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Yes, I know that this is a very broad generalization. And yes, there may be one or two people out there who are unable to work and who have repeatedly been denied the Social Security Disability Claim who do not have an underlying sleep disorder...but in three years of family medical practice in a public clinic for the uninsured and underemployed, I have not seen those  people yet.  What I have seen instead is an epidemic of undiagnosed, untreated sleep apnea.

Here is my "typical" disability denied patient. He/she worked all her life and then got laid off in middle age---when sleep apnea tends to strike. Maybe the layoff was attributed to the recession. Maybe her job was canceled and a new job was created for which she did not qualify--i.e. she was "fired" but they did not want to call it that.  Maybe she was out of work one day too many for one of the diseases that an untreated sleep disorder causes---like chronic pain, depression, stroke, car wreck. Maybe she was late getting in to work one too many days, because she gets no sleep at night and wakes up dead tired each morning. Maybe she made a terrible mistake on the job due to her inability to concentrate and remember. Maybe her disposition got bad because she has not slept in years and a customer complained.

Too bad her doctor did not diagnosis her sleep disorder while she was still working and had insurance. She could have gotten treatment which would have returned her to her old productive self. While she was waiting for treatment to kick in, she could have told her employer "I have sleep apnea which means I have a temporary disability" and the employer would have been obligated to make allowances--allowances that he did not have to make for her being tardy/crabby/forgetful.

Sadly, obstructive sleep apnea (OSA) remains the most commonly missed common diagnosis in this country, with a whopping 10% (or more) of people over 40 suffering from it and an even more alarming 80% of that 10% having never been diagnosed no matter how many times they have seen doctors for their myriad of OSA related problems. That means 8% (at least) of working Americans---and driving Americans--over 40 are running around chronically sleep deprived.

As described above, people with untreated osa do poorly in their jobs and they get fired. Or, they realize they have to quit because they are a danger to the public. They have many, many, many health issues---chronic pain, depression, accidents, elevated blood pressure, ED, strokes, heart failure, heart attack, hard to control diabetes, poor memory, poor concentration---which they can not afford to get treated since they no longer have insurance or a job.

People with OSA know that something is wrong with them. They typically see a lot of doctors and get treated for everything under the sun except their sleep disorder in the years before their OSA is diagnosed. If they are unlucky enough to lose their job during this process, they will try to get health care. Seeking a small monthly S.S. check and Medicare coverage,  they fill out their disability form and list 1) back pain 2) high blood pressure 3) depression. And then, they are despondent when Social Security turns them down on the grounds "You can read and write and use your dominant hand. Get a clerical job."

Except, they can't work a clerical job. They fall asleep in front of the computer. They make mistakes. Their spouses nag--"Why aren't you the man/woman I married?" They sense that something is wrong so they go online and read about Chronic Fatigue Syndrome and other (untreatable) diseases. Do they have early dementia? That one's untreatable, too.

The OSA sufferer appeals his disability denial. He gets a lawyer. But if his family doctor was not able to diagnose his sleep disorder, his disability attorney is not likely to catch it either.  Doctors are so bad at diagnosing all but the most obvious and worst cases of OSA, that your only chance of getting an accurate diagnosis is to 1) walk into the doctor's office, say "My spouse says I snore and stop breathing at night and I looked it up and I think I have sleep apnea and so does my brother/father/son" or 2) see one of the relatively few primary care doctors who has experience diagnosing and treating sleep apnea and who will not just take your word for it when you say "But doc, I don't snore." How do you know you don't snore? Have you asked your family? If I have a high suspicion of a sleep disorder, I have the patient go home and ask. Very often the patient is surprised at what they learn.

When do I suspect OSA? There are a lot of ways in which it presents. Here is one that is very common in my underemployed, uninsured patient population.  When a patient who has not been involved in a catastrophic wreck and who does not have a devastating autoimmune disease like lupus has been turned down by SS for their complaint of chronic pain, I automatically do an OSA screen. And, in my experience treating middle aged, unemployed or underemployed people without health insurance, 95% of them have an undiagnosed sleep disorder. Remember, sleep deprivation increases you pain and inflammation, it decreases the effectiveness of pain meds and it increases the appetite for high calorie low nutrition foods causing weight gain---so, yes, your back really does hurt. But surgery is not going to fix that hurt. Getting a good night's sleep for a few weeks will fix that hurt. But you won't get sleep without a sleep study and OSA treatment and you won't get that without insurance.

This is a really sad Catch-22 type situation that is costing this nation dearly since it takes highly skilled and experienced workers out of the work pool and throws them into early retirement. If anyone in the government really wants to cut Medicare expenses, maybe they should create a quality measure for sleep disorders. Right now, doctors who treat Medicare patients have to document that they are screening for breast cancer, smoking, depression,  diabetes and high blood pressure control.  Maybe the government should toss in sleep disorders screening too. It wouldn't cost that much. OSA can usually be diagnosed based on clinical exam alone. The oximetry and sleep study are just to confirm the diagnosis, judge the severity and determine what treatments are indicated.

Maybe disability attorneys should buy their own overnight pulse oximetry machines and hire someone to reads the results. I have seen a number of patients who were repeatedly disability denied succeed in their disability claim when they could show the judge that they stop breathing 50 times an hour. One successful appeal would more than pay for the machine.

Maybe a sleep history should become an integral part of the medical history, along with "cardiac" and "respiratory." Doctors would find that many of their "difficult" patients---i.e. the ones who fail to get better---have a treatable disease. Maybe specialty boards like the Family Medicine Board should start requiring that residents in training do a sleep medicine rotation.

 Maybe the auto insurance industry should conduct a public health campaign to alert drivers to the danger of having 8% of over-40 drivers driving like they are drunk--which is what untreated OSA patients do. It would cut accidents and insurance claims.

Even those who do not have a sleep disorder need to be aware of OSA. Remember, the untreated OSA from which 8% of your neighbors over 40 (make that 16% of your neighbors if you live in an African-American or Asian-American community) suffer, is costing you tax money and making your roads unsafe. And there is a 1 in 10 chance that you will be among the unlucky ones once you reach middle age.

Originally posted to McCamy Taylor on Sun Nov 03, 2013 at 07:29 PM PST.

Also republished by In Support of Labor and Unions, Community Spotlight, and KosAbility.

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Comment Preferences

  •  Tip Jar (129+ / 0-)
    Recommended by:
    Betty Pinson, jo fish, NightOwl40, denise b, murphy, CanisMaximus, texasmom, The Pollster, hangingchad, sceptical observer, tofumagoo, nomandates, dsb, Sailorben, my2petpeeves, sturunner, WakeUpNeo, bakeneko, VClib, Youffraita, antirove, gffish, blueoasis, Cofcos, kyril, mettle fatigue, Fiddler On A Hot Tin Roof, ladybug53, 88kathy, jiffykeen, Superpole, edie haskell, rubyclaire, sngmama, hannah, skepticalcitizen, nannyboz, marina, donnamarie, HeyMikey, emmasnacker, Nebraskablue, petestern, poco, TrueBlueMajority, MKinTN, martini, FischFry, Lefty Ladig, zerelda, geordie, Oh Mary Oh, Morgan in Austin, scronk, kharma, stlsophos, marykk, BlueJessamine, grimjc, Aaa T Tudeattack, LilithGardener, Floande, Gordon20024, Nina Katarina, Zinman, Unknown Quantity, oldliberal, john07801, annrose, Sylv, radical simplicity, whaddaya, sdf, wasatch, Shakludanto, Ice Blue, sap, ksp, JDWolverton, splashy, highacidity, Mentatmark, BRog, SteelerGrrl, Heart n Mind, sillycarrot, FloridaSNMOM, chantedor, CJB, roses, Spirit of Life, doingbusinessas, imchange, CharlesII, exNYinTX, Omir the Storyteller, Dianna, icemilkcoffee, greengemini, Kasoru, South Park Democrat, old wobbly, J M F, RantNRaven, theKgirls, Sean Robertson, Dave925, CroneWit, Involuntary Exile, joeschmeaux, Zaq, worldlotus, Bernie68, akmk, wishingwell, freeport beach PA, fallina7, BlueMississippi, freakofsociety, corvaire, Matt Z, weck, FarWestGirl, suesue, Larsstephens, oldpotsmuggler, terabytes, SingerInTheChoir, MsGrin

    "A dog starved at his master's gate/Predicts the ruin of the state" Blake

    by McCamy Taylor on Sun Nov 03, 2013 at 07:29:16 PM PST

  •  I have a question for you (31+ / 0-)

    If I know how common undiagnosed sleep apnea is JUST FROM READING THE NEWSPAPER, then how is it that so many doctors overlook it?

    Things like this I just don't get.

    •  Million dollar question (27+ / 0-)

      I have done two surveys of FPs trying to untangle this web. So far, I know that if the FP has assisted in the diagnosis and treatment of sleep disorders in residency and/or if he has attended live seminars on sleep disorders, he is more likely to be OSA aware--and once a doctor is osa aware, he sees it in his practice and diagnoses it. However, sleep medicine is not routinely taught and sleep apnea seminars for primary care are not widely available. That is from the physician side.

      From the patient side, it is easy to understand the problem. The number one sign--snoring so badly that you stop breathing many times an hour---only happens when you are asleep. BY the time you are awake, you are breathing again. So, unless a family member remarks upon it, you do not know the sign. And since OSA is not high on the list of things that people get educated about---as opposed to, say, the ten warnings signs of cancer or the signs of a a heart attack--many people who observe their loved ones apnea never mention it.

      "A dog starved at his master's gate/Predicts the ruin of the state" Blake

      by McCamy Taylor on Sun Nov 03, 2013 at 08:11:19 PM PST

      [ Parent ]

      •  See your title. I am somewhat reluctant to (24+ / 0-)

        suggest you correct the spelling of study because stduy might actually get more eyeballs. But, in the interest of accurracy..............

        My spouse has had mild sleep apnea for a long time. I make sure he gets lots of sleep by nudging him off his back when he begins to snore. It's actually getting less severe with old age (75). His new primary care doctor suggested that a t-shirt with tennis balls inserted in a pocked on the upper back keeps people on their sides. The spouse thinks he sleeps on his back all the time, but I know better. There are practical reasons why married people live longer. They've got someone to watch their back. :)

        My DIL uses one of those sleep machines and likes the mask. I keep trying to convince her that sleep before midnight is more important than after. She has a habit of going to bed late because, as she explains it, she was long afraid of going to sleep -- which is understandable if a person is near suffocation several times a minute. DIL is not yet fifty, so she also had early-onset sleep apnea. Perhaps people who had their tonsils out are less susceptible.

