If the Vauto doesn't help I give up on CPAP

[SorryIamNormal]

Looking at your chart that is the only conclusion after eliminating everything else. On top of that I noticed you have some periodic breathing. That is a sign of heart trouble if I’m not mistaken. 

Not to sound like the others but your apnea is more than treated and you don’t have constant flow limitations with possible RERA’s that would explain not feeling well. Your AHI is below 1 with only 1 tick on flow limitations. 

Yes, his apneas and hypopneas are mostly treated but when you zoom in on the flow rate, he has obvious flow limitation on every single night.

I posted a few waveforms here.
http://www.apneaboard.com/forums/Thread-...#pid323857

Just one more night of this, and the Vauto will arrive!! ???  LETS HOPE

[Osiris357]

Yes, his apneas and hypopneas are mostly treated but when you zoom in on the flow rate, he has obvious flow limitation on every single night.

I posted a few waveforms here.
http://www.apneaboard.com/forums/Thread-...#pid323857

I understand that. What I’m trying to say is we can’t fix a myofunctional problem or cranial issue. PAP pressure can’t blow up a balloon and can’t open an air way from chin tucking so it definitely won’t get more air efficiently past an obstruction like that. All I meant is his time would be better spent asking people who understand those issues. We understand sleep apnea caused by the throat collapsing not malformation of the skull. That’s another ball of wax altogether that needs an understanding of his myofuntional issues that are causing his sleep disordered breathing. 

I wasn’t saying leave the forum. I was just saying we are the wrong people to ask because we don’t have that knowledge. Maybe someone does who isn’t always on the forum but a forum focused on his underlying issues may be a better choice for him so he can get this figured out faster

[SorryIamNormal]

Yes, his apneas and hypopneas are mostly treated but when you zoom in on the flow rate, he has obvious flow limitation on every single night.

I posted a few waveforms here.
http://www.apneaboard.com/forums/Thread-...#pid323857

I understand that. What I’m trying to say is we can’t fix a myofunctional problem or cranial issue. PAP pressure can’t blow up a balloon and can’t open an air way from chin tucking so it definitely won’t get more air efficiently past an obstruction like that. All I meant is his time would be better spent asking people who understand those issues. We understand sleep apnea caused by the throat collapsing not malformation of the skull. That’s another ball of wax altogether that needs an understanding of his myofuntional issues that are causing his sleep disordered breathing. 

I wasn’t saying leave the forum. I was just saying we are the wrong people to ask because we don’t have that knowledge. Maybe someone does who isn’t always on the forum but a forum focused on his underlying issues may be a better choice for him so he can get this figured out faster

The problem is that no one does.  I've already seen two 'functional dentists' and one of them was a diplomate in dental sleep medicine.  The dental sleep appliance didn't change anything.  But the daytime TMJ splint DID help a ton with TMJ issues.  All I am trying to do is SURVIVE and stay sane for the next 12months so I can get the MMA.  The time to fix developmental facial isssues was 25 years ago.

I think I have realisitc expectations.  The Vauto can do more 'stuff'.  Hopefully the expiratory? flow limitation stuff will go away with the vauto or it can mitigate that by lowing the pressure on exhaule.

I'm already going to the sleep dr on jan 15th.  Outside of that, the only other thing I can do is try another sleep dentist and a different type of sleep appliance.  The one I was given is called the shark fin or dorsal fin I can't remember which.

[SuperSleeper]

I don't want to argue with (those who are) cpap apologists.  It only works 50% of the time. 

Come on, SorryIamNormal... Yes, I know you're unhappy with your own CPAP treatment.  That's very apparent.

But, I think your statement that CPAP only works 50% of the time is completely misleading and factually untrue.  The truth is that a lot of folks who receive a CPAP machine do not put forth the effort to adjust to CPAP, or they are simply uninformed on how to solve simple problems that can be easily remedied, and a good portion of them return their machines or have it sitting in the closet.  That's a compliance issue and/or a comfort issue not a success issue.  Yes, it's due in part to poor patient support and help on the part of the medical professionals, I agree.  Much more should be done by them to help folks adjust to CPAP.  But then again, that's why Apnea Board exists-- because they aren't doing their jobs.

Again, if someone has Obstructive Sleep Apnea, then CPAP is the gold standard.  If it were not so, we'd be talking more about other options that work better in this forum... this forum is called "Apnea Board", not "CPAP Board".  But guess what?  There's not many people talking about other options that work better, simply because for the vast majority of people who have OSA, most other options do not work as well as CPAP.

