> 1.1 Continuous positive airway pressure (CPAP) is recommended as a treatment option for adults with moderate or severe symptomatic obstructive sleep apnoea/hypopnoea syndrome (OSAHS).
> 1.2 CPAP is only recommended as a treatment option for adults with mild OSAHS if:
> they have symptoms that affect their quality of life and ability to go about their daily activities, and
> lifestyle advice and any other relevant treatment options have been unsuccessful or are considered inappropriate.
> 2.4 Major risk factors for developing OSAHS are increasing age, obesity and being male. OSAHS is also associated with certain specific craniofacial characteristics (such as retrognathia), enlarged tonsils and enlarged tongue. Use of alcohol or sedatives can also increase the risk or severity of the condition. OSAHS has been reported to affect up to 4% of middle-aged men and 2% of middle-aged women in the UK. It is estimated that 1% of men in the UK may have severe OSAHS.
> 2.5 Treatments aim to reduce daytime sleepiness by reducing the number of episodes of apnoea/hypopnoea experienced during sleep. The alternatives to CPAP are lifestyle management, dental devices and surgery. Lifestyle management involves helping people to lose weight, stop smoking and/or decrease alcohol consumption. Dental devices are designed to keep the upper airway open during sleep. The efficacy of dental devices has been established in clinical trials, but these devices are traditionally viewed as a treatment option only for mild and moderate OSAHS. Surgery involves resection of the uvula and redundant retrolingual soft tissue. However, there is a lack of evidence of clinical effectiveness, and surgery is not routinely used in clinical practice.
Talking about weight loss in a thread about lack of sleep is not a derailment; it is not condescending. Lack of sleep is one cause of obesity. Obesity plays a major role in lack of sleep.
The point you are making is correct and well argued for. I also think I sucked at expressing myself and haven’t been very polite at all.
I also think that this is a much better comment than your first one. I really think one should be very careful when dragging victim terminology into this discussion or, in fact, any discussion about weight. I have been unable to lose weight for years (all the time being extremely aware of how shitty I felt all the time and the negative impact on my health) and now after I did I’m still not sure how I actually did it.
Point is, it’s not as simple as telling people to just lose weight. Because just losing weight is extremely hard and it’s time we acknowledge that. And I’m not talking about the raw mechanics of losing weight here – those are easy and work with mathematical precision (well, ok, I myself may be generalizing too much here, but for me they did: if calories out minus calories in are equal to roughly 7000 I had lost 1kg, maybe ±.3kg, though that’s probably mostly due to the inherent uncertainties of estimating calories).
It’s about psychology and accusing people of playing the victim or trying to insult them to lose weight is just not a workable strategy. It just doesn’t work. Or it may even work for some people, but I don’t think it’s in general a wise strategy because it’s plain dehumanizing.
> In the UK positive pressure machines are only recommended after lifestyle interventions have been tried.
The medical opinion in the US is that CPAP is the first-line treatment to be done in parallel with any necessary lifestyle adjustments in all cases of OSA.
> Recommendation 1: ACP recommends that all overweight and obese patients diagnosed with OSA should be encouraged to lose weight. (Grade: strong recommendation; low-quality evidence)
> Recommendation 2: ACP recommends continuous positive airway pressure treatment as initial therapy for patients diagnosed with OSA. (Grade: strong recommendation; moderate-quality evidence)
Though not explicitly stated in the paper, the general consensus I have heard from physicians here (and others in this sub-thread have stated) is that lifestyle intervention is much more likely to fail if CPAP is not initiated in parallel.
> 1.2 CPAP is only recommended as a treatment option for adults with mild OSAHS if:
I can't see the definitions of mild and severe, but clearly this is not recommending CPAP only "after lifestyle interventions have been tried" for the entire population.
I have no issues with doctors giving someone advice – but that’s really not the point here.