Replies to This Discussion

Permalink Reply by Jay Polatnick on February 10, 2012 at 8:58am

Banyon,

       So President Reagan was really an apneac throughout his life without knowing it ?

No other contributing factor may have lead to his development of Alzheimers ?  Sounds very presumptious on your part.

       'National Health disaster' ?   It's absolutely serious, but sounds like you're asking for gov't intervention.  Of course, the latter is a whole entire new thread.

Cheers,

Jay

Banyon said:

Reply by Jay Polatnick 9 hours ago

Many of the symptoms and resulting disease states are accurate, but you're bordering on 'fear-mongering'. OSA undoubtedly has a strong impact on mental deterioration, but many other factors are involved (fat-free diets, aluminum toxicity, etc)

 

After visiting a nursing home weekly for six years and observing those in the Alzheimer's unit and those in the "pre-Alzheimer's" unit, there is no doubt in my mind that OSA by itself is the leading cause of dementia.

I also have no doubt that OSA by itself leads to "high blood pressure, stroke, heart attack, cardiac arrhythmia, heart failure, sudden cardiac arrest, stroke, depression, bipolar disorder, psychopath (and the list goes on), or dead."

I have no appreciation for a meek approach to this serious, national health disaster.

 

• ▶ Reply

Permalink Reply by 99 on February 10, 2012 at 9:48am

it is not just a national disaster but also an international disasater 

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Permalink Reply by Jay Polatnick on February 10, 2012 at 9:50am

Possible U.N. intervention ?  A G8 summit in Brussels or Davos ?  : D

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Permalink Reply by Somnonaut on February 10, 2012 at 10:21am

To all those who hope an oximeter will give them the information they seek, it most likely will not. In terms of severe frank apneic events, oximetry will typically dip, even when using CPAP, as there is no air entering the airway, (ie. suffocation), ergo dip in oxygen attached to the hemoglobin. BUT...for the events that more than likely are happening when using CPAP (hypopneas), there will be, more than likely, a marked DECREASE of the oximetry level drop, while the "event" (change in airflow of 30% or 50%) depending on how your lab scores it, with the resulting 4% or 3% drop in oximetry (or arousal) which goes along with the scoring chosen above) will likely not yield a desaturation due to the increased level of flow still happening through this constricted airway. It is something we routinely experience during polysomnography and wrestle with while making sure the events that are titrated against are true events. This is why arousals (EEG component) are important. As I have said in other venues..."It's the Arousals Stupid." (ala Bill Clinton campaign mantra.)

We need a better indicator of sleep fragmentation which is the source of the daytime sleep. You may be having Limb movements in your sleep that fragment your sleep and it has nothing to do with your OSA therapy. These, and other, sleep disorders overlay each other, and it requires precision medical investigation to get at the heart of the matter. Going to a QUALIFIED SLEEP PHYSICIAN is the key. The local pulmonary doc or neurologist who may dabble in their typical sleep complaining patient, is not usually qualified to look at the totality of your sleeping issues.  

What you would be much better suited (though possibly precluded from using due to headgear for the CPAP) is a ZEO http://myzeo.com which will record an EEG based measure of sleep.  THere are also other consumer sleep products. Jawbone http://jawbone.com/up and Fitbit http://www.fitbit.com/ use a motion based sleep estimating algorithm, and also help coach you through weight reduction. 

Do people here feel consumer sleep interest is high? I have been trying to get people in the industry interested in consumer sleep products, but they have turned a blind eye to the field. I think it is huge.  I have always felt this way since I published my algorithm back in 1992. http://www.zzzratio.com 

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Permalink Reply by Banyon on February 10, 2012 at 10:23am

Banyon,

So President Reagan was really an apneac throughout his life without knowing it ?

No other contributing factor may have lead to his development of Alzheimers ? Sounds very presumptious on your part.

'National Health disaster' ? It's absolutely serious, but sounds like you're asking for gov't intervention. Of course, the latter is a whole entire new thread.

Possible U.N. intervention ? A G8 summit in Brussels or Davos ?

 

Jay, I think anyone with who reads on an eighth-grade level or higher can easily read what I wrote and see that you have misrepresented it. I clearly did not say that OSA is the single cause of dementia. Go back and read my post if you care to. Your comment about Reagan is only silly drama.

Also the use of the word 'national' does not constitute a call for government action. You have made another misrepresention. It might be very puzzling to a rational person why you would make such a comment in contributing to a rational discussion.

You have accused another SleepGuide member of engaging in something "borderering on fear-mongering". How would you characterize the silly drama in your last two posts?

