Should she get the shiny black CPAP to match?

Anaesthesia
Volume 48 Issue 2 Page 147-148, February 1993

To cite this article: G. J. SMURTHWAITE, P. FORD (1993)
Skin necrosis following continuous positive airway pressure with a face mask
Anaesthesia 48 (2), 147–148.
doi:10.1111/j.1365-2044.1993.tb06856.x

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Abstract
Skin necrosis following continuous positive airway pressure with a face mask
G. J. SMURTHWAITE11G.J. Smurthwaite, FRCAnaes, FFARCSI, Registrar, Intensive Care Unit, Royal Albert Edward Infirmary. Wigan Lane, Wigan, Lancashire WNl 2NN and P. FORD22P. Ford, FRCAnaes, Consultant, Intensive Care Unit, Royal Albert Edward Infirmary. Wigan Lane, Wigan, Lancashire WNl 2NN1G.J. Smurthwaite, FRCAnaes, FFARCSI, Registrar, Intensive Care Unit, Royal Albert Edward Infirmary. Wigan Lane, Wigan, Lancashire WNl 2NN 2P. Ford, FRCAnaes, Consultant, Intensive Care Unit, Royal Albert Edward Infirmary. Wigan Lane, Wigan, Lancashire WNl 2NN
Summary
 
A 60-year-old woman with respiratory.failure required ventilatory support using a continuous positive airway pressure face mask. She developed extensive necrosis of the skin of the bridge of the nose. A number of precipitating factors are discussed and suggestions made to minimise the risk qf this complication.

thewriteone wrote:

The linguistic correction you are right about but it doesn't alter the facts.  While your explanation is possible, possible does not mean true.  My conclusion is equally possible.

Yes, mine is only possible, and phrased as such.  You phrased yours as fact, and a misrepresentation at that.  That's the difference.


_________________
John
CPAP'd on 18 Sep 2007
ResMed Elite S8 w/ heated humidifier
Swift II + chin strap
Pressure 8 w/ EPR

jabberwock wrote:

thewriteone wrote:

The linguistic correction you are right about but it doesn't alter the facts.  While your explanation is possible, possible does not mean true.  My conclusion is equally possible.

Yes, mine is only possible, and phrased as such.  You phrased yours as fact, and a misrepresentation at that.  That's the difference.

Frankly I don't remember.  I believe it was a legitimate conclusion to draw based on the article but then again, I do make mistakes.  I went through a hellacious completely unsuccessful CPAP titration, got almost no sleep, discovered I have not just obstructive but also central, came home, came looking for some support and got slammed for doing and posting research not in a medical office, not fabricating or falsifying data, using extreme care to avoid any potentially questionable data and not only got slammed on the basis not of my own posts even because I was at the sleep lab but because someone else asked a question about information I had offered.  I was told not to put up my research and the thread about it was LOCKED something which didn't happen to the people putting rubber cement on their faces or creating their own CPAPs out of fish tanks or any of 1000 other ridiculous ideas that are in no way shape or form "accepted therapies" because someone might ignore the warnings, misread my remarks, ignore the fact that it's an internet discussion board, mistake me for God and perform neurosurgery on themselves with a supplement as anesthesia and I would be responsible and get sued.  Now I'm not asking anyone to give a rat's *** whether or not this could be the only potential option to keep me alive til my daughter turns 18, because clearly I'm a much more dangerous providerer of information and the people who would be stupid enough to listen to my ****  probably are lots better off buying Joe's Sleep Wonder Supplements with free CPAP and if you call now comes with an eight piece fly fishing set that also cuts, dices, purees, and cures headaches for only 6 payments of not $299.99, not $199.99, no special to you today for only 6 payments of $99.99 with automatic 60 day renewals on the supplements.

So praise the lord and pass the hypocrits because I'd swear I've seen most of the people, foaming at the mouth at my audacity to try to find a way to survive and be twisted enough to share it, recommending all sorts of "unapproved" things to help with apnea other than CPAP and UPPP.

I must have made a wrong turn somewhere because I'd swear I've seen more respect and common decency in Penthouse Forum.

I hope you are danged proud of yourself for locating two errors where I accidentally misstated a conclusion as a fact.  I forgot, only "You're committing suicide" and "You will die!" and "You're killing people, you should lose your license" said to non CPAP compliant people (usually said most often by people who left their own apnea untreated until they were significantly more impaired than the object of their outrage) are allowed to state suppositions as absolute facts.  I forgot reading all those posts that the forum doesn't allow posters to make medical claims and pronounce prognoses.  

Sure does make for an interesting, reliable, objective, trustworthy source for information.  

Maybe someone can tell me when I'm going to die reading tea leaves and tarot cards as diagnostic tests and then I'd have been allowed to post my findings.  It must have been the research that made everyone upset, right?  And the grammatical errors of course.  

Now if only I'd had 2 hours of sleep last night I'd have figure it out on my own.  What a fool I am.

Why can't i sleep good with my CPAP on but i feel like i get a good nights rest with out it on?

@MWells810

Probably just not given yourself enough time and opportunity to get used to the mask and machine?  

Most of us find it very hard to get to sleep when our sleeping conditions are changed significantly -- I think a mask and machine qualify as significant change!  