      •  But (2+ / 0-)
        Recommended by:
        worldlotus, FarWestGirl

        Don't they read the newspaper? Don't they read anything that keeps them current on significant things like this? How can it be that I know it and they don't?

        This is off-topic and I apologize, but on a similar note: I have Sjogren's. When I was first diagnosed I went to the Sjogren's Foundation website and read the front page:

        About Sjögren's Syndrome
        ...Today, as many as four million Americans are living with this disease.

        Although the hallmark symptoms are dry eyes and dry mouth, Sjögren’s may also cause dysfunction of other organs such as the kidneys, gastrointestinal system, blood vessels, lungs, liver, pancreas, and the central nervous system. Patients may also experience extreme fatigue and joint pain and have a higher risk of developing lymphoma.

        And yet, on the patient forums I visit, I am frequently seeing people who are told by their RHEUMATOLOGISTS that the disease does not cause fatigue or joint pain. Or that it's just dry eye and dry mouth. Or that it's a very rare disease.

        I'm not a doctor basher. But this really floors me. These are not just primary care doctors telling people these things - it's specialists.

        People really do need to research their own symptoms, as hard as it is.

        •  Doctors tend to recall the training they had (3+ / 0-)
          Recommended by:
          cynndara, denise b, FarWestGirl

          in Med School. Once they're in practice, they're busy enough and there is so much new information coming at them that they don't have time to learn about every new condition or disease.

          Additionally, medical students quickly learn to be conservative in their diagnoses - you don't diagnose dengue fever if ordinary influenza is much more likely.

          So, doctors will keep up with new treatments for ailments they diagnose all the time, but they aren't likely to be as receptive to diagnosing common problems as symptoms of some new disease.

          As you said, patients have to diagnose their own symptoms - but they also have to be critical of their own perceptions. Doctors get far too many patients who are erroneously convinced that they have "the disease of the month" and need "Expensive medication advertised on TV" to deal with it.

          •  Are you a doctor? (0+ / 0-)

            People at the Sjogren's forums often talk about bringing reading material to their doctors to educate them about the disease. I wonder how the doctors react to that. I wouldn't dare do it.

            But then what can the patient do if his doctor is ignorant about his condition? It isn't always possible for everyone to go from doctor to doctor looking for someone knowledgeable. I am lucky I am in a big city and found someone who knew what was wrong with me on the second try.

            I want to cry when I read some of their stories.

    •  My Dr. thought I had bipoler (34+ / 0-)

      I was like um no way. So instead of gong to the Psych Dr. (I have no history of mental illness and neither does my family) like my Dr. wanted I went to a sleep clinic.. I had not slept in like 3 days but went to a sleep study visit  that then got me in early for and  put me on Ambien and  They told me I had 97 Apnea events  or so per hours.. Put me in a mask w/CPAP and diagnosed me with Central Sleep Apnea. Its been 8 months and my health is way better.  I also sleep from 6 to 8 hours a night.  I used to sleep for 4 hours a night for years. I thought I was always an insomniac..  But it was me developing full blown  sleep  issues. Dr did not catch it she probably  only could see a sleep derived middle aged man  complaining to the Dr that I felt like  something was wrong with me cause I could not sleep. She quickly went right to mental health. I know my self fairly well so called a sleep disorder clinic hear in  Tampa who has offices near me and got a study.. best thing I ever did.

      "We need a revolution away from the plutocracy that runs Government."

      by hangingchad on Sun Nov 03, 2013 at 08:37:25 PM PST

      [ Parent ]

      •  I could not sleep.She quickly went right to mental (16+ / 0-)

            Very glad you knew you self and stuck with it. And I wonder why she didn't investigate why you couldn't sleep.

        We are all pupils in the eyes of God.

        by nuclear winter solstice on Mon Nov 04, 2013 at 03:15:14 AM PST

        [ Parent ]

        •  Most PCP don't recognize one of the signs (2+ / 0-)

          of sleep apnea and don't ask the right questions...

          "Death is the winner in any war." - Nightwish/Imaginareum/Song of myself.

          by doingbusinessas on Mon Nov 04, 2013 at 09:31:45 AM PST

          [ Parent ]

        •  A lot of MDs do that especially the incompetent (2+ / 0-)

          and/or lazy ones. I went to my gp once when three quadrants of my face were acting wonky and my right pupil blew after I took a hot bath. Did he send me to a neurologist? No. He told me to get a facial, sweetie, and it'll all go away. A facial! Oh, to have known then that was grounds for a sexual harassment lawsuit. I also didn't know then that sending me to a specialist would yank money out of his own pocket. As for a shrink, he already tried that. All that twit did was spend the entire hour trying to talk me into believing in god. That wasn't gonna happen.

          That being said, I do believe in having a good shrink even if you're perfectly sane. It's great to have a specialist who will tell your other docs your complaints are organic. In other words, look harder.

          The patient should help out, too. First, don't lie to your doctor. Is your house a rat's nest? Do you say you quit but still snitch cigarettes? Fess up, even if it makes you look like a doofus. Any little thing might be the key.

          Any jackass can kick down a barn, but it takes a good carpenter to build one.--Sam Rayburn

          by Ice Blue on Mon Nov 04, 2013 at 09:42:38 AM PST

          [ Parent ]

      •  Sleep deprivation results in manic behavior. (18+ / 0-)

        Some doctors may mistake the effect for the cause. I'd suggest that sleep deprivation comes first.
        Also, because medical training often involves sleep deprivation as part of the routine, doctors may not notice that what they endured during residency has significant health consequences over the long term. Sleep is something we can catch up, but not if the deprivation is constant.

        •  Catch Up on Sleep (10+ / 0-)

          In the mid 1990s I spent 3 years working literally around the clock for my startup. I noticed a study published in probably 1997 that tested people's ability to make up lost sleep. They looked at the effect on their condition when they missed sleep, and tested whether they'd returned to normal after catching up later.

          Makeup sleep has something like a "half life", but turned around in your favor: You can miss up to an entire night's sleep (on the first night), and make it up the following night (second night) by adding half the lost hours to a full night's sleep. You can make it up the night after (third night) by sleeping a quarter of what was missed extra sleep time. Indeed you can even make it up yet another night later (fourth night) by sleeping an eighth what you missed. After that no makeup. This ratio over time was true for any amount missed.

          If your baseline of a full night's sleep is say 8 hours a night, after missing one you can sleep 12 hours the next night, or 10 hours the night after that, or even just 9 hours the third night after the missed one. If you slept 4 hours to begin with so missed 4, over the next few days you could make it up by sleeping total 10, or 9, or 8.5 hours depending on which day. Of course you're living at a deficit until you make it up.

          It was a pioneering study, so a lot of details outside the simple case of missing some hours were not studied. Like if you didn't fully make up missed sleep in one night, but rather slept extra over two or more nights in the following few days. Or if you missed sleep again in the three days whether you'd ever make up the sleep originally missed. No data on makup sleep in naps separate from just extending baseline sleep time. No longterm effects were studied, so it might have only affected whether you felt tired and your immediate performance, with no makeup for longterm sleep loss effects. No word on whether this works for missing  sleep on than more than one night in a long while.

          So while it wasn't useful for me in my chronically sleep deprived condition, it did at least suggest that after a few days that sleep I had missed was totally lost. It meant that missing sleep in the beginning of the workweek cannot be made up on the weekend, though promptly adding some sleep even if put off for a night or two is worthwhile.

          And it meant that a lot more study is worth doing, because so many people miss sleep all the time, and there is some kind of mechanism for recovery - that doesn't even take much time if you can make it to a day or more later. But I've been too busy sleeping since that time to follow any followup research.

          "When the going gets weird, the weird turn pro." - HST

          by DocGonzo on Mon Nov 04, 2013 at 06:47:38 AM PST

          [ Parent ]

        •  Worse Sleep deprivation can result in (5+ / 0-)

          complete psychotic breakdowns. If only all psychoses were so easy to cure.

          Any jackass can kick down a barn, but it takes a good carpenter to build one.--Sam Rayburn

          by Ice Blue on Mon Nov 04, 2013 at 09:46:08 AM PST

          [ Parent ]

  •  Excellent diary. (30+ / 0-)

    This should be recc'd and read widely on this site.  I suspect that you are correct in your assertion about the numbers of folks who have undetected/undiagnosed/untreated OSA.  

    I don't think that all snoring is a sign of sleep apnea, but certainly the other things you mention along with snoring (fatigue, depression...etc)  should make folks seek a sleep study at a minimum.  

    Again, great diary.  Thanks for writing it.  Hope that it gets recognized for the insightful and informative piece it is.  

    A celibate clergy is an especially good idea, because it tends to suppress any hereditary propensity toward fanaticism. -Carl Sagan

    by jo fish on Sun Nov 03, 2013 at 07:45:42 PM PST

    •  Agreed. This is a health issue.. (18+ / 0-)

      ....that gets swept under the rug and short-shrifted in media exposure. I have sleep problems, but it's mostly due to pain. I have a friend who must wear a C-PAP. It made a world of difference for him. At 62 he was able to return to full-time work.

      "Wealthy the Spirit which knows its own flight. Stealthy the Hunter who slays his own fright. Blessed is the Traveler who journeys the length of the Light."

      by CanisMaximus on Sun Nov 03, 2013 at 07:59:03 PM PST

      [ Parent ]

    •  The incidence of osa is easy to determine. (18+ / 0-)

      Every few years someone takes a 1000 random people, screens them for OSA, find out how many have it and then finds out how many of the ones who have it do not know it. Easy as pie to do (though it costs a bit). The sad thing is that the percentage who have it keeps going up, while the percentage who do not know it stays the same, meaning that there are more and more people going undiagnosed.

      "A dog starved at his master's gate/Predicts the ruin of the state" Blake

      by McCamy Taylor on Sun Nov 03, 2013 at 08:15:00 PM PST

      [ Parent ]

      •  You have to agree on criteria (2+ / 0-)
        Recommended by:
        FarWestGirl, murrayewv

        The definitions for sleep "events" can vary from lab to lab; there is no one universal standard.  In this country labs will county a desat of 3% as a hypopnea for private insurance, but Medicare/Medicaid insist on 4% and some labs insist that 2% is enough.  Most labs will score a hypopnea as seriously as a true apnea, even if the 3% desat is from 99% to 96%.  Obviously the definition of events will affect the number scored, and the number scored yields your RDI.  Of course, the more the better if you're selling the overpriced treatment.

