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.

Tuesday, December 14, 2010

CPAP NOT WORKING? WHAT TO DO WHEN YOUR CPAP DOESN'T IMPROVE YOUR SYMPTOMS.

CPAP is extremely successful at treating sleep apnea. Why do 60% of patients abandon such a successful treatment?

There are many reasons given by patients, but a very common response is that their CPAP did not work? When patients report that their CPAP does not work they usually mean that the symptoms of sleep apnea were not relieved. They may still be tired or wake with morning headaches. Often they find that they cannot sleep with the CPAP or they actually had their sleep disturbed by CPAP.

It is not uncommon to see patients who no longer have sleep apnea but have as many arousals as they did before CPAP. Some patients display a higher arousal index with CPAP than with their apnea untreated.

Another common problem is complex sleep apnea where following treatment with CPAP there is breakthru central sleep apneas. These may be due to over-titration of the CPAP pressure blowing off the CO2 (carbon dioxide) which decreases the urge to breathe.

THE MOST COMMON REASONS TO ABANDON CPAP ARE ABOUT COMFORT NOT THAT CPAP IS INEFFECTIVE! I HATE CPAP! is a common complaint.

Many patients complain about mask comfort. Some patients have acne, facial irritation or rashes from the masks. Other patients have trouble being tethered to the hose while others complain about CPAP noise.

Whatever the complaint if CPAP is ineffective or the patient cannot tolerate it an alternative to CPAP is important. Oral Appliances are considered a first line treatment for mild to moderate sleep apnea that patients almost always prefer to CPAP. Oral Appliances are not a first line treatment for severe sleep apnea but are considered an alternative to CPAP when patients cannot tolerate CPAP.

The severity has little effect on how well patients tolerate CPAP and so it can be expected that 60% of severe apneics will also abandon CPAP use.

Medicare is now going to accept the use of oral appliances for treating severe sleep apnea after CPAP fails.

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posted by Dr Shapira at 1:52 PM