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Anyone here diagnosed with Sleep Apnea have any other medical issues like excessive weight, heart condition, take drugs, had an ENT check thier esophogus for obstructions and soft pallet issues.
I was diagnosed with sleep apnea severe and obstructive but the diagnosis at DENT Neuro Institute cited caused by esophogeal narrowing, soft pallet elongation, anterior surgical intervention and cardiomyopathy. The Sleep Apnea was secondary to the medical conditions cited and always is.
I was impressed with DENTS thorough diagnosis. Some places they will only state: Severe Obstructive Sleep Apnea. I wanted to know why I have it and they told me.
Has anyone else had a comprehensive exam to determine what else is causing their sleep apnea since sleep apnea cannot exist without some other medical condition. I am hoping this will cause others to think about the possible underlying causes of their sleep apnea.
The goal, is to get people thinking about the real cause of their sleep apnea stimulating those suffering from sleep apnea to ask questions to their treating medical provider like, why can't i get off this Cpap? Response from physician should be: well if you lose the weight or if we remove partial soft pallet tissue or scar tissue, or maybe we can try Coreg to help stregnthen your heart muscle, or lets look into your brain signals functions or lets reduce the amount of narcotics you are on. This is what your physician should be stating to you and hopfully they have.
Wearing a Cpap is a tasking, miserable and downright horiffic experience to have on and taking care of it can be a task in itself. I cannot imaine going camping and having to take my Cpap with me. Why not look further into the underlying causes of why one has sleep apnea and try to fix the medical condition first? how many here have really gone through this and who have really asked what is causing my sleep apnea????
Views: 121
Replies to This Discussion
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Permalink Reply by assholes showing my profile when on
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I had the scar tissue removed and the soft pallet shaved and I no longer snore, I can breathe at night no problem. I had the underlying issue resolved and that resolved the OSA.
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Permalink Reply by Teresa Hoehn on
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Hi Jeff,
Surgery can work for some people depending on the severity of the OSA and also the anitomical problems. Surgery has proven to be helpful about 50% of the time if the patient has mild to moderate OSA. People that have severe sleep apnea rarely have resolution of OSA but often are able to decrease the amount of pressure needed with their PAP devices.
Your comment about the CPAP being the best alternative may be true depending on the patients ability to tolerate PAP therapy. I agree that in most cases I am able to assist my patients in CPAP verse surgery. Unfortunately I can name 4 patients that went through multiple surgeries including UVPP, Jaw advancements and Nasal surgery to find they still had OSA. In one case the patients AHI was 67 before surgery and 62 after. He was able to go from a CPAP pressure of 18 to 12. Not able to get rid of CPAP and the surgery was very painful. I alway recommend to my patient to at least try the CPAP it's way less painful and invasive.
CPAP may seem a chore but look at the alternatives.
Teresa
j n k said:It is crucial to know the exact location of the obstruction when considering the possibility of surgery. Other than that, it doesn't really matter. Most who have apnea surgeries, with a few rare exceptions of course, still have to use CPAP to fully treat their obstructive apnea, if they want to feel their best while they are awake. Generally speaking, surgery may help, but only tracheotomy cures apnea. The rest may lessen, but don't cure. The major jaw surgeries can come really, really close, but they are quite major surgeries that are much more life-altering than simple, easy-to-use PAP therapy.
Eventually you will make peace with the idea of how easy PAP therapy is, relatively speaking. It is not nearly as big a deal (for most) as many people seem, at first, to make out of the idea of it. You only have to wear it at night, while you are unconcious. What could be easier and less invasive to waking life than that?!! It works beautifully. Batteries are small for camping. It is not much more of a hassle than remembering to take a toothbrush and some underwear.
Surgeries are for people who can't make CPAP work for them and so have to settle for second-best treatment or have to get surgery to make their PAP therapy more effective. Surgeries are expensive, have side-effects, are mostly not reversible, and rarely end up allowing a person to deal with OSA very effectively on their own. Most end up going on CPAP after surgery anyway, if they want to feel their best. If you can make PAP work well without surgery, the best ENTs will not even consider you a candidate for surgery.
