History of Sleep Studies

Here is some information taken from the 4th edition of Principles and Practice of SLEEP MEDICINE

Almost every day I hear someone ask why sleep apnea is "all of a sudden and issue" Well it has always been an issue, we just took longer to discover it than cardiac problems, strokes, etc. Which is kinda of amazing since sleep apnea has allot to do with strokes and cardiac issues!
Anyway just a brief history of sleep studies.

1928- First recording of electrical activity on a human brain
1930's- Realized there was a difference in brain wave activity from sleep vs. awake.
1950- Realized there were 5 significant stages of sleep ( we now only use 4)
1951- REM was discovered (first observed in cats, then studied humans)
1960's- Started doing all night observed sleep studies
1965- Discovered Apnea's
1972- Added cardiac sensors to the sleep studies
1974- Officially named Polysomnography
1980's- CPAP invented. First one used a vacuum motor for the blower.

"Field of sleep medicine has existed for only about 4 decades. The field is still evolving as new disorders are being discovered."

"More has been learned about sleep in the past 60 years than the preceding 6,000."


At last count there was over 88 sleep disorders.

Here is a fact that I actually have on all my letterheads. " 18 million Americans have sleep apnea, 90% of which have been undiagnosed."

Well I hope this sheds some light on why sleep apnea is "all of a sudden a big deal"

We used to think people died of 'natural causes'. Now we know what those 'causes' are. I think the other part has to do with Global Warming too.

Thanks Montana User, very interesting. Also wanted to say that I've been enjoying your other posts.

Thanks Katie! I am trying to fill in gaps where I can. I know how frustrating all this is! I dont always practice what I preach..lol. I got so frustrated with my mask the other night I took if off and slept without! Wow do did I feel miserable the next day!! So now I have a little more patients for it.

montana user wrote: Here is a fact that I actually have on all my letterheads. " 18 million Americans have sleep apnea, 90% of which have been undiagnosed."

And, the chilling part of that statistic is that, of those who HAVE BEEN diagnosed and prescribed this therapy.......there's only about a 50% compliance rate.


As is typical for new users, I too went through some random nights of taking my mask off about a month or two into therapy. However, about a year or so later, I managed to catch myself in the act of taking my mask off during the night. I had the lower right clip disconnected, but had not yet lost the seal and quickly put the clip back in. The only thing I could think of that made me do it was possibly to scratch or rub my face for some reason. I don't recall having an "itch", but might have.

Thanks for your contributions to the forum.


Den

Our Primary Dr who is a geriatrics specialist in a large practice says that 60-70% of his patients diagnosed and prescribed cpaps for OSA are not using them a year later. Our son who is a solo NYC Internist with younger patients claims 50% discontinue use. The other statistic they claim is that a large percentage(they both told me but I forgot the %) of patients for whom they prescribe sleep studies refuse to even have them. My son says he distinctly highlights that fact in the patient's office records. He's very amazed but not surprised by his father's determination to succeed.

Edit: I also wanted to add that both of these excellent Drs have told me they are able to diagnose OSA but only through continuing education courses,very little in medical school, and admit they are not qualified to really oversee a patient's therapy and the problems that come with it. It was our Primary who recommended a sleep study years ago but got overlooked by all the cardiac and orthopedic surgeons that came afterwards who attributed my husband's symtoms to his other medical issues and not OSA.

It isn't just CPAP. Compliance with medical recommendations generally is low.

In fact, the group of people who comply with medical recommendations in general (leaving aside, for the moment, whether the recommendations merit compliance or not) is so distinct there is increasing belief on the part of medical researchers that they constitute a separate sub-population.

Actually, there are two components to this discussion: the healthy user bias, and the compliance effect.

Put simply, the healthy user bias holds that “people who faithfully engage in activities that are good for them — taking a drug as prescribed, for instance, or eating what they believe is a healthy diet — are fundamentally different from those who don’t.”

The compliance effect is a component of the healthy user bias. It finds that people who comply with health recommendations “are different and healthier than people who don’t.”

These two effects have been confirmed in large-scale clinical studies of various health conditions. Over and over, researchers have found that people who take what they are prescribed for a health condition – even if it is a placebo – fare better, health-wise, than those who do not.

