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Flipping the model presents a new way to treat sleep apnoea

news.flinders.edu.au

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Re: Flipping the model presents a new way to treat sleep apnoea

#41

Post by Aurornis »

elric wrote: post #36

The only reason why CPAP has such abysmal failure rates, is because followup is an absolute joke. Patients are titrated in a sleep centre, typically for one night, and are then sent home with a machine, probably the shittiest mask the sleep centre had on hand, and a kick out the door. With some luck, patients have to come in once a year, usually to prove that their therapy is compliant with whatever harebrained schem…

I know some medical professionals in this domain who would disagree with your assessment. The hardest part is convincing patients to come back for followups and to comply with treatment.

Even my primary care doctor said he has abysmal compliance rates with apnea treatment because so many people decide that wearing any device every night is too much to ask.

I half suspect that apnea is being diagnosed so aggressively that people with even mild apnea are getting treatment. This would explain why patients are willingly giving up a treatment that is life changing for the better in patients who are suffering severe symptoms.

Re: Flipping the model presents a new way to treat sleep apnoea

#42

Post by elric »

xnx wrote: post #6

Reduction is sleep apnea seems like a likely second-order effect of GLP-1 drugs.

Maybe. I'm not convinced. There is some correlation between obesity and sleep apnea, but skinny people can develop sleep apnea just as easily as fat people. It is very difficult to lose weight (and very easy to gain weight) once you do develop sleep apnea for a variety of reasons, so the causal relationship might even be reversed.

That being said, if you suffer from OSA and have a lot of fat on your chest and around your airway, losing some of that fat might help. Maybe GLP-1 drugs can do that in spite of OSA.

Re: Flipping the model presents a new way to treat sleep apnoea

#43

Post by Aurornis »

Tarsul wrote: post #10

For myself I noticed reducing my own bodyweight helped a lot (so from 108kg to 100kg was already helping me a lot). Which also means that I know that I cannot allow myself to regain this weight again... ;)

Not every apnea sufferer is overweight, but it’s at the top of the list of causes by a very wide margin.

Weight reduction is extremely effective for most (though not all, there is a small minority of non-responders) in this situation. The challenge is that patients hate to hear it from their doctors so many doctors won’t even bring it up. Doctors are increasingly dependent on patient ratings for their performance reviews so difficult topics are often avoided.

Re: Flipping the model presents a new way to treat sleep apnoea

#44

Post by monkpit »

fnordpiglet wrote: post #37
DrAwdeOccarim wrote: post #7

Totally agree. My journey started with TMJ disorder. Turns out bruxism (teeth grinding) is common in sleep apnea patients; I assume because it forces the lower jaw forward. I started with a mandibular advancement device and it was amazing. It completely relived my debilitating TMJ jaw pain and fixed my sleep apnea. I couldn’t believe how amazing I fet every morning. Unfortunately, and which was clearly communicated t…

I want to emphasize the importance of seeming an ENT. I also saw an ENT, but very early in my journey. I also had sinus surgery. After recovery was the first time in my life I could breathe fully through my nose. I had no idea - it was like being blind and being able to see for the first time, except I had no inkling others could see. That actually opened up a realization that the sinus issues they fixed had led to c…

What’s the antibiotic?

Re: Flipping the model presents a new way to treat sleep apnoea

#45

Post by fnordpiglet »

monkpit wrote: post #44
fnordpiglet wrote: post #37

Earlier quoted context omitted.

I want to emphasize the importance of seeming an ENT. I also saw an ENT, but very early in my journey. I also had sinus surgery. After recovery was the first time in my life I could breathe fully through my nose. I had no idea - it was like being blind and being able to see for the first time, except I had no inkling others could see. That actually opened up a realization that the sinus issues they fixed had led to c…

What’s the antibiotic?

https://en.m.wikipedia.org/wiki/Mupirocin

Re: Flipping the model presents a new way to treat sleep apnoea

#46

Post by thomasqbrady »

When you see a paper like this, what, if any, path is there to seeking this kind of treatment? I know someone who would likely be interested in this, but I know from prior experience of my own that just trying to reach out to the researchers listed is a long process that can be fruitless. Is there an intended/better way? I know about clinicaltrials.gov, but that’s only helpful if there’s an ongoing study of the thing you’re interested (which is less likely if you’re reading about findings).

