ANy data/studies showing that cpap treatment improves the

johnthomasmacdonald wrote:Dream Stalker - if you look at the study you provide, here's what it says: ...

... Certainly if you are interested in avoiding heart disease you can make a MUCH MUCH bigger difference by eating a handful of nuts each day. Eating nuts 4x a week reduces coronary heart disease by 37% over those who never or rarely eat nuts.

Sorry. I'm not sure what point you are trying to make or why you want to convince anyone out of CPAP treatment.

You asked ...

johnthomasmacdonald wrote:
If it is so clear that cpap treatment reduces mortality in mild and moderate apnea, the data should be available, if it is , I can't find it

If you want to talk yourself out of using CPAP, you should just do it -- go ahead and trade your CPAP for a bag of nuts.

I'm pretty sure I went untreated for 25 years and I did managed to survive. But by the time I turned 46, I began to feel like I was going to die before I reached my 50th birthday. CPAP therapy turned my life and health 180 degrees and I just turned 53 less than a week ago -- and I feel like when I was in my early 30's. I was so amazed by this turn around that I researched it and learned why. Sleep apnea causes severe hormonal disregulation. Hormones provide the language used by our cells to communicate with each other and the external world. I was lucky that I did not become one of those morbidity statistics. I guess you could say I was an outlier (just as most people will tell you I am ).

Anyway, so as for Hill's criteria, I agree completely that proper nutrition is key to keeping our hormones and cells working properly and when they are working properly, our cells are genetically expressed for a state of good health. However, keep in mind that oxygen is an essential nutrient to our body cells just like essential fatty acids, proteins, vitamins, and minerals that nuts provide. And if you become deficient in O2, which is what happens when you have sleep apnea, you will suffer the wrath of hormonal disregulation and the resulting chronic and degenerative diseases that lead to premature death.

So grab your bag of nuts, but without proper O2 you will likely end up with a CV event.

johnthomasmacdonald wrote:http://imtheramedical.com/wp-content/th ... 8.1079.pdf

Here's a study from Australia that follows a group for 13 years - they are divided up into Non-apnea, mild-apnea (ahi <16) and moderate/severe apnea ahi>16

Interestingly, the untreated mild-apnea group ( mild here is actually mild/moderate) actually has a LOWER (although not significant) death rate over 13 years than does the non-apnea controls - 6 vs 7%

and while the moderate/severe has a much higher death rate 33% - they are also obese, a BMI of 34 verses 26 for non-apnea and 27 for mild untreated apnea

Again there are apples and oranges once you throw in things like obesity and other life situations. If these people are not twins or triplets living the same way the data is shaky.

Dream stalker - I don't understand all the emotion - is this a religious cult?

It is really unreasonable to ask for EVIDENCE that using a cpap machine reduces mortality for people with mild to moderate apnea?

What started my interest was that on Sat i linked up with my best friend from Boston who is an Oncologist/research scientist at Harvard Medical School/mass general hospital. It was HIS opinion that treating sleep apnea for people with mild to moderate apnea is a scam to generate loads of money for sleep clinics, machine manufacturers and sleep doctors .

This led to look for the data showing that HE was wrong. I can't find it. If it makes you feel better and more rested - excellent!!! enjoy!! why would i give a damn what you do.

If untreated mild to moderate apnea is so dangerous and cpap makes such a huge difference in survival and heart attacks - the data should jump out - it doesn't.

I have no emotion in this, I want to find out what the actual answer is.

The fact that you have so much emotion about the question seems bizarre and rather inappropriate.

Are you aware that there are LOADS of medical treatments out there for which there is NO evidence that they actually work and in fact considerable evidence that they make things worse? Look into recent clinical trials where people with back pain are given SCAM surgery ( where they just put cut you and sew you up so you can't tell whether they actually did anything) to compare outcomes to the actual surgery - the result, the scam surgery actually outperformed the actually surgery. The Placebo effect is REAL. Those people who feel less pain after surgery, swear by it.


Here's a story on the back surgery as an example:

Spinal Surgery Is A Money-Making Scam
admin | Aug 19, 2010

We’re taught to respect and trust authority figures like teachers and priests. But that trust is never more sacred than with doctors… After all you literally trust them with your life. When you consult a doctor, you trust they have your best interests at heart.

But a new phenomenon in spinal surgery may make you revise that thinking.

The back pain business is a billion dollar industry that offers enormous financial rewards for savvy doctors. The next time you’re laid up in bed with back pain and you think a trip to the doctor’s is your best bet… think again. There’s a very good chance that the pill she prescribes… the device she promotes… or the surgery she suggests… may not be necessary at all. And the best solution might have been something else entirely… something cheap, simple and safe.