Why are you behaving like this? I don't get the point.

 

 

• ▶ Reply

Permalink Reply by MZH on February 10, 2012 at 10:35am

Somnonaut said:

To all those who hope an oximeter will give them the information they seek, it most likely will not. In terms of sever frank apneic events, oximetry will typically dip, even when using CPAP, as there is no air entering the airway, (ie. suffocation), ergo dip in oxygen attached to the hemoglobin. BUT...for thes events that more than likely are happening when using CPAP (hypopneas), there more than likely will be marked DECREASE of the oximetry level drop, while the "event" (change in airflow of 30% or 50%) depending on how your lab scores it, with the resulting 4% or 3% drop in oximetry (or arousal) which goes along with the scoring chosen above) will likely not yield a desaturation due to the increased level of flow still happening through this constricted airway. It is something we see routinely during polysomnography and wrestle with making sure the event that are titrated to are true events. This is why arousals (EEG component) are important. As I have said in other venues..."It's the Arousals Stupid." (ala Bill Clinton campaign mantra.) We need a better indicator of sleep fragmentation which is the source of the daytime sleep. You may be having Limb movements in your sleep that fragment your sleep and it has nothing to do with your OSA therapy. These sleep disorders overlay each other, and it requires precision medical investigation to get at the heart of the matter. Going to a QUALIFIED SLEEP PHYSICIAN is the key. The local pulmonary doc or neurologist who may dabble in their typical sleep complaining patient, is not usually qualified to look at the totality of your sleeping issues.   

__________________________________

I'm one with frequent arousals but have had no PLM or cardiac issues in my 4+ studies. This fragmentation has never been addressed by all 3 sleep doctors. I find that very strange. I also have flow limitations that don't seem to be connected to any events. What on earth can that mean? (My docs never look at detailed graphs; they only care about summaries. Makes me want to scream. Why not look at them? ! Argh!)

• ▶ Reply

Permalink Reply by Jay Polatnick on February 10, 2012 at 10:45am

My point is to stimulate other solutions (beyond or including CPAP) to this very troubling condition.   I just don't see CPAP as earning 'The Gold Standard' title for what is a multi-faceted physical (sometimes neurological) ailment.   I reference some of Dr. Steven Park's work for one in regards to malocclusion and underdeveloped airway structures as a probably cause.   My 8th grade English teacher would be proud.

Banyon said:

Banyon,

So President Reagan was really an apneac throughout his life without knowing it ?

No other contributing factor may have lead to his development of Alzheimers ? Sounds very presumptious on your part.

'National Health disaster' ? It's absolutely serious, but sounds like you're asking for gov't intervention. Of course, the latter is a whole entire new thread.

Possible U.N. intervention ? A G8 summit in Brussels or Davos ?

 

Jay, I think anyone with who reads on an eighth-grade level or higher can easily read what I wrote and see that you have misrepresented it. I clearly did not say that OSA is the single cause of dementia. Go back and read my post if you care to. Your comment about Reagan is only silly drama.

Also the use of the word 'national' does not constitute a call for government action. You have made another misrepresention. It might be very puzzling to a rational person why you would make such a comment in contributing to a rational discussion.

You have accused another SleepGuide member of engaging in something "borderering on fear-mongering". How would you characterize the silly drama in your last two posts?

Why are you behaving like this? I don't get the point.

 

 

• ▶ Reply

Permalink Reply by Somnonaut on February 10, 2012 at 10:46am

Uhh, the report: http://www.thirdage.com/news/sleep-apnea-mask-can-change-your-face_...

"The patients did not report and noticeable changes, but the scientists could see that there was a reduction in the prominence of both the upper and lower jaws. This was a result of shifting dental arches and incisor tooth placement.

However, Hiroko Tsuda, lead author of the study, says that the side effects should not be a cause for major concern.

I [would] never say that CPAP users should stop using their CPAP because of this side effect, Tsuda said."

And in searching for the actual report I was led to the abstract book for World Sleep 2011,

http://www.worldsleep2011.jp/pdf/sbr.pdf

which offered this nugget I post to show just how far we have to go in understanding the mechanisms of OSA, and how it is so destructive and harmful. 

