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.

Friday, July 13, 2012

DO I HAVE TO WEAR A CPAP ( BiPAP) MACHINE FOR THE REST OF MY LIFE?

This is a frequent question asked by patients with sleep apnea that is treated with CPAP> There are many answers to that question. Obviously the best alternative to CPAP is an oral appliance for most patients but there are also many other alternatives.

While the majority of patients complain about CPAP and 60% discontinue using it completely it is important to remember that one i four patients using CPAP love their CPAP machines, masks and hoses. They give them back their lives and these patients have no desire to be free from CPAP.

Their are alternatives to CPAP and Oral Appliances. Weight loss is very effective for some patients who see their obstructive sleep totally resolve with weight loss.

WEIGHT LOSS ALONE IS NOT EFFECTIVE FOR ELIMINATING OBSTRUCTIVE SLEEP APNEA FOR MOST PATIENTS. IT WILL ALMOST ALWAYS REDUCE THE SEVERITY OF SLEEP APNEA BUT THE TRUTH IS THAT MANY PATIENTS ORIGINALLY GAINED THE WEIGHT DUE TO SLEEP APNEA. METBOLIC SYNDROME IS WEIGHT GAIN DUE TO APNEA AND RELATED HORMONAL DISRUPTIONS.

MANY THIN AND/OR ATHLETIC PATIENTS HAVE SLEEP APNEA DUE TO THEIR ABNOMAL (pathologic) ORAL PHARYNGEAL ANATOMY.

PATIENTS WITH POSITIONAL SLEEP APNEA USUALLY RESPOND WELL TO WEIGHT LOSS THERAPY.

Positional therapy is excellent for patients who only have apnea episodes on their back (supine). A danger in this treatment is patients who no longer have apneas or hypopneas may now have UARS or RERAs.

Bimaxillary advancement surgery is the most effective long term surgical solution. i strongly suggest that prior to surgery an oral appliance trial be done. It will predict success but also increase success rates because the amount of advancement necessary can be determined prior to surgery.

Morbidly obese patients are not good canidates for oral appliances or jaw advancement surgeries. Bariatric surgery to first lose weight it probably a more reasonable first step. Any surgery is more dangerous in the morbidly obese and in patients with sleep apnea.


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posted by Dr Shapira at 9:14 AM