Update - Positional Sleep Apnea Therapy

NightMonkey wrote:

ems wrote:

NightMonkey wrote:ems, Show me one therapist who screens all patients for sleep disorders upfront and sends the positives to sleep doctors and it will give your statement some credence.

My therapist. If I had listened to him a year and one-half ago, I would have started CPAP a year and one-half sooner. He didn't "screen", but suggested I go for a sleep study.

Well that is something, but not much.

I could not with good conscience continue to practice talk therapy on a patient for 18 months when I suspected a sleep disorder. Every session would begin with, "Have you had a sleep study yet?" and end with, "I have to discontinue your therapy unless you immediately make an appointment to see a sleep doc."

He "suspected" sleep apnea. He didn't know I had sleep apnea. He wasn't about to take me by the hand to a sleep specialist... that was up to me. He wasn't my daddy, he was my therapist. Withholding therapy b/c I didn't take him up on his suggestion, would have absolutely been the WRONG thing to do!

I agree with EMS on this one. If you were in treatment for drug abuse and was told they would discontinue if you kept using what would that solve? Same situation here, you can only help someone so much. In the end YOU have to take personal responsibility for your own health.

During my split-sleep-study, I was asked half-way through the first part of 'sleeping time' to change from my side/stomach to my back so they could assess that position for OSA.
My results show the difference between side/back-sleeping and I definitely had OSA no matter which position I slept in.
When they strapped me to XPAP for the remainder of the study, again I was woken to change from side/stomach to my back for them to assess.

Maybe I'm just a boring ol' textbook case - I have severe OSA, which when treated with XPAP at 9cm only, has given me AHIs always below 1.0 so the therapy works ideally for me - without not so much.

xena

ems wrote: Withholding therapy b/c I didn't take him up on his suggestion, would have absolutely been the WRONG thing to do!

Your therapist is either ignorant of the mental health problems that sleep disorders cause or was too gutless to say, "I have to discontinue your therapy unless you immediately make an appointment to see a sleep doc." Or maybe he needed the $150 per hour.

I think members of this forum should be irate at the preponderence of therapists who are ignorant of sleep disorders and continue to "talk" to their patients and charge them $150 per hour while the patient is in desperate need of sleep therapy.

But hey, it was your 18 months, your time, your suffering, your expense. If you are happy with that therapist, I'll let it be.

But this comment that you made earlier in the thread lead me to believe you were not happy with that 18 months:

ems wrote: If I had listened to him a year and one-half ago, I would have started CPAP a year and one-half sooner. He didn't "screen", but suggested I go for a sleep study.

Cuda wrote:I agree with EMS on this one. If you were in treatment for drug abuse and was told they would discontinue if you kept using what would that solve? Same situation here, you can only help someone so much. In the end YOU have to take personal responsibility for your own health.

I see nothing in the thread that indicates ems is a drug abuser.

I'm no tech, but I believe it would be relatively rare for a PSG to show every stage of sleep in every position. That is an important point, I think, since the stage of sleep can have a big effect on how someone breathes while he happens to be in a particular position. So even when there might appear to be some positional aspect to the number of events, one night is unlikely to paint a complete picture. Generally, they want to titrate for supine REM, as I understand it, since that is the position AND STAGE in which many have the most trouble breathing.

Here are two things posted today that are germane to the OT.

TheArgus wrote:Hello all

About a year ago I attempted to use the CPAP machine after having a sleep study done that found I had sever Apnea. On my side they said I needed a pressure of 12 and on my back I needed a pressure beyond the 20 limit of the machine (not really sure what all this means)

...

viewtopic/t68841/Apnea-solutions-for-so ... harts.html

Pugsy wrote:I think it was another forum member, Rooster (Roster) who has reported the most impressive pressure needs variances with regards to sleeping on his back vs his side.
Supine needs 18 or 19 cm...
On his side 9.5 cm
...

viewtopic.php?f=1&t=68752&p

I never said he was. I was stating that a professional telling you they will not treat you unless you comply with their demands is silly in more areas than just sleep apnea.

Cuda wrote:I was stating that a professional telling you they will not treat you unless you comply with their demands is silly in more areas than just sleep apnea.

