<i> sleep apnea is very frequent and very likely if you are overweight.</i>
The current theory on apnea is that the throat collapses due to lower pressures on inhale. Being fat makes that situation worse. However, I believe some percentage of people with apnea are blocking on exhale due to anatomical structure or some such. CPAP would not work in this case (CPAP raises the internal throat pressure during breathing to avoid collapse). I think the number of people blocking on exhale could be quite high -- given the high CPAP treatment failures and the number of non-overweight apnea suffers. But the doctors and researchers deny that blocking on exhale is even possible.
CPAP raises pressure all the time (stands for continuous positive airway pressure) so it avoids collapse at any time, not just during inhalation. I never heard of problems during exhale but if they exist CPAP should be quite effective anyway given that success rate of the machine is pretty much 100% when used correctly.
It is also true that in quite a number of cases there are better solutions that using CPAP: most OSAs (obstructive sleep apnea) are due to obesity and losing weight would be a much better way to deal with it. Alas, lots of people find it easier to stick with a mask for the rest of their life rather than changing their daily routine (ironically my father is one of those, I am afraid).
Well, this is the medical establishment's party line on apnea -- complete with arrogance, condescension and non-sense.
I am questioning the differential pressure theory of apnea causing throat collapse. That is basic physics and the assumption behind CPAP. Your reply that even if people block on exhale "CPAP should be quite effective anyway" is non-sense on your own terms. Throat pressure is positive on exhale (even without CPAP) and blockage would be impossible since no forces could be generated to cause a collapse. You haven't heard about blockage on exhale because its impossible according to the current theory and so no one is looking for it.
I am not deny that CPAP works for some people but its really only around 30%. The medical statistics say its 100% effective "when used correctly" because they drop the people from the stats who are "non-compliant". Given that apnea is a horrible condition, do you think those that drop CPAP are not being helped? Ultimately, people give up in frustration and are accused of being too fat and too lazy to use the CPAP and diet. Blame the patient. Is it possible that cause and effect works the other way -- that its easy to get fat and difficult to lose wt when one is obstructing because of the lack of energy and will-power? Is it possible that CPAP only works with certain types of apnea and is ineffective otherwise? How does the current theory explain the large numbers of apnea patients who are not overweight?
I have apnea, I am not overweight and I block on exhale. I know because I've "caught" it occurring a number of times on waking. When I explained this to my doc he laughed in my face and said it was impossible. Another doc said I was just dreaming. I think they are both wrong and that the current theory of apnea is incomplete. Something not due to differential pressure blocks my throat, like a backflow valve, on exhale while I sleep. I can't imagine that I am the only one with this type and I think it might be fairly common.
Anyway, the reason for my post is not to harangue you but in the hope that a medical researcher or doctor will hear of this alternative view and reexamine apnea and its treatment with fresh eyes and an open mind.
I am sorry your doctor didn't take it seriously but I'd wait before accusing of "arrogance, condescension and non-sense". You make it sound like a conspiracy.
Why don't you go to a sleep center, see a sleep doctor and have a polysomnography done? That way you'll make sure what the problem is. With a polysomnography they routinely measure the air influx in and out: if you have in but not out they'll see that, no need to "look for it".
In a sense he did take me and himself seriously. By the accepted theory on apnea, my symptoms were impossible. Hence the dismissal. In the docs mind its as if I were arguing for ET or Loch Ness, etc. I appreciate your compassion but you should be sorry that my docs did not have an open mind.
> but I'd wait before accusing of "arrogance, condescension and non-sense".
Well, your comment on block-on-exhale was non-sense by your own standards and a pretty standard reply which you did not defend. If you point this out to a doctor they do not explain, they get defensive or dismissive -- just like you. Is that arrogance or condescension?, I forget. You wouldn't happen to be a doctor would you? BTW, I noted that you did not address the issue of the stats and I can see that might sound like a conspiracy but is not. Its just the way that the medical industry rolls but you have to dig in to get the details and most docs don't have the time and take the JAMA articles at face value.
> You make it sound like a conspiracy.
I hardly think my supposition that the docs have missed something here amounts to a conspiracy. No tinfoil required, just read medical history. How about the highschool girl who self-diagnosed Crohn's disease in biology class just last week that all her doctors had missed. Or Drs. Semmelweis and Oliver Wendell Homes who advocated hand washing during childbirth to prevent puerperal fever and were treated with "disdain and hostility" by their own colleagues per historical accounts. (Imagine their attitude if the patients had suggested that the docs wash their hands!)
And let's not forget how patients with ulcers were told the cause is spicy foods and stress until Drs. Marshall and Warren proved that H. Pylori bacteria was the cause. Do you think that patients who followed orders were accussed of cheating on spicy foods and, despite reducing stress levels, still had no relief? How much do you want to bet that 30% of those who followed the Rx under the wrong theory found relief and 70% of those who followed the Rx got no relief and gave up. Those who gave up were then omitted from the stats as "non-compliant" and the Rx of bland food and reduced stress was 100% effective "when used correctly" as reported in JAMA and by crocowhile. I could go on but I think you get the point -- doctors miss things and wrong cause yields no or limited cure, no conspiracy required.
> Why don't you go to a sleep center, see a sleep doctor and have a polysomnography done?
Tried that but it is a long and windy road with many tollbooths along the way and no assurance of reaching the destination.
> That way you'll make sure what the problem is. With a polysomnography they routinely measure the air influx in and out: if you have in but not out they'll see that, no need to "look for it".
This is an incredibly naive statement that makes me think that a) you are an academic and b) you've never had a medical condition that requires the doc to actually think.
Anyway, one sleep doc said the standard Rx no matter how I block is diet, CPAP then surgery. He was not open to the discussion that CPAP makes no sense for block on exhale and could not even confirm that the sleep test would identify that. I contacted a sleep tech who administers these tests and he said they don't look for block type, they just count blocks per hour that disrupt sleep. So many per hour and you qualify for CPAP per the insurance industry. I guess when all you have is a CPAP everything looks like a nail, or something like that.
> Good luck!
Thanks!
Fortunately, I am able to control my apnea on my own using a variety of techniques. However, I have no guarantee that this will remain so as I get older. Plus a medical professional solution would almost certainly be better. As I stated in my prior reply, I am hopeful that a medical researcher or doctor with an open mind comes across this thread and question the current apnea theory so a solution can be found. On that optimistic note, perhaps you can forward this thread to one of your colleagues. Thanks.
The current theory on apnea is that the throat collapses due to lower pressures on inhale. Being fat makes that situation worse. However, I believe some percentage of people with apnea are blocking on exhale due to anatomical structure or some such. CPAP would not work in this case (CPAP raises the internal throat pressure during breathing to avoid collapse). I think the number of people blocking on exhale could be quite high -- given the high CPAP treatment failures and the number of non-overweight apnea suffers. But the doctors and researchers deny that blocking on exhale is even possible.