. Absolutely. But a good attitude helps you put up with the inconvenience of it all and adjust to the mask and rushing air and noise and whatnot. Compliance makes the treatment work. A good attitude makes the patient more easily compliant.
Yep, MikeMoran, the smoking comparison occurred to me also. Might as well start smoking again because after all, I haven't keeled over yet from it. I haven't seen anybody walking down the street with a cigarette falling down dead either. How do I know smoking is harmful? But not much humor in that for me right now. A good friend of ours now has head and neck cancer directly resulting from his smoking habit...the habit he was sure wouldn't hurt HIM....58 years old.
Jan in Colo.
Sorry about your friend Jan. Sure I joke on here but people should know I take this very seriously. You really can't ignore something this important. I truly fail to understand how people can walk away from a proven therapy just because it didn't restore them to their full health after a few nights use. I can't say there has been a dramatic change in my life since CPAP but I know it has done that for some and I have hope it will catch up with me. Meanwhile I know it is doing me much more good than doing nothing.
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neversleeps
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