Father with Transient Ischemic Attack and sleep apnea not compliant to CPAP

by JC
(Sullivan, IN, USA)

Hi. My dad has been told he possibly had 2 TIA's (Transient Ischemic Attack) in 2 days due to untreated sleep apnea.


(He also has Vascular Dementia and prostate cancer, and a genetic movement disorder called Essential Tremor.)

We knew he had sleep apnea 2 years ago when he had a sleep test at his neurologist's insistence.

He tried for a week to wear the mask, but absolutely would not wear it, so we gave up on it and "Trained" him to sleep on his side with pillows behind his back (we were told that might help.)

Now, two years later he ends up in the E-room 3 times in two days due to possible TIAs due to sleep apnea.

The doctors could find no evidence of TIAs on the Cat Scans, but the neurologist was consulted and she said he doesn't need to be in the hospital, he needs a CPAP machine.

So the E-room doctor came in the room and said "Mr. Clerk, if you don't wear a CPAP machine and mask TODAY, you could have another episode and not wake up." Well, this obviously frightened mother and me (Mom and Dad just had their 70th Anniversary, so mother doesn't get very far from dad).

Dad recognizes the problem most of the time, but some times he forgets he has sleep apnea.

It's this problem that we are confused about: Does he absolutely need to wear the CPAP mask? He hates it. We stay up all night next to him and put the mask back on to make sure he doesn't die, as we were told, but it's wearing out the whole family. And it's making dad depressed and angry at the sleep mask.

He has no quality of life because he's forced to wear this "nasal pillow" (a ResMed Mirage FX). He's already broke a couple of them. It seems like all we've done the past 6 weeks is fight about the stupid mask and making him wear it.

How do we get him to keep the mask on all night? we can't find anyone to give us answers on ANYTHING.

We can't find a sleep doctor who will take us, and our neurologist dropped us.

Our Primary Care doctor takes a week to do one simple return phone call. We got our prescription for the CPAP machine from the E-room doctor.

We're floundering.

Answer


The Transient Ischemic Attack (TIA) can be caused by untreated sleep apnea. The breathing sleep disorder often causes a temporary disturbance of quality blood supply to an area of the brain, and this is the main cause for TIA and stroke.

When I say "quality blood supply" I mean normal oxygen blood levels, which should be over 94%. However, some sleep apnea patients have 60% oxygen levels, which is very serious problem, and some doctors are amazed why that person is still alive.

The article about sleep apnea oxygen level explains more about this issue.

But now we have to think about your father's treatment. I believe he has a severe case of sleep apnea, and I don't think positional therapy is enough for him.

The options will be:
With your father's age, I don't think surgery is a clever option now. Dental appliances? Well, these devices have proved a good rate of success, almost equal with CPAP therapy.

However, CPAP is the gold standard treatment for sleep apnea, you already have a prescription, and you already have the CPAP machine. That's good news!

Now, it would be helpful to know if your father have had a sleep study. Without the results from the sleep test, is almost impossible for the doctors to recommend an air pressure for an effective treatment.

So, the question is: do you have the sleep study results?

Let's suppose the doctor gave you all the information necessary to have an efficient CPAP therapy. The only thing that makes the difference in your sleep apnea treatment is the CPAP mask.

This mask can be the heaven, or can be the hell, for a patient, and there are so many people out there who hate the CPAP and the masks.

However, choosing a CPAP mask is more difficult than choosing a pair of shoes. You have to test the shoes before buying them, right? The same with the CPAP mask.

By the way, did your father tested the CPAP masks before buying? If not, here are some articles that can be helpful for a better mask acquisition:
As you can see from these articles, choosing a CPAP mask is a BIG thing, maybe one of the most important object in your house (if you have sleep apnea). So, choose carefully.

Before going to buy another CPAP mask, see if you can find why your father hates it. Similar case for the shoes: why can't I wear my new shoes? Are they too short? Too big? Don't like the material?

To see what are the most common problems with CPAP masks, please click here. It should be something here that should help your father.

Bottom line... Many people throw away the CPAP masks, because they don't know how to choose the right mask for them. But knowing more about these mask will help you tremendously to find the best one.

Hang in there! You are not alone. In fact, almost every CPAP user had problems, except the lucky ones.

I hope it helps. Don't be afraid to comment back.

Remy Thierry
Founder of Sleep Apnea Guide


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Aug 12, 2011
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Thanks for your insight
by: JC

To answer your followup questions, yes he has a sleep study, it's 2 years old, he is wearing the mask, but it's a battle all night long. He simply doesn't remember why he's wearing it or why he has to keep it on so he takes it off. He has so many TIA's due to vascular dementia and his right cartoid artery is 100% blocked, that he MUST wear the CPAP every time he naps or sleeps, which is pretty often.

He fights with the mask. Last night he tore the hose in half.

We've found a new Primary Care doctor and our first visit with them is this coming Wednesday (it's Friday 08/12/12 as I write this), so hopefully she'll have some workable solutions. I hope. Our old primary care doctor didn't take the problem seriously enough and simply jokingly suggested we use Gorilla Glue to glue the mask to his face. I wasn't very amused with her joke, either....

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