        In America, private insurance usually won't pay for an RDI under 5, but I've seen a sleep doc try to make the diagnosis nonetheless, multiple times.  In Britain, they point to published data that indicates no significant effect of treatment on RDI's under 15.  That's DEFINITE data, but your sleep center won't tell you that.  There is no point whatsoever in CPAP treatment for RDI of less than 15.  The data from 15-30 is ambiguous, and considering the high level of self-interest among those accumulating the data, that alone militates against accepting claims that the treatment is especially effective in the 15-30 range.

        CPAP is only unambiguously therapeutic for OBSTRUCTIVE sleep apnea with RDI > 30.  Central sleep apnea almost always requires Bi-PAP, and CPAP over the lowest settings will often make the apnea worse!  Furthermore, at least a third of "OSA" is actually attributable to upper respiratory congestion, which is exacerbated by CPAP without humidification, and can be treated much more cost-effectively with a humidifier and a little bit of menthol or eucalyptus oil.

        Finally, sleep apnea does not cause chronic pain.  However, if you send a patient with chronic pain to a sleep clinic, there is still a 70% or better chance they will be diagnosed with sleep apnea, because 90% of the human race suffers from SOME form of sleep-disordered breathing, and it's the sleep clinic's business to demonstrate that and sell you CPAP for it regardless of what's really disturbing your sleep.

        •  There most definitely is a universal standard (0+ / 0-)

          for what defines these sleep events. The standard is set by the American Academy of Sleep Medicine.

          Apnea is defined as an airflow reduction of 90% or more that is  of at least 10 seconds duration.

          Hypopnea is defined as an airflow reduction of 30%-89% lasting at least 10 seconds and must also be followed by a 3 second or longer arousal from sleep as indicated by EEG or by an O2 desaturation of 4%.

          There is no wiggle room here, and any certified sleep center is obligated to use these standards.

          One final note is that those suffering from sleep deprivation often complain of fibromyalgia type pain, so to say that OSA never contributes to chronic pain is not quite the whole story.

  •  I've had 2 sleep studies. One said no apnea (5+ / 0-)

    one (a center that only does sleep studies, and hands out "discounts for friends to get a study") that said both my son and I have it.

    We both got CPAPs. We both used them religiously.

    It didn't make any difference. I think it was a scam.

    I'd like to start a new meme: "No means no" is a misnomer. It should be "Only 'Yes' means yes." Just because someone doesn't say "No" doesn't mean they've given consent. If she didn't say "Yes", there is no consent.

    by second gen on Sun Nov 03, 2013 at 08:03:17 PM PST

    •  Here you raise a whole other issue.Treatment (34+ / 0-)

      While the biggest obstacle at the moment is getting people and their doctors to even THINK about the POSSIBILITY of a sleep disorder, you are not home free once you consider the possibility.

      OSA is a spectrum disorder, meaning that it can range from mild to always in a coma. And, there are different flavors of OSA that depend upon what causes it, what exacerbates it, how old the person is, where he lives, what he does for a living etc. Because there can be different exacerbating factors, everyone's osa is a little bit different and their treatment needs to be individually tailored--and may have to be flexible, since some exacerbating factors come and go. Remember, we are not talking a clogged artery that can be opened. We are talking a person who has an inherited tendency to let the airway close while sleeping (in most people, that airway will keep itself open no matter how hard the person' sleeps) plus a whole lot of other factors such as 1) must sleep on back due to lumbar disease (apnea is much worse with back sleeping) 2) muscle relaxers for on the job injury (unmasks sleep apnea 3) weight gain for whatever reason (unmask sleep apnea) 4) get swollen lymph nodes from mono/lymphoma/flu (unmask sleep apnea) 5) get head and neck radiation for cancer (80% chance of getting osa) 6) get a goiter (unmask sleep apnea). Etc. The list is nearly endless.

      The treatment of choice in kids is get  the tonsils out. The "treatment of choice" in adults is supposed to be CPAP--but that is BS IMHO. Only about 25% of people with OSA will benefit from CPAP. The closer the person is to the coma, the better the CPAP seems to work. Where I live, pollen is a huge problem and many people's osa is triggered by their allergies. Aggressive allergy control, HEPA filter, moving to the desert, side sleeping is effective osa treatment for a subset of people with osa. If you go to sleep drunk, you are more likely to have apnea, so abstaining for the alcohol can make a world of difference.  If you have a severe under bite, an oral appliance (i.e a retainer) that pulls the jaw forward at night may fix the problem.

      I too have had "no apnea" studies and "apnea" studies. If I get a study when pollen counts are low, I do not have apnea. If I get a study when my allergies are flaring up, I have apnea. If I go out of town when the pollen is really bad, I sleep much better and feel better. Cortisone shot does the same thing.

      CPAP made me sleep worse than the apnea. This is not at all uncommon. Do not let your doctor write an rx for CPAP and tell you that you are cured.

      BTW, one reason doctors do not look for OSA is they often have had a few bad experiences with treatment. They diagnosis someone with osa. They write an rx for CPAP. They do no counseling, have no follow up. Next year, patient comes back and says "I stopped using the cPAP. It didn't help." Doctor hears this story a few times and concludes that nothing can be done for sleep apnea, so why diagnosis an untreatable disease?

      "A dog starved at his master's gate/Predicts the ruin of the state" Blake

      by McCamy Taylor on Sun Nov 03, 2013 at 08:35:45 PM PST

      [ Parent ]

      •  I would imagine each is diffrent (15+ / 0-)

        Cigna monitored me for six months and so did the pulmonary Dr.  I now only have 1 to 2 apnea events a night and I can tell.. I sleep wonderfully now with no medication etc.. It took me a month to get used to the mask but I knew I must.  

        "We need a revolution away from the plutocracy that runs Government."

        by hangingchad on Sun Nov 03, 2013 at 08:46:04 PM PST

        [ Parent ]

      •  I need my tonsils out (10+ / 0-)

        but I don't know how to go about asking for it.

        I don't know if they even do it in adults. But I've needed them out since I was a kid. I had tonsillitis over and over again and at some point they just stopped returning to normal. They're permanently, constantly, visibly enlarged. I have trouble swallowing. And every time I get a cold they get enormous and red and painful and I have a little trouble breathing even when I'm awake.

        I probably have OSA. Don't know, and can't afford to find out. But I don't want a CPAP. I want my damned tonsils out. How do I do that?

        "Let’s just move on, treat everybody with firmness, fairness, dignity, compassion and respect. Let’s be Marines." - Sgt. Maj Michael Barrett on DADT repeal

        by kyril on Mon Nov 04, 2013 at 12:53:28 AM PST

        [ Parent ]

      •  It can be hard to get a sleep study & diagnosis (19+ / 0-)

        even if you tell the Dr. directly, "I snore.  I snore so loudly and disruptively that people staying 3 floors below in my house are unable to sleep. My husband says I stop breathing repeatedly and snort to start again. I fall asleep at stoplights. Every day I wake up with a headache." I told various doctors this for years. Finally I said, "I think I have sleep apnea. How do I go about getting diagnosed." That doctor said, "Oh no, young women who are not obese don't get sleep apnea. Besides you would have to wear an ugly, uncomfortable mask to sleep if you have apnea." I had to agree to weeks of unhelpful "treatments" before she would agree to a sleep study.

        Of course I had sleep apnea. The day I woke up from my titrating study with the CPAP was the first day in years I woke up without a headache. My doctor still didn't think I would use the CPAP; she knew she wouldn't if one were prescribed.  But if wearing an ugly, uncomfortable device to sleep makes you feel human again why wouldn't you use it? It was clear she didn't understand how debilitating the condition is.

        I may have had apnea since childhood. Childhood pictures show a pale, skinny kid with deep circles under the eyes.  I always looked like I had 2 black eyes. My family always complained about my snoring and sleep-walking and -talking. I think it just got worse and worse as I got older, and I just kept compensating until I couldn't anymore.

        The past 50 years we: -Ended Jim Crow. -Enacted the Voting Rights Act. -Attained reproductive rights (contraceptive & abortion). -Moved toward pay equity. Republicans want to take our country back. I WON'T GO BACK!

        by petesmom on Mon Nov 04, 2013 at 05:24:48 AM PST

        [ Parent ]

        •  Congratulations (1+ / 0-)
          Recommended by:
          FarWestGirl

          for your perseverance in getting what YOU needed, and knew you needed.  One of the problems with modern medicine is the reliance on statistical generalizations.  Statistics don't matter a hill of beans in particular instances, and every single living human body is unique.  You were the expert on YOUR body, you made the call and got what you needed.  Good on you.

      •  YMMV (5+ / 0-)

        We are fortunate enough to live near the bay area, where Palo Alto medical clinic pioneered sleep studies, so the local docs tend to be young, enthusiastic, well trained or they're old crusty doctors we've known forever who were trained by said bright young things.   The sleep centers that have appeared in the last decade are professional, the science behind it seems sound and they share their results.  

        One huge improvement me and my wife got from a CPAP was kind of unrelated.  We both have suffered from post nasal drip our entire life, with noses that clogged at the slightest cold/allergy exposure.

        Turns out, running dry, filtered air through your nasal cavity for 8ish hours every day clears that right up.   People whose nose is dry anyway need humidifiers, which greatly complicate the maintenance and cleaning of your machine (as adding water to any complex system will do).   But for us, the dry air was a godsend.

        I do not know, however, how much they pursue alternatives to the CPAP/BIPAP approach.  Both my wife and I had severe, quite obvious sleep apnea and we had already tried HEPA filters for allergies,and in my case the nose thingies that you can buy over the counter to expand your nostrils, etc.  We also only slept on our sides by habit, etc. It was worse with cold or allergy, but it was always present.

        I don't consider "moving to the desert" or "away from allergens" more practical than buying and maintaining a CPAP, but that will depend on individual situation.   Losing weight nearly always helps some, my symptoms started when I passed 200LB or so (I'm 6'3, so that wasn't exactly obese, but it wasn't the body I had in my 20s either).  My wife though, just has a tiny, funny shaped nose and had apnea at every weight she's been, ranging from 115 to 160lb. (she's got a thyroid condition, and when the meds get out of adjustment she gains or sheds weight suddenly) So weight doesn't always change things.