Re: Flipping the model presents a new way to treat sleep apnoea

#47

Post by elric »

Aurornis wrote: post #41
elric wrote: post #36

The only reason why CPAP has such abysmal failure rates, is because followup is an absolute joke. Patients are titrated in a sleep centre, typically for one night, and are then sent home with a machine, probably the shittiest mask the sleep centre had on hand, and a kick out the door. With some luck, patients have to come in once a year, usually to prove that their therapy is compliant with whatever harebrained schem…

I know some medical professionals in this domain who would disagree with your assessment. The hardest part is convincing patients to come back for followups and to comply with treatment. Even my primary care doctor said he has abysmal compliance rates with apnea treatment because so many people decide that wearing any device every night is too much to ask. I half suspect that apnea is being diagnosed so aggressively…

That's a catch-22, and it's exactly why followup is important. And why physicians should talk to patients, instead of just sending them on their merry way with a cheap CPAP and a shitty mask. "Here's a shitty mask and some random pressure, good luck, and remember to use it for 4+ hours each night and byebye."

If you're unfortunate enough to require a stoma, they don't just randomly attach a bag and send you home. You're sent to a stoma nurse. You're educated on the life changing effects of having to use a stoma. Your nurse will help you find a type of bag that's right for you and can help you deal with complications. But with OSA, we slap a mask on people and don't even tell them that there are dozens of kinds.

Now, I'm sure this all depends heavily on where you are, how shitty the healthcare system is over there, and even who you see at which sleep centre. But in general, CPAP would be very well tolerated if we could help people to optimize their therapy.

Re: Flipping the model presents a new way to treat sleep apnoea

#48

Post by taeric »

TheBlight wrote: post #3
taeric wrote: post #2

The number of people that are using a CPAP is honestly mind boggling to me. The number that have gotten one, and then refuse to wear it is even crazier. I remember when I first got one, I assumed it was some niche thing that was going to be unheard of from everyone I talked to. Turns out, not so much. I don't think it has been a miracle device, by any measure. But I'm curious what makes it so hard to stick to for so…

Is it really difficult to understand why people don't like sleeping with a mask that makes noise?

It isn't that it is hard to believe it can happen. It is so many people, though, that it is hard for me to comprehend.

And yes, the mask can make noise, but typically not as much as the person makes snoring for your partner. Modern ones, in particular, are fairly quiet and can be tucked under the night stand such that they make about as much noise as basic forced air venting systems do. Which is not much.

The mask can be uncomfortable some nights. They do have a variety of masks to try, though. And if it isn't working, they have other options.

That last point is actually refreshing for me in this story. So many bounce off a CPAP into nothing. Hopefully efforts like this story will help people find something that can work.

Re: Flipping the model presents a new way to treat sleep apnoea

#49

Post by taeric »

hindsightbias wrote: post #24
taeric wrote: post #2

The number of people that are using a CPAP is honestly mind boggling to me. The number that have gotten one, and then refuse to wear it is even crazier. I remember when I first got one, I assumed it was some niche thing that was going to be unheard of from everyone I talked to. Turns out, not so much. I don't think it has been a miracle device, by any measure. But I'm curious what makes it so hard to stick to for so…

Not as mind boggling as the obesity rate. I’m very aggressive towards friends about cpaps. I bother them until they do a sleep study. It is life changing for many of us.

Agreed, and one does not preclude the other. :D

Re: Flipping the model presents a new way to treat sleep apnoea

#50

Post by taeric »

lcuff wrote: post #35
taeric wrote: post #2

The number of people that are using a CPAP is honestly mind boggling to me. The number that have gotten one, and then refuse to wear it is even crazier. I remember when I first got one, I assumed it was some niche thing that was going to be unheard of from everyone I talked to. Turns out, not so much. I don't think it has been a miracle device, by any measure. But I'm curious what makes it so hard to stick to for so…

I sweat where the mask contacts my face, so that's one issue. As others have said, it can be noisy. I find the noise highly variable based on how it sits on my face and if there are things (a pillow, a sheet, my hand) in front of the discharge vent. At times it feels claustrophobic. I feel vastly better in the morning if I've used the device for more than half the night, so I'm very motivated to make it work.

They make a stupid number of different masks, so it is worth trying the different types. Also worth pursuing the dental ideas linked in this story. Looks fairly promising.
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