There is a process of denial and mourning you go through. We all do. But after that is over, you realize that the gold-standard for treating apnea really isn't all that bad. You don't have to mutilate yourself to use it, and it only adds about 5 minutes to your morning routine of getting ready for the day. CPAP works GREAT! For the majority, anyway. You will come to love that machine, believe it or not, once it represents how you feel every morning after using it. You won't dread taking it camping--you will be eager to and will look forward to it.
I know you don't want to hear that right now. But I said it because it is true and you need to hear it, in my opinion.
jeff
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Permalink Reply by Mary Z on
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I was impressed with DENTS thorough diagnosis. Some places they will only state: Severe Obstructive Sleep Apnea. I wanted to know why I have it and they told me.>
Richard, If you don't mind me asking, where did you get your information that OSA is always secondary to another medical condition?
I have other medical conditions- essential tremor, hypothyroid, some cognitive and memory problems (treated successfully with Aricept), bipolar disorder. For me it's a question of the chicken and the egg. I was born in 1952, came of age in the 70's, and have many indiscretions in my past. My depression came first as a teenager, other problems as an adult. Some of these conditions- primarily cognition and memory may be a result of OSA, but I doubt they are the cause. I've been pretty thoroughly examined and scanned so I don't think there are many stones left unturned. My impression is that my OSA is a separate entity caused by upper airway blockage despite airflow drive.
That is it may be seconday to another condition, but not necessarily.
I have also learned that the less invasive the treatment, the better it is. General anesthesia is not to be taken lightly and it's is necessary for any surgery
Mary Z.
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It a mazes me when a Doc. tells most of us sleep apnea is 75% due to weight the doc. doesn't help out more to the people who need weight loss...the Doc. knows what kind of safe perscriptions could help in the loss of weight area. now I was not told what is my cause for my sleep apnea, just that I do snore loud, well this is my family say. lol, but my test showed I stop breathing 44x in 8hrs of testing at 10sec. ea x., so that scares me, needless to say I don't sleep more that 3hrs at a time.
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Richard, you raise some interesting questions. What exactly was the diagnosis underlying your OSA?
You seem to have a medical background, would you elaborate?
I find my CPAP to be easy to handle, falling sleep on my feet at 8:30 in the morning and not being able to drive due to excessive sleepiness was not. I would like to hear more about your background and reasoning. I also would like to see the results of the sleep study that showed your OSA was cured.
You make some strong statements.
Thanks,
Mary Z.
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Permalink Reply by susan mccord on
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Jeff, I absolutely agree with you about surgery not being the be-all and end-all for apnea patients. Dr. Park held a teleconference just this week, which I attended as I usually do, on this very subject. I, for one, was totally shocked to learn how complex the surgical decision-making process re: structural problems really is. You're right, he's a surgeon, but he clearly doesn't see surgery as a "cure", even if it's successful (that doesn't include tracheotomy). He encourages CPAP compliance at every turn and always has since I've known anything about him.
I have more to say about this--a lot more--but I want to read the entire thread to see where you guys are before I jump in. Richard's Discussion questions are multi-layered and not just about surgery. So I'll be back!
Susan McCord :-)
j n k said:I have no argument with your statements. I apologize if mine seemed to be in conflict with that. And I appreciate your post for balancing how I may have overstated my position in my attempt to counteract the orignial poster's implications as I percieved them.
I agree 100% that many are helped by surgery. And I am not against that. I am especially impressed when someone having difficulty with PAP therapy is helped to make it more effective. Good surgeons do good work.
But when a patient has an uninformed aversion to the idea of PAP therapy and is then, in my opinion, preyed upon by a few bad eggs who promise that there is no need even to consider PAP because there are simple surgeries that solve the root cause of the problem completely, better than PAP, I take issue with that approach, myself. Obviously, from your words, you are not one with the approach I have trouble with.
For me, to my way of thinking, the most balanced surgeon I've heard on the matter posting here regularly is Dr. Park. I am impressed how he makes sure patients give PAP the full shot and how he never makes false promises about what he does.
My statements are not meant to attempt to trump the experts and practitioners. Patients need to know the percentages when they make choices. And the idea of a simple surgery lowering AHI as effectively as PAP can be a particularly alluring one to many patients trying to figure out whether they should consider PAP therapy.
