Life Without CPAP is about a public hospital and clinic system that decided that sleep studies to detect sleep disorders such as obstructive sleep apnea and treatments for OSA such as CPAP were ineffective and too expensive. The money spent diagnosing and treating sleep disorders could be better spent elsewhere. And so, the administrators adopted a system wide policy. No county patient would get a sleep study. No one would get CPAP. Period. If anyone was in danger of dying from untreated OSA, they would be offered a tracheostomy—a surgical procedure in which a hole is cut in the throat and a tube in inserted in the airway. A permanent fix. And about as appropriate for most OSA as decapitation would be for migraine headaches.
The decision was a quiet one. There was no sign over the door of the hospital advising patients that if they had a sleep disorder, they should probably seek treatment elsewhere. The people being seen assumed that their health care providers would diagnose and treat their medical problems to the best of their ability. Since public awareness of sleep disorders is low, very few of them would have noticed if a sleep disorder was missed or not treated. They were grateful to be getting “free” health care that they otherwise could not afford.
This book is about the five years I spent working as a family physician with an interest in sleep disorders for a public health system that declared that sleep disorders did not exist—and if they did, we would not treat them. Sort of like Alice through the looking glass.
While the administrators’ intentions were good----allocate limited resources where they could be used most effectively---the results were not what they hoped. For sleep is an essential function of all higher animals, including humans. If you disrupt sleep, you disrupt the system of checks and balances that keep our bodies functioning in times of low stress. Sleep disorders tell the body, in effect, “You are living in a time of war. Mobilize all your defenses now. Live like there is no tomorrow.”
Do that long enough, and there may well be no tomorrow. Blood pressure goes up. Blood sugar goes up. The appetite goes up---have to put on pounds in preparation for that coming famine. Stress goes through the roof. So does paranoia. Can’t trust anyone. Pain levels rise, the body’s way of keeping you alert even when you don’t need to be alert. The libido falls. Don’t want to sire any children, not with all this danger looming. The elevated blood pressure and sugar take their toll on the arteries. Here comes that first heart attack at 3 am in the morning. That first stroke----
Now, add in unlimited medical resources to treat the results of that chronic sleep deprivation and what do you get? A lot of money spent chasing consequences when it might be cheaper and more effective to treat the underlying disease. But once folks in power make up their minds, it can very hard to persuade them to change their minds. If you know that sleep disorders are inconsequential and that the available treatments are ineffective, you will not see sleep disorders. You will see an epidemic of coronary artery disease and uncontrolled diabetes. You will allocate your resources towards the cardiology department. You will hire more clinical pharmacologists to get your patients’ blood sugars under control----
Never realizing that all that money is being thrown down an enormous sinkhole. For, if you fix the coronary arteries without fixing the underlying sleep apnea, the heart will quickly become diseased again. If you control the sugars without controlling the OSA, the patient will continue to put on weight. If you allow sleep deprived men and women to drive on the streets of your community, they put everyone at risk, and Everyone will be brought to your emergency room in an ambulance to be treated for their life threatening injuries.
What’s that you ask? What difference does it make to you, in your community, if people with sleep apnea in some other part of the country are not getting the treatment they need? Right now, at this very moment, around 8% of Americans over 40 all across the country have OSA and do not know it. But they sense that something is wrong. As more and more of them get insurance, they will seek out doctors, trying to figure out why their minds are no longer sharp, why their bodies seem to be falling apart, why they ache all over. They will visit doctors complaining of memory loss---and their new doctors will get expensive neurologic work ups. They will describe joint and muscle pains---and they will be checked for arthritic conditions and get MRIs of their spines, knees and shoulders. They will describe their panic attacks---and spends years in therapy, taking two, then three, then four medications, some of which will cause their weight to rocket up, making their underlying sleep disorder all that much worse. They will talk about the palpitations that wake them from sleep and get extensive cardiology evaluations. These tests will cost tens of thousands of dollars. They will see specialists and subspecialists. And, in 4 times out of 5, none of the doctors will guess what is really wrong with the patient, unless he happens to be hospitalized and unless a nurse happens to walk by in the middle of the night when he is snoring and she or he notices that the patient has frequent pauses in breathing and the nurse alerts the doctor and the doctor knows what the snoring and apneic spells mean.
Because, with the exception of pulmonologists (lung specialists), Ear Nose and Throat (ENT) specialists and a handful of Sleep Medicine Specialists, American doctors are extremely bad at diagnosing sleep disorders. So bad, that they miss 8 cases out 10. Meaning that unless something is done to bring physicians up to speed, they will waste a lot of valuable time and medical resources before their patients with OSA receive a correct diagnosis.
How much time and how much money?
Back in 1999, Kapur et al. calculated the excessive cost associated with undiagnosed OSA as $2700 versus $1,384 per year. In other words, in the year before doctors determined that someone was, in fact, suffering from sleep apnea, they did tests and treatment totaling twice what they would have done on the average person. Where did the money go? To work up chest pain. To treat uncontrolled diabetes and high blood pressure. To look for brain tumors and multiple sclerosis.
“Although the data are limited, the effect of sleep disorders, chronic sleep loss, and sleepiness on accident rates, performance deficits, and health care utilization on the American economy is significant. The high estimated costs to society of leaving the most prevalent sleep disorders untreated are far more than the costs that would be incurred by delivering adequate treatment.”
From Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem
http://www.ncbi.nlm.nih.gov/...
There is an epidemic of undiagnosed and untreated sleep disorders. It has a huge economic impact on our country. It affects road safety, work place safety. It leads to early disability and retirement, putting a strain on the Social Security fund and Medicare.
If we get universal healthcare without improving our primary care physicians’ ability to recognize and treat sleep disorders like sleep apnea, we risk wasting enormous sums of money the way that the health clinic I am about to describe wasted health care resources treating the effects of sleep apnea instead of addressing the underlying problem.
From the Introduction to Life Without CPAP, available free for five days at Amazon for Kindle (and other electronic readers) by McCamy Taylor. If you would like to read Life Without CPAP but do not have an electronic reader send me a message and I can send you a word document.