So I went to this lecture the other night . . .

Date: Wednesday, November 03, 2010
Time: 6:15 PM to 8:15 PM
Topic: Sleep Apnea Side Effects-Comorbidities
Speaker: Ari Klapholz, M.D., F.C.C.P.
Location: 134 West 26th Street, 2nd Floor, New York, NY

http://manhattanawake.org/
http://www.newyorksleepandpulmonary.org ... octors.php

Re: Should I Go to This Lecture Tonight? . . .

Of course - they need you to ask the right questions

and to

challenge any misleading information

and to

sing them a song if they get bored .

cheers

Mars

I might take a guitar if I were sure it wouldn't get stolen on the subway ride on the way there or back.

Cany you play a harmonica?

A few weeks ago, the local AWAKE meeting was the same subject.
The speaker was one of the cardiologists at the hospital.

I figured I already knew about enough bad stuff that happens w/out cpap,
was doing all I could to prevent any of the known ones
and didn't need to know of anymore,
........so, I'm good, to not go.

YMMV

kteague wrote:Cany you play a harmonica?

No. But I have an hour or so to learn, I guess.

carbonman wrote:A few weeks ago, the local AWAKE meeting was the same subject.
The speaker was one of the cardiologists at the hospital.

I figured I already knew about enough bad stuff that happens w/out cpap,
was doing all I could to prevent any of the known ones
and didn't need to know of anymore,
........so, I'm good, to not go.

YMMV

I like the way you think, Carbonman!

Jersey Girl wrote:Dear Jnk,

Yes, it would be wonderful if you could go to the meeting and then report back to us. I am in NJ and have often wanted to go to NYC to an awake meeting, but it just ends up that I can't get there for one reason or another. So, if you could let us know a synopsis of the meeting, that would be very helpful.

Thank you!

Jersey Girl

I'll see what I can do. One of my bosses just handed me a stack of work, though, so I'll have to see if I can pull off going instead of working this evening.

Maybe if I didn't "waste" so much time on the forums . . .

So didya go or work?

Yeah...did'ja?

Yep, I went. And I didn't get fired.

The doc's ppt file can be downloaded right now at this link: http://manhattanawake.org/meetings/past

He has sleep apnea himself, and he once used to work in intensive care. So he had me at hello.

He said the apnea-overweight association rule ain't a rule anymore. Well said.

He is big on the apnea-insomnia connection, and he spoke of people who say "I can't fall asleep" when it eventually turns out that the root of their problem is actually OSA or CSA. According to him, whenever someone says to him "I sleep too little" or "I sleep too much," he immediately thinks "sleep apnea." He doesn't, however, consider the relationship between OSA and insomnia to be cause-effect, though, since he finds that both conditions need to be addressed simultaneously but separately for best success. Related comorbidities that play off each other, in a sense.

He noted how rarely "treating depression to fix insomnia" works--you have to treat the sleep problem to solve the underlying problem, although the depression can't just be ignored and may have to be addressed while getting at the sleep problem. His way of saying it was "depression does not magically melt away." Again, well said.

He stressed that patients with both OSA and insomnia often present with depression/anxiety/pain. He talked about the three P's of dealing with insomnia: Predisposition (such as classic type-A personality), Precipitating factors (such as onset of stressful situation), and Perpetuation (naps/alcohol/time awake in bed, which extend the problem and make it worse). SLEEPING PILLS ARE NOT THE ANSWER! You tell 'em, Doc!

He mentioned that a lot of CBT practitioners who specialize in treating insomnia do very good work and help a lot of people.

He stressed how big a problem alcohol is. Recovering alcoholics who haven't touched the stuff in years may continue to have fragmented sleep from the previous years of alcohol abuse. My heart goes out to those.

What impressed me the most about him was that whenever he spoke of CPAP, he used phrases such as "good CPAP therapy" and "effective CPAP treatment." And he uses home-machine-reported data as an indicator of successful therapy. Ya gotta love that in a sleep doc.

One particularly interesting comment was an aside he made that many docs feel that CPAP should be the primary treatment for GERD, but that the only problem with that idea was that "insurance would NEVER pay for it."

He also said straight out that "Apnea CAUSES weight gain, not just the other way around." For him, the proof of that is how many patients have sudden acceleration of weight gain in the six months preceding seeing a doctor. Obviously, to him, the sleep problem causes that phenomenon.

He said that EVERY OSA patient that is also a smoker needs the full PFT test. It's a must. Overlap syndrome needs a modified approach.

When asked (by a dentist of course) about his view of dental appliances, his answer was a slam dunk: "It may be an option, but frankly it depends on how high you want to set the bar for treatment. And the problem is, I have no way of knowing which patients might do well with one." Yeah, baby, yeah!

In his opinion, the high failure rate with CPAP is a simple matter of patients not having access to good help. He spoke of "hand-holding," but not in a derogatory way, in that patients aren't getting enough of it. Let's all hold hands and have a moment of non-silence here for that statement.

He said CBT for getting used to the mask is an option for those who just can't get the PAP thing working for them after a long time trying. His point was that two things are needed for PAP therapy to start correctly: Patience and education. And the initial week or two are absolutely crucial in that respect. So, gang, let's remember to be patient and educational to the newbies, OK?

He balked at the statement that "weight loss treats OSA." He emphatically stressed that it does not. "But," he said, "it often DOES 'improve' a person's condition." He repeated again that it is not a "treatment."

His view of the fibromyalgia connection with OSA was fascinating. His way of looking at it is that OSA is worsened when "unperceived" pain is still perceived by the brain during sleep, which causes alpha-intrusion. The chronic pain causes increased tiredness in that way, which, in turn, makes the airway more likely to close. This creates a vicious circle, since fragmented sleep then heightens pain perception.

Those are some highlights as filtered through my damaged brain. Food for thought, anyway. Hope that gives a taste.

I wish all you guys could be there for the meetings. There's plenty of room. One day we'll all have to meet up there and have a troll-roast or something.

Great report, as always, Jeff! Thanks for the good read.

well thank you for going to that, what a fabulous doc, and great report!

Im so pleased that they arent pushing the overweight bit anymore.. that was an ill conceived stereotype, wish they would knock it off about the
snoring too.. not everyone snores who has osa, or even has daytime sleepines..

and finally, they realize insomnia can be a huge symptom, duh! who wants to go to sleep when they are going to suffocate every night?

I wish they would modify some of the tests they give for sleep apnea to include insomnia as a symptom..


aha, treating gerd with cpap, love it! I just got over a year of treating larynx reflux..

ahh, unperceived pain? that is interesting.. perhaps those of us who have a high tolerance for pain are being disturbed at night and dont
even know it..

He said CBT for getting used to the mask is an option for those who just can't get the PAP thing working for them after a long time trying. His point was that two things are needed for PAP therapy to start correctly: Patience and education. And the initial week or two are absolutely crucial in that respect. So, gang, let's remember to be patient and educational to the newbies, OK?

Oh well said, I think sometimes we forget what it was like to come here frightened, shocked, and not thinking clearly.. so yes, patience..

one question:
WHY DONT THEY HAVE SLEEP APNEA CLASSES FOR EVERYONE WHO IS DIAGNOSED EVERYWHERE, LIKE THEY DO WITH DIABETES?

Thanks for the report, it was awesome!

Thankyou jnk. Very much appreciated.