amazed at this person quitting therapy

[DoriC]

What's even more amazing is that most of us here are not Doctors/Dentists so how come we know the dangers of untreated OSA?

[Emilia]

I'd invite him to check out a great online forum about cpap! It's called cpaptalk.com and he can find answers to all his cpap problems there.

Geesh! My dentist is also non-compliant with cpap, and his wife is a dermatology doctor. I hadn't seen in him a long time as I rarely get past the hygienist when I am there, but I needed a filling/crown earlier this year, and that is when I was shocked to see he put on quite a bit of weight. In our initial conversation, I told him about my Dx, and that is when he admitted to being Dx'd himself. He said he was non-compliant and hated using the machine/mask. I gave him a mild lecture! This dentist spends a lot of his time doing sedation dentistry so he is often in the surgical suite doing multiple procedures on folks who want to get everything done in one fell swoop.....hence, hours of work at a time. I'd be reluctant to do that knowing he is probably a bit foggy. Luckily the work I've needed has only required a minimum of his attention with the rest handled by dental assistants.

[SleepyT]

What's even more amazing is that most of us here are not Doctors/Dentists so how come we know the dangers of untreated OSA?

Dori...I swear...you are on it! It's true! How come doctors can't google like everyone else...at the very least?!

[BrianinTN]

I don't think the decision to give up necessarily reflects "bad judgment" -- just a different set of weights on the various factors.

A doctor and/or a dentist should be among the first to understand the ramifications of constant, nightly oxygen deprivation - whether they 'feel fine' or not. This seems like one of the definitions of "bad judgement" to me.

Tony

That doesn't negate what I said at all. To be overly simplistic about it, he may be weighing the possibility of, say, 10 more good years of not feeling frustrated and exasperated and even-more-tired against 25 more years of feeling all of those adjectives. (If he happens to be a stats guy, he'd think of it like I do -- as a probability distribution, with various probabilities assigned to different outcomes.) It isn't bad judgment if the choice is an informed one. Health (much like politics) is a personal matter full of personal choices. When we disagree, it does not necessarily mean one person is right and the other person is wrong.

[ameriken]

That doesn't negate what I said at all. To be overly simplistic about it, he may be weighing the possibility of, say, 10 more good years of not feeling frustrated and exasperated and even-more-tired against 25 more years of feeling all of those adjectives. (If he happens to be a stats guy, he'd think of it like I do -- as a probability distribution, with various probabilities assigned to different outcomes.) It isn't bad judgment if the choice is an informed one. Health (much like politics) is a personal matter full of personal choices. When we disagree, it does not necessarily mean one person is right and the other person is wrong.

He can make whatever decision he wants and personally that's his choice and he can do what he wants. However if I am a patient of his and he's going to tell me he's going to be an ex-CPAPper, then I'm an ex-patient.

[BrianinTN]

He can make whatever decision he wants and personally that's his choice and he can do what he wants. However if I am a patient of his and he's going to tell me he's going to be an ex-CPAPper, then I'm an ex-patient.

That's of course fine too, because it's (also) a personal choice. But it's important to note, I think, that it's an attempt at a risk averse one. There's some probability that he's relatively asymptomatic and doesn't have daytime sleepiness, so he's perfectly competent to do his job while not being treated. There's also some probability that xPAP makes him much more exhausted, rather than less. And there's some probability (given the large extent to which many people have undiagnosed apnea) that the next dentist you have suffers from it and simply is unaware. There are an awful lot of unknowns, so while changing dentists may make a person feel better, it may (or may not) be the "best" choice.

The whole reason I commented in the first place here is that I've noticed an often-misguided association when people post between their condition and that of others. Not everyone has the same symptoms and severity, and not everyone reacts to treatment the same way. Yes, sometimes, people give up prematurely or have not exhausted all the available paths. But there are a lot of factors and variables in play, so assuming that person B is stupid or exercising poor judgment or is endangering others on a routine basis because he does not do what person A did isn't a valid assumption.

[JointPain]

When I was not being a good compliant CPAP user not that long ago, I thought I didn't feel all that bad. I was exhausted all the time, sure, but I thought that was just working too long, not exercising enough, putting on a bit of excess weight etc. So, I can understand him being in denial of how serious it is, and we've all heard the stories about how long it takes for some people to subjectively feel better. I also don't imagine dentists are treated much better at the sleep clinic / DME than the rest of us.

What I do find hard to accept is his wife's attitude. My wife was on my case constantly about my snoring and the long pauses in breathing during the night. I'm just amazed that as a doctor his wife isn't on his case to continue with the CPAP and find some other way to address the exhaust issues.

