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

[Osiris357]

You are missing all of our points. 

I’m bowing out of this thread and gonna grab my popcorn along with Dave and sit back and enjoy smh wow

[Sleeprider]

Dr Park is very persuasive and can even sound neutral regarding CPAP/BPAP. He has many testimonials and is a great spokesperson for his profession. The comparison to Dr. Oz by Supersleeper is well deserved, although I think Park is actually competent. In fact, if he was to diagnose that you have a maxillofacial malformation that could benefit from surgery, I would have no qualms if you decided to pursue that option; however for most doctors that recommend such procedures, I would want a second opinion. I don't need to see his lectures or read his articles...been there done that. He is inclined to favor surgery over PAP because he does not specialize or even try to explore the potential of the therapy that competes with his preferred and profitable approach. For someone like you that is self-diagnosing in order to find any solution to a problem that has eluded you so long, his promises sound irresistible. If that is where you decide to go, then do it without objection from me, but it's just not what we're about on Apnea Board. To be honest, your results simply don't fit the profile Otolaryngology surgery or even changes in you PAP therapy. I hope we can make you feel better and less disrupted in your sleep, but the problem is not apparent in the data you have been posting.

[Melman]

I have a friend who tried the surgical solution because he didn't want the inconvenience of CPAP. He now uses CPAP because the surgery was only a temporary fix for his apnea. With my help in adjusting his therapy his apnea is now well controlled. Six close friends and I are successful CPAP users. I have one friend who is unsuccessful because he refuses to use it. I know it's a small sample but I'm convinced based on our experience and all the successful users on this form that Dr. Park is wrong.

[SuperSleeper]

Our very first Moderator on Apnea Board (ConnCarl) had a couple of surgeries for sleep apnea (UPPP & MMA).  Here's his reply to someone who was asking about the surgical options:

Shanes, the most interesting thing about your post, to me, is that if Apnea Board had existed twelve years ago, I might have written the same thing, pretty much word for word.

Nobody likes dealing with XPAP.  Take me, for example.  Ask around and you will discover that I am not exactly the XPAP Poster Boy.  But even I will admit that XPAP is usually a better option than surgery.

I had my first polysomnogram back in 1993.  When they showed me the CPAP machine I spluttered, "No way am I using that!"  I insisted on UVPPP, which I now realize was one of the biggest mistakes of my life.

UVPPP rarely "cures" OSA, but it carries enough baggage for a trip to the Australian outback.  For example;

Don't plan on taking a casual dive in the pool.  The water pouring in though your nose would drown you in pretty short order.  And nose clips won't stem the flow.  Vise Grips might.  

If you eat in a trendy restaurant, chew your food in small quantities and swallow carefully, otherwise your dining companion may be treated to the spectacle of a piece of vermicelli (the pasta, not the worm) falling out of your nose and onto the table with an embarassing splat.

If you finally throw in the towel and go on XPAP after UVPPP, you can forget about using one of those comfortable, unobtrusive nasal pillow interfaces.  In fact, forget about a nasal mask of any kind.  You'll almost certainly need a full-face mask, with all the flaws common to those designs.

But if you're like me, you won't just give up after UVPPP...and you can always find a surgeon to oblige you.  You can get hyoid myotomy and genioglossus advancement next.  

First, they break the little bone that holds your tongue down.  Then they grab it with a pair of needle-nose pliers and wind it (like spaghetti onto a fork) to pull your tongue down so it won't fall back and block your airway.  Of course, pulling it down also means pulling it forward, so your tongue will be sticking out a bit further than before.  For me, this means biting my tongue violently every time I sneeze.  Then they sort of shave your tongue down with with a polished stainless steel device that looks suspiciously like a wood planer.  I never could have imagined that there were so many nerve endings in my tongue, but in retrospect, I suppose I should have seen that coming.  I remember thinking afterward that if I only had a cyanide capsule, I could have just bitten down on it.

But wait, there's more!  The next step in the Stanford Protocol for the Surgical Correction of Obstructive Sleep Apnea is Maxillo-Mandibular Advancement, or MMA for short.  I'll spare you all the gory details and just share this much; when they're cutting your upper jaw away from the rest of your skull with a sawzall, you'll probably be thinking, "That tongue-shaving experience was like a walk in the park, relatively speaking."

Unless your pressure requirements are abnormally high...say 25 cm or so...or there is some structural abnormality that makes you an excellent candidate for surgery, I would strongly suggest that you give XPAP a long, hard look.

People are amazingly resilient.  You would be surprised what you can get used to.  I'm not saying it will be easy initially, but almost anyone can use XPAP.  The trick is to address the specific problems that are making you uncomfortable.  If you find the pressure too high to exhale against, a BiPAP machine can reduce the pressure on exhalation.  If you find your mask uncomfortable, there are many alternative interfaces to choose from.  If drying is a problem, a heated humidifier should help.

You're in the right place, at least.  Please feel free to keep asking questions, and if you're going to insist on surgery, make sure your surgeon reviews all the possible side effects and complications with you, including any impact the procedure under consideration could have on your future use of XPAP therapy.

