What if...?

Why do women with PCOS have such high rates of OSA (even accounting for BMI)?
Why do young men have far higher rates of OSA than young premenopausal women?
Why do different ethnicities develop OSA at different rates?
Why are rates of OSA increasing .... latest figure I saw was that 1 billion adults now have OSA globally.
What is the best treatment for OSA patients with a low arousal threshold?

I don't think questioning is wrong or frivolous at all. Asking questions and hoping for improvements in treatment does not diminish the current treatment. If someone wishes that a cure for cancer be found does this diminish current treatment? Not at all!

If it is a simple matter of anatomy then one would expect that the comorbidities caused by untreated OSA would reverse over time with treatment, and yet this doesn't happen. Weight does not drop off miraculously, insulin resistance does not reverse in quick order, and blood pressure doesn't plummet.

So I don't think it is wrong to maybe dig a little deeper and ask "what if it is just a bit more complicated than opening up a throat at night?"

I sometimes get the impression that XPAP is seen as a holy grail to restoring good health. It can only do so much. Weight loss is probably equally important and diet as well. Optimal OSA treatment is not just about XPAP.

Arlene1963 wrote: ↑

Sat Jun 23, 2018 8:40 am

Why are rates of OSA increasing .... latest figure I saw was that 1 billion adults now have OSA globally.

That is an easy one. Diagnosis. Sleep apnea was not defined as a medical condition until 1965. It took a lot of effort to build up a sleep medicine industry and educate doctors and the public. More people are getting diagnosed. There are also more people afflicted due to the obesity epidemic.

To be clear:

My concern is the people who decide not to treat their condition but decide to try to reduce stress and practice breathing exercises instead.

I am not worried at all about researchers scientifically investigating the causes of, and future treatments for, OSA.

jnk... wrote: ↑

Sat Jun 23, 2018 9:32 am

To be clear:

My concern is the people who decide not to treat their condition but decide to try to reduce stress and practice breathing exercises instead.

I am not worried at all about researchers scientifically investigating the causes of, and future treatments for, OSA.

And to be clear I too do not believe for a second that trying to reduce stress and doing breathing exercises will help at all with OSA.

Looking now at the study DH linked to viewtopic/t171932/CPAP-machines-for-sle ... -risk.html re heart failure and XPAP use one thing that stands out is that although XPAP use reduces HF in those who have OSA and use XPAP versus those who have OSA and don't use XPAP, folks with OSA and who use XPAP still have a much higher rate of HF compared with the general population as we age.





This is what bothers me, and makes me upset. Why is our health so compromised by OSA and what can we do to level it back to "the background population"?

I have allowed myself to go off on a bit of a tangent here on this thread because I guess I am pretty angry. Sorry forum folks.


That said:

I am absolutely convinced that at this time XPAP is essential for the treatment for OSA.
And I use my XPAP every night.

Arlene1963 wrote: ↑

Sat Jun 23, 2018 10:11 am

folks with OSA and who use XPAP still have a much higher rate of HF compared with the general population as we age.

Ridiculous. Just look at the limitations:

Main limitations are the observational study design, the use of administrative databases for all diagnoses, and the inability to eliminate the possibility of unmeasured confounders.
We did not have information on body mass index or smoking status, which could both be relevant confounders and overrepresented in the patients with SA.

A propensity‐matched analysis could have strengthened our results, but it was not possible because of our time‐dependent study design.

We lacked information on the severity of SA, and 86% of the diagnoses were unspecified. Likewise, 57% of the HF diagnoses were nonspecific, which limited us from making any assumptions as to the direct causal pathway between SA and HF.

http://jaha.ahajournals.org/content/7/13/e008684

Not to mention, there is no indication of what percent of the time the CPAP patients were actually using CPAP; nor, if their therapy had been tweaked to be highly effective; nor, how many years they damaged their heart before being diagnosed and treated.

