(08-02-2013 10:08 PM)Don in Austin Wrote: I am a little puzzled about OSA occurrences which cause heart damage while not dropping oxygen level
It's because of the adrenaline rush you get when your body jolts you out of sleep after an apnea event. Too many of those adrenaline rushes is not good for your heart. The blood O2 levels don't need to fall below 90% for you to have such a jolt to your system - all that needs to happen is for you to have an apnea event.
I understand your frustrations. I'm simply pointing out that you have no independently verifiable or non-subjective evidence that your two non-CPAP therapy options are actually reducing your apnea or hypopnea events significantly (lowering your AHI).
Most of the studies for oral devices have been done by those who have a vested financial interest in selling oral devices. Or they have too small of a a sampling to be statistically significant. For the handful of studies that are somewhat objective, they never conclude that AHI is reduced substantially by using an oral device - usually only slightly reduced
. Nowhere near the success rate that CPAP has.
If you're relying upon a dentist who's major solution is an oral device, unfortunately many times it's a pre-determined solution looking for a problem to solve. When all you have is a hammer, every problem looks like a nail.
Quote:My oximeter reports which, by my understanding DO show events in the reports I generate.
Unfortunately, they do not show apnea or hypopnea events. They may show drops in blood oxygen, of course, because that's what pulse oximeters do. If you're having an apnea or hypopnea event that does not have a significant corresponding drop in blood O2 levels - your oximeter will not record that.
Quote:Its not a gold standard when its not tolerated, and its well known that compliance statistics for CPAP are pretty dismal.
"Compliance" and "toleration" issues with CPAP happen most often because people don't stick with the treatment for various reasons: improper pressure, improper humidity levels, no comfort settings like a ramp feature or C-flex/A-Flex/EPR technology, wrong type of mask or wrong size of mask or improperly attached mask (too tight usually), or the psychological issues associated with having to sleep with a CPAP mask attached to you for the rest of your life etc. Unfortunately, even the medical professionals give up too easily and mark a patient's file with the dreaded "CPAP not tolerated" statement. It takes complete commitment and a lot
of time, encouragement and support to make it work. When a person makes that total commitment, they usually find out that CPAP was the best solution for them and worth the extra effort to stick with it long term.
Far too many people quit on CPAP too early. That is the fact that is truly dismal
. And it's the reason Apnea Board is here - to help folks stay with CPAP and help them solve the issues that occur when one starts on CPAP therapy. We have evidence contained within the posts of this forum that time and time again, patients were on the verge of giving up on CPAP, when all they needed was some advice and help and encouragement from other patients here to get over a seemingly unsolvable problem with their CPAP machine or mask. We do this because CPAP is indeed
the gold standard
for OSA treatment. Oral devices are not. We go with what is proven
and what works
. We don't recommend that folks give up on CPAP and settle for a solution that simply cannot compare to CPAP in effectiveness. I wish the medical community would provide such support for patients who run into problems with CPAP, but unfortunately it's lacking in most areas.
Quote:I have read studies showing oral devices to be beneficial.
Are oral devices better than nothing at all? - Yes, of course. But the evidence shows that they cannot compare in lowing apnea events when placed side by side to CPAP therapy. Beneficial? Of course - since they're better than no treatment at all. I personally feel as though oral devices are a very poor solution when compared to CPAP. The unbiased evidence is just not there with any degree of authoritative and conclusive studies on oral devices.
Quote: Please understand, I am aware of it being the "gold standard" so, being stubborn by nature, I gave it a good try.
CPAP is not something you "try". It is something that you commit to for life. You must make
it work for you. Until you get to that level of commitment, you'll give up on CPAP every time. Yeah, I know you'll say that you did fully commit to it. That's what everyone who gives up on CPAP seems to say.
Am I saying your oral device or your positional therapy is useless? No, of course not. But neither can compare to the effectiveness of CPAP.
Of course, just my opinion. Take it or leave it.