CPAPtalk.com

chunkyfrog wrote: ↑

Mon Oct 31, 2022 4:59 pm

more women suffer from TMJ.

No comment.

In fact, I think I just bit my tongue.

D.H. wrote: ↑

Mon Oct 31, 2022 1:19 pm

lynninnj wrote: ↑

Mon Oct 31, 2022 1:12 pm

this is consistent with what we were talking about last week wrt mens vs women’s healthcare.

thanks for posting. Sadly it’s only an editorial and not a study diving into it.

I know. They're asking the question, not providing any real answer. Yes, it is an infomercial of sorts, but I thought that it was a good way to introduce the topic of gender disparity.

You can't answer questions you never think to ask.

So the fact that they're asking these questions is, in fact, a big step forward for those of us who are female and have OSA. Particularly for those of us who are female and don't react to xPAP the way our (male) docs expect us to react. And also for all those females out there with symptoms of OSA who are not given a sleep test simply because their PCP thinks the symptoms are caused by various and sundry reasons collectively thought of as "female problems."

Because once the questions are asked, its a matter of catching the interest of the right people so they will apply for the grants needed for the studies that will start answering the questions.

And it sure seems to me that the question of whether the Medicare definitions unfairly target women for exclusion from diagnosis and treatment is already answered:

Although recent AASM guidelines allow hypopneas to be scored on the basis of a 3% desaturation or an arousal, there is considerable controversy over optimal definitions. Currently, U.S. Medicare recognizes only the AHI4P definition. We found that the AHI3PA compared to the AHI4P definition resulted in a larger relative increase in women than men. Thus, defining respiratory events using lower saturation levels and including arousals will increase the relative proportion of women classified with OSA.--Sex differences in obstructive sleep apnea phenotypes, the multi-ethnic study of atherosclerosis; Christine H J Won, Michelle Reid, Tamar Sofer, Ali Azarbarzin, Shaun Purcell, David White, Andrew Wellman, Scott Sands, Susan Redline; Sleep, Volume 43, Issue 5, May 2020, zsz274, https://doi.org/10.1093/sleep/zsz274
Published: 05 November 2019 -- https://academic.oup.com/sleep/article/ ... 74/5613151

So the question of the number of women "with OSA" may depend, unfortunately, on what definitions are arbitrarily used.

Shame on Medicare for excluding women by failing to keep up with the phenotype science.

lazarus wrote: ↑

Mon Oct 31, 2022 6:35 pm

And it sure seems to me that the question of whether the Medicare definitions unfairly target women for exclusion from diagnosis and treatment is already answered:

Although recent AASM guidelines allow hypopneas to be scored on the basis of a 3% desaturation or an arousal, there is considerable controversy over optimal definitions. Currently, U.S. Medicare recognizes only the AHI4P definition. We found that the AHI3PA compared to the AHI4P definition resulted in a larger relative increase in women than men. Thus, defining respiratory events using lower saturation levels and including arousals will increase the relative proportion of women classified with OSA.--Sex differences in obstructive sleep apnea phenotypes, the multi-ethnic study of atherosclerosis; Christine H J Won, Michelle Reid, Tamar Sofer, Ali Azarbarzin, Shaun Purcell, David White, Andrew Wellman, Scott Sands, Susan Redline; Sleep, Volume 43, Issue 5, May 2020, zsz274, https://doi.org/10.1093/sleep/zsz274
Published: 05 November 2019 -- https://academic.oup.com/sleep/article/ ... 74/5613151

So the question of the number of women "with OSA" may depend, unfortunately, on what definitions are arbitrarily used.

Shame on Medicare.

Yep. As someone who is getting ready to go on Medicare next summer and whose diagnostic sleep study showed that I have a significant problem with hypopneas with arousal (and no hypopneas that count for Medicare), this issue is of great concern to me.

Those "recent AASM" guidelines date back at least to 2010, when my own diagnostic study showed an RDI of 23 if you count the hypopneas with arousal. If you exclude them (as Medicare insists), my Medicare AHI goes all the way down to 3.5.

robysue1 wrote: ↑

Mon Oct 31, 2022 6:46 pm

Yep. As someone who is getting ready to go on Medicare next summer

It is my opinion that you'd sure make one heck of a great interview subject for any journalist around the U.S. sleep industry wanting to take this on directly.

Hey, I can dream, can't I?