Back Pain Is Big Business

Have no doubt: back pain is big business. Approximately 90 percent of all Americans suffer from back pain during their lives. In fact, more Americans stay home from work because of back pain than any other reason. And an estimated half-million Americans opted for spinal fusion surgery in 2006 alone.

Do you know what all these figures add up to? Fifty billion dollars. That’s right… we spend $50 billion on back operations each year.

That’s a huge revenue stream, and it adds up quickly. Did you know that a single spinal screw sells for about $1,000? And do you know how much it costs to make that spinal screw? About $65!

Spinal equipment and devices are huge business. And in a new twist… the doctors who prescribe those surgeries and devices are the same ones who are actually invested in the products themselves. One doctor had over $500 million invested in a spinal device that he actively prescribed.

And what’s really disturbing is that many good doctors and several studies suggest those operations don’t do any good.

“In terms of unconscionable benefit-cost ratios and treatments that are more harmful than helpful, we have a system that is simply unsupportable,” says Dr. Norton M. Hadler. “Back pain has little to do with ruptured discs or spinal pathology.”

Instead, he says that the spinal surgery industry is driven by personal profit opportunities – both for the device makers… and the doctors who invest in them and prescribe them.

Honesty and the Hippocratic Oath

And he’s not alone in what he’s saying. If you’re looking, you will see that the news is crowded with high profile cases of surgeons being paid huge sums to promote spinal devices and surgery.

Here’s just one harrowing case – first reported in the Boston Globe and later picked up by news services across the nation.

Arkansas neurosurgeon Patrick Chan pleaded guilty to soliciting and accepting kickbacks from medical device maker Blackstone.

Blackstone paid him monies in the form of “bogus consulting contracts, fake research studies, and gifts.” Those payouts were in return for Chan prescribing and using the company’s devices in spinal surgeries.

The suit also revealed that Chan told a young trucker that he needed surgery. Chan told him that if he didn’t get it he’d be a quadriplegic. Terrified, the trucker agreed. Chan went ahead with surgery and implanted a spinal device in his back.

A later independent evaluation of the pre-surgery MRI showed the procedure was completely unnecessary.

This is just one well-reported case of doctors trading your interests for fat payouts. But it’s emblematic of a disturbing phenomenon in spinalsurgery.

High Profile Scams

Plenty of other cases focus on the deals that the device makers themselves are making.

MSN reported that device maker Medtronic Inc. paid $40 million to settle government charges that they were giving kickbacks to doctors in exchange for using their spinal implants.

The Wall Street Journal reports that the same company paid over $15 million – in just the first quarter of this year alone – to spinal surgeons for “consulting and royalty” fees.

One Tennessee neurosurgeon was paid $3.97 million for a “range of surgical plates, rods and screws used in spine surgery.”

The Wall Street Journal concluded that it’s difficult to break down “whether payments are legitimate royalties or inducements to sell products.”

Kicking up Expense

“In run-of-the-mill cases, doctors aren’t even supposed to do an X-ray or MRI unless the pain lingers for six weeks,” says Dr. Ray Sahelian. “Yet a study in 2009 found nearly one in three patients get some kind of back scan within that first month.”

Another doctor showed that this is happening all the time.

Dr. Roger Chou of Oregon Health and Science University in Portland reviewed six studies involving 1,800 people with lower back pain.

He found that patients with no serious underlying causes who received imaging tests fared no better than patients who received standard treatment without the imaging.

That’s obviously significant: imaging tests are expensive. Worse, X-ray and CT scans expose patients to unnecessary doses of radiation.

“Routine use of costly X-ray, MRI and CT scans on patients with lower back pain may be unnecessary,” says Dr. Sahelian. “While most patients have no serious underlying condition causing the low back pain, doctors often order imaging procedures that can check for problems like herniated disks, muscle injuries, arthritis or broken bones.”

Why are you worrying about longevity? You seem to just be prolonging the misery.

johnthomasmacdonald wrote:
I have to admit that in six months of using it the entire night, every night - except for Sandy and a night testing the dental appliance - and I feel MUCH MUCH more tired now than i did prior to using cpap

and since starting cpap treatment I've gained about 15 pounds, I wasn't overweight to start with

When the treatment is worse than the condition, drop the treatment.

Try sleeping on your sides or stomach without using CPAP.

Black Spinner writes: "Again there are apples and oranges once you throw in things like obesity and other life situations. If these people are not twins or triplets living the same way the data is shaky."

RIght so in the absence of any convincing evidence that a treatment works, shouldn't the default be "DO NO HARM"?

All I've asked for is where is the evidence that treating mild to moderate sleep apnea with a cpap machine improves outcomes - i find it really strange that so many seem to consider this an unreasonable question.

Even if a person just finds that they feel less fatigued on cpap, i would consider that a very useful outcome and worth it.

BUt for all those who come here and don't feel more rested on cpap and find the treatment very uncomfortable and actually feel LESS rested and more fatigued on it, shouldn't there be strong evidence demonstrating why they should continue the treatment? not just anecdotal stories.

