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HomeHealth InsuranceReaders and Tweeters Take Positions on Sleep Apnea Therapy

Readers and Tweeters Take Positions on Sleep Apnea Therapy

Letters to the Editor is a periodic characteristic. We welcome all feedback and can publish a variety. We edit for size and readability and require full names.

On a ‘Woke’ Journalist’s Journey

I discovered Jay Hancock’s piece moderately intriguing (“Extreme Sleep Apnea Analysis Panics Reporter Till He Finds a Easy, No-Value Resolution,” Oct. 3). Whereas I agree that positional remedy is commonly missed as a first-line remedy for obstructive sleep apnea, one has to take a look at this severe, life-threatening well being situation in a bit extra element. First, Mr. Hancock’s analysis was central sleep apnea, which suggests both a neurologic and/or respiration management etiology. Sleeping on the aspect could stop airway obstruction, however the underlying trigger has possible not been addressed. Second, the hazard right here is that — a bit like hypertension, with which there are little or no perceived signs — a catastrophic occasion would possibly happen with little or no warning. Third, it seems that the positional remedy on this case alleviated the situation — however as one will get older, the situation will possible worsen.

Backside line: Why does this specific affected person have this situation and what could be achieved to deal with the foundation trigger as an alternative of taking a symptomatic strategy? My worry is that, left untreated, the sufferers go to sleep with a false sense of safety to by no means get up the subsequent morning.

— Dr. Dave Singh, an adjunct professor in sleep medication at Stanford College, Stanford, California

Not loving the tone right here. For each Jay Hancock, there are what number of lives modified/saved by CPAP remedy?

— Liz Beaulieu (@hmeliz) October 4, 2022

— Liz Beaulieu, Yarmouth, Maine

Lastly! Jay Hancock uncovered the sleep apnea medical racket. I’ve one other remedy choice: Throughout covid, many inpatients had been intubated within the susceptible place. I used to be interested in that and did some Googling. Not solely does sleeping in your abdomen enhance lung capability, the gravity on the throat is a pure remedy for sleep apnea. Whereas troublesome to adapt to, it’s higher than a CPAP. Once more, medical doctors don’t point out it. No cash in a easy gravity resolution.

— Peg Keohane, Syracuse, New York

A reminder of how medical suppliers work to drive up prices for remedy leading to lowered pay for working People!”Pointless care is a giant purpose People’ insurance coverage prices — premiums, copays, and deductibles — are inclined to rise 12 months after 12 months.)”

— Stanley Morrical (@StanMorrical) October 3, 2022

— Stanley Morrical, San Francisco

I wish to thanks for this very well timed article. I’ve suspected there was extra to the query of apnea than was being reported. As acknowledged, it’s a huge business that perpetuates the concept that everyone seems to be affected.

The reporter’s discovery that side-sleeping is the reply is completely legitimate, as I made up my mind way back. The article needs to be broadly disseminated as it’s of utmost significance to thousands and thousands who’re falling for the hype!

— Lawrence Dee, Chino Valley, Arizona

Sleep apnea is over-diagnosed, primarily based on pointers set by a company funded partly by makers of CPAP machines used to… deal with sleep apnea, @JayHancock1 reviews. An alternate “remedy” is commonly missed: Sleep in your aspect! by way of @khnews

— Robert Roy Britt (@RobertRoyBritt) October 4, 2022

— Robert Roy Britt, Phoenix

My mouth dropped open once I learn Jay Hancock’s piece about sleep apnea. You’re the harbinger of a tidal wave, my good friend. The social gathering is simply getting began.

Empowered Sleep Apnea is a mission we created to guard particular person sufferers from the “conveyer belt” of the American well being care system, because it’s poised to cope with tens of thousands and thousands of recent diagnoses of sleep apnea, which can quickly be made in major care and dental places of work throughout our nice land, utilizing automated, wearable expertise. That point is coming inside 18 months.

You suffered as a result of there was insufficient teaching for a very sophisticated illness. Easy as that. All those that will probably be subjected to a cloudburst of automated diagnostics could have the identical journey to make. Out of necessity, your resolution was to slog by your individual analysis to get your self some sane path. You empowered your self. Good on you.

My resolution was to take my life’s work as a patient-centered sleep medication doctor and switch it into one thing lovely to behold, so that everybody can profit from sane teaching. Our mission hinges on affected person empowerment. Our web site is a pleasant introduction. Our podcast can also be a blast that I feel your readers would discover very fascinating.