      •  As someone who (5+ / 0-)

        has tried CPAP, with at best mixed success, on numerous occasions, I very much agree. Having comorbid insomnia (as my doctors have come to call it), finding a solution has been very tricky indeed. Although I made it through the CPAP trial period (at least 4 hours a night for 3 months), I never got full benefit. Nasal pillows were ineffective, because I am a mouth breather (and wearing a headgear did not seem to help), even after I had my deviated septum fixed. A more recent attempt to use a full face mask was a miserable failure, as it caused intense claustrophobia. On those rare nights when I was able, with the help of ambien, to fall asleep with it on, I would frequently wake up in the morning to find it on the floor. My wife would tell me of my thrashing in great agitation at 2am and ripping it off my face, but I would have no memory of this.

        I am now in the early stages of trying out an oral appliance -- I was fortunate that our insurance covers a major part (but, alas, not all) of the steep cost of this ingenious device. It is adjustable at very small increments, and on my dentist's instructions I am being quite conservative with moving it forward. The good news has been that so far I have been for the most part able to tolerate wearing it; it is too early to say, however, whether I have been getting more restful sleep.  I'll go back in for another sleep study when I have it adjusted to the full "out" position to see what tale it tells.

        I like to imagine that as awareness of the prevalence of OSA increases, new, more effective, and more easily tolerated treatment methods will start to appear (as medical device companies try to tap into what will become a lucrative market, indeed).  We can only hope this happens sooner rather than later!

        -- Stu

        "Oh me oh my oh me oh my What a lot of funny things go by!" - T. Geisel

        by sdf on Mon Nov 04, 2013 at 08:16:11 AM PST

        [ Parent ]

    •  I was fortunate that a neurologist diagnosed me (1+ / 0-)
      Recommended by:
      cynndara

      with Chronic Fatigue Syndrome and Fibromyalgia after undergoing a great deal of neurological tests that sometimes were quite painful like the nervous system testing.  But in the end, it was worth it to get a complete diagnosis that turned out to be neurological in nature.

      Contrast that with a friend of mine who went for a sleep study, got the mask  , but it turned out that her problem was indeed more than sleep apnea, she had diabetes, high blood pressure, clinicial depression and more.

      What ended up curing my friend of all of her ailments was bariatic surgery as she was overweight and all weight loss and exercise regimens had failed..this was a woman who walked 5 miles per day plus other exercises and an extremely good diet.   It turns out her sleep disorder was mainly due to the diabetes and depression and other health ailments solved by weight loss.

      But I guess she did have sleep apnea due to weight, she lost that and her sleep disorder, irritable bowel, diabetes,all vanished.  

      In my case, fibromyalgia is the main culprit causing the sleep disorder so my doctor says doing a sleep study will solve nothing but treating the fibro properly will.

      Keystone Liberals on Twitter @ KeystoneLibs , Join PA Liberals at http://keystoneliberalsforum.aimoo.com/

      by wishingwell on Mon Nov 04, 2013 at 02:53:29 PM PST

      [ Parent ]

      •  Good for your doctor! (2+ / 0-)
        Recommended by:
        FarWestGirl, wishingwell

        The clinic I worked at insisted on diagnosing fibromyalgia patients with obvious alpha-delta brainwaves in sleep as having sleep apnea if they snorted and rolled over once an hour (as people in pain usually will).  A good doctor looks at all the information instead of narrowing their focus to what they like best or have the easiest pill to handle.  You seem to have one.

  •  I can't agree more. (25+ / 0-)

    I have a great doc. She listens, she explains, she cares. But she didn't prescribe a sleep study until I told her that my family reported that I stopped breathing when I sleep (and I snore very loudly--but we all knew that!!).

    So, back when I had insurance, I got a sleep study which uncovered sleep apnea. A second study with a CPAP machine revealed that the machine did allow me to sleep without snoring or waking. And my breathing was normal.

    I use my machine every night. I love it. I lost weight and have much more energy than I did before. And no more falling asleep at the wheel or when watching tv.

    I wonder what Markos thought when he started this blog? Sure, come for the politics, but stay for the friendship and cat pics!

    by The Pollster on Sun Nov 03, 2013 at 08:19:54 PM PST

  •  This is a long post but here goes... (28+ / 0-)

    For the last 8 months I have been on CPAP as I have central sleep apnea. Some damage I would imagine of the poverty and rationing I used to have to do with insulin and poor control  no drs visits on a regular basis etc.. I never had been diagnosed  until 8 months ago after getting less and less sleep. At one point it had been 3 days where I could not sleep at all.. On the second day I called the hospital to ask what I should do It was try melatonin, or over the counter sleep meds and call the Dr tomorrow.. So I did that.. I went to the Dr. and she wanted me to go see a psychologist (I was in my head like no way.. this is not mental illness: she probably thought bi polar disorder). So I called the local sleep center and  begged them to see me. They did that same day  I went in and they saw me and said something is wrong..   Put me on the bed and wired me up and..   they gave me some small Ambien..  never had one and it made me sleep. I was awaken to the sound of  we need to get some oxgen in you.. I said how long have I been asleep. 40 minutes and already had 96 Apnea events.  They titrated me and let me sleep the rest of the night.. it was amazing the best sleep ever..  in years like 26 or so years.  I have been more energetic, lost some weight 42 lbs (I am still overweight). And the most amazing thing is that for years I have had macular Edema  which is swelling in the back of the eye and cists of that liquid.. Well all of that is gone now my Dr. was happy she did not expect them to just do that.  I know I felt like I had been dying this last year and that was probably my body saying something is amiss. I wont nap with out the mask in place.  I am just glad I got it diagnosed. I work from home for a college so I do have coverage and have the knowledge if I lost my job I could get ACA help.

    "We need a revolution away from the plutocracy that runs Government."

    by hangingchad on Sun Nov 03, 2013 at 08:25:17 PM PST

    •  I had a sleep study (16+ / 0-)

      and had both central and obstructive sleep apnea, but could not afford the cpap machine and did not think I could tolearate it anyway.

      I gave up wheat and am on a low carb diet (modified Atkins) and increased the good fat in my diet -- whole milk, olive oil, avocados, nuts -- plus more veggies and water.

      I've lost 8 pounds so far and my husband reports I'm not snoring anymore.

      worth a shot to try for some of the rest of you.

      The GOP -- Hating Women, Gays and People of Color since 1854

      by Former Chicagoan Now Angeleno on Sun Nov 03, 2013 at 08:35:19 PM PST

      [ Parent ]

      •  other things related to women: I can remember (9+ / 0-)

        saying to the doctor last year, "I don't know if I want to go to sleep or just lay down and die..." Turns out I was on the verge of doing the latter- I had lost so much blood through what I thought was just a difficult menopause that I actually needed three blood transfusions to get enough red blood cells back into me to bring my oxygen levels back to normal. So I was having all the symptoms like personality changes, inability to stay up during the day but waking up 'unable to breathe' at night until I sat up or walked around, etc. but it was not 'apnea.'
            It was low oxygen from something else though. Changes your life to start getting enough oxygen again!

        We are all pupils in the eyes of God.

        by nuclear winter solstice on Mon Nov 04, 2013 at 03:26:53 AM PST

        [ Parent ]

    •  Central Sleep Apnea (4+ / 0-)

      is most common in folks who have either congestive heart failure or neurological disorders such as being status post stroke.  Central Sleep Apnea is not effectively treated by standard CPAP. In fact standard CPAP worsens central apnea. There are a couple of specialized modes of CPAP that are used in central apnea cases.  If you are feeling better, I assume you must have one of these special CPAP machines.  
      One method of treatment for central apnea is Bilevel Cpap with a set back up rate so that if you stop breathing the machine triggers a breath. This is occasionally effective, but often is not.  The newest and by far the most effective treatment for this type of apnea is Auto Servo Ventilation.

      •  sounds like my trusty bi-pap s/t (2+ / 0-)
        Recommended by:
        FarWestGirl, belinda ridgewood

        I've been using my Bi-pap that has a timer for over 20 years. For those who don't know, a Bi-pap helps you expel the carbon dioxide after the machine has helped you inhale the air. A carbon dioxide build-up leads to narcosis and that leads to check-out time. Got my first machine very unexpectedly when in the hospital for pneumonia and was crashing when they gave me oxygen. It was quite a shock to hear the next morning, as a 26 year-old single woman, that I was going to have to use this boxy contraption that made me look like a Star Trek Borg. But the before/after difference with the machine was huge -- like seeing in color after a monochrome world. It made the ICU quite lovely. I had had so little awareness that my cognition was impaired by oxygen deprivation, and I'm talking 15+ years of feeling tired/lazy, getting referrals for therapy when I was dead-tired all the time, etc. I agree that med providers (not just docs but NPs, PAs, and others) should include sleep in a patient history, and I wish sleep overall got the kind of respect diet and exercise do. Sloths, alas, are designated sinners. But it's better now than when I was really an outlier (young, female, underweight) at the sleep laboratory.

        I'm sorry to know so many people struggle with sleep apnea but if you've got access to testing and treatment -- a big IF -- I'd hate to see people avoid them. Believe me, I get the adjustment issue for even a plain old C-pap, it took me a good year or so to really accept that the Bi-pap was my (first) life partner. But I've been through other medical-related adjustments and this one at least gives me a clear and immediate benefit. The machines are way better now than they were, too, much quieter and smaller than my original 15 lb behemoth. As to cost -- well, mine's thousands more than a C-pap and I based job choices on quality of medical coverage. That's basically life with a pretty severe disability -- there are just regular, fairly high costs to factor in.

      •  I use ASV not sure if this is one of the special (0+ / 0-)

        devices but whatever it is saved my life. The Dr is thrilled I went from 96  (or 97) would have to get my paper out. But now I have 1 to 2 events an hour..  I am so thankful.

        "We need a revolution away from the plutocracy that runs Government."

        by hangingchad on Mon Nov 04, 2013 at 09:48:14 PM PST

        [ Parent ]

    •  You owe them your life. (1+ / 0-)
      Recommended by:
      FarWestGirl

      Seriously.  When central sleep apnea gets that bad, either the heart is failing and causing the apnea, or the apnea will soon cause the heart to fail.  Think about it; the heart is the one muscle in your body that NEVER rests.  It can't.  Sleep is essential for it to at least catch up.  Past a certain point of repeated de-oxygenation, the heart is damaged and can't repair itself.  You were heading there.  By getting you the oxygen you needed to sleep, those good folks enabled your body to heal what was fast becoming progressive and irreversible damage.