They been using cpap machines for something like 33 years, the data that it is useful for people with pre-existing heart disease or those with severe sleep apnea are convincing, the data for those with mild to moderate Is NOT>

The fact that people with mild to moderate apnea tend to be far more obese than the general population and thus you are comparing apples to oranges would be a great argument - but would apply if those with mild to moderate apnea showed higher mortality/morbidity rates as would be predicted. The fact that they don't, means you would have to argue that obesity is actually improving the health of mild to moderate suffers since without treatment their overall mortality rate is basically identical to the thinner controls

John,

In an email exchange with the sleep medicine dentist on the other board, he cited the Busselton Health Study. Apparently, the mortality rate for mild untreated sleep apnea is not that much greater than for folks who don't have it. It is for folks with untreated moderate and severe apnea.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2542953/

I appreciate your skepticism about medical studies. Having that could have saved me years of psych med h-ll. But better late than never.

49er

johnthomasmacdonald wrote:Dream stalker - I don't understand all the emotion - is this a religious cult?

It is really unreasonable to ask for EVIDENCE that using a cpap machine reduces mortality for people with mild to moderate apnea?

What started my interest was that on Sat i linked up with my best friend from Boston who is an Oncologist/research scientist at Harvard Medical School/mass general hospital. It was HIS opinion that treating sleep apnea for people with mild to moderate apnea is a scam to generate loads of money for sleep clinics, machine manufacturers and sleep doctors .

This led to look for the data showing that HE was wrong. I can't find it. If it makes you feel better and more rested - excellent!!! enjoy!! why would i give a damn what you do.

If untreated mild to moderate apnea is so dangerous and cpap makes such a huge difference in survival and heart attacks - the data should jump out - it doesn't.

I have no emotion in this, I want to find out what the actual answer is.

Mortality is one small issue. It is not very important as far as I am concerned. I look after my mother. Yes she is alive and for the last 4 -5 years has been surviving with dementia and decreasing mobility as she has little strokes and the dementia eats her brain. Far more important to me is the quality of life. I don't give a flying fuck to live those extra years as a vegetable, I do care to live my current life as a none vegetable with enough energy and verve to actually DO something. Will it keep off the heart attacks and strokes and diabetes (which would lead to heart attacks and strokes), that would be nice and considering my cholesterol is down and so is my blood sugar and my BP then according to the latest medical theory it will.

TheUglyTruth wrote: "Why are you worrying about longevity? You seem to just be prolonging the misery."

Misery? I love life. I'm having a great time

I started cpap treatment hoping that it would improve my energy level and I had assumed that their was strong evidence showing that it was beneficial in preventing serious medical issues down the line.

I'm a great believer in preventative medicine. On sat an MD friend of mine told me that there isn't any convincing data that cpap improves the health of those with mild to moderate apnea. In his opinion, it's a money making scam . I was sure he must be mistaken so i searched the literature and find that at best, the evidence is very weak.

I find it quite amusing that so many seem to get angry at just asking the question -

Black spinner wrote: "Mortality is one small issue. It is not very important as far as I am concerned. I look after my mother. Yes she is alive and for the last 4 -5 years has been surviving with dementia and decreasing mobility as she has little strokes and the dementia eats her brain. Far more important to me is the quality of life. I don't give a flying fuck to live those extra years as a vegetable, I do care to live my current life as a none vegetable with enough energy and verve to actually DO something. Will it keep off the heart attacks and strokes and diabetes (which would lead to heart attacks and strokes), that would be nice and considering my cholesterol is down and so is my blood sugar and my BP then according to the latest medical theory it will."

I like mortality statistics since they aren't open to interpretations - for example, only pay attention to improved cancer treatments when you see the Mortality rates drop ( which they are finally), much of the other "improvements" merely reflected early diagnosis and thus "longer survival times" -

As i said in another post, if you feel better rested and have more energy - GREAT- i think that this is as good a reason as any to continue treatment

BUt now you are arguing that treating mild to moderate apnea is saving you from strokes, diabetes, heart attacks, and being a vegetable - where is the DATA showing that cpap improves your odds of avoiding these illnesses - I don't see it in the literature

All I've asked for is where is the evidence that treating mild to moderate sleep apnea with a cpap machine improves outcomes - i find it really strange that so many seem to consider this an unreasonable question.

Even if a person just finds that they feel less fatigued on cpap, i would consider that a very useful outcome and worth it.

BUt for all those who come here and don't feel more rested on cpap and find the treatment very uncomfortable and actually feel LESS rested and more fatigued on it, shouldn't there be strong evidence demonstrating why they should continue the treatment? not just anecdotal stories.