Arlene1963 wrote: ↑

Sat Jun 23, 2018 10:11 am

I guess I am pretty angry.

You know anger is a risk factor for heart disease?

Until better mousetraps are made, we must wear the one we have--even it it fits like crap.
Otherwise, work on the next generation ourselves;
because it is evident that much that is being touted is mere fancy for the sake of profit.

Hang Fire wrote: ↑

Sat Jun 23, 2018 11:07 am

Arlene1963 wrote: ↑

Sat Jun 23, 2018 10:11 am

folks with OSA and who use XPAP still have a much higher rate of HF compared with the general population as we age.

Ridiculous. Just look at the limitations:

Main limitations are the observational study design, the use of administrative databases for all diagnoses, and the inability to eliminate the possibility of unmeasured confounders.
We did not have information on body mass index or smoking status, which could both be relevant confounders and overrepresented in the patients with SA.

A propensity‐matched analysis could have strengthened our results, but it was not possible because of our time‐dependent study design.

We lacked information on the severity of SA, and 86% of the diagnoses were unspecified. Likewise, 57% of the HF diagnoses were nonspecific, which limited us from making any assumptions as to the direct causal pathway between SA and HF.

http://jaha.ahajournals.org/content/7/13/e008684

Not to mention, there is no indication of what percent of the time the CPAP patients were actually using CPAP; nor, if their therapy had been tweaked to be highly effective; nor, how many years they damaged their heart before being diagnosed and treated.

Arlene1963 wrote: ↑

Sat Jun 23, 2018 10:11 am

I guess I am pretty angry.

You know anger is a risk factor for heart disease?

Thanks Hangfire for taking the time to look at the study in more depth, it gives me relief to know that it is probably "junk" although it is being touted as good news for those of us with OSA! Pretty sad.

And yes, anger is not good for my blood pressure so I am going to chill. Good advice Hangfire.

Hosecrusher, sorry for hi-jacking your thread.

In harmony with Hang Fire's post, until someone does a study of CPAP users in which the definition of a CPAP user is someone who uses it at fully optimized pressures all night every night, I do not believe that the benefits of CPAP have been accurately studied.

And until then, my scientific basis for using CPAP is that no study anywhere has conclusively found the slightest benefit whatsoever from bad sleep and bad breathing. (OK, maybe one study tried to prove that for a narrow population of people much older than I am, but I dismissed it.) Call me an extreme absolutist. I've been called worse.

And as for me, hijacking threads is just what I do.

I like it when you post, Arlene1963. Even when, or perhaps especially when, you disagree with me. Just sayin'.

Snoregone Conclusion, I am coming from the perspective that the body adapts to stresses and naturally tries to heal itself. If you are stuck in a fight or flight nervous state, it is in your best interest to avoid being eaten by the tiger so your body adapts by preventing you from entering into a deep restful sleep.

Sleep apnea is a symptom of your body adapting to a stress. What if the stress could be identified and eliminated or minimized? Would your body then reduce or eliminate the symptom and work on healing itself?

Unfortunately there are a multitude of stresses available. Also, what you may think of as a stress I may find it not stressful and actually somewhat enjoyable. This makes this process individual and somewhat difficult to figure out.

One size does not fit all.

The goal is to experience a restful sleep so we can jump out of bed in the morning ready to greet the day.

I don't think animals have this problem, but there may be some observations with dogs... I really don't know.

Arlene, hi-jack away to your hearts content.

The purpose of the discussion is to ask the hard questions and do some reflection.

At the risk of hi-jacking my own thread... What if high blood pressure was a symptom of the body adapting to a stress. In order to repair the damage in the body and revert to a healthy state the blood pressure needs to go up to insure a supply of oxygen and removal of by products of the healing. If this were the case would it make sense to take a chemical to reduce the blood pressure with the result of this hampering the repair process...? Perhaps it would make more sense to figure out what is being repaired, help the repair process, and let the body adapt to being healthy by lowering the blood pressure naturally.