[MidnightOwl]

The whole reason I commented in the first place here is that I've noticed an often-misguided association when people post between their condition and that of others. Not everyone has the same symptoms and severity, and not everyone reacts to treatment the same way. Yes, sometimes, people give up prematurely or have not exhausted all the available paths. But there are a lot of factors and variables in play, so assuming that person B is stupid or exercising poor judgment or is endangering others on a routine basis because he does not do what person A did isn't a valid assumption.

I'm very glad you said that. I was made uncomfortable by the assumptions made on this thread and others. There's huge variability in the underlying conditions that will get you sent home with an XPAP machine yet that seems to get overlooked all the time. Not everybody desaturates for instance. AHI could be one point above the cut off instead of one below. Or possibly the person could have neither apneas or hypopneas - not all prescriptions are determined by insurance standards. For all we know the person described could have had apneas during testing only because he was forced to sleep on his back by the tech and never does that at home. We just don't know.

At the other end of the spectrum are the assumptions that everyone posting here has straight apnea with no pulmonary issues or others that might make their condition more serious and their treatment more complex. I don't have any other conditions and I'm sure the instructions I got from my doctor took that into account and might have been very different for someone who did.

Midnightowl

[MidnightOwl]

He can make whatever decision he wants and personally that's his choice and he can do what he wants. However if I am a patient of his and he's going to tell me he's going to be an ex-CPAPper, then I'm an ex-patient.

It's your privilege to do that. I'm not sure what I'd do faced with a doctor with a disorder that was correlated - SOME OF THE TIME - with impairment. The one time it came up the doctor retired before I was forced to make a decision. I was considering leaving however even though this doctor might never have been impaired. And I wasn't willing to rely on them making the decision to remove themselves though in fact that was what happened.

You might want to consider also how you'd feel if people decided that you should lose your job because statistically some of the people who use CPAP already suffered permanent cognitive impairment before being diagnosed even though you did not.

midnightowl

[tonycog]

That doesn't negate what I said at all. To be overly simplistic about it, he may be weighing the possibility of, say, 10 more good years of not feeling frustrated and exasperated and even-more-tired against 25 more years of feeling all of those adjectives. (If he happens to be a stats guy, he'd think of it like I do -- as a probability distribution, with various probabilities assigned to different outcomes.) It isn't bad judgment if the choice is an informed one. Health (much like politics) is a personal matter full of personal choices. When we disagree, it does not necessarily mean one person is right and the other person is wrong.

The problem is that you only listed two options. There are more than those two choices. '25 more years of feeling frustrated and exasperated' makes the assumption about XPAP that frustrates me so much: "I hate my XPAP and I will never get used to it so I'm going to quit." None of us should perpetuate this attitude. There are more than the two options that you mentioned. There is an all-important third option: "I hate my XPAP but I need to work through the problems and find solutions for my own good." People who quit XPAP (I have at least 8 friends of mine who have quit) seem to only consider those two options, they don't consider the all-important third option: Keep working at it.

To stop using life-saving therapy because it is not as comfortable as we would prefer is, to me at least, the epitome of bad judgment.

Thanks,
Tony

[DreamLady]

He can make whatever decision he wants and personally that's his choice and he can do what he wants. However if I am a patient of his and he's going to tell me he's going to be an ex-CPAPper, then I'm an ex-patient.

You might want to consider also how you'd feel if people decided that you should lose your job because statistically some of the people who use CPAP already suffered permanent cognitive impairment before being diagnosed even though you did not.

midnightowl

For instance, truck drivers must be proven to be compliant with therapy if they have sleep apnea. Non-compliance is subject to immediate lost of certification to drive and suspension of your CDL. Once that is on a truck driver's record, he's toast. I believe the same is true of airline pilots. No doubt someone will correct me if I'm wrong.

Also, I might add, the LAST person who should be judging the state of his/her own impairment or lack thereof, is someone with untreated sleep apnea. That's like asking a drunk if he's fit to drive! I had NO idea how bad a shape I was in until I started to feel better. I thought things were humming right along. Sure, I was a little tired, but experienced NO daytime sleepiness, and put it down to aging, lack of sleep (duh, there was a reason I wasn't getting enough sleep), etc. It wasn't until I was called on the carpet at work that I took a step back and thought maybe something was wrong. No one was suprised EXCEPT me when I got the diagnosis of severe sleep apnea (an estimated AHI of over 70, probably much worse since I never got past stage 2). After one year, I can honestly say I feel more like myself than I have in YEARS. Again, I had no idea how bad things were until I got therapy and even then it took about nine months for me to recover to something close to my former self.

