I have seen the mindset towards CPAP therapy improve throughout the years and be SO MUCH more widely accepted. Unfortunately, there still seems to be a stigma associated with using a CPAP because of the way we have been taught - If you’re overweight, you may have sleep apnea. Working in both hospital settings and homecare settings, It still seems this has been the demographics of patients getting referred for the most part, at times with no symptoms while someone that is symptomatic that doesn’t fit the high-BMI criteria is told to sleep more, eat earlier and essentially do everything else but a sleep test. I’m sorry but my 4 years of education in Respiratory Therapy and Polysomnography, along with 10 years in the practical clinical setting tells me that is a bunch of bologna and that there needs to be a much more proactive education and screening regarding sleep apnea and sleep disordered breathing as it closely relates to MANY co-morbidities that can be prevented.
PS. Have I shared with you that my youngest patient to start CPAP was a healthy 8 year old male at the time and my oldest client to START CPAP only because of generalized fatigue was 100 years old? Both were successful through CPAP titration and purchased CPAPs for on-going use. Goes to show it's never too early or too late for a sleep assessment and therapy, but the sooner it's fixed, the sooner you can Own the Night and Seize the Day.
As it stands, ⅓ of our life is written off as “unknown or good” because we are asleep. Sleep is generally not looked at until lots of other problems start to arise, a reactive approach. While not all sleep disorders are due to sleep apnea, If we tell our physician that we are starting to wake up at night, have issues falling asleep/staying sleep etc, they may base it on age and disregard a screening method for Sleep Apnea or Worse, prescribe sleeping pills to keep you asleep! That will only make things worse down the line - It's all fun and games until we hit that brick wall of dependability and decreased drug effectiveness. If we spend ⅓ of our lives in a physiological stressful state affecting quality of sleep, rest assured Mental Health, Cardiac health, Metabolizing Hormone regulation, Circadian Cycle regulation, etc. can be, and usually is negatively affected.
I’ve heard a common theme of complaints about starting CPAP therapy and similar justifications from coast-to-coast over and over. Ultimately it comes down to just unawareness of the damage it can cause to the body, lack of full education from the health care professional, denial about our own health / sleep / Family history, and just plainly turning down CPAP or any sleep therapy because it is not a pill we can take.
Some Inductive reasoning to think about before reading on:
“When it looks like a duck, and it swims like a duck and it quacks like a duck, It's probably a duck”.
Waking up at night due to age. Doesn’t everyone?
Yes many do. Many are also not diagnosed with OSA, and I bet they would all test positive if they underwent a sleep study. Remember sleep apnea is heavily underdiagnosed and Age is also a factor when considering sleep apnea. As we age, our muscles can get weaker and are more prone to collapsing, leading to increased stress which results in increased urine production to naturally lower systemic blood pressure. Denial and non-compliance to start a permanent therapy (vanity) is/are also major reasons for no testing. The longer we wait, the more complex our health may become and we may be faced with overall higher medical bills and may need a more sophisticated type of therapy which costs much more.
“There’s no way I’ll be Darth Vader at night. It’ll ruin my sex life”. I get the initial startling, life-altering thought process. I’ll explain…
Libido- You are more likely to have increased libido with treatment of sleep disordered breathing. Increased energy and overall well-being = more time for fun without being exhausted.
Snoring- Subconsciously (or consciously) affects your partner’s sleep, thus affecting quality of their sleep, making both snorer and partner more “edgy” or irritable and tired. They will also absolutely detest your snoring since it affects them.
Mind over matter. Okay, do we really think the visual of a CPAP machine will ruin the mood? Hey, As far as I’m concerned, I’d rather get a good sleep than snore in a spouse’s ears. Also last I checked people don’t usually put on the Darth Vader masks before the funny business. I mean, maybe if we REALLY like Star Wars? Hmm..
Vanity | Embarrassment. Goes along with Mind over matter. I truly hope no one here thinks like this but this is the stigma and the killer for many patients for starting therapy and on-going compliance. So I’ll ask, what’s better, trying to impress someone by hiding the CPAP, getting worse sleep and keep having the same issues or own up to the chronic issue of sleep apnea and let your partner sleep in peace without snoring and most importantly protect your own health. Remember, about 60% of the population has undiagnosed sleep apnea and are horrible snorers so in actuality your partner may have it and not know it. In my mind at least, it should be the snorers that should be embarrassed for not taking care of their health and the social nuisance of snoring, not the people doing something proactive about their health.
What if we could act in a PROACTIVE method rather than REACTIVE? How do we think that will affect the medical industry (aka tax dollars) and most importantly individual’s health and quality of life? Personally, I bet we would see less high blood pressure crises, prediabetic stages, less medications needed, reduced Insomnia, less Motor vehicle accidents, etc. as we’d be treating an issue that can be occurring over 30% of our lives and affecting over 60% of the population. Having said this, please understand that sleep is ONE factor affecting these co-morbidities and there are many others that can be contributing factors such as dietary intake, exercise levels, stress levels, etc. Rarely is it just one isolated issue but sleep seems to be VERY overlooked and tends to be a common denominator for hypertension, diabetes, anxiety, depression, low libido, Red Blood Cell count, appetite and metabolism control and much more.
With all that said, I am happy to say that in Canada, so far at least in 2 of our provinces (Alberta and British Columbia) are regularly referring all types of patients for Home Sleep Apnea tests to get a fast and very accurate assessment of patients’ sleep. In my practice, it was clear physicians were starting to be open to more vigorous screening due to the readily accessibility. I’m pleased to say that I was one of the therapists assisting in educating family physicians on what to look for when screening for sleep apnea and truly seems to have caught on... rightfully so!
In Ontario, there are private routes you can go through for a Home Sleep Apnea Test, get a diagnosis and start treatment within a week of referral rather than months and years. Best of all, we are the ONLY PROVIDERS IN ONTARIO to work with insurance companies aiming to get coverage for your CPAP machine. Also, did you know it would actually cost significantly less out of pocket to go privately through insurance rather than publicly and you get your treatment in a fraction of the time? Unfortunately, in Ontario the public sector will automatically refer to the Sleep Labs and not provide the option for home sleep tests unless specifically requested.
It also just so happens Ontario has the highest Sleep Lab per capita out of all North America and Latin America, a technology that existed back in the 1980s while the rest of the world is going towards Home Sleep Testing for diagnosis or rule out of sleep apnea alongside the Sleep Labs to FastTrack diagnosis and treatment. I hope there is no coincidence there…….Don’t get me wrong, Sleep Labs are Golden Standard for Sleep Disorder diagnosis. However, I can assure all readers, Home Sleep Clinics and Sleep Labs can and do work synergistically in other provinces and countries, specifically for the diagnosis and/or rule out of obstructive sleep apnea, for some reason just not here.
I am always encouraging patients to spread the word about sleep apnea which is why I run things quite differently than the average CPAP vendor in Ottawa, or Ontario for that matter. Focusing on educational material and general knowledge regarding sleep, sleep disorders, recurring follow ups for replacement and cleaning schedules and many more areas of respiratory therapy, improves my clients’ understanding of what we are living with. So please do share with family and friends as the more people become aware, the faster the change can be.
In conclusion, the faster we can steer away from “Vanity'' issues, the less stigma there will be associated with owning and using CPAP therapy. The quicker we can get Home Sleep Apnea tests made available to the public through public funding, the sooner people will resolve their sleep issues rather than having to wait months and years with nightly sleep issues affecting your health.
Maybe you’re asking yourself, why am I sharing this? Well, knowledge is power.
Best,
Rafael Mendonca, RRT CPSGT Manager
Comments