CLINICAL TRIALS ADDRESSING OSA
ASSOCIATED CARDIOVASCULAR AND
METABOLIC OUTCOMES: PAST, PRESENT
AND FUTURE
J-L PEPIN
1
1
INSERM U1042, HP2 laboratory and Locomotion, Rehabilitation and
Physiology Department, University Joseph Fourier and Grenoble University
Hospital, BP 217, GRENOBLE 09, France

Intermittent hypoxia (IH) is inducing oxidative stress and consequently
promotes inflammation, endothelial dysfunction and cardiovascular
morbidity. Effective treatment of OSA may represent an important target
for improving cardiovascular risk. Large-scale randomized controlled
trials (RCTs) demonstrating the benefits of OSA treatment with respect
to hard cardiovascular outcomes (e.g., cardiac events and death) are
then necessary. An alternative is to design shorter-term RCTs using surrogate cardiovascular end points such as endothelial function, carotid
intima-media thickness or arterial stiffness. Research efforts should also
be directed at identifying novel treatment interventions that affect the
specific pathophysiology of cardiovascular consequences of OSA. The
most effective strategy for reducing OSA-induced hypertension remains
to be delineated. In OSA patients, the blockade of angiotensin II receptors reduces blood pressure fourfold more than CPAP. Recent studies
suggest that spontaneous overnight fluid shift from the legs to the upper
body is associated with obstructive sleep apnea. Spironolactone is
potentially interesting for reducing this overnight fluid shift and then
improving both blood pressure and the severity of OSA. This hypothesis
remains to be validated in RCTs. Our group has demonstrated that the
leukotrienes pathway is activated in OSA-induced atherosclerosis. We
have also described a specific inflammatory profile in aortic walls of
mice exposed to IH with a key role of the chemokine RANTES. A
5-lipoxygenase inhibitor or anti-inflammatory drugs like statins need
to be evaluated as able to prevent atherosclerosis progression in OSA.
Response to CPAP therapy in terms of cardiovascular and metabolic
outcomes differs in non-obese and obese patients. The failure of CPAP
to alter metabolic or inflammatory markers in obese OSA emphasizes
the need to offer a combination of multiple modalities of treatment
including weight loss and physical activity

We should be encouraging patients to use CPAP or whatever therapy their doctor and they have decided to use to mitigate OSA and all sleep disorders. That is the driving home point. Everything else is BS and here-say. Just do what you have to do to improve your sleep. 

Mack D Jones, MD, SAAN said:

Jay,

If and when it occurs in adults, I'd consider it to be a "minor side effect." You have choices. Would you rather be alive and healthy with some facial changes on CPAP or avoid CPAP to protect your face and be an obese diabetic with high blood pressure, stroke, heart attack, cardiac arrhythmia, heart failure, sudden cardiac arrest, stroke, dementia (Alzheimer's Disease), depression, bipolar disorder, psychopath (and the list goes on), or dead.

BTW, read "Deadly Sleep," Is Your Sleep Killing You? In it I discuss some of the alternatives to CPAP.

Jay Polatnick said:

Respectfully, Dr. Jones....CPAP can be an excellent treatment for many sufferers.   If it comes down to being an apeac or not an apneac then I'd say remarkably so.   'The Gold Standard' is actually lining the makers of CPAP machines pockets without little serious debate going on to explore the alternatives.    As you should know, CPAP machines have some downsides too.  

Question, are permanent changes in facial structure considered a minor side-effect ?

http://www.apneasupport.org/permanent-changes-in-face-from-cpap-mas...

• ▶ Reply

Permalink Reply by Sarah Gorman on February 10, 2012 at 11:27am

Somnonaut said:

Uhh, the report: http://www.thirdage.com/news/sleep-apnea-mask-can-change-your-face_...

"The patients did not report and noticeable changes, but the scientists could see that there was a reduction in the prominence of both the upper and lower jaws. This was a result of shifting dental arches and incisor tooth placement.

However, Hiroko Tsuda, lead author of the study, says that the side effects should not be a cause for major concern.

I [would] never say that CPAP users should stop using their CPAP because of this side effect, Tsuda said."

And in searching for the actual report I was led to the abstract book for World Sleep 2011,

http://www.worldsleep2011.jp/pdf/sbr.pdf

which offered this nugget I post to show just how far we have to go in understanding the mechanisms of OSA, and how it is so destructive and harmful. 