That argues that you should be looking at the reasons why YOU are reacting differently and what YOU as an individual should do about it, not that the treatment in general is a problem.
I have a mild asthma. The medication causes me to be very dizzy, something that is a big problem when I have to lift my mother in and out of her chair. This means I have chosen to limit my use of the medication by making an intelligent decision based on my individual reaction to prescribed meds. My risk, my choice.

They been using cpap machines for something like 33 years, the data that it is useful for people with pre-existing heart disease or those with severe sleep apnea are convincing, the data for those with mild to moderate Is NOT>

The fact that people with mild to moderate apnea tend to be far more obese than the general population and thus you are comparing apples to oranges would be a great argument - but would apply if those with mild to moderate apnea showed higher mortality/morbidity rates as would be predicted. The fact that they don't, means you would have to argue that obesity is actually improving the health of mild to moderate suffers since without treatment their overall mortality rate is basically identical to the thinner controls

That assumes the same lifestyle. What if those obese people are actually trying to lose weight by eating healthier and exercising? Besides thin does not always mean healthy or having a healthy lifestyle. Are these thin people then because they are unhealthy? Because they are mountain climbers and risk takers? Are they construction workers or farm labourers or military personnel? Did the weigh this in their study? Fat people at a desk job have a different mortality then a firefighter or farm labourer.

johnthomasmacdonald wrote:
BUt now you are arguing that treating mild to moderate apnea is saving you from strokes, diabetes, heart attacks, and being a vegetable - where is the DATA showing that cpap improves your odds of avoiding these illnesses - I don't see it in the literature

Well like I said in the almost 3 years I have been on cpap my cholesterol, BP and blood glucose levels have dropped. And while I have tried to eat healthier I am really not eating that much different from before cpap when I was already working at eating healthier. ETA: these are considered indicators that I am less likely to have a heart attack.

Meanwhile my stress levels have gone through the roof according to the stats. I have 1) lost my job, 2) moved twice 3) decided to retire 4) am now looking after my parents waiting for my mother to die slowly. I get 4 hours a week off to shop.

johnthomasmacdonald wrote: I feel MUCH MUCH more tired now than i did prior to using cpap

johnthomasmacdonald wrote:

I love life. I'm having a great time

Now which is it?

johnthomasmacdonald wrote:Dream stalker - I don't understand all the emotion - is this a religious cult? ...


... The fact that you have so much emotion about the question seems bizarre and rather inappropriate.

Perhaps you misunderstood my sarcasm and multi-level frames of communication for ... emotion?

I agree 100% with your skepticism of the modern healthcare system. It is based on a paradigm of treatment for profit and therefore not always in the best interest of the patient. I prefer the health paradigm of Naturopathic Medicine (vis medicatrix naturae) and similar alternative therapies that do less harm than the treatment (as TheUglyTruth noted). So yes, I shun unnecessary surgery, drugs, and other treatments that do not promote our own body to heal itself.

What I tried to explain to you is that our state of health is the genetic expression of our body cells in response to environmental stresses via the biochemistry of hormones. This complex biochemical system requires essential nutrients that include air, water, energy (as thermal, chemical, electromagnetic, and kinetic), and food (as fatty acids, proteins, vitamins, and minerals). There is nothing emotional about that except that emotions do influence our hormonal symphony based on how our minds perceive our physical and mental environment.

If you want to call my view a cult, I suppose that's your prerogative but if you really want something more cult-like you should here my view of the current state of modern civilization -- will make your skepticism of the modern healthcare system pale in comparison.

You are taking a myopic view of the issue IMO. There are many factors that may lead to premature death from chronic degenerative diseases like heart attacks and (add your list here). But I do somewhat agree with your best friend -- there are indeed some who have mild or moderate sleep apnea that can be better treated through diet simply because their sleep apnea is caused by obesity. But not everyone's sleep apnea is caused by poor diet alone, some have the cumulative or inherited epi-genetic expression of a small lower jaw, large tongue, and/or small throat opening -- conditions that we cannot easily heal ourselves and thus requires long-term treatment. So for them CPAP therapy provides them that essential nutrient that most would die from if withheld for more than just a few minutes, oxygen. Is that too emotional for you?

johnthomasmacdonald wrote: ...
I started cpap treatment hoping that it would improve my energy level and I had assumed that their was strong evidence showing that it was beneficial in preventing serious medical issues down the line. ....
... I find it quite amusing that so many seem to get angry at just asking the question -

So are you saying you don't have sleep apnea and just thought you could add some zip to your energy with CPAP while hedging for your future health?

No one is angry. You are coming here to tell us that CPAP is a fraud. There are people here who have real experience with the treatment that has changed their lives for the better. It is hard to expect that they won't disagree with you.

John,

You are fortunate to have been able to purchase an FDA-approved oral appliance, as you stated in other posts. Those are supposed to be good for mild to moderate SA. So why not just use that?