Good luck!  Carl

[SorryIamNormal]

You are missing all of our points. 

I’m bowing out of this thread and gonna grab my popcorn along with Dave and sit back and enjoy smh wow

And those are what exactly?  That Park can't be trusted?  I only found this information after everything every Dr told me never came true!  I kept being told over and over (by an ENT at the time) 'you'll feel better tomorrow'.  This_never_happened.  So I looked for more information, just like how I arrived at this forum.

If people think he is the dr oz of anti-cpap then OK.  His information makes sense to me, when everything I've been told by someone wearing a white coat has never come to pass.

And I was wrong about the compliance part.  He says its between 40-80%, and long term compliance is between 10-20%.  I go back to the insurance part because they don't necessarily have a vested interest from a medical perspective either way.  What other lifetime medical condition for durable medical equipment do you have to rent before you can own it?  If it's for life, why does that happen? 

the lack of CPAP compliance does not equate to CPAP being unsuccessful.

How is this meaningful in the real world to patients?  It's the medical systems job to accommodate and facilitate a mask and machine that maximizes the success of the therapy.

[Sleeprider]

You came here with a conclusion, and I think you're a real sport to give the Aircurve 10 Vauto a shot. Just remember to come back after surgery, if you elect to go that direction and set us straight.

[SuperSleeper]

And I was wrong about the compliance part.  He says its between 40-80%, and long term compliance is between 10-20%.

The point you seem to again completely miss is that a lack of compliance with the therapy has nothing to do with therapy success rates.

Let's take CPAP out of the equation.  If I were to use your same logic with regard to another device (a heart pacemaker for example), I could make up statistics where I include include heart patients who had a pacemaker implanted, but refused to go back to the doctor to have the pacemaker adjusted properly on a regular basis.   Such patients are deemed to be "non-compliant" with their pacemaker therapy (and yes, this does happen, my dad has a pacemaker so I know it happens).  I could include such "non-compliant" patients in the statistics for "pacemaker success rates" and make it look like pacemakers are "statistically" a much poorer therapy for heart conditions than they actually are, because I've literally "stacked the desk" against pacemakers by including folks in the stats who refused to get their pacemaker properly adjusted. 

Of course, if I did that, most reasonable people would agree that non-compliant people should not be included in "pacemaker success rate" computations.  Why?  Because they never were compliant with their pacemaker therapy are are not a valid data point for determining success rates for pacemakers.

The similar logical leap that Dr. Park is asking folks to make is a faulty one, just as my pacemaker example is a faulty one.

the lack of CPAP compliance does not equate to CPAP being unsuccessful.

How is this meaningful in the real world to patients?  It's the medical systems job to accommodate and facilitate a mask and machine that maximizes the success of the therapy.

It's only meaningful to you if you can understand what I've posted above in my pacemaker example.  You'd first have to understand how that same faulty logic is applied when you claim that lack of compliance = poor success rates for CPAP.

And yes, the lack of compliance for CPAP is mainly due to people not receiving adequate coaching, follow-up care and advice for proper adjustment of their CPAP machine.  That's a known issue.  But it's a therapy compliance issue, not a therapy success rate issue.

[ApneaQuestions]

FYI: Some factual data relating to the assertion or assumption that "you have to rent a PAP machine first"...

I can and DID buy my CPAP machine (HCPC code E0601) using my insurance - I did it 3 months ago. No rental was necessary.
I can and DID buy my BIPAP machine (HCPC code E0470) using my insurance - I did it 4 days ago. No rental was necessary.

I was NOT forced to rent them first.

However, I could NOT buy my "BIPAP & Backup Rate" machine (HCPC E0471) - I could only rent it - so I declined.

Why they made an exception with the advanced machine was somewhat of a mystery to me at first.. but having thought further...my best guess is due to the contra-indications for people with heart issues. If you give someone a lifetime ownership of that machine and they subsequently develop the heart complaint you can do them harm. By insisting on a rental it gives the opportunity to retrieve the machine if it later becomes necessary or wise. But that was only a guess.

P.S. This was in response to... "If cpap is so wonderful then why does everyone has to rent their machine at first? Maybe because people give up on it? "

[SorryIamNormal]

And I was wrong about the compliance part.  He says its between 40-80%, and long term compliance is between 10-20%.

The point you seem to again completely miss is that a lack of compliance with the therapy has nothing to do with therapy success rates.

You must be a real joy to be around in real life.

[SuperSleeper]

You must be a real joy to be around in real life.

Yes, but it gets lonely up here at the North Pole.  

Merry Christmas.  

PS - I'll try to make my first stop in your city to put your Aircurve 10 Vauto under the tree.  No need to put cookies or cocoa out for me, I'm on a diet.    

Seriously though, I really hope you do get your problems solved.  I just fear that it may not be sleep apnea that is causing all the issues, and surgery is such a permanent (and rather drastic) solution.

Good luck to you.