How I think sleep apnoea should be treated
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- čas přidán 9. 06. 2024
- I explain (and also occasionally rant about) what I am trying to achieve by trying to help people with obstructive sleep apnoea. I want to show what my goal is and how I think sleep apnoea treatment needs to change otherwise slowly patients will disengage from medical services.
I also talk through step by step what my process is with helping people with sleep apnoea. I explain why I want people to use CPAP and how I eventually hope to get them off it again.
I hope you find this video useful, Merry Christmas everyone.
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0:00 Introduction
0:19 What doctors think of sleep apnoea patients
1:27 How people think I treat sleep apnoea
2:08 Sleep studies
3:03 Why I try to avoid in Hospital PSG - Home sleep studies are better
4:07 Drug Induced Sleep Endoscopy
6:20 Multiple levels of obstruction
8:01 Blood tests
8:24 Case example of how I treat sleep apnoea
11:16 How many people use CPAP
12:45 Why people lose weight with OSA treatment
17:02 What about snoring?
21:12 Being a doctor or just following an algorithm
23:21 I apologise to patients - and start ranting
26:17 Conclusion
** Disclaimer - The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional. ** - Věda a technologie
I'm a former OSA patient of Mr Veer, and so is my mum. Both our operations with him were different, I had large tonsil which occluded my airway when asleep which he treated with a Uvulopalatopharyngoplasty (UPPP), and she had a large tongue base which was treated with radio-frequency ablation to shrink it. Both operation were very successful. I no longer suffer from OSA; no more brain fog, waking up with headaches, being moody, poor concentration, and painful joints/ body aches. As far as I am concerned, my quality of life and that of my mum has been tremendously improved thanks to Mr Veer; he is truly amazing and I cant say enough positive things about him.
What was yours and your mum's AHI before each procedure?
Very glad you are both well, thank you for writing in.
OMG, this is exactly what I want! Congratulations on your recovery! 🙏
Where are you located
@@kapalhill1823 West London
My experience with the American medical system is they do a sleep study, Rx a CPAP and send you on your way. Its complete rubbish.
I'm sure you'll be able to find someone there who might interested to take you on. Good luck!
Same in Canada. I’ve been struggling for 5yrs now and still can’t use cpap. No hope here ans im so desperate. I hope there will be something coming up because this thing is life threatening and I don’t know what to do
They do this because it has been established that insurance will pay. Another example of this is butchering the stomach to treat obesity.
Same in the UK!
Yes. Same thing here in South Africa
Wish I could find a doctor like this in the U.S.
Interestingly, I was first diagnosed by a US doctor via an email conversation in 1997. Totally on his own time, so they are out there. Not confirmed by the NHS till 2003 & not treated until 2007, so it's very variable wherever you are I guess.
In 2007 that particular Drs view was I was fat and that was that. I lost 40Kg & it made no difference...SATS 71%...fixed in the main by BiPAP & a different Dr (didn't get on well with CPAP).
Wish I knew this sooner- just got the inspire surgery- not activated yet- only have mild sleep apnea. I believe snoring can also come from
Stomach problems- gerd and such but that was not explored. Medical society doesn’t understand that issue well yet either
Dr Zaghi at the breathe institute
I have chronic OSA and been on a CPAC for 8 years. All that was don't was three sleep studies and then came the machine. No follow up ,no other test,no look down the throat,no other evaluations. Just you have it here is the machine and use it for the rest of tour life. Now I have a weak esophagus, bad acid reflux, sleeping issues,headaches and my teeth are in a diffrent position everytime I wake. I've only seen the doctor once and I'm told to lose weight. I lose weight and he tells be I still need to use the machine. Phillip had a recall on there machines ,several years ago and I still haven't recieved a new one and the CPAC machine cause cancer per phillips recall reason. I feel Iike this machine is why I have spams in my esophagus but no one will confirm it or treat nor explore the possibility. I still have brain fog , headaches and fatigue. 😢
Ditto. It’s not a matter of finding a doctor that’ll prescribe a sleep study, it’s being as deeply knowledgeable and as thorough, not to mention being in close proximity to that individual. I also like that as a surgeon, going straight to knife is not his first thought. I know I’m over simplifying greatly, but this is a nice benefit of being in Europe, it’s akin to us yankees going from one state to the bordering state.