And the positive effects for the compliant population spill over beyond whatever condition is being treated – compliant users are less likely to suffer not only from the studied condition or disease, but experience reduced rates of death from homicide, suicide, and accidents, as well.

The long-term population here (at cpaptalk.com) is made up of people who are committed to complying with the recommendation for CPAP use, even going beyond the basic recommendation to self-monitoring and adjusting. Everything I've read from people here and about the compliance effect and the healthy user bias suggests to me that the community here is distinct from the population at large. Make sense?

MoneyGal wrote:It isn't just CPAP. Compliance with medical recommendations generally is low.

In fact, the group of people who comply with medical recommendations in general (leaving aside, for the moment, whether the recommendations merit compliance or not) is so distinct there is increasing belief on the part of medical researchers that they constitute a separate sub-population.

Actually, there are two components to this discussion: the healthy user bias, and the compliance effect.

Put simply, the healthy user bias holds that “people who faithfully engage in activities that are good for them — taking a drug as prescribed, for instance, or eating what they believe is a healthy diet — are fundamentally different from those who don’t.”

The compliance effect is a component of the healthy user bias. It finds that people who comply with health recommendations “are different and healthier than people who don’t.”

These two effects have been confirmed in large-scale clinical studies of various health conditions. Over and over, researchers have found that people who take what they are prescribed for a health condition – even if it is a placebo – fare better, health-wise, than those who do not.

And the positive effects for the compliant population spill over beyond whatever condition is being treated – compliant users are less likely to suffer not only from the studied condition or disease, but experience reduced rates of death from homicide, suicide, and accidents, as well.

The long-term population here (at cpaptalk.com) is made up of people who are committed to complying with the recommendation for CPAP use, even going beyond the basic recommendation to self-monitoring and adjusting. Everything I've read from people here and about the compliance effect and the healthy user bias suggests to me that the community here is distinct from the population at large. Make sense?

Your post maske sense at least for CPAP compliance. Since this is a minimal, non invasive treatment, I am more inclined to be compliant. Other medical recommendations that consist of very invasive or critical procedures really should be carefully thought over and compliance is not always the automatic answer for me (oe doe others). Even prescribed drugs are not necessarily an automatic compliance item....and they shouldn't be. Way too much take a pill for this and that instead of finding the underlying cause and trying to make changes. CPAP, however is a no brainer if you can just make an adjustment and remember it could save your life.

My sister is a neurologist and she says she's had people storm out of her office when she's recommended a sleep study. I guess those folks are in that "non-compliant" group ... or would prefer to comply by taking a pill.

Very good comments! You are correct that studies show that 50% of people stop using their CPAP. Seems crazy to me! I think those that stop using CPAP have fallen through the cracks. Meaning they did not like their mask, and no one would help them, or they needed an adjustment to their pressure and didn't or couldn't get it done. Just my guess though.

I have had a home apnea screener for 2 months now and am sitting around 10% of the people who test "positive" on the screener refuse to have a sleep study. I also find this amazing! Why take the home screener to confirm what you think is wrong, then not go forward with it! Now I will say a small percent of these people have no insurance and that is their reason( I give the home screener out for free). So I may be wrong here, but i think allot of it falls back to education! I just had a friend of mine ask me on Facebook (after I posted something about apnea) about signs and symptoms. She has all of them, but when I explained CPAP she said "NO Thanks" I then went into the cardiac problems she can have as well as her chances of having a stroke. I also explained how CPAP works and how much better she will feel. She has now agreed to come in for a study. So it took my about 5 minuets of explaining everything to her. I know doctors are busy, but I think 5 minuets for some education to a patient is not uncalled for. This forum is one of the Best ideas I have seen when it comes to helping other people with questions, or just making them understand there issues are normal (mask leaking, etc). Thank you again to everyone who posts and/or reads for education!!