It is my opinion that good surgeons will not give the impression that, for example, "UPPP should be tried first before trying PAP, since UPPP will get at the root of the problem and prevent the need of ever considering PAP again." Too many unsuspecting patients have heard that over the years and have swallowed that line, including the hook and sinker. I don't doubt the motives of the surgeons. But with good surgeons like Dr. Park spreading the word on the true state of affairs these days, there is no excuse for a surgeon being that uneducated today, in my opinion.
Teresa Hoehn said:Hi Jeff,
Surgery can work for some people depending on the severity of the OSA and also the anitomical problems. Surgery has proven to be helpful about 50% of the time if the patient has mild to moderate OSA. People that have severe sleep apnea rarely have resolution of OSA but often are able to decrease the amount of pressure needed with their PAP devices.
Your comment about the CPAP being the best alternative may be true depending on the patients ability to tolerate PAP therapy. I agree that in most cases I am able to assist my patients in CPAP verse surgery. Unfortunately I can name 4 patients that went through multiple surgeries including UVPP, Jaw advancements and Nasal surgery to find they still had OSA. In one case the patients AHI was 67 before surgery and 62 after. He was able to go from a CPAP pressure of 18 to 12. Not able to get rid of CPAP and the surgery was very painful. I alway recommend to my patient to at least try the CPAP it's way less painful and invasive.
CPAP may seem a chore but look at the alternatives.
Teresa
j n k said:It is crucial to know the exact location of the obstruction when considering the possibility of surgery. Other than that, it doesn't really matter. Most who have apnea surgeries, with a few rare exceptions of course, still have to use CPAP to fully treat their obstructive apnea, if they want to feel their best while they are awake. Generally speaking, surgery may help, but only tracheotomy cures apnea. The rest may lessen, but don't cure. The major jaw surgeries can come really, really close, but they are quite major surgeries that are much more life-altering than simple, easy-to-use PAP therapy.
Eventually you will make peace with the idea of how easy PAP therapy is, relatively speaking. It is not nearly as big a deal (for most) as many people seem, at first, to make out of the idea of it. You only have to wear it at night, while you are unconcious. What could be easier and less invasive to waking life than that?!! It works beautifully. Batteries are small for camping. It is not much more of a hassle than remembering to take a toothbrush and some underwear.
Surgeries are for people who can't make CPAP work for them and so have to settle for second-best treatment or have to get surgery to make their PAP therapy more effective. Surgeries are expensive, have side-effects, are mostly not reversible, and rarely end up allowing a person to deal with OSA very effectively on their own. Most end up going on CPAP after surgery anyway, if they want to feel their best. If you can make PAP work well without surgery, the best ENTs will not even consider you a candidate for surgery.
There is a process of denial and mourning you go through. We all do. But after that is over, you realize that the gold-standard for treating apnea really isn't all that bad. You don't have to mutilate yourself to use it, and it only adds about 5 minutes to your morning routine of getting ready for the day. CPAP works GREAT! For the majority, anyway. You will come to love that machine, believe it or not, once it represents how you feel every morning after using it. You won't dread taking it camping--you will be eager to and will look forward to it.
I know you don't want to hear that right now. But I said it because it is true and you need to hear it, in my opinion.
jeff
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Hi Richard! I'm extremely interested in this Discussion you've posted, and in your description of your personal experience with CPAP.
Re: are any of us being tested for other medical conditions that may "cause" OSA: Yes, I am. First I want to say that there IS a direct relationship between apnea and heart disease. Period. I was diagnosed with heart disease in October 2005. Was diagnosed with high moderate to low severe OSA in June 2009. I have a superb cardiologist caring for my heart condition. He has many patients who also have sleep apnea. It's the chicken and the egg thing, for sure. No one really seems to KNOW what causes what. They DO know that there's a RELATIONSHIP between OSA and heart disease/diabetes/weight/chronic inflammatory process within the body/and something else that I can't recall at the moment. So you're right if what you're talking about is "relational".