      •  The sent me to get a radioactive stress test after (0+ / 0-)

        about 6 months and had no damage. That and a sonogram showed a healthy heart. He was not sure why and just said "genetics, luck". I had been so sick. I was falling asleep at stop lights.. put my car in reverse and  fell asleep in reverse.. could not sleep with melatonin, cold medicine Nyquil...  even with Trazadon I only slept for about an hour or two at the most.. I started feeling like something was so wrong and perhaps I was going to die soon. I changed my will, I told my Facebook friends I loved them. it had been like 3 days without sleep and I was losing it. My mother and I called qach of he three days cause she knew I could not sleep.  I thought my whole family was insomniacs.. they are but little did I know that My Mom, My brothers all have apnea. I am the only one who has  the central though probably due to damage from poor diabetes control in my youth and ok control now.. not the best but trying hard.  6.8 A1C hemoglobin. It used to be high for years.. I have some complications and Central sleep apnea I count as one of them.  Those last three days were me desperately finding out what was wrong with me as I knew I would die if I could not sleep. I know for sure I would have passed sooner  if I would have left this untreated and I am sure others don't get treatment. I hope the ACA changes that.

        "We need a revolution away from the plutocracy that runs Government."

        by hangingchad on Mon Nov 04, 2013 at 10:01:33 PM PST

        [ Parent ]

  •  however in some cases, the apnea is really (18+ / 0-)

    secondary to other problems in some cases.  While I listed apnea among my problems, my primary problems had to do with insults to my nervous system and chronic problems with my joints, including gout, sciatica, CPS, wastage and atrophy of musculature due to injuries, paresthesis, generalized arthritis, chronic back pain due to disc degeneration, high blood pressure and various late effects from nerve damage. (I have probably left out a few things)

    In the end, I received disability because the ALJ saw me walking with a cane and demanded to know how I got to the courthouse that day (my daughter drove me) and how many times had I halted going into the courthouse (3 times).
    Apnea was far down my list with anorexia

    The important thing for receiving disability is your narrative and your props.  Applying is all about theater; therefore while some 70% may be rejected on first application, I think 60% of rejections are overturned at some point in the process as applicants become more savvy at how to approach the system.

    •  submitting a boatload of med records hardcopy (7+ / 0-)

      also helps, especially if you go through them with a highlighter pen to make the specific bodyparts affected and the specific diagnoses POP off the page.

      as the volunteer paralegal said who helped me get mine on the first try, "make it EASY for everyone in the decision chain to say YES."

      •  problem is getting your docs to send docs (9+ / 0-)

        since many physician offices are not that well run and, esp. if you have several physicians and more than one chart (due to overflow from your original chart), getting records out in a timely fashion can be a problem.  This is one argument for a universal EMR whereby your office records are identical regardless of number of providers or number of disciplines involved

        •  you are SO right! NEVER rely on DRs to send them. (2+ / 0-)
          Recommended by:
          entlord, FarWestGirl

          besides, if you're in this position you seriously need to have in your own possession an excruciatingly complete copy-set of all your medical records, or you have no data in hand to argue from.

          it is indeed an argument for universal EMR, aside from reports in medical literature of the disastrous state of american EMRs because of the planned-obsolescence/profit factor in the companies producing EMR programs.  the programs used by my HMO keep 'purging' data every time they do a major update, and since there were no paperrecords kept, there's no documentation by which to correct the EMR unless i buy printouts on a regular basis.

          to narrate a bit more as a cautionary tale to others, by 'promising' to send medical records to my state's SSA contractor & to my outside Drs and then not doing it, my hmo screwed me out of state disability, caused me an additional 16 month delay in receiving SSDI, and 'complexified' my receiving care from outside physicians out-of-my-own-pocket.  (Patients did not have legal right to their own medical records at the time).   During the total 22-months, my entire life savings except for modest IRA were wiped out in my having to live on savings.  by the time my paid-into SSDI benefits were approved (after i got ALL my records, copied & highlighted them under the tutelage of a disabled paralegal, & submitted them in a wad nearly 2" thick), the best earning years of my life had fallen off the far end of the calculation period, and the monthly benefit amount was so small, and the waiting period for medicare still a year to go, that i had to go into my IRA as well.  due to destruction of my financial means, it cost me the chance to get rehabilitative medical care because i had no money to pay for it and my hmo wouldn't provide that care.   so at age 46 i was forced into being permanently disabled, unemployable, with no means to do any gainful work at all.   i'm not impoverished but i am on the thin shakey edge of falling into that. thank you american healthcare system and corrupt workers' comp jurisdiction for wrecking my life. i couldve been a taxpaying insurance paying productive citizen if they'd met their responsibilities.  instead i'm a burden on society.

          i must say, 'tho, that all the outside Drs were extraordinarily kind about letting me take as long as necessary to pay, and handed me copies right across the counter with zero fee, even 'tho the law did not require them to do that.

          luck i think you get by being vigilant and well-prepared.  so good luck everyone!

          •  matter of fact some state medical societies (2+ / 0-)
            Recommended by:
            FarWestGirl, mettle fatigue

            and boards, back in the day, held that the release of medical records directly to the pt was unethical.  This viewpoint changed about the same time the view on docs advertising changed

            It took me 4 years to win my case and cost me $6500 in legal fees

            •  so glad you prevailed finally. (0+ / 0-)

              when you say that amount for fees, i'm thinking that what everything else cost you to just keep going 'til you won must have been hell.  many people are just broken in pieces by the system and literally can't keep trying.

              i don't know if it's true or not that there are a lot of fraudulent claims submitted & the fraudsters are so good at what they do that the system has to be extremely stringent and that makes it hell for the genuine disabled.

              if we continue reforming healthcare, we'll reach a point where people are helped BEFORE their health issues become disabling, and if disabling then rehabbed for some form of reasonable gainful work, and if the health issues are too bad for that then at least hopefully more and more folks will benefit from the Jimmo v Sebelius/Medicare Win that finally eliminated the "improvement potential" as a requirement for skilled out-patient services.

              in a civilized society, no one should be left behind. no one.

              •  yep mega medical bills, a crashing Wall Street (1+ / 0-)
                Recommended by:
                mettle fatigue

                and a credit crunch made it where I had $1M in medical bills and no way to borrow money (banks turned down loaning me $10K on $100K of property) so I was forced to tap my savings and cash out when the DJIA was around 7500 (thank goodness I got into the market when it was at 1200 but it still devastated my savings)

  •  I have a machine and use it religiously. (15+ / 0-)

    And it does help - but I know that something is still not right - either the mask is slipping off or leaking or the pressure is too low - but I don't have coverage to get it checked out.

    It did nothing to help my disability claim at all, even with permanent lung damage and lessening of function listed clearly as issues.

    I DO have psychological issues, but I have physical ones as well - all of them are documented and treated to the best of my ability over years - I have sought out the best low income/free care I can find. But it's not been enough to get Medicaid or to get my claim approved.

    •  Are you enrolled in ACA plans? (4+ / 0-)

      The Medicaid expansion may help you qualify without having to prove disability, just poverty.

    •  If you can find a way (3+ / 0-)
      Recommended by:
      Mortifyd, FloridaSNMOM, FarWestGirl

      to try out different masks, you may find something that works better.  I went through a few--even tried a full face mask but that freaked me out.  I found a mask I really like, and it's both more comfortable and more effective than what I started out with.  My apnea is still not perfectly controlled, but the new mask makes it a little better.  

      •  I've been using a nasal pillow mask for years (1+ / 0-)
        Recommended by:
        FloridaSNMOM

        As a full face will not stay put on me.  but my headgear is getting old and I have had to refit it several times - it's on it's last legs.  When I can afford it (haha!) I will replace the headgear as that is much cheaper than a whole new mask - which is beyond my means.

      •  why? (1+ / 0-)
        Recommended by:
        FloridaSNMOM

        Why does the full face mask freak some people out! I must admit I was afraid I wouldn't be able to sleep with it at first, but from the first night I don't notice it at all. Seriously, when I'm in that half-asleep-half-awake state in the morning and my nose itches, I go to scratch it and hit the mask. I'm so used to it now. And I sleep on my stomach, so I kind of sleep with my face pressed into it and still don't notice it. But mine is a new style and it is very lightweight.

        "Every Pootie is a masterpiece." - Da Vinci

        by mdsiamese on Mon Nov 04, 2013 at 10:48:44 AM PST

        [ Parent ]

  •  I love my CPAP (7+ / 0-)

    I knew I snored but didn't know how bad it was until I woke up in the middle of the night on all fours trying to get air into my lungs.  It felt like I hadn't taken a breath for two minutes.  After telling my Dr. about it he sent me for a sleep study.  Now my BP is better than it has been in decades and most nights I get a full night sleep, unlike the 4-5 hours I was getting before.  I wish a Dr. had asked me about my sleep years before.  

    Republican tax policies have led to financial conditions which have caused Republicans to demand cuts to programs they have always opposed.

    by AppleP on Mon Nov 04, 2013 at 04:09:51 AM PST

  •  As in Bed-Stduy? n/t (1+ / 0-)
    Recommended by:
    Bernie68

    You know, I sometimes think if I could see, I'd be kicking a lot of ass. -Stevie Wonder at the Glastonbury Festival, 2010

    by Rich in PA on Mon Nov 04, 2013 at 04:53:06 AM PST

  •  And (7+ / 0-)

    if you have sleep apnea and gastroesophageal reflux you get to experience the extra special treat of waking up abruptly while choking on your own stomach acid.

    "Ain't no blade can protect you from the True-True." - Old Georgie, Cloud Atlas.

    by klingman on Mon Nov 04, 2013 at 05:31:16 AM PST

  •  Many older docs are less aware of OSA (5+ / 0-)

    They trained before medicine even clarified the diagnosis. Not to be too critical there are many great older docs.

  •  GET A LAWYER. (8+ / 0-)

    I have been practicing Social Security disability law almost exclusively since 1997. Now I concentrate on higher-level appeals.

    I do not have the medical expertise to agree or disagree with the diarist. But--I would love for the diarist to be able to analyze his patients' disability applications by represented vs. unrepresented applicants. And I can definitely say that no diagnosis, including sleep apnea, is a surefire ticket to winning a disability claim.

