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Sleeping Man with a CPAP Mask
Every night without exception, Paul Blumstein wears a mask that prevents him from waking up repeatedly, out of breath.
He was diagnosed with a condition called sleep apnea. Although it helps, he does not like to wear the mask.
"It's as if an octopus had been hanging on my face," said Blumstein, 70, of Annandale, Va. "I just want to sleep from time to time without that feeling."
It has been two decades since doctors have fully recognized that breathing that stops and starts during sleep is linked to a host of health problems, even early death, but it remains unclear. is not a treatment that most people find easy to use.
Respiratory pressure masks, the most common remedy, have an improved design, become smaller and quieter, but patients still complain of sore nostrils, dry mouth and claustrophobia. Now, new ways to conquer sleep apnea, and the explosive snoring that accompanies it, are competing for a place in the rooms of millions of people who want a good night's sleep. The products range from a $ 350 blockage intended to discourage the back to a $ 24,000 surgical implant that pushes the tongue forward with each inhale.
Dental tips work for some people but have their own problems, including jaw pain. Some patients attempt surgery, but often it does not work. Doctors recommend weight loss, but dieting and exercise can be difficult for people who do not sleep well.
Up to now, there are no pills for sleep apnea, but researchers are working on it. A drug containing THC, the active ingredient in marijuana, has shown promise in a study this year.
What is sleep apnea? In affected people, the muscles of the throat and tongue relax and block the airways during sleep, caused by obesity, aging or facial structure. They stop breathing, sometimes up to a minute and hundreds of times each night, then wake up with loud gasps and snores. This prevents them from having a deep and restful sleep.
They are more likely than others to have strokes, heart attacks and heart rhythm problems, and they are more likely to die prematurely. But it's hard to know if these problems are caused by sleep apnea itself, or by being overweight, lacking exercise or anything else.
For specialists, the most studied first-choice remedy is continuous positive airway pressure (CPAP). It is a motorized device that pumps air through a mask to open the sleeper's airways. About 5 million Americans have tried CPAP, but up to a third have given up during the early years due to discomfort and inconvenience.
Martin Braun, 76, of New York has stopped using his noisy machine and clumsy mask. still trying after a car accident when he fell asleep at the wheel. "It's at this point that I realized, OK it's already serious," said Braun, who commissioned a calmer CPAP model.
Sleep medicine is a relatively new field. The most rigorous studies are small or do not follow patients for more than six months, said Dr. Alex Krist of Virginia Commonwealth University, who participated in a panel of federal recommendations on the treatment of apnea sleep.
"We do not know as much the benefits of sleep apnea treatment as we should," said Krist, vice president of the US Preventive Services Task Force
. Longer, the evidence shows that it can reduce blood pressure, improve daytime sleepiness, decrease snoring and reduce the number of times the patient stops breathing. CPAP also improves quality of life, mood and productivity.
With notable results, many CPAP users, even those like Blumstein with a love-hate relationship with their devices, persist
Blumstein was diagnosed about 15 years ago. he's asleep behind the wheel at a traffic light. He shared his frustrations with the use of a mask at a recent meeting organized by the patient with the Food and Drug Administration, as did Joelle Dobrow of Los Angeles, who said that "I'm not sure about it." It took her seven years to find one she liked. 26 different mask styles, "she said. "I've kept a spreadsheet so I do not duplicate it."
Researchers are now focusing on how to get people to use a mask more accurately and predict who is likely to To give up and replace it with a dental appliance. 19659004] "It's the bane of my existence as a sleep doctor," said Dr. James Rowley of Wayne State University in Detroit. "Much of what sleep doctors do in the first few months after diagnosis helps people use their CPAP."
It's important to act quickly because of the policies of use or loss of insurance from insurers.
Medicare and other insurers stop paying for a rented CPAP machine if a new patient does not use it enough. But patients often have problems with sets and masks, with little help from equipment providers, according to Dr. Susan Redline of Brigham and Women's Hospital in Boston
]. 69, from Escondido, California, was one of the first to receive a pacemaker-like stimulator that stimulates a nerve to push the tongue forward during sleep. Today, more than 3,000 people worldwide have received the Inspire implant. Infections and perforated lungs have been reported; the company says that serious complications are rare.
McCullough said that she asked her doctor to remove the device shortly after it was activated in 2015.
"It was Frankenstein-ish I did not like it at all, "McCullough said. "My tongue was struggling on my teeth."
Others like the implant. "My quality of life is 100% better," said Kyleene Perry, 74, of Edmonds, Wash., Who had one in February after struggling with CPAP for two years. "People say," You look so much better. "I have a lot more energy."
The THC pill, known as dronabinol, is already used to relieve the side effects of chemotherapy. A small experience in 73 people suggests that it helps some but was not completely effective. It could work better in combination with CPAP or other devices, said researcher David Carley of the University of Illinois at Chicago. He holds shares in Respire Rx Pharmaceuticals, which has entered into a licensing agreement with the university for a pill against sleep apnea.
As the search for better treatments continues, listening to patients will be essential, Redline said. I only treat a very small percentage of people effectively, "she said.
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