I love your philosophy. I just turned 57 last month and have been watching your channel since late last year. Last year I was on the Keto diet for 6 months and couldn't get below 183 lbs. and that is with swimming 3-4 times a week for 40 minutes. My friend said if I lost weight I would get rid of the sleep apnea. WRONG I started a new Job 14 months ago that has great insurance. My sleep study showed I was having 72 apneas per hour and Oxygen was in the 70's. My primary care Dr. was speechless. I saw an ENT, I said yeah I know I need to lose weight. He said your weight has nothing to do with this, but since I started using a C-Pap and showed him my numbers that were between 5-10 apneas per hour he said to continue. It was very difficult in the beginning and I already wear a night guard for teeth grinding. I have to say it took about 5 months to get used to the C-Pap. It did give me terrible anxiety in the beginning to go to sleep. I had to mentally give myself permission to take it off at any time during the night. Once I did that I began to be able to leave it on longer. By April 2022 I weighed 195lbs.at my well needed foot surgery. By July I started noticing my weight was finally starting to drop. I noticed sugar and caffeine cravings going away, as well as allergies. Before the Cpap, I was using a Netti Pot daily to help me breathe better. I haven't needed to use it in a month and allergies going away. I feel my immune system is getting stronger, because obviously I sleep better. Since April, I have been weighing myself weekly and have been losing 3 -4 lbs a month without really trying. My only exercise has been walking the dog a couple times a day for 20 minutes. I am now down to 174 lbs. Woo Hoo! It's been 3 years since I weighed this. I still find myself getting better sleep all the time. Last Saturday I got 9 hours sleep. Last night was 7 hours sleep and it said the AHI was .6. My AHI is now averaging between 1 and 2 per night. It's amazing how sleep apnea really changes the body chemistry. I feel like I'm climbing out of a rabbit hole, and my health is getting better all the time. I appreciate your videos. Wishing you and your family a Merry Christmas and Haooy New year
Happy New year!
@@donnalang5105 happy new year :) I started the apap therapy with 61 apneas per hour, and now it's 0-1. I weigh 300 lbs though. I'm really struggling with weight loss. I have high blood pressure and I'm prediabetic. I try to walk an hour and a half a couple times a week and watch what I eat, but I could do better with dieting. Kinda need advice on dieting.
Amazing story, so glad you managed to work this out on your own. I think this is inspirational. Merry Christmas and Happy New Year to you too.
Ive watched a few of your videos. Very informative. Thanks. I haven’t seen one yet where you mention jaw surgery as a possible option. Do you sometimes see a need for MMA if tonsillectomy, septoplasty, turbinate reduction or MAD or CPAP don’t work.
Please have a look at my video on how successful is surgery for information about MMA
One of those rare doctors, that understands what it's like for a few patients who can't tolerate CPAP. Keep up the good work Dr Veer.
Look into the BIPAP machine, might be a lot less jarring to use...
🤲🙏🌷
The NHS needs more great doctors like you.
So does the USA!!!!!!!!!
Also Canada.
omg, a specialist who is also a scientist. not simply applying the cookie cutter approach but seeing patients as individuals, and taking great care to make an accurate diagnosis! incredible, and sadly far rarer than you should be, doctor. I will be sending this to my sleep specialist, who, frankly, is inferior to google at this point. thank you for your sensitivity and your enquiring mind, and finding the balance between following evidence based guidelines while leaving the dogma aside. thank you!!!
All doctors should be like this. Thank you!
This video made me feel like crying. If I had a lot of money I'd fly to England just to see you. I live in a wealthy state that has health care coverage for those who are low-income like myself, in a country that supposedly has some of the best medical schools in the world. And yet it essentially came down to giving me a CPAP and abandoning me (and acting like it was my fault) when I couldn't use it. None of the things you're talking about were addressed. I guess I need to go back in and make them address these things. I had given up, thinking nothing could be done and that I'd just become more and more sleep-deprived as I get older with the attendant health issues. I can't even tell you how angry I am. What good is it to have all this information if it doesn't inform the treatment people need to get better? The system is so very, very broken.