I once tried an eye mask for sleep, to block light out.  It wasn't a cheapie, it was really well made, well padded and it seemed to fit well, was comfortable.  Yet I could never really get to sleep soundly with it on and would wake up more often than when I didn't wear it.  I didn't really need it, it was just an experiment so I gave up on it quickly.

Luckily for me the CPAP mask and machine have not been nearly as hard for me to adjust to, I didn't sleep terribly well the first couple of weeks but after that it was much easier to adapt to.  It also helped me that my attitude was that I *need* to use CPAP, it's not some simple experiment to see if it helps.  I think the key is perseverence in wearing the mask every night even if you're awake half the time.  Also looking for any tricks that will help make the mask and machine seem less intrusive.  There's lots of help on this forum for ways to do that, scattered throughout numerous posts.  

Hope this helps, Blessings,
--pseudonym

I was aware of the face trauma report and other contraindications for CPAP such as in cases of barotrauma.  Yet again, if a competent sleep doc. is involved, they would have enough experience and knowledge to know that you don't use a CPAP if there isn't a patent airway.  Do you really think that these extreme cases are the norm for the thousands of people who use a CPAP?  I have a list somewhere of these contraindications for extreme cases.  And I did discuss that we have two posters we have had with ear problems.  Thousands more have posted who don't have these issues. Are you afraid to go out of your house and live a great life because of the minuscule possibility that something bad will happen to you?  This is what is known as risk/benefit.

You are suggesting people give up their CPAPs for a completely hypothetical treatment without any study or efficacy assessment.  We are not censoring you, we are making sure people get adequately treated.  To not do that is irresponsible.  There is another similar thread about a treatment which may improve apnea.  That treatment is even more credible because it has a study and publication.  Just like with you, we tell people not to give up their CPAPs until their apnea status is assessed by a sleep study.  And I am collaborating with those people to disseminate that information in a responsible manner.  You can find it here, so we do not censor potential methods to improve apnea while continuing to use CPAP therapy.  We stop those kinds of posts when they are presented in a way which makes people think that those are safe and studied valid methods to use instead of a CPAP.

And thanks for posting Dr. McNicholas's email address.  I wrote him for clarification about the CPAP treatment and AHI discrepancy.

Vicki


_________________
That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

Vicki-

I would be happy to discuss the legitimacy of my research as well as several other matters.  Unfortunately I have been warned about posting such on here and I cannot send you a private message as the function was disabled.  

If you care to leave me a private message with an alternate email I will respond there.  

Don't believe everything you hear.

Vicki wrote:

And thanks for posting Dr. McNicholas's email address.  I wrote him for clarification about the CPAP treatment and AHI discrepancy.

Hi to all,

Vicki, thanks for making the inquiry. I am interested in that info, as it's difficult to draw any conclusions from just the short version. I am not sure that AHI data is a discrepancy. If people died, then possibly their AHI data was removed from the range. So, if more people in the untreated group died, and they had high AHIs, then wouldn't one expected outcome be a lower median in the untreated group?

Based on what I have read, I would expect that the AHI would worsen in both groups over time. So I would be interested in knowing if they noted the change in the average AHI for each group.

Guest MJ,

That is an interesting supposition but the groups were calibrated to be equal.  Also, it specifies that the deaths and cardiovascular events was higher for the non-CPAP users than the CPAP treated users, which would skew the data in the opposite direction if your suggestion was true.  In fact, if your theory was true wouldn't that suggest that the increase in hypopneas was even greater for the CPAP users than suggested by the study?

The study suggests that CPAP treats the oxygen flow as planned but that it may aggravate the underlying problem.  My suspicion is that sluggish responses in the airway are worsened by atrophy because the CPAP is doing all the work.  The CPAP might also be causing damage to the throat muscles and undermining the nerve signals which atrophy with lack of use.  The body is very efficient at modification to surroundings and CPAP creates a chronic altering of the airway.

In short, it's always risky to mess with Mother Nature, sit in a chair all the time and you will weaken the leg muscles.  Use it or lose it right?  Any doctor will tell you that.  Why would throat muscles be immune to the basic laws of physics?  Now if CPAP was a temporary fix this might not be significant but anything used 8-10 hours a day for life is going to have some effects.  This is probably why CPAP is not recommended for mild to moderate apnea unless there is significant impairment.  My suggestion is not proven but may be why the dirigeroo (sp?) is working and in fact, the principle behind the dirigeroo is the same basis on which I make my suggestions--exercise strengthens weak muscles.  CPAP, a passive aeration device,  does the opposite.

This train wreck is over.  


And to any future "thewriteone's" We do not allow the advocacy of unproven treatments that put people at risk because they are not being treated with a PROVEN apnea treatment.  So if you are trying to sell your new wonder vitamin, bug zapper, cane tips down the throat or what have you, you will find that you will not be welcome here.

I am sure we will get attacked and slandered that we are in the pocket of x, because we didn't allow someone to suggest a non-proven therapy, but we are not the experimental sleep apnea forum, we are the American Sleep Apnea Association with the designated goal to reduce injury and illness, not cause more.

Thewriteone,

This is blatantly false information.  CPAP therapy is recommended for any degree of apnea.

thewriteone wrote:

This is probably why CPAP is not recommended for mild to moderate apnea unless there is significant impairment.

Vicki


_________________
That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.