I've done a ton of reading and questioning about this stuff 'cause I'm pissed off that I have it too--what I've gathered consistently is that NO ONE truly can say that any particular thing is CAUSATIVE. It's just too young of a science, I guess. But that's true with many dangerous and life-threatening illnesses. For instance, some people with absolutely NO risk factors have heart disease, cancer, diabetes, etc.--you get my drift. No one knows with certainty what causes some of these kinds of diseases. My guess, and it's only a guess, is that they're eventually gonna find out that ALL these things are inter-relational, i.e., that all all are intertwined in some way and one can set off another. In my mind, that doesn't equal "causative".
In my opinion, bodies don't live and behave separately from their separate parts. It's seems all one big package to me. You asked about "drugs"--I assume you're talking about Rx medication prescribed by an M.D. And yes, I take a LOT of Rx medications. I've always wondered what impact they have on my body as a whole. I have blood testing done, at my request, every 3-4 months to follow liver/heart/kidney condition. There IS an impact on liver and kidneys--so far low level but clearly they're affected by my Rx protocol. I'm not sure where you're going with this particular issue and would like to know more about your thinking about it.
You asked also whether any of us had medical diagnostic testing done in order to confirm the etiology of sleep apnea. Since just prior to diagnosis with OSA, I've had an MRI (brain), a full neuro exam, and am currently undergoing intense treatment and testing for severe sinus problems I'm having which began just after I started on CPAP on a consistent basis the end of July, early August. Powerful antibiotics x 20 days, an ENT exam, addition of an oral 6-day steroid protocol, plus some kind of measured-dose steroid nasal spray. That entire combination is the ONLY thing that's seemingly been successful in stopping this chronic sinusitis problem I've had for months.
I then had a complete CT scan of my sinuses which came back clear of lingering infection, polyps, cysts, or structural problems. ENT has examined my jaw/chin/throat for any sign of malformation that might be contributing to OSA = no risk factors there.
Next step is allergy testing to either diagnose or r/o that. I have NEVER, in 67 years, experienced any type of sinus problem, allergy, or pre-disposition to upper respiratory illnesses. I've been remarkably healthy all my life. Or so it seemed. I'll be very surprised if I find out I now have allergies because I had absolutely NO symptoms ever, up until I started CPAP. No one, including me will say that CPAP has caused my sinus problem. However, I believe now that there IS a relationship between the two. Again I'm not willing to say it was causative.....
My weight is within normal limits. I was a little overweight when I was diagnosed, maybe 15# or so--I have since lost all that weight plus some more. I know I can't allow myself the luxury of messing with my weight anymore. And I won't.
I don't know if any of this answers your original questions. I assume you'll let me/us know. I DO want to tell you how sorry I am that you've had such a terribly difficult experience with CPAP so far. I had a tough time adjusting to mine initially, as everyone who was on SG at the time can attest to!!!! But I can't in all honesty say that any of it has been "horrific" or either of the other two words you used about yourself. I'm used to it and have been for months. I was 100% compliant from August on. I've been off CPAP for 3 weeks tomorrow. I got so sick that I absolutely could not tolerate it. That hadn't happened ever before, so I went with what my body was telling me. I don't want to resume it without a re-titration because I'm not at all certain my pressure's correct. It it's messing with my sinuses in some way, I don't want to risk starting that lousy issue again. But considering the fact that I have no titration scheduled yet, I'll probably go back on tonight or tomorrow night.
I have NO intention of stopping CPAP treatment. It works--I feel better than I did for I don't know how long before I was diagnosed. CPAP does help!!! I'm a believer.