Jeff, It is good to hear that you have adapted well to treating sleep apnea symptoms using CPAP. Perhaps your body is now working to heal itself.

To be clear:

My concern is that people treat the symptoms and don't take the extra step to identify the root cause(s). CPAP does an excellent job of keeping the airway open, and this helps a lot. Being in total health also does an excellent job of keeping you alive and I don't think it matters if you use a CPAP while in perfect health.

A sleep study was involved in diagnosing the condition. If reducing stress, breathing exercises, and practicing good sleep hygine help the only way to measure this is to have another sleep study. If the follow up sleep study shows that while on your back and for the entire night you had an AHI of 0.00 and your O2 levels were steady around 96%, you may at that time consider if you want to continue using CPAP.

What if the body is adaptive?
What if the body works to heal itself?

HoseCrusher wrote: ↑

Sat Jun 23, 2018 4:14 pm

What if high blood pressure was a symptom of the body adapting to a stress. In order to repair the damage in the body and revert to a healthy state the blood pressure needs to go up to insure a supply of oxygen and removal of by products of the healing. If this were the case would it make sense to take a chemical to reduce the blood pressure with the result of this hampering the repair process...? Perhaps it would make more sense to figure out what is being repaired, help the repair process, and let the body adapt to being healthy by lowering the blood pressure naturally.

How about... take a chemical to reduce the blood pressure (personally don't think it would hamper the repair process), while helping the repair process by eating healthfully, exercise and attempting to lower the stress level. I suppose it would be ideal to allow the body to lower blood pressure naturally, but for some, a chemical is a necessity.

HoseCrusher wrote: ↑

Sat Jun 23, 2018 4:14 pm

Arlene, hi-jack away to your hearts content.

The purpose of the discussion is to ask the hard questions and do some reflection.

At the risk of hi-jacking my own thread... What if high blood pressure was a symptom of the body adapting to a stress. In order to repair the damage in the body and revert to a healthy state the blood pressure needs to go up to insure a supply of oxygen and removal of by products of the healing. If this were the case would it make sense to take a chemical to reduce the blood pressure with the result of this hampering the repair process...? Perhaps it would make more sense to figure out what is being repaired, help the repair process, and let the body adapt to being healthy by lowering the blood pressure naturally.

From the medical literature, the “stress” isn’t because of high blood pressure, but because of the stressors that are the cause of the higher blood pressure: to a meaningful degree, again, based on medical literature, sleep apnea causes the body the long-term stress that results in higher blood pressure to try to keep from suffocating all night, every night. In addition, sleep deprivation as well as the stress chemicals tends to drive people to eat more and retain weight, yet another factor that contributes to higher blood pressure.

High blood pressure does not help do more than (for temporary exertions) provide more oxygen, etc. while it results in significant systemic stress that, without something to lower it, can result in severe (up to and including fatal) damage to multiple organs including the brain, lungs, kidneys and heart, and likely others I’ve not named, if it is allowed to persist for too long without rest in between that and a relaxed state.

As a single data point, I’ll use myself as a firsthand example: at 35, I suddenly went from having ideal blood pressure, to, in less than 6 weeks (I forget the exact time, but no more than that) going for a physical, and finding my blood pressure was 160/100, which is very unsustainable. They ran an EKG on me, and found I had an arythmia in one of the waves (ST wave, IIRC). I was referred to a cardiologist, and over time, got treatment accordingly. In recent years, I don’t have an arythmia that has shown up on an EKG in the doctor’s office. I don’t even want to think where I would have been if I’d gone a year before getting high BP controlled.

Thus, the idea that you could let high blood pressure run long-term to heal is fatally stupid in that even if it doesn’t kill you in a short timeframe, with all the other things it does to you (many can’t be reversed once they’ve gone on too long, and I’m not sure how long that is or what all thosecthings are, and I’d prefer to keep it that way by not going there! ) your lifespan will almost certainly be significanly shortened, while also giving you a very piss-poor quality of life for that limited quantity.