And ignorant, probably unethical, and plain WRONG! Along with the fact that if he had demanded I go to a sleep specialist or not see me again, trust me, he wouldn't have seen me again!

NightMonkey wrote:

Your therapist is either ignorant of the mental health problems that sleep disorders cause or was too gutless to say, "I have to discontinue your therapy unless you immediately make an appointment to see a sleep doc." Or maybe he needed the $150 per hour.

Hi NightMonkey

Withholding therapy because someone will not do what the therapist suggests is only to be used when the client is using their time with the therapist to serve a purpose unconnected with the stated aim of the therapy, and, by choice, continually sabotages the therapy.

Then there may come up a situation in which the therapist has not the knowledge, or skills, to help the client. It is then appropriate to refer the client to a therapist that can deal with that problem. And this has to be done skilfully, or the referral may fail.

There are also some problems that some therapists are emotionally incapable of helping with (eg the presenting client is a perpetrator of physical or emotional abuse that the therapist has personally experienced but has not yet sufficiently recovered from, and consequently, gets triggered). This is a sad situation for everybody, the therapist who is still in recovery, the perpetrator who may never again seek help to stop, and consequently, the perpetrators victim who may well continue to be abused.

And it is often important for a client that the therapist does not get into areas that the client is not there for, on the other hand, it is the duty of the therapist to be of help to the client, even if that may cause anger or resentment. This is an individual call.

And finally there are those who would agree with yourself. And what they are doing is engaging in a power struggle, in which their ego is more important than the wellbeing of their client. It is also the easy way out for incompetent therapists whose clients are resistant.

In the ideal world all therapists would be able to help all those who present for therapy, but we will never have an ideal world. So in the meantime, hopefully, we will all do what we can, remembering that we all are fallible *&%$#@* up human beings, with nowhere else to go

I have simplified the issues, but I hope this will help to give you a different perspective on this

cheers

Mars

PS This post is not to be taken that I am hijacking my own thread, just having a slight deviation

mars wrote: I have simplified the issues,

The issue is already quite simple and none of the posts were as long and complicated as yours.

This is not about refusing to help the patient. It is the exact opposite. It is about helping the patient in an effective and timely way.

Mental health counselors should be trained to screen all patients on the first visit for SDB. The same for GPs, hospitals, and many of the specialists.

A person contracted with a mental health counselor should not have to wait 18 months to find out they have sleep apnea. That is extremely poor medical care.

It is a very simple issue.

NightMonkey wrote:

mars wrote: I have simplified the issues,

The issue is already quite simple and none of the posts were as long and complicated as yours.

This is not about refusing to help the patient. It is the exact opposite. It is about helping the patient in an effective and timely way.

Mental health counselors should be trained to screen all patients on the first visit for SDB. The same for GPs, hospitals, and many of the specialists.

A person contracted with a mental health counselor should not have to wait 18 months to find out they have sleep apnea. That is extremely poor medical care.

It is a very simple issue.

Hi NightMonkey

and here's me thinking I was clarifying it for you

Of course, you did say

Your therapist is either ignorant of the mental health problems that sleep disorders cause or was too gutless to say, "I have to discontinue your therapy unless you immediately make an appointment to see a sleep doc."

and that is what I thought I was responding to.

Trying to prove that you got something right by responding about something that was not questioned is an old trick, not in the least honest or helpful. Sorry you took it that way, but I never continue discussions with those who use spurious arguements.

cheers

Mars

NightMonkey,

You may want to reread ems's post slowly, one word at a time. It seems to me, from how I read the post anyway, that the therapist did exactly what you say he/she should have done. The therapist recommended a sleep study. It was the patient's choice whether or not to listen to that advice to get a sleep study.

Or maybe I have misread what ems posted.

NightMonkey wrote:It is a very simple issue.

Unless of course you can't afford the study. I guess not having enough money for a study in your world means no help at all until you come up with the funds.

jnk wrote:NightMonkey,

You may want to reread ems's post slowly, one word at a time. It seems to me, from how I read the post anyway, that the therapist did exactly what you say he/she should have done. The therapist recommended a sleep study. It was the patient's choice whether or not to listen to that advice to get a sleep study.

Or maybe I have misread what ems posted.

No... you didn't misread my post. That's exactly what I said.