CLINICAL TRIALS ADDRESSING OSA
ASSOCIATED CARDIOVASCULAR AND
METABOLIC OUTCOMES: PAST, PRESENT
AND FUTURE
J-L PEPIN
1
1
INSERM U1042, HP2 laboratory and Locomotion, Rehabilitation and
Physiology Department, University Joseph Fourier and Grenoble University
Hospital, BP 217, GRENOBLE 09, France

Intermittent hypoxia (IH) is inducing oxidative stress and consequently
promotes inflammation, endothelial dysfunction and cardiovascular
morbidity. Effective treatment of OSA may represent an important target
for improving cardiovascular risk. Large-scale randomized controlled
trials (RCTs) demonstrating the benefits of OSA treatment with respect
to hard cardiovascular outcomes (e.g., cardiac events and death) are
then necessary. An alternative is to design shorter-term RCTs using surrogate cardiovascular end points such as endothelial function, carotid
intima-media thickness or arterial stiffness. Research efforts should also
be directed at identifying novel treatment interventions that affect the
specific pathophysiology of cardiovascular consequences of OSA. The
most effective strategy for reducing OSA-induced hypertension remains
to be delineated. In OSA patients, the blockade of angiotensin II receptors reduces blood pressure fourfold more than CPAP. Recent studies
suggest that spontaneous overnight fluid shift from the legs to the upper
body is associated with obstructive sleep apnea. Spironolactone is
potentially interesting for reducing this overnight fluid shift and then
improving both blood pressure and the severity of OSA. This hypothesis
remains to be validated in RCTs. Our group has demonstrated that the
leukotrienes pathway is activated in OSA-induced atherosclerosis. We
have also described a specific inflammatory profile in aortic walls of
mice exposed to IH with a key role of the chemokine RANTES. A
5-lipoxygenase inhibitor or anti-inflammatory drugs like statins need
to be evaluated as able to prevent atherosclerosis progression in OSA.
Response to CPAP therapy in terms of cardiovascular and metabolic
outcomes differs in non-obese and obese patients. The failure of CPAP
to alter metabolic or inflammatory markers in obese OSA emphasizes
the need to offer a combination of multiple modalities of treatment
including weight loss and physical activity

We should be encouraging patients to use CPAP or whatever therapy their doctor and they have decided to use to mitigate OSA and all sleep disorders. That is the driving home point. Everything else is BS and here-say. Just do what you have to do to improve your sleep. 

Mack D Jones, MD, SAAN said:

Jay,

If and when it occurs in adults, I'd consider it to be a "minor side effect." You have choices. Would you rather be alive and healthy with some facial changes on CPAP or avoid CPAP to protect your face and be an obese diabetic with high blood pressure, stroke, heart attack, cardiac arrhythmia, heart failure, sudden cardiac arrest, stroke, dementia (Alzheimer's Disease), depression, bipolar disorder, psychopath (and the list goes on), or dead.

BTW, read "Deadly Sleep," Is Your Sleep Killing You? In it I discuss some of the alternatives to CPAP.

Jay Polatnick said:

Respectfully, Dr. Jones....CPAP can be an excellent treatment for many sufferers.   If it comes down to being an apeac or not an apneac then I'd say remarkably so.   'The Gold Standard' is actually lining the makers of CPAP machines pockets without little serious debate going on to explore the alternatives.    As you should know, CPAP machines have some downsides too.  

Question, are permanent changes in facial structure considered a minor side-effect ?

http://www.apneasupport.org/permanent-changes-in-face-from-cpap-mas...

Jay,

As someone who watched a large proportion of my extended family die young (we're talking 30's and 50s here) from what turned out, in retrospect, to be undiagnosed sleep aepena,  I think that Dr. Jones is, if anything, UNDERstating the problem.  

I went to various docs for years , starting in my twenties complaining of severe insomnia, panic attacks, a very irregular heartbeat and  hypoglycemia.  After thirty years of misdiagnosis, I finally diagnosed myself by going to a sleep clinic.  Why? because since I wasn't morbidly obese, middle-aged and male, the diagnosis was missed.  Of course, by then I was diabetic and had a number of other OSA related health issues and was starting to experience memory problems as well. 

In the meantime, my father, by then in his 70's, had become a brittle diabetic, had a quintuple bypass, a number of strokes and was well into dementia.  He went to the Mayo Clinic three times for three days each and saw three separate teams of doctors to try to deal with his ongoing cardiac, stroke and severe short term memory problems. (Yup, they thought he had AD as well as multiple infarct dementia)  and all three teams completely missed the diagnosis.  Of course, he had, severe OSA, (AHI =69) diagnosed only when I sent him to a sleep clinic. He was one of the worst cases they had ever seen. 

Sadly, by then it was too late for him.  He couldn't handle the machine or remember why he needed to use it. I was more fortunate, and after seven years of 100% APAP use have recovered substantially 

Whether the PAP machine manufacturers  are making too much money is the least of the problems. The question you and everyone else should be asking is, why isn't there a full court press going on to get people diagnosed and treated early enough in life that they avoid all the expensive comorbidities??  One possible answer is that the drug companies don't want them in treatment until they come up with the Holy Grail of at least a semi-effective pharmaceutical treatment. But the minute they do, watch the commercials and public health messages proliferate.  