    The vast majority of Social Security disability lawyers take cases on contingency--which means you pay no money up front. Get a referral to a lawyer in your area here: http://www.nosscr.org/...

    "The true strength of our nation comes not from the might of our arms or the scale of our wealth, but from the enduring power of our ideals." - Barack Obama

    by HeyMikey on Mon Nov 04, 2013 at 05:42:28 AM PST

  •  OSA is not a "temporary disability". I was (6+ / 0-)

    diagnosed in 1999 and it took until 2012 until I was properly treated.  CPAP therapy works but if you don't have the proper fitting mask or proper air pressure you still have the same issues as if you were never treated at all which is one of the reasons so many people fail at CPAP therapy.  I still have issues with it, but have learned to DEMAND better care because being nice and waiting for the doctor to get it right....even the "specialists"....won't get you feeling better.

    •  For some it is temporary (2+ / 0-)
      Recommended by:
      Bernie68, FarWestGirl

      OSA is tied to obesity. For some, losing weight is curative.

      "Every Pootie is a masterpiece." - Da Vinci

      by mdsiamese on Mon Nov 04, 2013 at 07:06:17 AM PST

      [ Parent ]

    •  If it took 13 years after diagnosis for you (2+ / 0-)
      Recommended by:
      FloridaSNMOM, FarWestGirl

      to finally get effectively treated, then you received poor treatment indeed.  The biggest reasons people fail CPAP therapy are: anxiety (a little Xanax can be amazingly effective at increasing tolerance if used early on) , poor mask fit as you stated, not being fully educated about the severity of their condition including the risks of non-compliance, or they may have  other untreated conditions that affect their sleep (pain, periodic limb movement of sleep). Those with mild apnea might be better suited for oral appliances as mentioned above. It is a fact that many sleep doctors only order CPAP since it is still considered the gold standard treatment, but hopefully they will become more aware of alternative treatments.

  •  I personally can't sleep on my back unless I'm in (7+ / 0-)

    a recliner or the head of the bed is similarly raised, or I wake up choking for air.

    I blame the "large tracts of land" and a narrow airway and a tendency towards being vaguely congested. And I still snore anyway.

    Now, my husband DID have a sleep study done and DOES have a CPAP, but he refuses to use it. (sigh) So there it rests.

    When you come to find how essential the comfort of a well-kept home is to the bodily strength and good conditions, to a sound mind and spirit, and useful days, you will reverence the good housekeeper as I do above artist or poet, beauty or genius.

    by Alexandra Lynch on Mon Nov 04, 2013 at 06:03:41 AM PST

  •  it's expensive (7+ / 0-)

    the study itself is expensive and the machine and accessories are expensive

    remember that some doctors are involved with schemes that reward them for NOT referring people to expensive specialists

    insurance paid for part of the cost of the machine and now I own it.   but insurance does not pay for the replacement accessories.  right now I need a new mask but don't have the $157 to replace it.   I am supposed to replace tubing and filters regularly every three months and they are cheaper but I do have to pay for them myself.

    i use it everytime i sleep, though. even if I am just taking a brief nap.

    the night i had my sleep study with the mask and woke up after my first good night's sleep in decades I almost cried I felt so good

    Politics is like driving. To go backward put it in R. To go forward put it in D.
    Drop by The Grieving Room on Monday nights for support in dealing with grief.

    by TrueBlueMajority on Mon Nov 04, 2013 at 06:18:38 AM PST

    •  I just replaced the soft rubber parts on mine (3+ / 0-)

      instead of the new mask. I got them on amazon for $40. I  couldn't afford to do the whole mask, I just wash it good every week or more if I've been sick.

      "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

      by FloridaSNMOM on Mon Nov 04, 2013 at 11:44:35 AM PST

      [ Parent ]

      •  the soft rubber parts are fine (1+ / 0-)
        Recommended by:
        FloridaSNMOM

        the part that breaks is always in the same spot--the thick plastic thread that attaches to the bottom strap and helps hold the mask close to my face.

        cool footnote: while looking for a picture of the mask I think I found a discount house that sells the mask for much less than the medical supply store I had been buying it from!!!

        Politics is like driving. To go backward put it in R. To go forward put it in D.
        Drop by The Grieving Room on Monday nights for support in dealing with grief.

        by TrueBlueMajority on Mon Nov 04, 2013 at 07:37:40 PM PST

        [ Parent ]

        •  Mine clicks in (1+ / 0-)
          Recommended by:
          TrueBlueMajority

          it doesn't have that thread, it works kind of like the clasp on an adjustable dog collar. If it had that thread I'd likely be breaking those all the time as well!

          "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

          by FloridaSNMOM on Tue Nov 05, 2013 at 10:16:23 AM PST

          [ Parent ]

  •  Treating sleep apmea is pretty expensive (4+ / 0-)

    even with insurance.  You need a complex piece of medical equipment that claims to need frequent changing of various plastic bits (to save money, only the filters actually wear out anywhere near the recommended replacement rate).   This device will require you to actually pay a couple thousand dollars each year, a problem for those with high deductible plans.  The sleep study isn't cheap either.

    To get the benefit, you will be sleeping with a mask on your face and a device pumping air into your nose for the rest of your life.

    I'm not saying the treatment isn't a good idea. My wife and I are both now strapped to those annoying machines and while we aren't in the group with dramatic immediate health benefits, the treatment clearly is helpful (my wife's sleep is more restful, I don't snore and wake her up, I wake up less in the night myself, etc and the blood oxygen numbers that alarmed our sleep docs are now happy and healthy)

     I'm saying getting treatment will be challenging to afford for anyone not comfortably middle class and employed or with a reliable income source.

    •  Not true. (3+ / 0-)
      Recommended by:
      ban nock, BlackSheep1, FarWestGirl

      I am recently diagnosed with OSA and could have had a machine without insurance for $350, mask & tubing would have been another $100. You don't have to replace the mask &  tubing that often. I went with a different provider under my insurance and my out of pocket is a little bit more for a nicer machine, but the non insured machine was ok.

      Btw, the CPAP machine is incredible. Makes a huge difference.

      "Every Pootie is a masterpiece." - Da Vinci

      by mdsiamese on Mon Nov 04, 2013 at 06:58:46 AM PST

      [ Parent ]

      •  Mine was a hell of a lot more expensive (2+ / 0-)
        Recommended by:
        JesseCW, FloridaSNMOM

        and the provider was chosen by the insurance company with any deviation = no insurance.

        I agree that you don't have to replace the consumables nearly as much as the recommendation.

        It can help many people a lot.  For me I actually don't feel any different, but my blood oxygen is way up and my wife doesn't have to listen to me snoring or freak out if I stop breathing, so it certainly helps her sleep.   She took over a year and a half to adjust to her bipap, but once she did, her sleep is much more restful, although she has Fibro, so "better" is a relative term.   It's more like she's really awful after sleeping without it and only in moderate pain and fatigue with it.

        •  when I was shopping for CPAP (3+ / 0-)
          Recommended by:
          FloridaSNMOM, greblos, FarWestGirl

          I called at least 10 different companies in my area and price quotes on similar machines varied greatly, but in no case was the price so high that I would call treatment so expensive that someone without insurance could not find a solution. My insurance is a 50% co-pay on durable medical goods, and I was offered machines that would cost me from $350 to $700 up-front (or $700 to $1400 without insurance). The one I settled on was a company where I paid $97 up front for the mask and the 1st payment on the machine and I make a $33 payment every month for 14 months, after which I own the machine. That is a co-pay, my insurance makes a monthly payment as well. But this saved me from having to come up with several hundred dollars up front.

          I did find out that one company does sell the machines for much less than what they charge the insurance company. Remember, with durable medical equipment, there is often a big difference between the actual cost of the device and what the supplier charges an insurance company. To get someone who doesn't have insurance as a regular patient, some sleep centers do come way down on their prices.

          "Every Pootie is a masterpiece." - Da Vinci

          by mdsiamese on Mon Nov 04, 2013 at 10:33:31 AM PST

          [ Parent ]

          •  This is much more in line with prices I saw (2+ / 0-)
            Recommended by:
            greblos, FarWestGirl

            working for a DME company.

            $700 to $1400 without insurance
            350 = way low.

            "But the traitors will pretend / that it's gettin' near the end / when it's beginning" P. Ochs

            by JesseCW on Mon Nov 04, 2013 at 11:07:42 AM PST

            [ Parent ]

          •  I stand by my statement (1+ / 0-)
            Recommended by:
            Bernie68

            People who are not comfortably middle class have difficulty dropping 700-1400+ongoing expense for consumables on anything.   That's usually meaning rent isn't getting paid, or a car repair isn't getting done that is essential to employment or food isn't on the table.

            Even half that isn't much of a bargain, and the people in that situation traditionally haven't had any kind of health insurance that mattered (deductible > anything they can afford to pay).

            Perhaps that'll finally change with ACA online, but durable medical goods is one area where even if you're past the deductible, the copays tend to be crappy (such as the 50% quoted above)

  •  Important and informative (7+ / 0-)

    This was one of the most fascinating, informative and important diaries I've read here in a while, as it might really save some people's lives over the long haul.  I don't THINK I have sleep apnea - I live alone so I don't know if I snore or not, and I cannot sleep on my back, always on my side - but I do generally feel crummy when I wake up in the morning.  So perhaps I will look into this to see if I'm having sleep deprivation issues.  Thanks for the diary!

  •  How to Treat It? (1+ / 0-)
    Recommended by:
    ban nock

    Once diagnosed, how do doctors treat obstructive sleep apnea?

    "When the going gets weird, the weird turn pro." - HST

    by DocGonzo on Mon Nov 04, 2013 at 06:30:01 AM PST

    •  I'll second this. (3+ / 0-)
      Recommended by:
      DocGonzo, greengemini, Bernie68

      I have been diagnosed, but will not tolerate a CPAP machine and it is not a cure.  I also have TMJ issues, and have high blood pressure as a result of the obstruction.  So I am on my way to prepping for having TMJ surgery next year, which hopefully will ease alot of my issues.

      "There is no barrier of people's acceptance. The only barrier is the media. Remember what people cannot see or hear, they cannot think about." - liner notes of Soft Cell's 'The Art of Falling Apart'.

      by dugjxn on Mon Nov 04, 2013 at 06:47:22 AM PST

      [ Parent ]

      •  TMJ (1+ / 0-)
        Recommended by:
        FarWestGirl

        and I had headaches every day for a year ... I went to an orthodontist -- after trying a ton of stuff, pillows, wisdom teeth removed, a custom mouth guard, other stuff I can't recall. ..-- but the orthodontist showed me some facial/jaw exercises -- !!! -- headaches gone in less than 48 hours. Turns out I was doing a jaw thrust & clench for stress which brought on the headaches and caused more stress, etc...

