I was diagnosed as having OSA and advised an Auto CPAP machine from a hospital in Bangalore, but I cannot sleep with it, I go crazy, its like putting a pillow in my face, my wife talked to you last week and took an appointment, but I was told that you are on leave, please do help me to save my life from this hell, I am really afraid of my future living on this machine. Please do help and expedite the surgeryâ€¦.Vishak from bangalore (my medical reports and sleep study results have already sent to you by wife Priya)
*Letter from a patient using CPAP
This prompted me to write this post. It may sound controversial, but let me explain and let the patients understand the truth.
Treatment of OSA.
OSA means obstructive sleep apnea, stoppage of breathing due to obstruction in the upper air passage.
Treatment of OSA is removing the obstruction, NOT wearing CPAP. Can you even dream of fitting CPAP in a child who is snoring and having OSA due to enlarged tonsils and adenoid?
This applies to adults too, remove the obstruction, and you are free. But those favoring CPAP have their interest, and honestly ask the patients, if they have another alternative, will they use CPAP life time?
What I feel after operating thousands of OSA patients over a period of 32 years, there is limited role of CPAP in OSA, but only in Central Apnea.
The Sleep physician put the blame on muscular hypotonia and all, the ENT surgeon or the maxillofacial surgeon who treat these patients very well know what causes OSA. How can the Sleep disorder physician without examining the patient\’s upper airway, and just doing PSG and advice CPAP?
They don\’t usually do Nasal endoscopy, Throat examination, Dental assessment, CT/MRI studies and try to find the cause of obstruction but what they do is CPAP titration and advise the patient to buy CPAP. It is absurd.
Life on a CPAP is miserable
Life on a CPAP is miserable, daily sleeping on it, if there is a power outage, you had it. Carrying the CPAP bag with you where ever you go is not easy. What if you traveling on a train or bus or even flight? Do they have power source provided? Not that I know and in a country like India.
Even your children may get frightened seeing you daily sleeping this gadget on your face, the child think that this father is on ventilator. There is excess dryness even with humidifier, the get frequent throat infections, and allergic reaction to masks on the face.
Hypotonia is not the cause of OSA
The etiology of OSAS is only partly known. The most obvious pathogenic factor is a narrow upper airway due to nasal blockage, enlarged uvula and soft palate, enlarged tonsillar tissue, skeletal anomalies, or fat deposits. There is no direct correlation between obesity and snoring. I see often very slim muscular patients suffer from OSA .There is genetic factors resulting abnormal configuration of the upper airway.
Weight increase often provokes impairment of obstructive respiration but does not always explain progression. Marked worsening of obstructive breathing has been found in some patients experiencing weight reduction, and there is no association between changes in weight and apnea index. After adolescence, the tonsils gradually become smaller, and the facial skeleton is usually not altered in adulthood. Another factor that changes over time must be responsible for disease progression.
The mechanism which causes snoring is based on the physical forms of your airways. When you sleep, the muscles of your throat relax, and your throat becomes narrower and floppy. This process is normal even for a healthy person. This is not Hypotonia.
However, if the airway narrows too much, airflow becomes turbulent. This airflow current makes the walls of the throat begin to vibrate when you breathe in or when you breathe out. You can reverse the Venturi effect on Bernoulli principle and all by removing the obstructive element.
These vibrations represent the characteristic sound of snoring. In other words, the narrower your airway becomes, the greater the vibration and the louder the snoring.
What Causes Snoring and OSA in Children?
Snoring in children can result from two things. First, there is an anatomical component, such as a small jaw or a small airway that the child was born with. Secondly, and the most common reason children snore is enlarged tonsils and adenoids.
So what alternative?
Children-Remove the enlarged Tonsils and adenoid
Adult, well the areas of the obstruction had to be identified and corrected by surgery, if conservative treatment fails. This is carried out by a well trained ENT and Maxillofacial surgeon who has treated OSA patients. There is no single tailor made surgery will solve the problem, variety of procedure like Septal correction, Turbinoplasty, Soft palate surgery, Pillar procedure, LAUP, CAUP,RF Base of Tongue reduction, Mandibular advancement, Hyoid suspension name a few, but not all. It depends upon the site of obstruction.
So the choice must be left to the patient after explaining everything-all treatment modalities. Let the patient decide what he wants, not the treating doctor.
(* The opinion expressed in the above post is personal after treating several dissatisfied CPAP customers over many years.)