— Dr. David E. McCarty, proprietor and CEO of Empowered Sleep Apnea, Boulder, Colorado

I’m certain it really works – glorious abstract of messy #sleep #apnea ‘remedies’ and 0 prices resolution for many individuals

— Artwork Sedrakyan (@ArtsyTwits) October 6, 2022

— Dr. Artwork Sedrakyan, New York Metropolis

As president of the American Academy of Sleep Medication (AASM), I write to deal with a number of considerations in regards to the current article “Extreme Sleep Apnea Analysis Panics Reporter Till He Finds a Easy, No-Value Resolution” (Oct. 3). Whereas I commend the creator for searching for medical assist for his daytime drowsiness and loud night breathing, I worry his article could mislead readers in a means that would jeopardize not solely their very own well being and security however that of others as effectively.

The creator is clearly dissatisfied with the care he obtained; nonetheless, utilizing this to counsel that almost everybody identified with sleep apnea ought to merely deal with it on their very own “without spending a dime” is harmful. Sleep apnea is a typical and power medical situation that will increase the dangers for quite a few bodily and psychological well being penalties, diminished high quality of life, motorized vehicle crashes, and untimely demise.

Positional remedy (which generally requires using a tool to take care of a side-sleeping place), although helpful for some sufferers with sleep apnea, isn’t the very best remedy for many sufferers, particularly these with average to extreme sleep apnea. Optimistic airway strain (PAP) remedy is the best-supported, evidence-based remedy for sleep apnea. The newest systematic evaluate and meta-analysis included 80 randomized managed trials investigating using PAP remedy to enhance outcomes. Thousands and thousands of sufferers with sleep apnea can attest to the life-changing — and even lifesaving — impression of PAP remedy. Therapy choice is a vital determination that needs to be made collectively by a affected person and their treating supplier.

Moreover, it’s inappropriate for the creator to make use of his expertise as justification to malign our total group and our 12,000 members. AASM strongly refutes the implication that help from business biases our medical follow pointers and insurance policies. Our pointers are primarily based on a evaluate of the most recent analysis by a job drive of specialists who decide the power of proof for a given remedy. The AASM additionally ensures conflicts of curiosity are mitigated by a stringent medical follow guideline improvement course of. Whereas the creator claims our group “funds its operations” with business help, that is merely unfaithful. Business help represents roughly 1% of our annual income and is guided by a transparent coverage that helps guarantee clear interactions to forestall undue affect and help public well being. Likewise, the implication that our members are prescribing PAP remedy as a part of a revenue-generating scheme is fallacious. The overwhelming majority of PAP gadgets are offered by sturdy medical gear suppliers, not by sleep facilities or sleep medical doctors.

I hope that readers struggling to get a great evening’s sleep will search data from credible sources and discuss with a trusted well being care skilled to find out which remedy finest addresses their particular conditions.

— Jennifer L. Martin, president of the American Academy of Sleep Medication, Darien, Illinois

Psst. Sleep apnea is sort of a racket.

— Timothy Noah (@TimothyNoah1) October 4, 2022

— Timothy Noah, Washington, D.C.

I simply noticed Jay Hancock’s article on my Google feed and browse it, as I endure from severe sleep apnea as effectively. I’ve obtained tailored mouthguards, so to talk, which seem to work moderately effectively.

However I’ve additionally been studying books on respiration, beginning with “Breath, the New Science of a Misplaced Artwork” by James Nestor, after which on to “The Oxygen Benefit” by Patrick McKeown. I spotted I used to be a mouth breather and that that contributes to the apnea downside as effectively and have since been attempting to be taught to breathe by my nostril always — to this point with blended outcomes, however the topic may be very fascinating because it pertains to much more than simply get a great evening’s sleep.

— Dimitri F. Frank, Málaga, Spain

An increasing number of hospital programs personal pressing care facilities which have limits on who they deal with — for each monetary causes. Pressing care facilities are a brand new excessive income stream for a well being system to generate quick cash making a pipeline of recent sufferers.

— James Hughes (@JamesHu29812484) September 30, 2022

— James Hughes, Savannah, Georgia

Treating Trauma — Adopted by Billing Trauma

I’m an emergency doctor who additionally works at pressing care. Whereas I admire sufferers attempting to be fiscally accountable with their selections, the pressing care did exactly the appropriate factor on this case (Invoice of the Month: “Turned Away From Pressing Care — And Towards a Large ER Invoice,” Sept. 29). Pressing care can sometimes handle fender benders or different minor accidents, however somebody whose airbags deployed and whose automobile rolled 3 times and wound up “crushed” up right into a tree ought to all the time go to the emergency room. The mechanism of such accidents may be very regarding and sometimes justifies a trauma activation and CT scans to judge for inside accidents. Pressing care isn’t geared up to deal with sufferers in the event that they develop life-threatening issues from a extreme harm.

