Any Thoughts Appreciated

Rocklin... Are you suggesting if I eat plant based foods I may be able to stop using the machine? Actually, I think you may have something there. I did try this way of eating for a few days... not realistic for me. Now, if someone would like to cook for me, I may reconsider. Much thinking/cooking involved and it's nearly impossible to eat out.

I do think animals have sleep apnea... ever been to the zoo? Didn't see even one ResMed by the way.

Rocklin,

I agree with alot of the points you made.

Here is a great example of a doctor who made a tremendous recovery from MS. One situation where supposedly, it is degenerative over time.

http://www.terrywahls.com/

As an FYI, just so this board understand my perspective, like many people, I was told by a psychiatrist that I needed to be on meds for life. Well, I thought differently and have been successfully off of them for nearly 2 years.

So that is why I am very doubtful when I hear any claims that something is for life especially without articles that prove this. Please don't misunderstand me, I am sure there are many people who will need a cpap machine for life.

But I just think there are too many unknowns about this condition to be making blanket claims. I guess after coming from the psych med world where treatment was allegedly for life, I am having a deja vu type of reaction.

""My cat, Ralph (The Destroyer of Worlds), snores loudly: should I try to titrate him with my trusty ResMed S9?""

Not if you value your life

49er

rocklin wrote:

robysue wrote:After all, OSA is a progressive chronic condition.

And like, oh, say, cancer, there are no natural regressions?

I think the word you want is remissions not regressions since "to regress" means to go backwards?

But---back to the mathematics:

The fact that natural remissions/regressions (i.e. a spontaneous cure) for real chronic medical conditions DO indeed exist is why Probability(Getting Better) is NOT equal to zero.

The fact that natural remissions/regressions (i.e. a spontaneous cure) for real chronic medical conditions are VERY, VERY rare is why Probability(Getting Better) is VERY, VERY close to zero.

IMHO, we must all catch ourselves, when, on the basis of some very limited studies we proclaim that "osa IS this, or osa IS that."

OSA has not been studied with anything resembling either the time frame, controls, or population numbers that either cancer or CHD have had applied to them. They have had literally billion of dollars poured into every aspect imaginable, tens of thousands of studies across the world.

And yet, in both those two heavily-mined fields, the perception of what was "so" shifted dramatically over time.

I think it's almost a given that the same evolution of thinking will apply to OSA.

In both cancer and CHD, there is an identifiable "enemy"---visible physical changes to the body that are clearly detrimental to our health and which treatment is designed to either eliminate (as in cancer) or repair if possible (as in certain forms of CHD).

In OSA we have perfectly functioning upper airways as long as we're awake. Sure, some of us have palettes that may be longer than normal or tongues that are larger than average, but during the daytime these physical variations cause us no problems. It's only when we are asleep that the trouble begins. And the early results from proposed surgical solutions that attack the observed physical anomalies have been mixed: Trimming all the excess tissue through UPPP doesn't seem to be particularly effective, and hence there may be more going on than just the amount of tissue in and around the upper airway.

And so the better analogy may be to high blood pressure---another chronic medical condition that leads to all kinds of problems, but at its beginning stages does not have an easy to identify physical target to attack. And the thinking about HBP and its medical significance has indeed gone through some significant changes in the last 40 or 50 years.

And like high blood pressure, the thinking about OSA HAS changed dramatically over the last 40 years. And it may very well continue to change. Once upon a time (and not that long ago), the kind of snoring reported with OSA was regarded as "bothersome" but not all that important and spouses were told, "Get earplugs or sleep in a different bedroom." Then the most severe cases of OSA were studied and folks with life-threatening O2 desats were offered trachs and further research into better treatments was started.

And after CPAP was invented? Folks with what we now regard as severe or very severe apnea were the ones who were put on CPAP. And folks with what we now call moderate or mild OSA were usually told something along the lines of "CPAP is not necessary yet. Lose some weight and see if that helps. But don't get too worried about it since a certain amount of deterioration in sleep quality is normal as we age."

And right now there's lots of disagreements in the world of sleep medicine about how to define a hypopnea: Is an O2 desat necessary? Or is an arousal enough? The definition you chose to use will indeed directly affect whether some people wind up with an OSA diagnosis. I offer myself as a prime example: Under Medicare's rules, I have NO OSA since my (Medicare) AHI = 3.5; under the AASM's Alternative Standard for scoring hypopneas, I have moderate OSA since my (Rule 4B) AHI = 23.1.

So right now, it seems to me that the important discussions and research work concerning OSA are still in stages of trying to figure out: Just what are the medical consequences of untreated and under treated OSA? and What criteria should be used to screen patients for determining their risk for OSA? and What criteria should be used to diagnose OSA? and Just how bad does OSA need to be before some kind of medical intervention should be done?

