Posted on 01/31/2018 10:24:14 PM PST by nickcarraway
Systematic Review: Patients with Sleep Apnea Achieve Similar Outcomes When Receiving Care From Sleep Specialist or Nonspecialist
Patients with obstructive sleep apnea (OSA) can achieve similar outcomes with care from a sleep specialist or a non-sleep specialist. The findings of a systematic review are published in Annals of Internal Medicine.
New treatment models have been proposed that would reduce reliance on sleep specialists by including providers not specifically trained as sleep specialists, such as nurses or primary care physicians.
Researchers from the Minneapolis Veterans Affairs Health Care System Evidence-based Synthesis Program and the University of Minnesota, School of Medicine reviewed 12 published studies to evaluate the effectiveness and harms of care by non-sleep specialists versus sleep specialists for patients with suspected or diagnosed OSA. The researchers assessed the studies to determine patient-centered outcomes (mortality, access to care, quality of life, patient satisfaction, adherence, symptom scores, and adverse events) and other outcomes, including resource use, costs, time to initiation of treatment, and case finding. The data showed low-strength evidence that OSA management outcomes are similar whether provided by primary care physicians, sleep specialist nurses, or sleep specialist physicians. The evidence was insufficient to assess for access to care or adverse events.
The researchers suggest more research to confirm these findings in other settings and among providers with different levels of experience and training and to determine how such care models should be implemented.
What really matters is whether the sleep interruptions actually matter. Ideally, humans should sleep 4+4 or 3+3 depending on age, not 6,7 or 8.
So, if a person is just getting up to urinate and staying up for long enough for body functions to resume, one should not treat the sleep interruption. On the other hand, if one is waking up gasping for air several times, it is a problem.
Bmk
There is no evidence that sleep interruptions make any difference. Some people thrive despite having a heavily segmented sleep, and other fare poorly on an uninterrupted 7 hours. We really understand very little, about sleep.
In terms of “gasping for air”? Yes, it is a problem. But the assumption (long-held) that CPAP is more than a band-aid is appearing shakier with each study that comes out. Apnea is potentially deadly. But what to do about it? That is the real question.
One thing that people should look at, seriously. Instead of the very invasive, and very serious, Stanford protocol surgery, a lot of people do very well with functional orthodontic work. But this whole “you have apnea, here is a cpap machine” is really very suspect.
I’ve snored my whole life, even when I was thin.
I got an Apple Watch for my birthday. A sleep monitoring app showed I wasn’t getting any deep sleep, so I broke down and had a sleep study done. Seems I was having over 90 incidents per hour, both obstructive and central apnea.
Been on the CPAP since August. I have much more energy during the day, but the expected weight loss hasn’t happened yet. I go to the gym 5 times a week, my job is very physical, and I eat less than 2000 calories a day, and still no weight loss.
I had a commercial drivers license for a volunteer bus driving job that I usually did one weekend a year.
A few years ago, I took my DOT physical and since I answered four questions honestly, I was suddenly at grave risk of the new bogeyman, sleep apnea.
(Question: If you lay down in the afternoon, do you fall asleep? Answer: Usually (Since that’s the whole point of a nap, 3-4 times a year) That’s how stupid the questions were)
The Johns Hopkins hospital sleep specialist laughed at the stupidity of DOT and told me the bar is so low, virtually everyone would fail.
That didn’t do me a lot of good. I was facing the loss of my CDL.
So I took the sleep study and was told that while I have apnea, it’s extremely mild and not in need of treatment, but, since the vaunted government is involved, I need to get a CPAP and would be spending about $1000 a year in Co-Pays.
Sadly, I gave up my volunteer job of over 20 years driving children to a Christian camp.
For the record, I drove my car 600 miles just to catch the bus, then team drove the 1000 mile bus run, then drove 600 miles back home. Got a good sleep at my mom’s house between the 600 mile drive and the bus trip and a few hours at a rest stop on the way home.
If I had apnea, there’s no way I’m making that trip.
I assume that Sleep Apnea is a real issue with some people, but when our government overlords manage to get involved, as usual, they could screw up a one car funeral.
I’m with you, now. Took me about 2 years to get used to wearing a CPAP, absolutely hated it at first. Secret for me was to not wear the mask quite to tight on my face. Now I’m like you, almost afraid not to sleep with it.
I snore like crazy and my wife was really getting angry about it. She bought me some type of mouth piece and I hated it; felt like I was going to drown in my saliva.
About a week ago she bought “SnoreStop.” And both she and I am amazed by how well it is working. I wake up breathing better.
Main ingredients:
Belladonna (yes, poison I think from Black Night Shade plant)
Nux vom
Ephedra (may be a problem with my high BP)
Hydrastis
Kali bic
Teucrium mar
Histaminium hydrochlor.
Dittos, been on BPAP since 2008. Lost 40 pounds and now on CPAP full mask. Break into cold sweet if I think something is wrong with the machine because I know how I'll feel in the morning without it. I'm a 100%'er and they can have all the studies they want. For me it works and has given me a better safer life
Plus, my wife is happy. It was her threatening to sleep in another room that was my primary motivation to make the CPAP work.
I have sleep apnea, and it was first discovered by nurses who had to keep coming into the room to wake me up and tell me to take a breath, after I had surgery on a broken ankle. At the time, I was underweight if anything. Now, some 15 years later, my doctor has asked me to keep my weight under control so I don’t add to the problem. So far, so good.
I use a mouth piece, it takes a little time but the saliva thing improves, sleep like a baby now but do occasionally drool all over the pillow.
Go to the mask that covers nose AND mouth. Doesn’t matter if you’re a mouth breather that way.
Bkmk
Just read that on a summary from a sleep specialist dealing with Severe Obstructive Sleep Apnea.
The only person I know who had to have a tracheotomy for this condition also had other major health issues due to a birth defect.
Ordinarily an obstructive apnea results in reduced airflow at night because during REM sleep our bodies breathe without conscious effort. When awake, or asleep but not in REM, our brains have more direct control over breathing.
So I’m not sure which cases are so extreme that a tracheotomy is required, but I have seen doctor notes that say this is sometimes necessary.
There are a small percentage of patients for whom sleep apnea can be corrected by surgery (not a tracheotomy), but most cases can not be remedied by surgery. On the other hand, most of these patients can reduce or greatly eliminate the symptoms of sleep apnea by losing weight.
It does have an impact on me. My oxygen levels were desaturating to 70%. With CPap I don’t go below 94%. With CPap and O2, I stay at 97% or above.
The most noticeable improvement, is brain function and memory, but also not as tired during the day. So while it might not be a “cure” for the condition, it has saved my brain.
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