    •  Treatment (2+ / 0-)
      Recommended by:
      DocGonzo, wishingwell

      CPAP is only one treatment. There is a surgery that some can have, I saw a nasal device that forces you to breathe, and of course there is always weight loss. A friend of mine with OSA was using a CPAP, then lost 40 lbs and found he no longer needs it.

      New and cheaper options will be found as more and more of that 10% get diagnosed.

      "Every Pootie is a masterpiece." - Da Vinci

      by mdsiamese on Mon Nov 04, 2013 at 07:03:52 AM PST

      [ Parent ]

  •  I learned I had sleep apnea as a teenager... (4+ / 0-)

    on a family camping trip, when my cousin scared me half to death waking me up because I stopped breathing.

    I also had asthma and was overweight.  When I lost weight, both the asthma and the apnea improved but didn't completely go away.

    As a final precaution, I trained myself to sleep with my hand positioned to hold my head so my airway always stays open.  It seems to work fine, I sleep well, and I'm in my 60's now.

  •  I've been on a CPAP for over a decade (5+ / 0-)

    but what they neglected to tell me was to see a sleep doctor every few years...  the pressure wasn't high enough to control my apnea.  Between that, pernicious anemia, an arachnoid cyst (brain), diabetes, cancer, etc., I was misdiagnosed with dementia last spring.  If my other doctors hadn't questioned that, I'd be on disability by now.  Luckily, I was sent to a sleep doctor, who ordered another sleep study, and then set the pressure higher.  It has made a huge difference.  So don't give up on your CPAP - it just may need adjusting.  My sister battled with hers for months before they found the right combination for her.  Be persistent, it pays off in the end.

  •  This happened to my MIL about 15 years ago (4+ / 0-)

    It totally destroyed her career. It nearly destroyed her health. The cruelest part was she had to wait 2 years after getting SSDI to qualify for Medicare. The only "luck" she had was Vocational Rehab paid for her first sleep study and CPAP machine.

    If a nation expects to be ignorant and free, in a state of civilization, it expects what never has and never will be. Thomas Jefferson

    by JDWolverton on Mon Nov 04, 2013 at 08:05:02 AM PST

  •  I had the good fortune to be working for a (3+ / 0-)

    psychiatrist who does research into sleep at the local university hospital. He's also a friendly gregarious fellow and got to talking to me. I snore then stop breathing.

    He wanted me to see someone he knows right away, but my insurance was 10K deductible. Now I'm on Medicaid as of last week and I'll be contacting him as he suggested.

    I can sleep anywhere at any time as I'm always tired. Nothing to do. I still work, have to support my family. When I take pills to sleep I feel like a new man in the morning but I can't take pills, already had my share of drugs for this life.

    My doc was positive they have ways to let you sleep. Some sort of device to wear on the head.

    “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

    by ban nock on Mon Nov 04, 2013 at 08:13:20 AM PST

  •  I was always a skinny kid and have apnea (8+ / 0-)

    My brother and his friends always thought it was funny that I stopped breathing when I was asleep. He says today that 7 year olds aren't supposed to snore like I did.

     In my late 30's I had a sleep study done. I stopped and started breathing several times per minute. That is hundreds of times per hour.
    They strapped a mask on me and said I didn't move for 6 hours and slept, maybe for the first time in my life. After 6 hours of sleep I was awake with amazing energy and clarity for almost 2 days.

    I will not fall asleep anymore not even for a nap without "my machine". Its amazing what oxygen will do for people;)

    A hungry man is not a free man ~ Adlai Stevenson

    by Max Runk on Mon Nov 04, 2013 at 08:22:49 AM PST

  •  I have OSA, COPD, and a thyroid disorder (6+ / 0-)

    as well as seizures. My pulmonary doc suggested the sleep study because my oxygen was dropping at night and my other half reported that he stayed awake at night in case I stopped breathing.. again. Plus I would wake up during the night feeling like there was no air in the room. Not only did the CPAP help with the night-time breathing issues, but it helps during the day because I don't have to recover from my O2 SAT dropping into the low 70's during the night. It's also postponed my needing oxygen at home. Nothing can reverse the damage of the COPD (due to asthma since my late teens and lack of insurance/treatment), but the CPAP has helped prevent further degeneration and improved function. I still can't work, because I get shortness of breath from walking across the house let alone anywhere else many days, but I can keep up with my children at home, get cleaning done through the day, etc.

    "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

    by FloridaSNMOM on Mon Nov 04, 2013 at 08:32:03 AM PST

  •  My old shrink used to ask about my sleeping (2+ / 0-)
    Recommended by:
    Dvalkure, FarWestGirl

    habits on every visit. I used to say I normally fell asleep whenever I wanted, slept through the night and woke up refreshed. I have had instances of sleep apnea but I was sure they were because of a confirmed allergy to dust mites. Once I vacuumed my mattress, got fresh pillows and changed my sheets I slept soundly.

    Since my vasculitis popped up and I had my spaying last spring I've had a terrible time sleeping through the night. Not even 5mg. of melatonin works. (I have considerable drain bamage due to a stroke back in '85 so my new neurologist was thrilled @ the melatonin. Here I thought I was only taking it to prevent my cluster headaches.) It doesn't help that now I've got to pee 2-3 times a night. Or that I'm always freezing cold. My gynecologist, allergist, psychiatrist, rheumatologist and psychiatrist can't figure it out.

    I know there's one problem with my sleep habits--I have a 60 lb. dog and four cats who sleep with me in my bed. Some mornings I wake up with three cats curled up along my torso. Like I say, they're the turtles, I'm the log.

    Any jackass can kick down a barn, but it takes a good carpenter to build one.--Sam Rayburn

    by Ice Blue on Mon Nov 04, 2013 at 08:39:12 AM PST

  •  I have apnea but my CPAP isn't doing the job (3+ / 0-)
    Recommended by:
    Dvalkure, FloridaSNMOM, FarWestGirl

    Well, not the whole job anyway. Sleeping with it is better than sleeping without it but I still feel like it's naptime most of the day. Part of the problem could be that one day my VPAP (which my doctor prescribed for central events and my cadillac health plan at the time happily paid for) suddenly went catatonic and started flashing an error code the source of all human knowledge doesn't seem to know how to clear, so I had to go back to the CPAP. I'm unemployed and uninsured and can't afford to fix the VPAP, let alone buy a new one or pay for a new study. Even when the VPAP was working I would still tend to feel tired.

    So what's the next step? I mean besides seeing my sleep doctor again, which I might be able to do after the first of the year when I go in front of the death panel the Medicaid Washington state was sane enough to buy into kicks in.

    By the way, thank you for this. I think I've had sleep apnea for at least 30-40 years. It's one reason I don't drive any more.

    Some men aren't looking for anything logical, like money. They can't be bought, bullied, reasoned or negotiated with. Some men just want to watch the world burn.

    by Omir the Storyteller on Mon Nov 04, 2013 at 09:28:42 AM PST

  •  Thank you for this diary (1+ / 0-)
    Recommended by:
    FarWestGirl

    I know the point was about those who are denied disability claims, but I think society must raise awareness of sleep apnea and help people get over their aversion to admitting they have this problem and accepting treatment.

    I'm single, overweight, 54, and for years have had trouble sleeping. Of course I snored, so bad it would wake me up so I didn't need anyone telling me. It was obvious. I suspected sleep apnea for years, but my aversion to all things doctor related got in the way of me doing anything about it. I dislike going to the doctor, sorry but it's just an annoying thing to do and so I don't go unless I'm certain I need to.

    This past summer, I had to go for several reasons. I took the opportunity to ask for a sleep study. My doctor was immediately supportive, his practice has it's own device that I took home and did the study in my own bed. As I suspected, I have severe OSA.

    I was quite afraid that if I had a full mask on my face I wouldn't be able to sleep, but the tech that went over the CPAP machine with me convinced me that was the kind I needed and that I'd get used to it. Well, the first night with it, I had ZERO problems sleeping. I can't believe I waited this long! I don't even notice the mask anymore, and I sleep so much more easily. I fall asleep within minutes and wake up easily and at the same time every morning, no alarm necessary. I'm getting 8 hours of restful sleep a night for the first time in years. I no longer fall asleep at my desk in the afternoon, I'm more alert at work.

    My insurance pays 50% of durable medical equipment, so I have to pay for half of the machine and mask and everything when it has to be replaced. But I called several companies that my insurance company works with and found one where my co-pay is $33 a month for I think 14 months, and after that I own the machine. That was easier than coming up with several hundred dollars up front. I do still have to pay for 50% of the mask, but unlike what some companies tell you, you don't have to buy a new mask every 3 months. My insurance allows me to buy one every 3 months, so I'll buy my 2nd mask soon and will have two, and then I'm not buying another one until one of them breaks.

    There are companies that really push you to buy the replaceable stuff every three months, that is how they make money. But it isn't necessary. Even without insurance, there are machines that are affordable. Yet people are put off from taking care of their sleep disorder because they believe they can't afford it, or they are afraid it won't work or they can't sleep with a machine. Seriously, the machine is quiet, I do use ear plugs but I think I could get used to the machine without them. And the treatment is worth every penny.

    Productivity of workers goes up, drivers are more alert, it's just something we need to improve as a society all around.

    "Every Pootie is a masterpiece." - Da Vinci

    by mdsiamese on Mon Nov 04, 2013 at 10:08:58 AM PST

  •  WONDERFUL info on Sleep Apnea! (3+ / 0-)
    Recommended by:
    Bernie68, akmk, FarWestGirl

    Who knew?  Well, you did, and you shared it here.  This needs a much wider audience.  Great work, thanks!

  •  Oxygen level question (1+ / 0-)
    Recommended by:
    FarWestGirl

    You can buy an oxygen tester that clips to the index finger for under $50, but it does not track you all night.

    If you wake up at night and immediately find a pulse of around 60-70 and an O2 level of over 96%, does that mean you were not O2 deprived?    I would think an O2 deprivation would yield a higher heart rate and a lower saturation if taken immediately

    How long does it take for O2 to get back up to a high range if you wake up from an apnea event?

