Karen was desparate. She was in the middle of medical school, and could not focus or had the energy to continue with her education. She thought that she had mono, but her doctors were not convinced. She went to multiple different doctors and was told that it may be chronic fatigue syndrome. She was disappointed that there’s really no cure, and that she has the option of taking prescription stimulant medications.
She then used all her energy to search for answers, and after weeks of going through the internet, she found out about extraction space reopening. She had undergone 8 dental extractions total: 4 wisdom teeth and 4 bicuspids a few years getter. After about 6 to 9 months, her intense fatigue was unbearable. She eventually underwent aggressive dental therapy, with rapid palatal expansion and extraction space reopening. She is now about 1.5 years into her treatment, and is feeling 90% better. She will be re-enrolling in medical school the following fall.
Over the last 15 years in practice, I have noticed a pattern amongst my patients with sleep apnea who are successful in being able to obtain better sleep. As I mentioned in past posts and podcasts, your mindset and motivations for wanting or needing to sleep better are more important than finding the right solutions for your sleep problems. Yes, the details, such as the type of therapy, which doctor you see, and in what order are important. But time and time again, patients that ultimately reach their goals faster have 7 habits, or mental states, in common:
1. Focus on “why” and not “what.” Why do you want to sleep better? Rather than saying, “what can I do to sleep better?” focus on what you wish to accomplish once you are sleeping better. Do you want to spend more quality time with your family, finish that project you’ve been too tired to complete, or enjoy a movie without dozing?
Something I have noticed over the years is that whenever I see commercial drivers or airline pilots, their rate of being able to use CPAP and sleep better with it is much higher than in the general population. It’s likely that their job depends on it, and they have made the decision early on to take care of the problem ASAP. If you fit this scenario, you are less likely to say, “let’s do some research,”or “get a second or third opinion.” Rather, you’re more likely to say, “Let’s do what it takes, NOW.”
Like athletes who notice that their performance is not what it used to be, or couples that don’t have the same level of physical or emotional intimacy that they used to, everyone will have different psychological motivations to address their physical sleep problems. Unless you have deep, personal motivations for wanting to sleep better, nothing that your doctor tells you about why it’s important to treat sleep apnea will matter. Throughout the course of this book, I had you do exercises to write down your heartfelt motivations for why you need to sleep. You described how it has affected your life negatively, and what you hope to feel or accomplish whenÂ you do sleep better. What are the barriers, and what is the next step that you must take to begin the process? Who will you be responsible to make sure that you follow through with your promises? By when will you commit to taking this action? Keep reviewing this document periodically.
2. Consider all options. Don’t just accept the first option that your doctor tells you about. In general, with exceptions, sleep doctors will generally recommend CPAP, dentists will offer oral appliances, and ENTs (otolaryngologists) will likely recommend surgery. Plus you’re already probably biased by what you’ve already read on the internet with different people’s opinions. All the different options have pros and cons, and what’s right for your friend may not be what’s right for you. Ideally, it would be great if you could try all the various options (like test driving a car), but that’s not realistic with health care.
3. Take action. Successful sleep apnea patients take immediate action. They bug the sleep labs for the fastest appointment available; they call me daily for their sleep study results. They are persistent. The opposite of this quality is what I see in people who have “paralysis by analysis.” They do their research but can’t make up their mind about which option to go with, fearing that it won’t work or there may be a complication. Without trying something, you won’t know whether or not it’s going to work, and this delays moving on to the next option.
4. Take responsibility for your own health. These are the people who will do whatever it takes to sleep and feel better. I have numerous patients that are unwilling to make the necessary lifestyle changes that I recommend. Either they don’t have the time, or they can’t work around their schedules. They come home too late to eat 3 hours before bedtime. They usually want a quick fix, namely a sleeping pill, and are unwilling to commit to a life change. One great example is a smoker with lung cancer who refuses to quit smoking.
5. Invest in your health. Typically, insurance companies will cover only the bare essentials for sleep apnea treatment. Sometime insurance won’t cover for any treatment if you don’t meet the 5 apneas and hypopneas per hour threshold. This means that if you stop breathing 25 times per hour, but each episode is 9 seconds long, then your AHI will be 0 and you’re out of luck.
Insurance companies and DMEs will most likely give you the most basic CPAP machines. You may need to switch to a different type of PAP machine, but insurance won’t cover for a new machine for 3 years. You may live in two cities, and don’t want to travel with your CPAP machine. In either situation, it’s not covered, so you will have to consider making the purchase yourself for an additional machine.
Oftentimes, you will have co-payments for prescription medications, or you’ll have to pay for over-the-counter medications or devices, such as nasal saline or strips to keep your nostrils open. If you find that it’s worthwhile investing in braces for you or your child, it’s even more important to invest in your sleep.
6. Surround yourself with trusted advisors. This begins with your sleep doctor, but may also may include a dentist, and otolaryngologist (ENT), DME company, and primary care physician. You need to take responsibility and coordinate care amongst all your medical health care professionals. Health care professionals are constantly pulled in 20 different directions. Oftentimes, they will not have interconnected offices or medical records. Don’t feel like you’re a nuisance if you keep calling. There some truth to the saying, “the squeaky wheel gets the grease.”
It is also important to have a supportive network of fellow sleep apnea sufferers, such as in a monthly AWAKE meetings (American Sleep Apnea Association), or an online forum, such as Sleeptember.org, or CPAPtalk.com.
7. Be persistent. Most people who come to see me are happy with their first choice of treatment, but some people need another option or multiple forms of simultaneous forms of therapy. I once saw a middle-aged man who underwent over 10 different sleep apnea procedures, and kept seeing different surgeons for more surgery. It was clear that most of the surgeons were very reluctant, thinking that he had some psychological obsession with surgical procedures. Despite multiple jaw, tongue base and soft palate procedures, I saw that he still had significant soft palatal collapse. He went to an ENT surgeon close to where he lived in the Midwest, who took care of this problem, and the patient felt significantly better. I also have countless stories of patients persisting with CPAP, and finally finding success. One caveat is that if something is not working, do something different. Albert Einstein once said that the definition of insanity is doing the same thing over and over again, and expecting different results.
Don’t worry if you do not have all of the above qualities. The more you have, the more likely it is that you may succeed, but these are not to be taken as being absolutely needed for sleep apnea success. For most people with routine sleep apnea who do very well on CPAP or oral appliances, these characteristics won’t matter. However, for a woman who has been struggling with CPAP for 3 years, or a man who has tried 3 different dental devices and an uvulopalatopharyngoplasty without success, these characteristics can be important.