In the meantime, hope that you don't lose too many relatives to OSA, because if you've got this issue, dollars to donuts, a lot of them do as well, and since most people with this condition remain undiagnosed, they have no idea.  Try to get them into treatment, and I hope you have more success with that endeavor than I have had.  

OSA is a topic in desperate need of a public health education program at the national level.

• ▶ Reply

Permalink Reply by Banyon on February 10, 2012 at 11:27am

Reply by Jay Polatnick 19 minutes ago

My point is to stimulate other solutions (beyond or including CPAP) to this very troubling condition.   I just don't see CPAP as earning 'The Gold Standard' title for what is a multi-faceted physical (sometimes neurological) ailment.   I reference some of Dr. Steven Park's work for one in regards to malocclusion and underdeveloped airway structures as a probably cause. 

 

That is better Jay. I think you and I probably agree on more than we disagree despite our first few posts in this thread.

I do believe that unhealthy jaw structure is a major cause of OSA. However, how do you think that fact translates to a negative for CPAP?

If I understand your overall position you see CPAP as a less-than-perfect solution. I agree with this position. However poor of a treatment you may believe CPAP to be, CPAP currently is absolutely the best solution for the greatest number of patients. In pursuing a solution better than CPAP, I don't see the need to disparage CPAP and disparagement of CPAP can be counterproductive to your goal.

Since this thread started as a narrow topic (tongue weakness), I would prefer to see the discussion of alternatives to CPAP, either current or potential future alternatives, in a new thread. If you start it I will participate.

 

 

 

• ▶ Reply

Permalink Reply by Banyon on February 10, 2012 at 11:32am

Wow Sarah, Why are you quoting all those long posts? You are just junking up the thread by repeating what we have already read. Use a little discretion and either refer to a quote without repeating it or paste only sections of the post that you want to reply to.

You might want to consider deleting your last post and starting over. I don't think anyone knows what you intended to say.

• ▶ Reply

Permalink Reply by Somnonaut on February 10, 2012 at 11:33am

Maybe, but your 7th grade science teacher would hang his head in shame. You are not seeing the true extent of CPAP's usage and the MILLIONS of people it has helped. All you like to do is belabor the miniscule number that have issue with it. Statistics is not your strong point. Fear mongering is.

Of course CPAP might not be perfect for everyone. No therapy is perfect. But, when comparing CPAP to any other therapy for OSA, it is immediate, it is temporary, it is effective, and it has very little down side, and nothing can compare with it. There is not much else a therapy can ask, besides be everything for everyone. Which of course it is not. It is a VERY useful and first line tool to treat this EPIDEMIC. Do the companies make money on it, sure they do. That is why we can get a little, silent box on our night tables that measures about 6-8 inches by 8-10 inches and provides night to night relief.  It should be the first line of therapy for its immediacy if nothing else.  

[You should have seen the first models of CPAP. They were the size of a vacuum cleaner..in fact they used a vaccum cleaner motor originally.]

Jay Polatnick said:

My point is to stimulate other solutions (beyond or including CPAP) to this very troubling condition.   I just don't see CPAP as earning 'The Gold Standard' title for what is a multi-faceted physical (sometimes neurological) ailment.   I reference some of Dr. Steven Park's work for one in regards to malocclusion and underdeveloped airway structures as a probably cause.   My 8th grade English teacher would be proud.

Banyon said:

Banyon,

So President Reagan was really an apneac throughout his life without knowing it ?

No other contributing factor may have lead to his development of Alzheimers ? Sounds very presumptious on your part.

'National Health disaster' ? It's absolutely serious, but sounds like you're asking for gov't intervention. Of course, the latter is a whole entire new thread.

Possible U.N. intervention ? A G8 summit in Brussels or Davos ?

 

Jay, I think anyone with who reads on an eighth-grade level or higher can easily read what I wrote and see that you have misrepresented it. I clearly did not say that OSA is the single cause of dementia. Go back and read my post if you care to. Your comment about Reagan is only silly drama.

Also the use of the word 'national' does not constitute a call for government action. You have made another misrepresention. It might be very puzzling to a rational person why you would make such a comment in contributing to a rational discussion.

You have accused another SleepGuide member of engaging in something "borderering on fear-mongering". How would you characterize the silly drama in your last two posts?

Why are you behaving like this? I don't get the point.

 

 

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