Susan McCord :-)
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Look on any site like Mato clinic or eny medical book. I have taken nunerous medical classes in order to obtain a Physician Assitant degree masters in the field and I have 20 years in Occupational Health and Safety including Environmental and Toxicology. I am stirring comments in order to obtain feedback. i am not saying any one procedure or anyone who uses a Cpap tha it also is the all cure. What I am asking is that people look at their underlying conditions. I am a medical professional and will again advise that sleep apnea is secondary to all other medical issues. It is my opinion and can be backup by Mayo clinic, Duke, and many other sites that are reputable in displaying thie ropinion reagrding sleep apnea and othe medical conditions.The Mayo Clinic alos states that Sleep Apnea is secondary to all othe rmedical condtions. Go to and read their sire on sleep apnea. I do not give opinions all the time rather I sate facts from other medical evidence and experiences. Surgery is not always the cure all but it worked for me since Sleep Apnea was secondary to something else I was suffering from. All i am trying to do is make other aware that there is more to sleep apnea than just sleep apnea and wearing a Cpap. To me its another way a treating someone partially. It only solves part of the proble. If you take the time to carefully read through what I have stated you will probably understand a little better. But from your response where did I get this info from, well i stated that.in a previous response. Again its being overweight that causes sleep apnea not sleep apnea causing someone to be over weight. This is a valid and true medicla statement even made by the Mayo Clinic!!! So even if sme of my responses were quoted by Duke or Mayo, I guess I am not correct in my medical opinion and the responses that these two well recognized medical professional institutions display are also incorrect??
Mary Z said:I was impressed with DENTS thorough diagnosis. Some places they will only state: Severe Obstructive Sleep Apnea. I wanted to know why I have it and they told me.>
Richard, If you don't mind me asking, where did you get your information that OSA is always secondary to another medical condition?
I have other medical conditions- essential tremor, hypothyroid, some cognitive and memory problems (treated successfully with Aricept), bipolar disorder. For me it's a question of the chicken and the egg. I was born in 1952, came of age in the 70's, and have many indiscretions in my past. My depression came first as a teenager, other problems as an adult. Some of these conditions- primarily cognition and memory may be a result of OSA, but I doubt they are the cause. I've been pretty thoroughly examined and scanned so I don't think there are many stones left unturned. My impression is that my OSA is a separate entity caused by upper airway blockage despite airflow drive.
That is it may be seconday to another condition, but not necessarily.
I have also learned that the less invasive the treatment, the better it is. General anesthesia is not to be taken lightly and it's is necessary for any surgery
Mary Z.
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Again I am a Physician Assistant with 20 years in Occupational Health and Safety, Toxicology and Environmental Health/Public health.
Mary Z said:Richard, you raise some interesting questions. What exactly was the diagnosis underlying your OSA?
You seem to have a medical background, would you elaborate?
I find my CPAP to be easy to handle, falling sleep on my feet at 8:30 in the morning and not being able to drive due to excessive sleepiness was not. I would like to hear more about your background and reasoning. I also would like to see the results of the sleep study that showed your OSA was cured.
You make some strong statements.
Thanks,
Mary Z.
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Permalink Reply by RockRpsgt on
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Richard I appreciate your comments and knowledge in this post. Yes there is always an underlying cause for apnea. Just as there is an underlying cause for any other medical condition. If you have apnea you should try and seek out those causes and rectify them. However it is not always that easy. Not all underlying conditions can be treated. Aging is one of those. Apnea is part of the aging process. Eventually no matter how healthy we are apnea will get the majority of us.
In my short time in the sleep field I have seen my pts try just about everything to keep from using CPAP. Medications, Surgery, and oral devices are probably the most tried. I won’t even get into the crazy experimental therapies that I have seen in my 500 or so sleep studies. In your post you talk about the many other solutions without ever once mentioning the impact CPAP therapy can have on a life. The truth of the matter is that CPAP is more likely to save your life than any of your above mentioned solutions. Also it is important that even in seeking out alternative methods that you should not discontinue your therapy. I do understand that CPAP is not for everyone. That does not mean that it is not the best treatment for apnea and its effects.
“The goal, is to get people thinking about the real cause of their sleep apnea stimulating those suffering from sleep apnea to ask questions to their treating medical provider like, why can't I get off this Cpap? Response from physician should be: well if you lose the weight or if we remove partial soft pallet tissue or scar tissue, or maybe we can try Coreg to help strengthen your heart muscle, or let’s look into your brain signals functions or lets reduce the amount of narcotics you are on. This is what your physician should be stating to you and hopefully they have”
Let’s talk about the heart. Apnea causes heart problems that can and will lead to CHF. CHF produces fluids that can cause a narrowing of the airway. Strengthening the heart could cause a widening of the airway and improve the severity of the apnea. This however is NOT a cure for apnea. If the apnea is not 100% cured the heart will return to its bad condition. Even an AHI of 5 could have detrimental effects on an already weakened heart. While being one of the strongest muscles in our bodies, we also have to remember that the heart is one of our most fragile. It can only heal so many times. The best treatment for heart problems in relation to SBDs is CPAP used in conjunction with heart medication. Coreg may not be enough. It definitely will not cure your apnea. I do find your statement on Coreg in correlation with getting off of meds a little oxymoronish.