Just because someone has additional medical complications and CPAP doesn't work for them is no reason to assume that CPAP machines are some sort of a "scam" or that CPAP has a "50% success rate".  Neither is one person's lack of "success" with CPAP any reason to assume that CPAP will not work for 1/2 of all others.  That's just not true and it's a disservice to those who are having difficulty adjusting to CPAP, and listening to such things may give them an excuse to give up on CPAP too early.

I'm hardly a "CPAP apologist" and I'm as against the "medical mafia" and the crooked DMEs and misinformed sleep doctors as anyone here. And we've even had a major CPAP manufacturer threaten a lawsuit against us for distributing the "secrets" of the CPAP clinician manuals, so I'm hardly on their side or the side of DMEs & sleep doctors.   But again, it's a failure of logic to assume that "because there are crooked or ignorant people in the CPAP industry" the CPAP treatment itself is somehow flawed or a poor option.

You're free to express your opinion on it, of course.  But you experience is hardly the norm and as you've expressed you've had terrible medical complications that the vast majority of sleep apnea patients have not had.  You're hardly the "average CPAP patient" in other words, so for others to draw conclusions based upon your experiences would be ill-advised, IMHO.

CPAP is still the gold standard treatment for sleep apnea, hands-down.  One man's bad experience does not make a statistically-relevant fact.

That said, I wish you luck with your new machine, once it arrives, and I'm hoping it can help some.  But like I've said from the very beginning in your threads, your major issues may be due to something completely unrelated to sleep apnea.

[SorryIamNormal]

I don't want to argue with (those who are) cpap apologists.  It only works 50% of the time. 

Come on, SorryIamNormal... Yes, I know you're unhappy with your own CPAP treatment.  That's very apparent.

That's a direct quote from Dr Steven Park who is an ENT dr in Manhattan and has a popular blog on sleep apnea.  I was astonished actually to hear him say that, because if someone like him speaks it has to be verifiable.  His quote (from memory) was 'every study I've looked at cpap they rig to make it look better than it is' and he also said 'the real compliance rate is 50%'.

If cpap is so wonderful then why does everyone has to rent their machine at first?  Maybe because people give up on it?   

Do you want the citation?  I am willing to scour his website and podcasts and find it.  I know what I heard.  He was trained at Johns Hopkins and has an excellent pedigree.   

I don't appreciate the condensation.  So I ask you (downright challenge you, just in an intellectual way)... do you want the proof or not?  Because I will prove you wrong.  It might take me a day or two, but I will find it.  AND if I misheard or mis-interpreted what he said, I'll post that proof too.

[SarcasticDave94]

I'm sure the doc you're quoting is probably educated and knows enough to write a book. And yet how many well educated doctors fail to treat the apnea patient with respect, understanding and functional knowledge of sleep apnea? I myself had a pulmonary doc do cookie cutter treatment; he saw OSA so CPAP was it and if I failed it was on me not doing it right. Here's a CPAP script for 20; OK go stick the mask on. You do have to factor in I had overwhelming central events with COPD already diagnosed. Yes ASV is a sub-group of CPAP IMO, but straight CPAP won't fix 124 CA over the 24 OA. That guy is a retired pulmonary cookie cutter Duck.

I'm only mentioning that because every apnea patient is unique, 100% of them. There are several flavors of CPAP to treat and several levels of machines to treat apnea. Some treat more than one diagnosis successfully, while other issues like CA take ASV unless other things like COPD get mixed in like in my case.

I am not on Apnea Board to do anything but support those who have taken steps in helping themself with success on apnea treatment. Unfortunately, there are a lot of patients that are diagnosed, including those that would be diagnosed if tested, that would rather fail than try to treat their apnea. I can't count those as CPAP failed them; they didn't do it. Personally I think the numbers could be skewed with that factor alone.

[SarcasticDave94]

Happy holidays

[Sleeprider]

Dr Park is a skilled Otolaryngology surgeon and his prejudice supports his profession. He prefers surgical solutions to positive pressure and I'm sure you know that. When he talks about a 50% success rate, he is correct that half of all persons prescribed CPAP for obstructive sleep apnea will ultimately fail, however that is owing more to the lack of skill and support in the medical profession in including sleep specialists, DME suppliers and insurance companies that drive diagnostics and dispensing protocols. I strongly feel the place to start is PAP therapy and not surgery. It is cost-effective and efficacious for most people, and the failures are the result of not getting the kind of support we provide here on Apnea Board and the difficulty of getting appropriate therapy if you don't fit the one-size fits all approach to this problem. PAP therapy needs some additional tools for people that will fail because they have central apnea and are misdiagnosed, or that have airway restriction and other conditions requiring bilevel to be effective and comfortable. The medical mafia wants you to have fixed prescribed pressure and no information or data. There are exceptions and the doctors that work with their patients as participants in their own therapy need be be recognized and commended. I wish they were the majority.

