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View Diary: Please Don't Say "Just Lose Weight" (90 comments)

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  •  OSA treatments (0+ / 0-)

    Surgery May cure Some people if their apnea was on the mild side, but my experience has been that the usual surgery (UPP) doesn't reduce airway obstruction enough to achieve an acceptable Apnea Hypopnea Index in folks whose apnea was severe. The ONLY surgery that will cure all OSA is a tracheostomy, which is the recommended treatment for severe OSA in someone who can't tolerate CPAP.

    Oral appliances, usually mandibular repositioning devices, can also be effective for mild OSA. Chronic oral appliance use is now associated with a high rate of complication in the form of displaced,crowded or loose teeth.

    If a tolerable mask is found and the patient still can't tolerate the pressure there are several options. First should be ensuring proper humidity levels. Second many machines nowadays are equipped with an optional setting designed to make CPAP more comfortable: Expiratory Pressure Relief or CFLEX depending on the manufacturer. My opinion is that these should always be set for maximum relief on everyone, but especially so if their prescribed setting is above 8-10 cm H20. A third option is Bilevel PAP or BiPAP which gives a higher pressure on inhalation and a lower pressure on exhalation. BiPAP is especially useful for people with COPD who are notorious for not being able to tolerate standard CPAP. A fourth option would be AutoPAP, a mode that delivers higher pressure when needed as is usually the case during REM sleep or supine sleep, but then delivers a lower pressure when not needed, usually during side sleeping or non-REM sleep. This AutoPAP mode might be especially useful for those who find they pull their mask off during sleep without realizing it.

    For people who simply can't tolerate the mask itself even after trying multiple types of masks, there are also other options. There is a relatively new "mask" that is actually a mouthpiece that fits into the mouth kind of like a scuba device that may be more tolerable. Another option may be found at nomask.com ( I am not affiliated with this company  and can't personally vouch for the product, but it might be worth checking out.) Another relatively new option are the adhesive Pro-Vent nostril valves (again, not affiliated). They are disposible after each night's use, do not require any machine at all, are often well tolerated by folks who hate CPAP; however I don't believe they are yet covered by insurance so there would be the out of pocket cost to consider. For some people, depending on the results of the initial sleep study, positional treatment may be effective. In other words, sleeping only on one's side. There are belt-type devices designed for this purpose which have a hump across the back to prevent one from inadvertently rolling onto his or her back. I've even heard of folks who sew tennis balls onto the back of their pajama shirts for this same purpose. As already mentioned, cognitive therapy or mild anti-anxiety agents may be helpful.

    For those who are using CPAP but still don't feel more rested,
    there may be a number of reasons. Inadequate titration is probably the most likely- in other words the machine is not delivering enough pressure to maintain a patent/open airway. Significant mask leakage or mouth opening is another strong possibility and must be addressed if present. If present, Periodic Limb Movement of Sleep (sort of like restless leg syndrome) may also need to be treated to prevent frequent arousals and fractured sleep. It is very important for OSA patients to avoid alcohol and other sedating medications (ie Ambien, Trazadone, etc.) as much as possible since they increase the severity of airway obstruction thus worsening apnea and could render the prescribed CPAP pressure ineffective.

    Thorough patient education is imperative. Untreated OSA leads to a much increased risk of worsening hypertension, worsening blood sugar levels, transient ischemia attacks (mini strokes), cerebral vascular accidents (strokes), cardiac problems such as congestive heart failure and/or atrial fibrillation. Anyone who dismisses CPAP out of hand does so at serious risk of early death.

    •  Forgot to mention (0+ / 0-)

      a couple options which may be effective for OSA.

      Sclerotherapy is the injection of a drug into the tissues of the pharynx which cause scarring and tightening of the tissues leading to an increased diameter in the upper airway and thus reducing apnea.

      Ablation is kind of like using a laser to achieve the same goal as above.

      Neither of these are FDA approved for OSA, ,but studies are being conducted.

    •  I keep telling him that, and he's had the CPap (0+ / 0-)

      adjusted twice by going back to the sleep clinic and having them figure out the levels he needs.

      I think he has the scuba mouthpiece now, and he rolls over or just moves, and it slips off and doesn't seal properly. Or he gets really uncomfortable and takes it off half-way through the night.

      His has a water tank he fills every night, so I guess that addresses the humidity thing?

      I saw the nostril things when I went searching last night. May try those.

      Confession time: When I'm not ranting about politics, I write romance novels

      by teresahill on Sun Sep 15, 2013 at 10:58:15 AM PDT

      [ Parent ]

      •  Teresa (0+ / 0-)

        It's good that he's adding water, but that doesn't necessarily mean he's getting enough humidity. The humidifier should be heated. The heat may automatically come on or there may be a button that has to be pressed to turn the heat on. Then there  may be a humidity level setting that might run from 1 to 6 or something along those lines. I would set it halfway to start. If the room is cool or there is a fan blowing over the CPAP hose that can also prevent proper humidity because the air in the hose cools before it reaches the mask. Cooler air has less capacity to carry moisture.  In those cases there is frequently condensation in the hose eventually leading to water sloshing inside the hose and making it more difficult to breathe through.  The absolute best way of ensuring proper humidity is with a heated wire hose. It has a wire running the interior length of the hose. The wire is heated thus keeping the air warm as it traverses the length of the hose.  These are only made by one or two manufacturers as far as I know, and they are specific to their CPAP machines.

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