Even though women get the medical short stick so often, men can get stung, too.
Breast cancer is more likely to be fatal in men than in us girls.
Attitude is so very significant in every aspect feeding into this.
As October ends, let us hope our guys and their doctors work to end this tragedy.

lazarus wrote: ↑

Mon Oct 31, 2022 6:35 pm

And it sure seems to me that the question of whether the Medicare definitions unfairly target women for exclusion from diagnosis and treatment is already answered:

Although recent AASM guidelines allow hypopneas to be scored on the basis of a 3% desaturation or an arousal, there is considerable controversy over optimal definitions. Currently, U.S. Medicare recognizes only the AHI4P definition. We found that the AHI3PA compared to the AHI4P definition resulted in a larger relative increase in women than men. Thus, defining respiratory events using lower saturation levels and including arousals will increase the relative proportion of women classified with OSA.--Sex differences in obstructive sleep apnea phenotypes, the multi-ethnic study of atherosclerosis; Christine H J Won, Michelle Reid, Tamar Sofer, Ali Azarbarzin, Shaun Purcell, David White, Andrew Wellman, Scott Sands, Susan Redline; Sleep, Volume 43, Issue 5, May 2020, zsz274, https://doi.org/10.1093/sleep/zsz274
Published: 05 November 2019 -- https://academic.oup.com/sleep/article/ ... 74/5613151

So the question of the number of women "with OSA" may depend, unfortunately, on what definitions are arbitrarily used.

Shame on Medicare for excluding women by failing to keep up with the phenotype science.

And this will fix-- what, exactly?

Because this study clearly shows this group of elderly females are inherently better sleepers-- across the board:



especially in the important N3 where they did dramatically better, as well as, interestingly, AI.

Access to the opportunity to benefit from and respond to PAP treatment in harmony with science-based AASM guidelines for using PAP for lowering the number of arousals for improvement of sleep for women nationwide.

Unless, of course, Medicare can convince the AASM that that the AASM doesn't know what the heck it is talking about with its definitions and treatment guidelines, in the long history of payors dictating to docs how medicine should be practiced as tail wags dog.

Or is it medically right for Medicare to deny RS1 her PAP treatment based on taking a position that differs from the guidelines of the medical body?

Excluding patients for not having the right kind of hypopnea is as bad as excluding patients for not being overweight males.

"I'm sorry, ma'am: AASM says you may benefit from PAP but Medicare says you don't get to find out."

Going back to my breakfast bowl of Vaseline Flakes.

lazarus wrote: ↑

Tue Nov 01, 2022 4:29 am

Or is it medically right for Medicare to deny RS1 her PAP treatment based on taking a position that differs from the guidelines of the medical body?

OK let's talk about rs. Here's the NPSGs:

viewtopic.php?f=1&t=55636&p=520725#p520725

Sleep efficiencies were 69.7% and 73.7% with TST 3.98 and 4.23 hours respectively.

IDK about you, but when I get 4 hours sleep, I am physically ill.

So she spends a LONG time fixing insomnia:

http://adventures-in-hosehead-land.blogspot.com/

Unless, of course, Medicare can convince the AASM that that the AASM doesn't know what the heck it is talking about with its definitions and treatment guidelines, in the long history of payors dictating to docs how medicine should be practiced as tail wags dog.

Maybe we should use this guideline:

https://jcsm.aasm.org/doi/10.5664/jcsm.27286

IMO, I think you're you're basing some major policy decisions on a couple of train-wreck NPSGs.

Going back to my breakfast of 2 Reese's Peanut Butter Cups.

All good points. Thanks, Rubicon.

And I agree completely, of course, that the interplay between conditions that are not mutually exclusive can be particularly difficult and frustrating for some patients desperate for improvents both in the quality of their sleep and in the duration of their sleep.

https://www.cpap.com/blog/sleep-apnea-and-insomnia/

Rubicon wrote: ↑

Tue Nov 01, 2022 5:11 am

IDK about you, but when I get 4 hours sleep, I am physically ill.

Hell, I am physically ill with 6 hours of sleep as evidenced by yesterday's horrible day just in general.
I don't really start feeling like a decent human being until I approach 7 hours of sleep and to feel really decent I unless I get 8 hours.
Plus it has to be not highly fragmented with multiple arousals.

Tall order for sure and it has absolutely nothing to do with my actual OSA therapy side of things. It's stuff that cpap can't fix that is my main problem. The OSA was an easy fix...now the bad sleep from the other stuff is a whole different animal.

Rubicon wrote: ↑

Tue Nov 01, 2022 3:49 am

Because this study clearly shows this group of elderly females are inherently better sleepers-- across the board:



especially in the important N3 where they did dramatically better, as well as, interestingly, AI.

And yet, when a postmenopausal woman complains that her sleep is bad, a typical doc drags out the stereotype and says, "Your postmenopausal and you should expect your sleep to not be particularly good any more."

robysue1 wrote: ↑

Tue Nov 01, 2022 1:58 pm

Rubicon wrote: ↑

Tue Nov 01, 2022 3:49 am

Because this study clearly shows this group of elderly females are inherently better sleepers-- across the board:
...

And yet, when a postmenopausal woman complains that her sleep is bad, a typical doc drags out the stereotype and says, "Your postmenopausal and you should expect your sleep to not be particularly good any more."

And he would be absolutely correct!

robysue1 wrote: ↑

Tue Nov 01, 2022 1:58 pm

...a typical doc ...

BTW is this "typical doc" male or female?