Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Wednesday, February 3, 2010

I HATE CPAP is an important public service for patients diagnosed with obstructive sleep apnea

I recently rceived this email from a patient.

comments : Your site is an important public service for those of us diagnosed with obstructive sleep apnea. Like most doctors, mine told me the only treatment worth considering for my mild OSA was CPAP. She scoffed at the mention of oral appliances, dismissing them as suited only to a special category of patients with TMJ symptoms. I mistrusted her absolutist statement,. Although I've been using the CPAP since she prescribed it, I have also been researching other professionally accepted treatments for OSA. Thanks to your website and many peer-reviewed journal articles, I've come to the conclusion that s I've I've learned there are a number of alternative treatments worth considering. Having been forced to uncover this information on my own has made me disillusioned with my pulmonologist-sleep specialist. I am in the process of finding a sleep center with a broader, more cutting-edge, and more personal approach to treating OSA. One factor I would like them to consider -- a
nd would appreciate your addressing -- is that I have esophageal problems secondary to systemic sclerosis. Also secondary to the SSc is mild pulmonary hypertension. Does the pre-existing condition of systemic sclerosis that includes these symptoms suggest any particular approach to the treatment of OSA? Thank you for all of your good work.

It is not uncommon for patients to wall into walls of ignorance or self interest. No sleep specialist should be unaware of the enormous successes with oral appliances. It is because oral appliances are so successful that they are considerd a first line treatment for mild to moderate sleep apnea by the American Academy of Sleep Medicine. Many sleep physicians and sleep centers have economic interests in DME companies that supply CPAP machines to patients. Sometimes these companies are owne by family members to evade federal Stark laws on self referral. Othertimes it is merely ignorance that causes doctors to make statements like this writer reports. When CPAP fails the majority of patients there must be alternatives presented to patients. CPAP is still an excellent and successful treatment but not for most patients. Oral appliances are also not for all patients. There must be honesty in the field of sleep medicine.

Dear Dr. Shapira,
Thank you for your thoughtful and encouraging reply to my questions.

I did a little bit of research about sleep centers in Houston, and you are right. Even though the lab I started with was little more than an extension of the hospital's pulmanology department, there are others out there that take a more modern approach to sleep medicine. Baylor, for one, seems to have a decent lab that emphasizes interdisciplinary treatment. I'll keep looking, but they're on the short list.

Thanks again for your excellent public education work on the internet. BTW, when I tell my various doctors about the eye-opening information you've posted on oral appliances, they inevitably ask the name of the site. It gets a laugh every time.
Elizabeth S.

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posted by Dr Shapira at 6:45 PM