Jason Tierney discusses the struggle involved with too little guidance when screening patients for OSA.
My Mom was rushed to the emergency room on her 63rd birthday. From there, she was transferred to the ICU for several days. This was during a spike in COVID numbers that elicited warnings to avoid non-life-threatening visits to the hospital. This was life-threatening. And an emergency.
My Dad called me with the news. Shocked but unsurprised due to my Mom’s indulgences, I asked what happened. He told me that during a routine visit, her PCP noted that my Mom’s O2 saturation was 74%. I’d previously urged my Mom to have a sleep test an incalculable number of times. She’d shriek, “If it’s a big deal, then a doctor would say something to me about it.” The doctor did say something this time. She said my Mom needed to be transported to the hospital via an ambulance. My Dad couldn’t drive her. It was too urgent.
At the hospital, they administered pulmonary function tests, a CT scan, and numerous other lab tests. Eventually they ordered a home sleep test, too. Guess what? COPD and (cue Final Jeopardy theme music) OSA.
We discussed what the next steps would likely be – CPAP, supplemental oxygen, physical therapy – when my Dad quizzically asked, “how do you know all this stuff?” I told him that it’s related to my work to which he chortled, “I thought you were a dental assistant or something like that.”
Fortunately, this event served as the impetus for my parents quitting smoking after more than 45 years, making positive dietary shifts, and getting started with OSA treatment. By “getting started with OSA treatment” what I really mean is struggling with CPAP with little medical guidance and almost no oversight. The frustration and failure my parents feel is palpable.
Note that I said “they.” That’s because I accompanied my Dad to his PCP appointment a few weeks after my Mom was discharged from the hospital. My Dad is a 65-year-old male with a history of smoking and an “I’m enjoying my retirement” happy hour schedule. There, I asked the doctor if he would order a sleep test. He confessed to not knowing much about sleep apnea. He asked if my Dad snored or if anyone witnessed apneas. I told the doctor that when visiting my parents, it’s virtually impossible to sleep in their house due to the ground-quaking snoring punctuated by the staccato horror movie soundtrack that’s actually my Dad gasping for air – trying to stay alive. Trying not to die.
Now, they both struggle with CPAP. They feel that no one is explaining things to them. Hoses and other supplies are sporadically shipped to their home with no directions or explanations. I have provided them with scripts of questions to ask the medical staff. My Mom and Dad feel like they’re being ignored or cast aside by the medical profession. At the same time, they’re reluctant to listen to me while they place deep trust in the words of a doctor – the doctor is an authority. They think I’m still a naïve, know-nothing kid wearing Underoos and riding skateboards. I keep telling them I quit riding skateboards when I was 15.
My parents visit the dentist at least twice per year. No one there said anything to them about OSA. And they don’t listen to me. But they would listen to you.
Screen your patients. Don’t make assumptions. Communicate. Someone’s parents need you. Please help them. Please.
p.s. Kudos to the American Academy of Dental Sleep Medicine for their recent position paper on home sleep testing. This stance is certain to improve access to care and likely to save lives. Thank you, AADSM.
Dr. Solveig Magnusdottir offers some more details on sleep disorders and screening patients for OSA in her article “Objective Sleep Disorder Screening” at https://dentalsleeppractice.com/articles/objective-sleep-disorder-screening/.