If Past Treatments Have Failed

Over half of our patients from central Ohio — and nearly all of the patients who have come to us from distant states and other countries — have already been evaluated at up to as many as six other sleep centers — only to be left without solutions for their sleep-related problems! Sleep apnea is by far the most common and most dangerous sleep disorder assessed at nearly all sleep centers. Untreated sleep apnea, if severe, causes such catastrophic complications as heart attack, heart failure and stroke. The leading treatment for sleep apnea is positive airway pressure (CPAP and its variants).

Tragically, some studies have shown that over half of the patients in the U.S. who were prescribed CPAP for treatment of their sleep apnea don’t use it with any regularity! And many patients with classic histories for obstructive sleep apnea are being told that their sleep studies did not show any significant problem–such that no treatment was recommended.
What reasons do we enounter for these tragic situations? We repeatedly note the following deficiencies in our patients’ prior assessments at other centers. Could any of these accounted for the poor results that you or a friend or family member experienced?

  • A careful history was never taken.
  • Observations of family members and bed partners were ignored whenever they suggested more serious problems than were documented during inadequate sleep studies.
  • The patients slept less soundly during their overnight monitoring than at home: resulting in both underestimates of disease severity and inadequate guidelines for treatment.
  • The sleep center assigned multiple patients per technologist: such that inadequate attention was paid to detail and to the individual patient’s needs during overnight testing.
  • Limited testing capabilities resulted in failure to diagnose such potentially serious conditions as upper airway resistance syndrome, epileptic seizures and gastroesophageal reflux during sleep.
  • There was a lack of meticulous attention to individual patient needs when prescribing treatments: whether CPAP, medications or other interventions.
  • Central sleep apneas (which occur in some 15% of patients with obstructive sleep apnea when they are started on CPAP or “BiPAP”, and in half of patients with congestive heart failure) were simply ignored because the sleep center did not offer the newer forms of therapy that would have controlled them–and the repeated pauses in breathing then rendered PAP both intolerable and ineffective.
  • When lack of attention to detail and lack of adequate follow-up support left sleep apnea patients unable to use CPAP or related therapies, the patients were simply referred for “second line” treatments that did not work–instead of the treating physician making any effort to render first-line treatments well-tolerated and effective.
  • Patients with potentially dangerous sleep problems were forced to wait for weeks or months before their sleep evaluations, and then were left without the results of their tests–and without any treatment!–for weeks or months after completion of their overnight studies, leaving them at ongoing risk of such complications as heart attack, heart failure, stroke, and sudden death in sleep.
  • There was no skilled follow-up care, support or responsiveness to patients’ needs after completion of testing: such that patients were forced to abandon treatments that might have helped them.
  • The responsible physician lacked adequate sleep medicine experience (and in many cases, practiced sleep medicine as a “sideline”).
The stakes are too high to leave serious sleep disorders untreated.