Let me guess….are you in California? That was my home state. Glad I’m gone.
I'm in the UK and my experience is just the same as yours. Every 6 months they change my settings but nothing improves. My stats are terrible. They've done something so I can't see the stats anymore and telling me they are fine! Now I am developing heart problems.
@@medwayhospitalprotest when the world changed over to 5g all of the machines stopped transmitting. Mine did. Resmed doesn’t care and dr says they started asking them to fix it, but they won’t. And don’t care. They are making massive $$$ off of us. I feel like you on this. I get blown off by the pulmonary dr. I lost weight on my own. Was doing well when I took meds for sleep and back pain. I’m off most if the meds, did better for a while but the stress on my body is mounting up from the stress of our world situation. Been off the machine but that is all they want to do. This dr is ignored here.
The sleep apnea surgery removing tonsils, adenoids, uvula, and excess skin in the back of the throat can permanently remove sleep apnea for patients, so that they don't have to wear a CPAP and don't have to continuously have return visits to their doctor.
It worked wonderfully for me, and I wish I had gotten it done years sooner. I no longer get sinus infections or ear infections after getting this surgery, so that was a bonus benefit.
I feel your pain dear. I’m the same.
I became a bit teary-eyed when you said sorry to those who were let down by medical professionals. I am part of the 30% that can not use a cpap machine and feel like I'm not being heard. The headaches and pressure in my ears from the cpap are horrific and worse than the symptoms of the sleep apnea. I'm getting fitted for an oral device now. Nobody has ever looked at my throat, nose, etc. and I'm just being checked off the list of what's next. I wish more doctors were like you and truly wanted to help and not just check off a box of tried this or that.
im in the same boat now and i have severe sleep apnea and i cant deal with the cpap i tried for a whole month and im giving up it has givin me soo much symptoms of aerophagia it isnt even funny and anxiety so ima try the oral appliance and going to see a ent doc to see if i have a deviated septum or any other bloackage
@@kevOzilla how are you now?
Hi Vik, I love your channel this may sound a bit over the top but I wholeheartedly believe it’s saved my life. Your videos helped me understand that I had sleep apnea and able to talk to my dr even though she only did a epworth test and told me that my score didn’t reflect that I had sleep apnea. So much so I paid for a sleep study myself where it was confirmed I had server obstructive sleep apnoea. I also paid for an ENT consultation where I was told just I had a deviated septum and I needed to loose weight to help with the snoring. I then took my private report to my GP where she referred me to sleep clinic where I had another sleep study and I was told that my AHI was 123.7 per hour, and that I qualified for CPAP but the clinic that did the study wasn’t commissioned to provide the treatment and there is an understandable waiting list. So in the mean time I purchased my own CPAP machine and within three days of using it everyone around me said I was my normal self again it was honestly like I was seeing colour again. Even though I don’t find it comfortable to use or look forward going to sleep if that makes sense, but it works so for now I will just put up with it I guess. I’m still waiting for my appointment since the last one back in may. I am so glad that I watched todays video as I recently had an appointment with an ENT consultant where he told me that there wasn’t much treatment for sleep apnoea other than a tracheotomy or many different operations that would inevitably lead to one. However I feel as if I can go back and ask for more and not just take his word for it and not be treated unless it an extreme measure. I really wish you were my consultant. It seems like it’s taking a while for the advancement of treatment for sleep apnea to reach the clinics and doctors up in the north west. Thanks again for all your videos! (P.S sorry for the long story)
It was a great story, thank you. I hope the North West catches up. I was trained in the North East and so a lot of the practice there is transferred across to the lakes. I hope you get to the bottom of this. keep going!
123 AHI per hour that’s really bad. Was that all on your back or on sides too
@day161 Great story! Glad you’re better! We could use Vik clones here in the rural middle of New York State!! He seems brilliant, and a true physician-compassionately giving us important information, when doctors we’ve consulted haven’t been helpful.
Yes we’re neglected here in New York
Dr. Veer sounds so wonderful. I’m in rural south, USA. I don’t think there’s any doctors here who are as knowledgeable. I wish we had someone like him here.