— Dr. William Weber, Harvard Medical Faculty / Beth Israel Deaconess, Boston

Extra proof that we’d like an everybody coated for every little thing, zero copay, federal single payer well being care system financed by truthful taxes.

— James Conner (@jrcflatheadmemo) September 29, 2022

— James Conner, Kalispell, Montana

This text is lacking the attitude of a medical supplier. I’m a retired board-certified emergency doctor with 33 years within the emergency division and greater than 5 years in pressing care and really feel the necessity to handle the medical care variations between the ED and pressing care.

I agree with the information of your article and don’t dispute the monetary points, issues, inequities of the damaged system. However there may be extra to the story.

The data, capacity, talent, and expertise of the supplier are key. The placement of care predisposes to the talents of the supplier however doesn’t assure them. You might obtain glorious to below-average care relying on the supplier. I’ve seen individuals die from auto accidents that had been despatched dwelling from pressing care after receiving an analysis by a normal practitioner not skilled in trauma. Some ED physicians miss issues, however the odds are higher that the ED physician is not going to miss essential circumstances.

Conversely, you would possibly get care from an skilled ED doctor at an pressing care.

Then there are the personnel and assets supplied. If it’s a easy “pressing” downside, no vital distinction in end result is more likely to end result.

There may be the dilemma. What’s an emergency? This has been argued in Congress: to err on the aspect of not lacking severe issues for which a “prudent layperson” may observe signs. So an emergency is what a “prudent layperson” believes it’s.

A few of the pressing care facilities I labored in turned away “third-party” circumstances however most didn’t — even throughout the similar hospital-owned pressing care chain. An choice could be to supply to pay money, asking for the cash-upfront worth. Troublesome to be correct in predicting the associated fee forward of time, however an estimate isn’t unreasonable. As a substitute of a low four-figure invoice, the household might need turned out to have a low three-figure invoice if not referred to the hospital after the pressing care analysis.

In my expertise, I’ve by no means seen a affected person despatched from pressing care (owned by or affiliated with a hospital) to the hospital for the only real purpose of the hospital billing a second cost. Many sufferers are despatched as a result of they want the next degree of care that isn’t obtainable, similar to hospitalization, injectable medicines, specialty care, imaging, and “stat” lab work not obtainable.

Certain, the hospital makes use of the pressing care as a feeder website, however the affected person (or the paramedic) will get to decide on which hospital to go to, if they’ve a choice.

Please do not forget that not all hospitals or pressing cares are the identical. Many smaller hospitals do not have some/many specialists required to again up the emergency division. Some pressing cares use primarily normal practitioners, whereas others use solely board-certified emergency physicians, nurse practitioners, or doctor assistants.

Sure, the system is damaged. Per a current webinar by the California Medical Affiliation: Up to now 50 years, the rise within the variety of physicians was 2%. Administrative well being care personnel elevated greater than 3,000%. (That features each the supplier and the payer aspect.)

— Dr. Mickey Kolodny, Palos Verdes Peninsula, California

The US healthcare system is so dysfunctional, it nonetheless staggers me at instances.

— Donald Farmer (@DonaldTreeHive) October 3, 2022

— Donald Farmer, Woodinville, Washington

After 40 years as a board-certified emergency medication doctor, I imagine the article by Sam Whitehead may be very deceptive. To begin with, the affected person ought to by no means have gone to an pressing care. Had she known as 911 as she ought to have, simply due to the mechanism of the crash, she would have been dropped at an emergency room. The ER clearly believed two CT scans had been wanted, which the pressing care wouldn’t have been in a position to present. The reporter didn’t dig into the small print of the acute trauma care this affected person wanted — aside from understating her post-accident state of affairs, which was self-defined. The creator writes as whether it is strictly an insurance coverage situation or a means for the pressing care/hospital system to realize sufferers.

There isn’t any indication of this taking place provided that the affected person wanted, by protocol, Superior Trauma and Life Help (ATLS). By EMS protocol and by malpractice case legislation, this affected person wanted a go to to a trauma heart emergency room. And the invoice is a very completely different situation. In different phrases, the creator completely missed the medical points to overstate and sensationalize billing points.