Obstructive Sleep Apnea based on currently available medical knowledge, for other than those where fat tissues swell up to cause blockage, is a side-effect of the poor physiology of the person that was bad from the start (OSA is something it appears one can be born with, definitely sleep apnea exists in babies: especially likely for babies not full-term) and just doesn’t fit together in an ideal way, or it degraded as time went by. Consider: your throat is coated in what’s effectively a form of skin that’s perpetually in a moist/wet environment subjected to most interesting things most of your external skin is not. How many people make it to old age and death with no sagging skin on the outside compared to when they were young? I can’t think of any old person I’ve seen that escaped that fate where they maintained original skin elasticity.

The bizarre concept that we just forgot how to breathe while in our sleep and we need to practice it? When people can be trained to explicitly sleepwalk (I’ve reportedly sleepwalked while growing up, but I can’t remember it) or explicitly stop it, then there is the tiniest smidgen of a chance there. Remember, though: breathing is part of the autonomous nervous system, including the parts in our breathing pipeline from out nose/mouth and down that actually has anything resembling controllable muscles, so it’s the human equivalent of autopilot that can’t readily be turned off.

For those that have it, what are the causes of OSA?

Life!

If we didn’t live long enough, we wouldn’t stress over it!

Snoregone Conclusion, I pretty much agree with your first sentence...

The body adapts to stress by raising the blood pressure. When the stress is resolved the body adapts again by lowering the blood pressure.

If you can't identify the stress (physical, emotional, or chemical) you end up with elevated blood pressure over an extended period of time and that can be dangerous.

Looking back to when you were 35 can you identify any physical, emotional, or chemical stresses that you were exposed to. Keep in mind this could be something like eating processed foods and the toxins and chemicals in those foods finally catching up with you. Perhaps you were fighting off a cancer formation... Perhaps you suffered an impact and your nerve channels were compromised in some way. I have no idea so this is something you need to spend some time reflecting upon.

Our nervous system runs our body. If there is a disrupt to the parasympathetic nervous system pathway for some reason, you end up stuck with the sympathetic nervous system. In this state your digestion ability reduces, your ability to sleep is reduced, and you end up constantly on edge. In addition, blood pressure and cholesterol is elevated in an effort for the body to repair itself. At this point there are some choices. You can chemically reduce the blood pressure and cholesterol and hamper the bodies repair process or you can try to identify the stressor and work on eliminate that.

As far as skin condition goes, I hang out with several old timers that have excellent skin. Here is a guy that is 113 years old.

http://www.lifebuzz.com/113-years-old/

While I have seen older people with totally wrinkled skin, I also see a bunch of older people that have better skin than I do and I am not all that old. My general observation is that those that have healthy skin seem to have a better outlook on life and experience a better quality of life.

I don't think we forgot how to breathe. I think the autonomic nervous system has been compromised and there is a lack of communication. This results in us being stuck in the sympathetic nervous state and we are prepared for fight or flight rather than the more restful state of rest and digest.

What if the cause of sleep apnea is a discommunication of the central nervous system? What if we could achieve restful and restorative sleep by addressing this problem and eliminating it?

The goal is to have restful and restorative sleep. We happen to use CPAP to overcome the symptoms of a closed airway. What if we could deal with the root stresser and end up with better quality sleep? This doesn't mean that you would stop using CPAP, it simply means that the quality of your sleep would be excellent and you would jump out of bed each morning ready to greet the day.

HoseCrusher wrote: ↑

Sun Jun 24, 2018 9:27 pm

older people that have better skin than I do

Check out their calf muscles. Strong calf muscles prevent ghost veins which are the major cause of wrinkling. Strong calf muscles come from exercise like walking uphill or other exercises designed to strengthen the calf muscles.

Other factors in wrinkling are damage from the sun, smoking and genetics.