There are a small subset of individuals that come to this forum that we are unable to coach to effective, comfortable treatment with PAP. We are frustrated that sometimes we just run out of solutions and problems persist. For those people we will suggest surgical intervention and other solutions, but unlike Dr. Park, it's not our first stop.

[SuperSleeper]

That's a direct quote from Dr Steven Park who is an ENT dr in Manhattan and has a popular blog on sleep apnea.  I was astonished actually to hear him say that, because if someone like him speaks it has to be verifiable.  His quote (from memory) was 'every study I've looked at cpap they rig to make it look better than it is' and he also said 'the real compliance rate is 50%'.

Steven Park is hardly what I would call "unbiased".   He's interested in selling his books and making a name for himself, and he's a HUGE advocate of surgical solutions for sleep apnea, because (wait for it...) he's a surgeon!  He often advises surgery for people who were simply having a bit of trouble adjusting to a particular CPAP mask.  He's the "Dr. Oz" of sleep apnea  (more of a "big shot" of his own creation than a true expert in the field).

If cpap is so wonderful then why does everyone has to rent their machine at first?  Maybe because people give up on it?

Again, faulty logic on your part again.   Again, let me re-state it:  the lack of CPAP compliance does not equate to CPAP being unsuccessful.  In order to correctly measure CPAP success rates, you must go to people who have actually USED CPAP machines for a while... not look at people who have given up after a few nights for various reasons, such as "I don't like having my face covered with a mask" or "I don't like the air blowing in my nose" or "It really hampers my love life" or "The CPAP is way too noisy!", or "I can't keep my mouth closed" etc.  

Do you want the citation?  I am willing to scour his website and podcasts and find it.  I know what I heard.  He was trained at Johns Hopkins and has an excellent pedigree.

Again, quoting the "Dr. Oz" of sleep apnea does nothing to advance what you're claiming here.  Many people have "pedigrees".   That does not equate to us needing to take everything that proceeds out of their mouth as absolute truth, especially when they have a vested financial interest in swaying people towards surgical solutions.

I don't appreciate the condensation.  So I ask you (downright challenge you, just in an intellectual way)... do you want the proof or not?  Because I will prove you wrong.  It might take me a day or two, but I will find it.  AND if I misheard or mis-interpreted what he said, I'll post that proof too.

I have no doubt that your representation on what Dr. Steven Park says is true. Neither do I doubt that you can come up with numerous examples of "Dr. Park's 'wisdom'".... What I doubt is Dr. Steven Park's motives and his vested interest in providing surgical solutions for sleep apnea patients, when many of those patients could be better served by simply giving them more information and guidance to help them adjust to CPAP, resulting in a non-invasive treatment.

Steven Park (of course) has to give some "lip-service" to CPAP because it obviously works for the vast majority of people who actually USE IT and don't give up after the first couple of weeks.  And he gives some good advice to deal with various sleep issues.  But he's WAY too quick to advise cutting into people who have simple compliance problems with CPAP.  

If you want to have a surgeon cut you up, that's fine.  For a small number of people it may be the only option that works.  But the assertion that a surgical solution is a much more successful treatment than CPAP for average sleep apnea patients is absolutely and completely ridiculous.  And that is what I object to.

Again, if surgical solutions were the gold standard for sleep apnea, guess what we'd spend the majority of our time talking about here on Apnea Board?

[SorryIamNormal]

Dr Park is a skilled Otolaryngology surgeon and his prejudice supports his profession. He prefers surgical solutions to positive pressure and I'm sure you know

I'm relistening to his podcasts because I'm determined to find the part where he talks about all of the cpap studies he has ever seen being 'rigged' to show it is better than it really is. 

He isn't any more biased as a surgeon than any other surgeon.  In fact (ironically) I'm listening to him now and he states very clearly that even though he is a surgeon, he always tries less invasive nonpermanent solutions first.  Including Cpap.

Do you want me to link to it where he says exactly this?  I'm going to relisten to the entire hour again and link it anyway.  Like don't shoot the messenger here I'm just reposting the information.  In fact I just bought his book even though I read it in the library years ago.  I've also said that cpap is ahell of a lot better than a tracheotomy -which was the ONLY option before CPAP.