My brother also has OSA (go figure) and was prescribed a CPAP, but falls into the non-compliant group. He used it less than a month and thinks he just doesn't need it... it can't be that bad, right? It doesn't help that a certain other family member believes that OSA is a "fad" diagnosis. My brother's issue was that he had a nasal mask and leaked from his mouth. I told him that maybe he should try a full face mask, but he said "they didn't want me to--they said I had to use a nasal mask." I'm not sure if "they" was his DME or his doctor's office, but I think they are inadvertently causing non-compliance by saying such things. We all know here that a patient is much more likely to be compliant if they are offered options and allowed to tailor their therapy to their own personal preferences and needs. Sadly, I was unable to talk my brother into trying again... but I intend to keep mentioning to him that I feel great and my therapy is going well--nagging him to start up again won't help, but maybe by demonstrating it can work, it might help.

pmcall57 wrote:My sister is a neurologist and she says she's had people storm out of her office when she's recommended a sleep study. I guess those folks are in that "non-compliant" group ... or would prefer to comply by taking a pill.

Besides all the symptoms we are familiar with clear thinking is also impaired. Mood swings and irritability are also seen.

Then there are those who seem to think they are not perfect if they have OSA - well I don't know anyone who is perfect.

Gumby is just thankful that OSA can be detected and corrected. Some ailments have no treatment at all.

A-MEN, Gumby!!!!!

Geminidream wrote:Your post maske sense at least for CPAP compliance. Since this is a minimal, non invasive treatment, I am more inclined to be compliant. Other medical recommendations that consist of very invasive or critical procedures really should be carefully thought over and compliance is not always the automatic answer for me (oe doe others). Even prescribed drugs are not necessarily an automatic compliance item....and they shouldn't be. Way too much take a pill for this and that instead of finding the underlying cause and trying to make changes. CPAP, however is a no brainer if you can just make an adjustment and remember it could save your life.

I agree with what you're saying here. I think the word compliance isn't quite accurate for the group they're trying to describe. I think the actual word should be pro-active. People who are pro-active may not always comply blindly with what their dr tells them. It's not that we think our dr's are wrong. We'd go somewhere else if we thought that. It's that we want to understand the process and be a part of the decisions. Dr's will treat a non pro-active patient in a way that they believe will foster the most beneficial compliance. But, with a pro-active patient they'll be more open to more complex solutions that may be more healthy. For instance, I saw my endocrinologist today and my cholesterol was up from last time but I'd lost 6 lbs. He would've prescribed a cholesterol med. But, seeing that I'm working on my weight thus working on my eating habits in general he opted to see how I do on my own. That's more healthy in the end because the cholesterol-lowering drugs have certain risks. If I'm successful on my own, it would be better.

Sometimes pro-active patients can annoy their dr's because they don't just jump on board every prescription. I think if this annoys a dr... it's not the right dr for me. One time I had a really frustrating conversation with our pediatrician about a certain vaccine that we'd decided against at that time due to our daughter not being well. Since I didn't just follow blindly what she was saying she tried to scare us into doing it. I just gave in. We switched dr's immediately even though we'd been with her for years. Years later after our daughter was diagnosed with autism our next pediatrician asked me if I thought vaccines played any part in the condition. I told him that I didn't think it did with our daughter but I did think it could play a part for a certain sub-set of children that have some kind of pre-disposition. Our old dr would've probably started yelling at me for that opinion. This dr listened to my views and just kind of nodded his understanding of my position. I don't think he agrees with me, but he doesn't hassle me if I postpone a vaccine for one reason or other. Sometimes he'll even suggest it to me knowing what kinds of things I'm concerned about. That's what I call working together. Now, this is all within reason though. Sometimes you really do need to just do what they say because it's just beyond our knowledge. But I think we usually know when that is.

This is a very interesting discussion to me (as is evident!). I wrote that first post in a hurry at work, and I could have been clearer. The compliance effect really just describes compliance with medical advice...good or bad.

The problem with that conceptualization is that it operates on the assumption that all medical advice is good, when we know it is not (how many doctors have many of us seen before getting diagnosed?!). In addition, though; the compliance effect and the healthy user bias speaks to a lot of basic health and well-being activities -- like eating a balanced diet, getting adequate rest (!), and exercising. People who do those kinds of things are known to be different from and healthier than people who do not. (And I say that having disclosed also on this board my struggles with eating and food; and knowing full well how challenging it is to build regular, sufficient exercise into your life.)

I like the idea of thinking about a population as compliant AND proactive. I really really believe the people on this board - those who come and stay - are different from "the norm" in all the best ways.