I read an article by the Associated Press “Future-minded people healthier” citing a study by Kansas State University researchers on the healthy lifestyle choices people make.
The study found that healthier lifestyle decisions are made by people who are future-minded as compared to present-minded.
According to the article, present-minded people need immediate rewards. Future-minded people understand the long-term implications of a decision today and will make better decisions.
This has me thinking about sleep apnea treatment success in relation to future-minded and present-minded thinking.
One of the big issues in sleep apnea today is compliance. Patients are failing to use prescribed CPAP machines because, well, CPAPs are not particularly convenient or comfortable. I wonder if a future study will one day show that future-minded sleep apnea patients are more compliant with treatment versus present-minded patients.
Would you think that a present-minded patient would ignore some of the long-term benefits of treatment if the CPAP doesn’t help them eliminate daytime sleepiness and feel more awake “right-now”?
Could it be implied that future-minded patients will put up with any short-term discomfort because treatment today has long-term benefits?
You’re absolutely right that people with sleep apnea that are successful tend to look to the future. One thing that I’m passionate about is studying people with sleep apnea and figuring out what are the common characteristics that determine their ultimate success. In addition to thinking about the future, they also have to have specific goals and a meaningful life purpose. Not just to sleep better, but to be able to enjoy life, be around when the kids are in their teens, be able to focus and contribute to the company, achieve their dreams, etc.
You’re also right in that many people don’t have the right mindset regarding CPAP when they first begin, so they end up failing. If you look at long distance truck drivers and airline pilots, they are much more likely to succeed at CPAP, for obvious reasons.
There’s a lot more that can be done to prepare, educate and provide feedback and support to improve the chances that people can benefit from CPAP. However, at the other extreme, how long do you try CPAP before going on to another option? If you’ve tried 3 machines, 10 masks, countless hours with sleep doctors, DME vendors, online forums, at what point do you go on to another option?
This is clearly a very sensitive issue, but there may be an atmosphere of feeling like you’re a failure if you can’t eventually succeed on CPAP. The forums like SleepGuide and ApneaSupport are great in terms of mutual support, accountability and constant feedback, but that can only take you so far. I see many people succeed after participating on the forums, but there are many others that can’t find success despite trying every mask, machine, DME vendor, tips and advice, sometimes for months or even years. I know this is happening because these people stop participating and some of them end up come to see me. They’re frustrated because they’ve tried everything, and all the successful CPAP people are saying it should work, while all the other options are frowned upon, usually based on either personal experiences or what they’ve read about on other sites.
Then there’s the patient that’s 100% compliant and doesn’t feel any better, even after 4-6 months. Sometimes, CPAP makes them feel worse, despite having no leaks and a very low AHI. These people don’t get any satisfying answers from forums, and they end up leaving. This may not be intentional, but the internet sleep apnea forums tend to self-select successful CPAP users who want to help others, or struggling CPAP users that eventually succeed because of the help they received and stay on to help others. There’s definitely a certain culture surrounding CPAP users (hoseheads) that don’t exist with other treatment groups.
Dental devices are mentioned once in a while, and opinions about surgical management are usually based on the same inaccurate information that most physicians subscribe to or based on worst case disasters.
Sorry for the long post, but your topic just touched a nerve. Yes, there’s a lot more that must be done with CPAP therapy, but there also has to be a systematic and formalized way of dealing with people who can’t tolerate CPAP, and offering them other options with the patient’s needs in mind, not what you think they need.
I spend most of my time with patients successfully getting them to use their CPAP machines, despite initial struggles. A significant number will also be good candidates for oral appliances, and some will need some kind of surgical intervention. Patients must understand all the options thoroughly before going on to CPAP. You also have to look at their life situations, including their diet, exercise, family and work environment, and other stress factors. If you give only CPAP, that’s no better than giving a pill. You have to treat the entire person as a whole.
Hi Dr Park,
Thanks for sharing your expert insight. It sounds like you are saying that humans are very complicated animals, whether on the forums or in real life, and the quest to answer a unique individual’s sleep apnea questions can be a journey, the journey of a lifetime.
I empathize with those who continue to struggle after trying very hard to find an adequate treatment. For those who have tried everything, maybe it means the next step is to seek out a different specialist or even multiple specialists in different medical areas (sleep, neurology, nutrition, etc), due to the seemingly infinite complexity of the human body.
I have benefited from the forums and they have helped me personally in figuring out what types of questions to ask my doctor. But that is just part of the journey. The other part requires specialists evaluating your unique situation.
Seeing a specialist for a medical condition is just like in business where companies hire consultants to handle difficult challenges when existing employees lack the expertise. Each consultant has a unique set of skills and experiences. As patients, we should pretend that we are our own business and treat our body as our corporate headquarters. When something isn’t working, we need to do what it takes to find a consultant to help us figure out the options.
-Dave
Hi, Sleep Apnea Dave. Just wondering, have you written about or looked into home sleep tests that can remove the need to go to a lab? As you know, diagnosing OSA has required an overnight stay in a hospital or clinic sleep lab. The limited capacity of many sleep labs is an issue, but a greater problem is that many patients are either unwilling to go to a sleep lab or find it difficult to reach natural sleep in that setting. The NovaSom® Diagnostic System is the first full-service home testing system that was cleared by the U.S. Food and Drug Administration for diagnostic evaluation of adults with possible sleep apnea.
Once prescribed by a physician, NovaSom is delivered directly to the patient’s home. The patient uses the diagnostic device for three consecutive nights, collecting sleep data such as respiratory events (apneas and hypopneas), snoring intensity, blood oxygen saturation, pulse rate and respiratory effort. The system itself consists of a compact bedside console and three sensors that are easily applied by the patient.
You can visit the Sleep Solutions, Inc. website if you’d like to learn more. Or, feel free to contact me directly. Thanks.
Hi Jamie,
Thanks for the information. I have used a diagnostic device (a titration device I think) at home many years ago and I’m sure I will cover the topic more in the future. Certainly home diagnosis has its advantages.
The nice thing about home diagnostic systems is the ability to sleep in your own bed with your own pillow. Some people get very used to their mattress and pillows – anything else will not do.
I can think of another use: the “routine check-up” sleep tests a doctor may prescribe to a patient every few years to determine if treatment adjustments are necessary.
-Dave