I apologize for this long response to your good points, Mars. I think this is a great discussion, myself. I'll leave the subject alone after these drawn-out statements of my opinionated 2 cents.
mars wrote: . . . for some, it may be better than nothing. . . .
True.
But for some (many? most? the vast majority? who knows?) it may be
worse than nothing, if "positional therapy" is made to sound like a widely accepted approach to moderate-to-severe OSA, and patients decide to abandon their efforts to give PAP therapy their full effort before moving on to the experiemental. I consider that a very real danger, so I attempt to clarify the limitations and the status of those approaches in comparison to the mainstream gold-standard treatment whenever I see the opportunity.
mars wrote: . . . aren't you assuming that correcting desats is all that is going on ? A sleep study would be needed for that. . . .
I only assume that it is dangerous to make treatment-approach decisions based on assumptions whenever data could be obtained for dealing with a potentially life-threatening condition.
mars wrote: . . . We are told that most of those to whom cpap is recommended do not use it, or try and fail to keep on using it. . . .
Perhaps that was another statement to "correct"? I don't know. Your choice.
mars wrote: . . . Why do we continually forget them, or blame them for not using cpap. . . .
No. I remember them by posting statements in threads where theoretical approaches that are vastly inferior to PAP therapy are discussed without what I see as needed clarification that those methods are not yet considered viable first-choice approaches for those with moderate-to-severe OSA.
Some who don't like the sound of PAP come to this forum because they are grasping at straws to keep from facing the reality of their medical situation. That is why I make posts in threads such as this one to clarify the point that the things being discussed here are not considered even one of the top four or five choices for the majority of those who are said to have "failed" PAP therapy.
I would like to repeat my point that unless you film yourself sleeping every night all night, you have no way of knowing whether you sleep in a certain position, or avoid a certain position, all night. That is true even if you strap a bowling ball to your back. You also have no way of dealing with situations that may increase your AHI, such as eating late, drinking alcohol, getting a cold, having allergies, etc. That is serious business for someone with significant OSA, and it CAN be dealt with, very easily, by positively pressured air.
Modern PAP therapy is a comfortable and easy way to keep the airway open for patients who get the help they need to make it work. It would be a shame if someone said "I can't get help from my DME to make PAP work, so I'll just try not to sleep on my back and then I can simply forget the entire diagnosis." Those people are the ones I don't want to forget, even if it makes my posts irritating to those who cannot, or will not, use PAP for some valid medical reason. Sorry about that.
mars wrote: . . . How many of those who failed with cpap were then tested to see if they had positional OSA, and then know how to alleviate some or all of their symptoms. . . .
In harmony with ozij's excellent point, until there are studies to verify the usefulness of that approach on a large scale (which I think is what she was asking for), few docs/clinics/payers would see any reason to waste their resources on testing something with so little scientific backing on any regular basis. As far as the industry is concerned, a doc's noting the positional nature of the apneas and telling a patient about it is fine, but it doesn't take the place of an actual
treatment for moderate-to-severe OSA. Docs are in the business of offering actual treatments that have been proven to work, unless they are the experimental-research kind of doc where the people they deal with understand that.
I personally believe that too many primary-care docs already tell their patients, "Eh, don't bother with a sleep study. Just lose a few pounds, avoid sleeping on your back, and then everything should be fine. You don't want to have to sleep with a machine every night do ya?" How many of those patients die in car accidents as they drive away from the doc's office?
Sleep medicine is a real field with real tests and real treatments for real sufferers whose lives are in real danger. Most severe patients can't afford to play around with sleep position. They need some effective sleep.
mars wrote: . . . We should think of ourselves more as OSA sufferer's, rather than cpap users. This then allows us to include in our concerns all those who do not (for whatever reason) use cpap, but do have OSA. I think by continually minimising the potential of positional sleep apnea we are doing a grave disservice to those I think we are supposed to be helping ie OSA sufferer's. . . .
I respect your position in principle, although I disagree with its application in this instance.
I think that when we discuss experimental treatment approaches (a good thing to discuss very often here, IMO) we should try to keep in mind the importance of constantly minimizing those approaches in comparison to PAP in order not to mislead the casual readers. There is a big difference between posting "I have decided to use an unproven experimental approach" and posting "Hey, look at all the scientific evidence proving that my approach is correct and that more should be doing exactly what I'm doing." One kind of post informs; the other kind has the potential to mislead, IMO.
mars wrote: . . . I know this is a cpap forum, but Johhny and Caroline have never hesitated to mention others forms of treatment (bravo ). . .
I am always happy to see a thread that discusses future potential approaches that are not yet standard. They are some of my favorite threads to read and to participate in. But I will trollingly attempt to interject information pointing out the limitations of those approaches in MY attempt to remember those readers having difficulty with PAP, if I feel that the experimental nature of what is being discussed may be lost on the casual reader.
I appreciate your tolerance of my posting what I consider to be counter-balancing info into those threads for that reason. And I apologize again if my tone seems to over-balance in the other direction.