Now for a long time the question What is the best treatment for OSA? did not receive much creative attention: After CPAP was invented and proved to be highly effective in managing OSA, the research $$ went into making CPAP more tolerable: Smaller, quieter machines. Heated humidifiers. Variable pressure machines. BiPAP machines. Heated hoses. Full data machines. More comfortable masks. More styles of masks. Smaller masks. Less cumbersome headgear. But in spite of all the improvements in making CPAP easier to use, CPAP therapy continues to have very high non-compliance rates. And so there is some real evidence that the world of sleep medicine is once again starting to look seriously at other ways to treat (and possibly CURE!) OSA. Oral appliances have come a long way in helping people who cannot or will not tolerate CPAP. The (in)famous experimental tongue-zapper may prove to be a godsend to some folks. And who knows, maybe someone will eventually figure out a way to definitively determine just what pieces of excess tissue really are responsible for our apnea and that could evetually lead more targeted, less invasive, less painful, and more effective surgical treatments.

Does anybody here really believe that we will not see a dramatic turn of events regarding OSA during the next twenty years?

That somehow OSA is exempt from a (God, I hate this phrase, but here it is:) paradigm change?

As my comments above indicate, I sincerely HOPE and EXPECT that within the next 20 years, there are some dramatic turns of events regarding how OSA is thought about and treated.

But ems is asking about the present. And the only way ems could suddeny Get Better is with a natural remission/regression---i.e. a miracle cure.

Now ems has also said she's 20 pounds overweight. So, unlike me, her Probability(OSA is caused primarily by weight issues) is indeed a positive number. How high is the probability that her OSA is primarily caused by the excess weight? I haven't the foggiest idea.

IMHO, there is no way you should be giving anyone definitive "no chance" odds on the likelihood that their OSA may have abated.

I never said "no chance"---I said there is ALMOST no chance of a spontaneous cure for OSA.

Curiosity makes me ask: Lets suppose that John Smith has been with high blood pressure and he has been taking HBP medication for a number of months and that the HBP medicine has effectively brought his blood pressure down to the normal range. One day John forgets to take his pill, but he stops by the local drug store for something and while there takes his blood pressure. And it's right at 122/74. Should John conclude that his high blood pressure has been cured? And that it's ok to stop taking his medicine?

And if asked what I think, should I NOT point out that there is virtually NO chance that his HBP has actually been cured? And should I NOT point out that it unwise to simply stop taking his HBP medicine?

I appreciate the responses from everyone. My feelings re this issue are all over the place. Not sure what I'm going to do or how I plan on handling this at the moment. Perhaps losing the extra 20lbs is a way to start...

Robysue... you do make some logical points.

ems wrote: Perhaps losing the extra 20lbs is a way to start...

Unless you want to do a sleep study on your side at your current weight, and if it comes back positive, do another one on your side after you've lost 20 pounds, it does seem reasonable that you might want to maximize your chance of a "cure" (or at least improvement) by losing weight and then repeating your sleep study.

ems, are you sure your sleep study doesn't break down your AHI by supine vs. non-supine? That would tell you a bit about how likely it is that your SDB is positional.

SleepingUgly wrote:ems, are you sure your sleep study doesn't break down your AHI by supine vs. non-supine? That would tell you a bit about how likely it is that your SDB is positional.

No, I'm not sure... will have to check that out. I have always slept on my side tho... not just since I started CPAP. I think I mentioned that the tech asked me to roll on my back during the sleep study... so maybe it does break down the AHI.

ems wrote:

SleepingUgly wrote:ems, are you sure your sleep study doesn't break down your AHI by supine vs. non-supine? That would tell you a bit about how likely it is that your SDB is positional.

No, I'm not sure... will have to check that out. I have always slept on my side tho... not just since I started CPAP. I think I mentioned that the tech asked me to roll on my back during the sleep study... so maybe it does break down the AHI.

Obviously techs want to titrate for the worst case scenario, which is usually supine sleep, but in the case of those with positional apnea, that is very unhelpful! Unfortunately, according to my sleep study, my SDB is equally bad non-supine, as supine.

I *think* that I only sleep on my stomach or sides, but in reality I do spend some time on my back (whether I want to believe it or not). Rarely I wake up on my back, and I have to imagine that there may be other times I'm on my back that I don't realize I am (after all, I'm asleep!).

[quote="SleepingUgly"]I *think* that I only sleep on my stomach or sides, but in reality I do spend some time on my back (whether I want to believe it or not). Rarely I wake up on my back, and I have to imagine that there may be other times I'm on my back that I don't realize I am (after all, I'm asleep!).[/quote ]


I may have rolled onto my back before CPAP and in the first several weeks of starting CPAP, because I would wake up with my mouth very, very dry. That hasn't happened in many months... I think I've trained myself to stay on my side(s) and to sleep with my mouth closed. If I do roll on my back I hear a loud swish (leak) which wakes me all the time and I roll back on my side. That happens maybe once during the nite.