What about those people that lose weight and still have apnea? Post surgery and still have apnea? Did your doctors explain to you that this was a possibility? Did your doctors explain to you that despite the results of your surgery and weight loss that your apnea will probably return within six years? How much damage do you think may be done before you realize it this time? How much irreversible damage was done this time?
I also hope that you do not have to ask you PCP to look at your brain signal function when you discuss bad sleep, fatigue, or heart problems with them. A PSG/EEG should be the first thing that they do and not something that you should have to ask for. I mean I would hope that by now the physicians realize that the proper test for hypertension and fatigue is a PSG. This brings up another interesting point to your post. Our medical community is just now beginning to get educated on sleep. Despite your 20+ years of medical training you had to seek out the knowledge. Do you not see the HUGE problem in this? Your pts spend 1/3 of their lives sleeping, yet if you had not developed apnea you would have probably not been educated on the disorder. I hope that one day they do find a cure for apnea, and put me out of a job. Until then the mayo clinic and DENTS will continue to distribute more CPAP units than apnea cures. What do I know though?
I would like to see the PSG results that prove you have an AHI of 0.
Rock
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Permalink Reply by RL on
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O.K. so I looked up Mayoclinicdotcom, did a search on Sleep Apnea, reviewed their general info. I don't see any suggestion that the cause of sleep apnea is other medical conditions, despite one statement of "overweight" condition being common among many but not all with sleep apnea. The followiing link http://www.mayoclinic.com/health/obstructive-sleep-apnea/DS00968/DS... describes Mayo's take on cause which is a basic description of the condition causing the obstruction, with no mention of other medical conditions. Additionally, Mayo sites "risk factors", not as causes per say, but related factors. If Mayo has some more detailed or medical practitioner level articles available that indicate otherwise, please provide specific info so we can all look at them for reference. Any other specific links or references would be appreciated. In my research I have found nothing so far that supports your interpretation on this sleep apnea condition and it's causes. As part of the scientific medical community, it is certainly possible for you to have a different opinion than some of your peers, and winning the argument depends on your evidence. I could appreciate your opinion more if you could back it up with specifics, especially considering it goes against the conventional wisdom that has evolved so far in this area.
BTW, did you have a PSG for yourself before trying a CPAP? If so, what was the resulting diagnosis?
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"Again its being overweight that causes sleep apnea not sleep apnea causing someone to be over weight."
The chicken or the egg theory. One of my favorite debates jnk!
Define overweight Richard. I have learned that being overweight is defined by having a BMI greater than 24%. The ideal BMI range is 19-24%. Say a person is 6'2". Their ideal weight is 194ilbs to 220ilbs. Studies show that no matter what you weigh that a 10% increase in body weight will increase your chances for apnea by 6 fold (Dr Mark Dyken MD University of Iowa Sleep Team). meaning that if a 6'2" person started out at 194 ilbs and had a 10%(19ilbs) weight gain they would more than likely develop mild apnea despite still being "underweight".
We also have to look at healthy children that develop apnea for a wide variety of reasons. Despite being underweight most of these children end up overweight if their apnea is not treated. Even if their apnea is treated via surgery or weight loss most will return to the original severity by adult hood. In both of these scenarios a hormonal imbalance is brought on by the arousals caused by even mild apnea. These hormonal imbalances cause a leptin dysfunction. Leptin is the hormone that tells our brain that we have enough stored food or fats. This would cause your body to crave carbs. The result of a leptin dysphunction would be an eating disorder. In these scenarios apnea would cause one to become overweight. Apnea is a vicious circle.
I am not saying that you are wrong. Being overweight is the biggest predisposing factor for apnea. An unhealthy skinny person is just as likely to develop apnea as an overweight healthy one. While I am sure that you are a very well educated person, probably more so than me, I do not think that you have all of the facts on apnea and healthy sleep.
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