Yours are some of the most helpful and encouraging videos on CZcams - If only all doctors were trained to explain so well....you seem to really understand the patients experience and offer wonderful medical advice....with humanity. I'm counting down the days to my appointment at the Royal National!
What a credit this Gent is to his Profession
Thank you so much for this Video. I have felt my whole life terribly tired and started to gain weight so much. At 39 finally they found after a sleep study I got very severe Obstructive Sleep Apnea with an AHI of 100 my oxygen level dropped til 68% extreme fatigue and still kept on thriving with everything in life. Docs were in shock how I did it all. I now am almost a 3/4 year using my Cpap machine, and I feel tremendous and slowly better. I even set my father to do a sleep study as well at the age of 76 and he had the same as me. AHI of 45 but had several strokes heart problems and alrzheimer now even due to never being treated. It's never too late to start using a Cpap machine. He already as my self is more alert and it really shows off. Never give up you all. Much love.
Great caring doctor who takes many good additional steps to treat patients. On the other hand, many other doctors are robotics, they spend a quick few minutes with patients and then provide the verdict 'you got this health issue and here is your prescription'...
You are absolutely right about the mental trauma that the medical system put a patient through. I was told I was just too fat and wanted attention - right to my face only to be diagnosed 6 years later with pain cause by an error in surgical procedure. Undiagnosed with OSA for 10 years plus. When retested rousing 69 times / hour. You carb load to try to get some energy! But I am just a fat slug who is causing my own hell and deserve contempt. Bless you for your compassion.❤ It has done my heart good.
I've started protesting outside my hospital because I just can't get any help. Now I'm developing heart problems. Same as you, they tell me its my own fault, but they do nothing except tweak the settings every 6 months and send me away again. I am 100% compliant with CPAP.
@@medwayhospitalprotest I am so sorry. Wishing you restored health and compassionate care.❤
@@medwayhospitalprotestis it possible for you to lose 10 percent of your body weight? Recent research has proven that doing this alone cured 85% of those who were diagnosed with atrial fibrillation (a major correlation exists between sleep apnea and atrial fibrillation and heart issues).
Kiaorana from New Zealand, I use a CPap machine, it does help, I just finished watching this video from Vik Veer, what a good man. I can see his genuine desire to help people resolve their issues, without harm.
Keep up the good work and other practioners will follow.
God bless us all in our journey to fulfill our potential and love one another as Jesus loves you
It's amazing that we have someone like you, offering people with sleep apnea hope.
As a former paramedic and current osa sufferer, I’d like to say thank you for your pragmatic and holistic approach to this problem. I was left feeling angry and insulted after being told by a consultant that I was ‘non compliant’ in my cpap use. They made literally no attempt to understand WHY this was the case. 18 months on I have improved but really in spite of, rather than because of, that consultant!
This is incredibly useful. Stumbled across your videos looking up Myofunctional therapy, as I've had a SA diagnosis, with CPAP treatment for over a decade, as well as a septoplasty, and am still suffering from very severe insomnia and fatigue. Really great to have my intuitions about the inverse link between weight gain and SA confirmed, as well as hear some of the frustrations I've experienced as a patient (in Ireland unfortunately) be validated. You're doing an incredible service to people in severe distress here. Thank you so much for taking the time to create these and share your perspective.
The world is such a better place with amazing people like you. I admire and am grateful for your loving contribution to helping people.
Thank you. Hearing you speak on this video makes me realize I'm not crazy! I live in the US so I can't visit you for treatmeant I'm just hoping there is a doctor in the new york city area who thinks like you. I'm so sick of doctors just having 1 approach. Its either a CPAP or an oral appliance and if it doesn't work its my fault. Keep doing what you are doing you are changing peoples lives in ways you will never know.
Thank you very much. I've followed your videos. My snoring was hard. In the end I got luckily diagnosed and now I use CPAP. I struggle but I'm very happy with it. You shed light during a very confusing time for me. Again thank you.
I've just found your channel and what you explained makes 100% sense to me and I'd be grateful to be a patient of yours
I'm on my second month of CPAP and to be honest its changed my life, before I was diagnosed I woke up every hour now I'm able to sleep 8 hour straight. I also have COPD Asthma overlap which has improved a little since starting therapy.