— Dr. Anthony F. Graziano, Oconomowoc, Wisconsin

suppose twice earlier than heading to an pressing care by way of @khnews

— kendra lee (@kendraedits) October 3, 2022

— Kendra Lee, Woodbridge, Virginia

I listened to your story as retold on NPR a couple of younger girl who had a excessive invoice for an ER go to after a automobile accident. I felt that the story was editorially biased, because it talked about nothing in regards to the necessities for take care of traumatically injured sufferers. It appeared to suggest visiting pressing care facilities as an alternative of emergency rooms. Though inexpensive, such amenities typically mustn’t take care of sufferers with severe accidents. Most hospitals require board-certified emergency medication physicians and have in depth assets whereas an pressing care physician could not have accomplished a residency. The “doctor knowledgeable” within the story clearly had no expertise within the care of traumatically injured sufferers. Having such perception would lend depth to what I noticed as a superficial have a look at a nuanced situation. Clearly the general public needs to be higher knowledgeable about cost-effective care, however an analysis after a severe automobile crash is inappropriate to be despatched to an pressing care.

— Dr. Christopher Goltz, Flint, Michigan

A Wealth of WISDOM

Good article (“Genetic Checks Create Therapy Alternatives and Confusion for Breast Most cancers Sufferers,” Sept. 21). With breast most cancers consciousness month upon us, I’d additionally level out the existence of the WISDOM research funded by the Nationwide Institutes of Well being, which is completely different approaches to utilizing genetic testing to display ladies for breast most cancers. Test it out at

— Dr. Daniel Halevy, New York Metropolis

Let the client beware. The truth that a marker could be detected doesn’t imply that it’ll assist you optimize remedy. #snakeoil #breastcancer@acog @apha_mch @aafp

— Cee A. Davis,MD,MPH (@cdBRComHealth) September 22, 2022

— Dr. Cee A. Davis, Winchester, Virginia

On the Beginning of Obstetrics Emergency Departments

I used to be disenchanted by your article “Child, That Invoice Is Excessive: Non-public Fairness ‘Gambit’ Squeezes Extreme ER Fees From Routine Births” (Oct. 13). Whereas I acknowledge that medical billing is commonly complicated and at instances even alarming to sufferers, I wish to share a couple of factors that I really feel had been downplayed or omitted:

  • The article gives the look that the obstetrics emergency division, or OBED, is created just by rebranding an current course of inside hospitals. The creator neglects to say that earlier than the OBED, most hospitals didn’t have OB-GYN hospitalists stationed in-house 24/7 to deal with emergencies. Previous to the implementation of the OBED, many expectant moms, involved that one thing could be flawed, weren’t in a position to see a doctor once they visited a hospital emergency room. As a substitute, they had been transferred to the labor and supply division to be evaluated by a nurse taking directions over the telephone from a doctor. If the affected person and her child had been in severe misery, it turned a ready recreation, with the chance escalating each minute she waited for medical consideration from her physician — or any physician. Lots of of hundreds of life-threatening emergencies are managed annually by OB-GYN hospitalists who employees obstetrics emergency departments.
  • Reporter Rae Ellen Bichell appears to have a beef with the follow of hospitals charging for an emergency analysis when unscheduled pregnant sufferers arrive on the hospital with medical complaints. Whether or not we prefer it or not, that’s merely the best way that well being care works in America. If you happen to present up unexpectedly at a hospital for analysis of a well being concern, you’ll be handled as an emergency — and you’ll possible obtain a big invoice comparable to the unscheduled care you obtained.
  • The creator works exhausting to ascertain or suggest a causal relationship between the personal fairness backing of medical staffing firms and the truth that hospitals are billing sufferers for emergency medical providers. Nevertheless, hospital service suppliers and distributors have completely no management over a hospital’s billing practices. This bit about personal fairness appears to serve no logical function on this article besides to make the story seem as a “whodunit,” casting personal fairness corporations within the position of immoral shadow bosses turning a revenue on the expense of unwitting expectant moms, when in truth they play no position in establishing the billing insurance policies that Ms. Bichell incorrectly and maybe unfairly characterizes as “moneymaking ‘emergency’ occasions.”

I’ve devoted my profession to the event and implementation of obstetrics emergency departments in a whole lot of hospitals throughout the U.S., however I’m unaware of any hospital turning routine births into moneymaking emergency occasions as claimed within the title and deceptive argument of this text. I stand by my assertion — and my honest perception — that having skilled medical doctors obtainable 24/7 on the labor-and-delivery ground has considerably enhanced the standard of care obtainable to expectant moms at a number of the most difficult and medically consequential hours of their lives.

Thanks for contemplating my standpoint.

— Dr. Christopher C. Swain, Charleston, South Carolina

Healthcare hyper-capitalism goes simply nice

— Adam W Gaffney (@awgaffney) October 13, 2022

— Adam W. Gaffney, Boston

Taking pictures Craps?

On-line inventory brokerage homes have made all cellphones into “playing gadgets” years in the past (“Habit Consultants Concern the Fallout if California Legalizes Sports activities Betting,” Oct. 5). What a load of crap that California gaming would all of the sudden create new circumstances of habit. Cease the crap reviews.