I vote with those who say run from any medical professional with untreated sleep apnea. Another way to look at it is, if he doesn't care enough about his/her OWN health to persist, how much is he/she going to care about yours?

[BrianinTN]

The problem is that you only listed two options. There are more than those two choices.

Actually, I was pretty clear that I was listing that as an example and that there were many possible outcomes -- hence my comment about probability distributions, as well as my use of the phrase "To be overly simplistic here."

'25 more years of feeling frustrated and exasperated' makes the assumption about XPAP that frustrates me so much: "I hate my XPAP and I will never get used to it so I'm going to quit." None of us should perpetuate this attitude. There are more than the two options that you mentioned. There is an all-important third option: "I hate my XPAP but I need to work through the problems and find solutions for my own good." People who quit XPAP (I have at least 8 friends of mine who have quit) seem to only consider those two options, they don't consider the all-important third option: Keep working at it.

What you're calling a third option is not always an option. For example, some people are intolerant to positive airway pressure, even at low levels. I've been diagnosed as one of those people by my doctor, so I know a little bit about this. No amount of "working at it" will change that fact. There is insufficient information from the OP to determine whether the dentist in question has simply not given it enough effort, or whether there might be other issues in play. Yes, plenty of people give up prematurely, but assuming that everyone who chooses to give up is lazy is an arrogant and at-least-sometimes incorrect assumption.

To stop using life-saving therapy because it is not as comfortable as we would prefer is, to me at least, the epitome of bad judgment.

Per the above, you're assuming it's a comfort thing. That's not always the case. If a person has spent years trying everything they can think of and then some, and they still feel worse when trying therapy than when not, I really can't blame them for throwing in the towel. Again, just because it's not the choice you would make does not make it bad judgment.

[archangle]

You've got to consider information overload.

The doctor is telling his patients all the time:

1) Fatty foods will kill you.
2) Being overweight will kill you.
3) Not getting your yearly checkup will kill you.
4) Not getting a prostate exam will kill you.
5) Smoking will kill you.
6) Not getting enough exercise will kill you.
7) Blood pressure will kill you.
8) Not getting a colon exam will kill you.
9) Not taking (latest and greatest expensive drug) every day for the rest of your life will kill you.
10) (Latest fad disease with an expensive new drug) will kill you.
11) (The drug we told you you had to have last year, but now know better) will kill you.
12) Processed foods will kill you.
13) Not eating enough of food group xyz will kill you.

Then he sees a patient or two every day who has condition X that would have been avoided if he'd just had procedure Y.

Maybe CPAP just gets lost in the noise.

[ameriken]

You might want to consider also how you'd feel if people decided that you should lose your job because statistically some of the people who use CPAP already suffered permanent cognitive impairment before being diagnosed even though you did not.

People could lose their job because of that impairment, and it doesn't matter how they feel about it. I don't understand how 'feelings' come into play. If a pilot has the condition and statisically could suffered impairment that could bring down the plane, does it matter if it makes him feel bad if he is taken off the job? The passengers' welfare comes above his feelings.

If there is a risk that my condition poses a risk to someone, it has nothing to do with 'feelings'. Like the dentist, I am self-employed in a client oriented business as well, and people hire me and fire me for whatever reason they decide, even if I don't feel good about it and even if it's unjustified. And guess what, no one ever takes into consideration how I feel about it (and they shouldn't). Just because I might feel bad because someone goes somewhere else should not be a requirement as to why they should continue paying me for what I do.

And likewise, if my condition poses a statistical threat that could bring some kind of harm to them after they hire me, then my feelings are secondary to their welfare.

[warrain]

I had a sleep test to see whether sleep apnea was causing my morning headaches. They told me I had apneas during the test but only when on my back. I had no history of daytime sleepiness. The sleep specialist, however, said I should start using a cpap. I've been using it for nearly 2 years and I still wake up with morning headaches. Turns out they are caused my a neck problem. I persevere with the cpap because of the perceived dire consequences of not doing so. I get rainouts on occasion in winter, mouth breathing is a constant problem and I have nasal and sinus issues. Frankly, I'd rather do without the cpap. I'm 70 and who knows how long I was suffering apneas before they were diagnosed 2 years ago. Has the bird already flown so to speak? Is there any point persevering with the inconveniences when I don't get any apparent symptoms not using it? I agree with those who say it is a very individual decision.

Warrain