No worries - happy to hear it was helpful 🙂🌺
Hmm, reading that you’ve had multiple sleep studies and been prescribed CPAP however it has not been successful highlights that there is some form of ‘failure to find the problem’ either in the sleep studies or by the physicians… diagnostic studies show apnoea - yes - however, they do not necessarily demonstrate positively whether it’s OBSTRUCTIVE, MIXED, or CLEAR AIRWAY/CENTRAL apnoea.
This happens when a secondary diagnostic study is done using more specialised testing equipment (not usually used in standard diagnostic tests), or during a titration study with excellent active monitoring by the sleep technician whom is controlling the device delivering the titrated pressure/s (pressures = the requirement if IPAP and EPAP when testing if someone has clear airway/central sleep apnoea). For instance, if it seemed the patient I was titrating was not stabilising on just singular pressure delivery (APAP or CPAP), and showed disturbance to their brain waves, SpO2, heart rate/EKG, etc, I would flick the machine into bi level delivery and titrated as if they have mixed or clear airway needs (this means their airway is NOT physically obstructing; instead, their airway remains OPEN, BUT, for some other reason, they are unable to ventilate enough VOLUME OF AIR to adequately exchange gases in their alveoli - they aren’t moving air in and out - so, I flick over to trying many forms of ventilation which is designed to move air in and out, instead of staying on singular delivery of CPAP/APAP which is only designed to splint the airway open so it doesn’t flip closed - the person still must have the ability to VENTILATE/breathe enough air in and out on their own, for CPAP/APAP to work, and thus be ‘comfortable’ and ‘useable’ overnight).
Ok, having said that, Inspire device would work excellently if the person only had physical obstruction of their upper airway as their problem; but if there is a problem moving air in and out (failure to adequately ventilate with or without upper airway obstruction) this device would not be the appropriate device to fix the problem. If a person didn’t titrate onto CPAP while watching all their other parameters for normalcy, I used non invasive ventilation (a form of IPAP/EPAP), and titrated/monitored. If they then were falling into normal sleep patterns per their other signs being monitored, then I would write this up as significant findings to the pulmonologist or cardiologist to consider when integrating sleep management for safe oxygenation and appropriate sleep treatment.
Some people who could not get comfortable on CPAP would have a study with me, and if I found CPAP wasn’t suited, I would trial them on bilevel delivery, which almost always became second nature to their nighttime breathing - simply because it was treating their problem, not working against them and their breathing needs - which is what happens when a person is using the wrong breathing equipment, resulting in them never being able to get used to it (which is pretty obvious once you know). In terms of implantable devices for clear airway apnoea (failure to adequately ventilate the lungs), one that comes to mind is the diaphragm stimulator - stimulating the muscle to contract and thus make a person take a breath. There are various brands for different purposes, however it is surgery, and like all surgery there are risks and limitations of efficacy (just like there are risks and limitations of efficacy in non-invasive bilevel delivery too, depending on the condition of the person and any other lung disease that may be there - sometimes bi level is contraindicated in particular lung tissue disease).
Ok, I hope that helps clarify why sometimes CPAP isn’t efficient and effective? Sorry it’s a long one, but it helps I think, to explain it comprehensively 🙂
You’re very right in that medical systems and professionals do not have the structures of service delivery in place to give decent comprehensive and connected-to-other-specialists-care, and so it leaves all the work to the patient, who is already burdened with illness, to have the time and energy to figure out what is going on and ‘lead’ flexible specialists to potential options, so that they can then use their knowledge of disease to narrow down the potential sources of illness. It’s taken me years to find practitioners that are willing to hear out my theories, using printed out research/scientific findings, to them. But, when they see my clinical reasoning, they then can say whether it might be, or that it’s not possible and we should look elsewhere. I am the specialist in my symptoms and their impact/severity/combinations, and using a chart as described in my previous post, I can categorise them. The doc is the specialist in how diseases manifest, so I try to put the two together to get the best outcomes. It’s different to going to a specialist and expecting answers; it’s taking a logical pattern to them to enable them to follow deductive logic in disease patterns and likelihoods - making it easier to figure out what might be happening. If they don’t like my methods and are dismissive, I then know they are the docs not interested in treating disease, but perpetuating it for the sake of an income, and I move on to someone who is in medicine to get patients out of it 🌺🙂
All the very best 😀