— Matt McLaughlin, Carpinteria, California

I am already battling display habit with my 13 yr outdated boy. very last thing i want is to fret about on-line sports activities betting as he will get older. No means on #Prop27. Habit specialists worry the fallout if California voters legalize sports activities betting

— Kristina Bas Hamilton (@kbashamilton) October 6, 2022

— Kristina Bas Hamilton, Sacramento, California

Measuring Fats: A Intestine Test

Julie Appleby supplied helpful data on how trendy medication misclassifies sufferers’ well being standing by using the physique mass index (“BMI: The Mismeasure of Weight and the Mistreatment of Weight problems,” Oct. 12). She included feedback advocating using waist circumference (WC, by tape measure within the standing place) moderately than physique weight to point extra particularly the place the metabolic issues could be discovered. She’s heading in the right direction, however her article might need gone additional to discover various, extra targeted indicators of extra adiposity.

Anatomically, greater than 90% of human physique fats could be labeled into three important depots: gluteo-femoral (hips, buttocks, and thighs) subcutaneous adipose tissue, belly subcutaneous adipose tissue, and visceral (contained in the stomach) adipose tissue. Of those three, solely the visceral fats is clearly related to cardiac and metabolic problems. Elevated gluteo-femoral subcutaneous fats has been proven repeatedly to be related to improved well being outcomes. Belly subcutaneous fats tends to have impartial, benign results for most people.

What we’d like is a straightforward adiposity indicator that may estimate the burden of visceral fats. Three a long time of analysis suggests {that a} easy measure of the supine sagittal belly diameter (SAD, generally known as the “belly peak”) predicts poor well being higher than the standing WC. When individuals are within the supine place, their benign, belly subcutaneous fats falls to the perimeters of the midline. Because of this, variation within the SAD, moderately than within the WC, is extra strongly related to the variation in visceral fats quantity. The SAD/peak ratio (SADHtR) is arguably even higher than SAD alone. The SADHtR has been proven within the federal Nationwide Well being and Vitamin Examination Survey (NHANES) to be considerably higher than BMI for figuring out main cardio-metabolic threat components, i.e., insulin resistance or serum triglycerides.

There’s a easy device that researchers or clinicians can use to measure the SAD: a low-cost, transportable, sliding-beam caliper. Numerous calipers can be found, all of that are inexpensive than a high-quality scale. And the calipers are simpler to calibrate, too.

Selecting between the adiposity indicators SAD or WC may depend upon the tactic’s simplicity and replicability. Particularly amongst individuals with massive bellies, the reliability of the standing WC is challenged by conflicts between minimizing pressure on the measuring tape and the tape’s tendency to droop unpredictably beneath the horizontal airplane. For the SAD, each the examinee and the examiner can chill out because the higher arm of the sliding-beam caliper descends simply to the purpose the place it touches the stomach. No additional judgment is required.

— Dr. Henry S. Kahn, Atlanta

Now can we cease speaking about #BMI and begin utilizing metabolic scores as measures of well being? And when you’re not somebody’s private doctor, your opinion is neither wished nor warranted.

— Morgan Harlan (@baiacou) October 13, 2022

— Morgan Harlan, Washington, D.C.

Revisiting the Homelessness Conundrum

To me, there is just one resolution to serving to our homeless get off the streets and into an setting that’s secure, that can present them with meals, medical consideration, and safety, in addition to present them a method to regain the lack of shallowness of so most of the homeless (“Sobering Classes in Untying the Knot of a Homeless Disaster,” June 21). Our navy bases may present all of the above, in fact, with the permission of the Division of Protection and base commanders. I see so many efforts at attempting to make the most of resorts, condominium buildings, and the like, which are costing our cities, states, and federal authorities a lot cash that basically is only a waste of time. We have to present our homeless that our authorities and all of us actually care about them. We have to supply them the chance to settle in on a navy base. They’ve the human assets and monetary assets to actually do one thing, and in a brief time frame. These homeless may even be provided up some duties to do on the bases. Please help this effort. Thanks on your efforts, too. I feel each coronary heart cries once we see this tragic state of affairs on our avenue, and leaves us feeling helpless and hopeless for them.

— Mike Stalsby, La Jolla, California

Incredible article exploring the intersection of excessive residing prices, drug use, and coverage to elucidate the homelessness disaster in Portland. how does a lot funding yield such restricted outcomes? $36 million interprets to 1500 mini houses/RVs?

— Arielle Kane (@ariellesophia) June 21, 2022

— Arielle Kane, Washington, D.C.


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