This delightful gentleman with coronary heart disease, in his late seventies, had developed both loud, irregular snoring and sleep attacks while driving, such that his cardiologist referred him to our Center in 1999.
His severe sleep apnea responded well for a time to bilevel PAP, with complete elimination of all sleepiness.
His health declined somewhat over the years, with a small brainstem stroke occurring in wakefulness. We recorded him again in 2007 because it appeared likely to us that his sleep apnea had worsened.
Such was the case. We found that he had developed severe Cheyne Stokes breathing in sleep (repeated "waxing and waning" of breathing effort with prolonged intervening pauses). He did well on adaptive servo-ventilation (ASV) with supplemental oxygen.
At that point in time, his severity was such that there was no alternative but to prescribe oxygen as well as ASV. We normally try to avoid oxygen therapy, since it is typically requires use of a concentrator that may weigh between 35 and 50 pounds (rendering travel difficult). Furthermore, many of these machines are quite noisy and can generate excessive heat. It is fortunate that the majority of sleep apnea patients do not require supplemental oxygen.
The patient complied fully with nightly use of both ASV and oxygen. We then learned during a routine yearly office visit that he was taking the heavy oxygen concentrator with him when he would visit his daughter in her New York City apartment. As there was no elevator in the building, this elderly heart patient was dragging it up four flights of stairs by himself!
Hence, we recorded him again for a trial of AVAPS, which had become available to us in early 2008. The machine, which is about the same size as a bilevel PAP unit, allows us to increase the patient's depth of breathing. We now have used it successfully in a number of patients to eliminate the need for oxygen therapy.
It worked like a charm. He now enjoys the use of AVAPS as a single treatment for his severe sleep apnea, without any need to continue enduring the inconvenience and drawbacks of an oxygen concentrator.
COMMENTS: AVAPS is an important recent breakthrough for patients whose breathing is inadequate to put enough oxygen in their blood. It is a variant of bilevel PAP (biPAP®) that also allows the physician to adjust how deeply patients breathe.
AVAPS is an invaluable treatment for many patients who are unable to take deep breaths during sleep--whether from spine deformities, severe obesity or muscular weakness. It also is an ideal therapy for many patients with chronic lung disease. Furthermore, AVAPS often eliminates the need for use of an oxygen concentrator with its inherent drawbacks, ongoing expense and inconvenience for travel.
If this patient's story reminds you of your own--or that of a loved one--please do not hesitate to contact us at flamenco@netexp.net with any questions that you may have. We are here to help.
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