    Hope somebody knows this.    I have OSA and use a nasal pillow mask, but I was not able to stand the constant pressure.   The air went into my stomach and also out through my tear ducts.  

    My machine adjusts the air pressure depending on need.   It is normally around 6-8 but can ramp up to much higher numbers of an obstruction is sensed.

    My doctor said this is not ideal, because you still have apnea events, just shorter and less deep.

    •  The simple answer to your question is (1+ / 0-)
      Recommended by:
      FarWestGirl

      No! Just because your O2 saturation is 96 when you immediately test it upon waking, that doesn't mean that you aren't experiencing apnea and associated desaturations.  If a person's lung function is normal, their oxygen level usually rebounds to normal within a few seconds of experiencing an apneic episode.

  •  Why Can't I Just Buy A CPAP Machine At Costco (1+ / 0-)
    Recommended by:
    mdsiamese

    and try it out without all this doctor prescription stuff?

    If it helps great.

    "I think that gay marriage is something that should be between a man and a woman.” - Arnold Schwarzenegger 2003

    by kerplunk on Mon Nov 04, 2013 at 11:09:46 AM PST

    •  good question (1+ / 0-)
      Recommended by:
      kerplunk

      I too don't understand why you need a prescription for a normal CPAP machine. It just pulls air out of the environment and blows it in your face.

      "Every Pootie is a masterpiece." - Da Vinci

      by mdsiamese on Mon Nov 04, 2013 at 11:13:49 AM PST

      [ Parent ]

      •  This is a pretty easy one to answer actually. (1+ / 0-)
        Recommended by:
        FarWestGirl

        First of all you need a perscription because the machine has to be properly set for each individual. You can't just pull a number out of a hat and go with that. Then there are risks involved. Even though the chances are small, there can be adverse effects from CPAP including infection, collapsed lungs, decreased cardiac output, not to mention that an improperly set machine will not help and could in some cases make the apnea worse.

        •  but (0+ / 0-)

          I can buy many things that can cause infections and other things.

          All the CPAP machine does is pull air from the environment and put it out. The mask and hose are not the part that requires a prescription. I can buy a gun without a prescription. I can buy oxygen without a prescription, I can buy other things that suck in the air and put it out, like a dehumidifier, air conditioner, fan, etc. The CPAP machine is the same, it is just calibrated.

          I can understand why a company would not want to sell a machine to someone without a prescription to avoid lawsuits if it doesn't work, but the actual machine is nothing that special and is similar to other things.

          "Every Pootie is a masterpiece." - Da Vinci

          by mdsiamese on Mon Nov 04, 2013 at 01:15:43 PM PST

          [ Parent ]

          •  Because, like with most things associated with (0+ / 0-)

            MD's and prescriptions, the industry needs its cut.

            So many medicines should be able to obtain over the counter as well.

            People usually know better than their doctors what they need.

            Same goes for contacts, once you have the right fit, its all trial and error. Online ordering makes sense. Doctors just want their cut.

          •  Perhaps you can buy an O2 type cylinder for (0+ / 0-)

            some kind of industrial use or something, but you can not buy oxygen for medical use without a perscription. Dehumidifiers, air conditioners and fans are not medical devices. Cpap machines are medical devices and may only be used with a perscription. Modern CPAP machines are far more complex than you seem to realize. Many of them are capable of operating in much the same way as mechanical ventilators. Long story short, it would be dangerous for untrained people to be able to buy them off the shelf. You seem to advocate that people with no medical knowledge diagnose and treat themselves without any physician involvement, or maybe I'm misunderstanding you.

  •  Really good post (2+ / 0-)
    Recommended by:
    Alexandra Lynch, FarWestGirl

    I'd only add one thing (to your headline, actually) Even if you get disability you need a sleep study. Even if it never occurs to you to apply for disability , you may need a sleep study. If you have some of the symptoms described above, go there. It's amazing the number of people I've met whose doc just says "lose weight and the problem will go away," as if that were even a useful prescription, considering the fail rate of weight loss.

    I think it's worth also reminding people that if they are diagnosed with sleep apnea, use the assistive tech, whatever it is, they're advised to use. If you live alone, borrow a relative or friend's kid to sleep over once or twice to report on sleep behaviors. Teenagers like to be of use so long as it's not their own parents.


    A beggar on horseback lashes a beggar on foot. The beggars change places, but the lash goes on. --WB Yeats

    by kestrel sparhawk on Mon Nov 04, 2013 at 12:32:59 PM PST

    •  Sleep deprivation makes it impossible to diet (2+ / 0-)
      Recommended by:
      FarWestGirl, kestrel sparhawk

      since sleep deprivation increases the desire for fatty, sugary high calorie foods. It is the body's way of trying to cope with being sleep deprived.  So, anyone who tells an obese osa patient "Just lose weight" is being very unrealistic. And callous. Like telling a paraplegic "Just get out of your wheelchair and walk." And it is quite possible that the osa came first and THEN the weight, in which case losing weight is not going to solve the problem.

      "A dog starved at his master's gate/Predicts the ruin of the state" Blake

      by McCamy Taylor on Mon Nov 04, 2013 at 04:43:38 PM PST

      [ Parent ]

  •  You can't get a clerical job (0+ / 0-)

    If one won't hire you because you don't have experience either... ERRR

    "Disappointment is anger for wimps," -Dr. Gregory House

    by freakofsociety on Mon Nov 04, 2013 at 04:29:10 PM PST

  •  Ohboyohboyohboy .... (0+ / 0-)

    As a former sleep technician who quit because of the vast proportion of OVERDIAGNOSIS of sleep apnea in lieu of a patient's very real other problems, lemme tell ya'll this is a warped and one-sided story.

    First, it's no question that sleep deprivation is a serious problem in this country.  But while about 90% of the working American population is sleep-deprived, that deprivation isn't caused by apnea.  It's caused by NOT HAVING ENOUGH TIME TO SLEEP.  Some degree of "sleep-disordered breathing" is NORMAL for the human species, an evolutionary result of squashing our noses into our faces like Persian cats and bulldogs (both of which also suffer respiratory problems as a result).  Sleep apnea is scored on a continuum, with the vast majority of the middle-aged and chronically-ill falling into a range of RDI 15-30, which indicates occasional dips in breathing throughout the night and most especially during REM sleep. THERE IS NO PROVEN BENEFIT TO TREATMENT for RDI less than 30.  Nevertheless, any sleep lab in this country will insist that an RDI of over 10 -- and often over 5 -- is an immediate danger that must, absolutely MUST be treated by artificial respiratory assistance during sleep.  

    Of course, said treatment costs between 2 and 3 THOUSAND for the machine, $100-$300 for the mask, and "requires" at least one $1500 sleep study every year for the rest of your life.  Roughly 50% of patients find the machine highly unpleasant or outright intolerable.  And if they do accept the therapy and adjust to using the machine . . . they will never get a decent night's sleep without such a machine again, because the use of the machine leads to atrophy of the muscles that are built up through years of physical work breathing against the resistance of a moderate obstruction.

    Genuine severe obstructive sleep apnea presents classic symptoms which any sleep partner can recognize: the patient audibly STOPS BREATHING for 5-60 seconds, followed by a series of extremely loud gasps, snorts, or snores.  Such patients also nod off obviously during the day.  If you or a friend or family member can literally fall asleep standing up, then DO haul yourself or them off to a sleep clinic: it can save lives.  But if you're suffering from chronic pain, then you're not sleeping BECAUSE OF THE CHRONIC PAIN.  I've sat watching the brainwaves of people in this condition night after night for four bloody years.  Sleep apnea doesn't cause pain.  Pain causes sleeplessness, except for the rare cases when pain MEDICATION causes apnea (that is, after all, how one dies of a morphine overdose).  And it's not obstructive sleep apnea, it's drug-induced central sleep apnea.

    Certainly, sleep and sleep history are important; like diet and exercise it certainly SHOULD be inquired after more carefully by the average primary care doctor.  But don't believe everything a fly-by-night sleep clinic tells you.  They live and work hand-in-glove with a very lucrative durable medical equipment industry that has been in growth mode for the last two decades diagnosing everyone in sight as having an illness that has no noticeable symptoms and for which all of the supporting research has been funded by the industry selling the (expensive, life-long) treatment.  Before you believe everything you're told by "experts" in this country, you should read material published in Canada, Britain, and France, where there is not such a happy marriage of treatment and PROFIT.   Sleep medicine rotations are a lovely idea, but only after sleep medicine starts acknowledging the wide range of sleep disorders and solutions instead of concentrating exclusively on Obstructive Sleep Apnea as the one and only issue of concern.  If the only tool you're willing to use is a hammer, then every problem looks like a nail.  If you're SELLING the hammers . . .

    •  Your conclusions are NOT supported (0+ / 0-)

      by the American Academy of Sleep Medicine nor by Medicare guidelines for treating OSA.  An index greater than the 10-14 range should always be treated. An index within the 10-14 range (and down to as low as 5) should be treated on a case by case basis, that decision being made based on the individual's medical history and symptoms. The presence of any number of co-morbidities (hypertension, coronary artery disease, atrial fibrillation, diabetes, stroke/TIA, etc.) are indications for treating those whose indices fall in the 5-14 range. Signs or symptoms such as hypersomnolence or excessive daytime sleepiness, frequent headaches and excessive snoring also justify treating milder degrees of OSA.

      Having said that, I will grant you that many sleep docs probably over-perscribe CPAP when other treatments might be effective. Quite a few people have positional OSA, ie they only have apnea when sleeping supine. My opinion is that they should be treated with devices designed to keep them off their backs. Problem solved and no CPAP required.  

  •  I use a CPAP (0+ / 0-)

    Ended up with one well after I first applied for SSDI due to pulmonary issues that put me on full-time oxygen therapy. After 2 years on O2, I noticed that no matter how much sleep I got, I was still always tired. I reported this to my then pumonologist, and he sent me for a sleep study. Turned out that I quit breathing 42 times an hour, and for so long that my oxygen sats drop severely. I also have to feed the extra oxygen in through a seperate fitting, and have had to do an overnight pulse-ox to check to see if I needed to increase the oxygen(yes, as it turned out). It does help, if you can stand to wear the mask.

    "Now is not the time to build fences around our freedom, but to emancipate our culture from the fear of losing it" Keith Olbermann, 2010

    by NightOwl40 on Mon Nov 04, 2013 at 07:03:40 PM PST

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