Jade wrote:jnk wrote:...but a person whose nervous system has become particularly sensitive to his imperfect sleep-breathing (as in a UARS-leaning patient) will likely need some self-tweaking and work that the other fellow doesn't need, and CPAP may not even be the best treatment for him...
I added the emphasis--jnk, could you say more about that part?
I am of the (nonprofessional) opinion that some mild-OSA patients can be just as super-sensitive to PAP therapy as some UARS patients seem to be and that such patients therefore may not respond as quickly and as well to PAP therapy as many moderate-to-severe OSA patients do.
Taking the extra time to get used to CPAP and paying particular attention to comfort tweaks may help some of those patients. Others may need custom-tweaked bilevel instead of straight CPAP. Others may not do well on any of those treatments because of exceptional sensitivities to pressure and the brain's remaining sensitive and unaccepting to any mask tried.
In other words, some of those sensitive people (medically speaking) may never respond well to PAP therapy no matter what they do or how well they do it. Those people may eventually want to try the alternatives to PAP therapy.
For example, mandibular advancement devices (MAD) have come a long way of late, in my opinion, and if a person who is sensitive to xPAP finds that he also happens to be responsive to MAD, I say
go for it. The MAD may only reduce AHI (roughly speaking) by 50% in 50% of patients, but if a person is one of those 50% of patients who respond, lowering AHI by 50% may be enough for that person to feel rested in the mornings and to have no particularly significant O2 desats either.
I happened to be one of the people with severe OSA who took to the therapy right away and saw results. But I have read enough here and elsewhere to understand that it wasn't willpower that got me where I am, it was simple response to therapy. However, if someone else gives the therapy the full shot and can't make it work because it makes him sleepier and more fatigued, no matter what he does, then things like dental devices and surgery become a viable alternative, and there is certainly no shame in them. So, even though this place is called CPAPtalk.com, those people should be very welcome here and should never be labeled anti-PAP-therapy or shunned as nonbelievers, as it were, if you will.
I firmly believe that PAP should always (well, nearly always) be the
first choice for treating OSA, even very mild OSA. I don't like that the AASM considers dental devices a viable FIRST choice. I disagree with that
very strongly. BUT, once PAP therapy has been thoroughly explored as a first choice, in that it has been given enough time and effort, I
fully support moving on to the generally-less-effective, but possibly still effective enough, treatments that are available to someone in that situation.
That was probably much more information about my opinions than you were looking for, but hopefully you can sift any wheat from the verbose chaff in the above. I just like hearing myself type. So, thanks for asking!