Thanks so much for the video is so informative and have now subscribed.
I absolutely love your philosophy and how you stick your head above the proverbial NHS parapet. You actually give a damn about your patients and you stick up for them and that’s a rarity. Good for you! My husband is on the waiting list for surgery with you and I know he’s in the best hands. Thanks so much for sticking to your ethics and throwing the proverbial middle finger to the iNsTiTuTiOn and doing what you’re so good at.
Thank you so much for being an excellent thoughtful intelligent and sympathetic Doctor...the world needs more like you... I thoroughly realize how hard it is to become a doctor and to stay in the profession in these trying times..you all need to support each other and to be the excellent human beings that you are for wanting to help people by becoming doctors!
Brilliant explanation as always Dr. Veer. OSA is multifaceted. You are such a great communicator, so knowledgeable and have great compassion for your patients. LOVE YOUR WORK!!!! Thank you for being you.
Your video has summarised perfectly the way I was treated before being referred to you at UCLH. I was made to feel that being slightly overweight was the main cause of my sleep apnea and snoring despite me explaining I had this problem when I was 3 stone lighter 40 years ago! I was given CPAP and then not offered another option despite me explaining that I was finding myself unable to tolerate it. I googled my issue and came across your work and I saw you privately. You very kindly suggested that I could ask my doctor to refer me to you on the NHS. They were reluctant to do so suggesting I could have something done locally. I am so glad I insisted and I was referred to you. I am due to undergo some further procedures soon and your approach to me is exactly as you described in this video. I can only offer my sincere thanks to you for not only the way you have listened and treated me. I now feel part of the process. Like others on here I am extremely grateful for the very informative content that you regularly post. Thank you😊
Glad you feel you are on the right path. Looking forward to catching up with you in the new year.
Kevin, I’m jealous you got to see this amazing well informed Doc. I know here in the states we still have some good doctors, yet sadly most are under the thumb of the hospital and or Medicare. Our government has stepped in between a doctor and their patient causing depression on all sides. I’ve been in the medical field for 40 years and have watched doctors who love their jobs and patients become depressed and angry, many have retired or are doing something else.
Hi Dr. Veer, great video. Also, thank you for reviewing the iNap which has been great for about a year and has replaced my cpap. I'm younger, physically fit, and was having issues with high pressures making cpap difficult (UARS). We need more docs like you in the US.
@nonamdsl3f7duuude We definitely need more access to docs of Dr. Veer’s knowledge and compassion in the U.S.! I can’t find a specialist like him. Best wishes!
the Breathe institute is in the U.S. Dr Zaghi
Please do not stop what you are doing. It is so valuable. Thank you for your commitment and care. If all doctors showed your level of concern I suspect that patients would be better able to help themselves.
Wow, a doctor who actually has compassion. How rare you are!
I’m one of those people going down “that” route, and it is a real challenge. My CPAP trial felt tortuous to me, much to the disappointment of my doctor (he was polite, but you could hear the annoyance in his voice).
This is a very humanistic approach to this all, and it helps just having you walk through your professional approach as I can then gauge my experience as someone who is new to all of this. Thank you.
This video is so helpful! This big-picture explanation helps immensely. I have felt discouraged, but this video clarifies that improvement is a process, and that there are a multitude of options that can help. I also appreciate how it is pointed out that weight loss is more difficult when a person is not sleeping. It's easier to work on the problem when one can set down the feeling of failure, and focus instead on what is possible.
Thank you for your message, I'm glad that it helped.
@@VikVeerENTSurgeon dr from what I have learned if nasal breathing isn’t corrected everything else goes wrong ,
What a fantastic approach to diagnosis. You are inspirational. ❤️
I love your rant!
You've given me hope that there might be life beyond CPAP 🙂
Thanks so much!
Subscribed!
Excellent video! Sedation to observe areas that potentially obstructing breathing etc. I'm really impressed with your thorough exam. I use CPAP and over weight. Went to clinic for sleep study but didn't have exam anything like that. I'm so tired of my CPAP but without I immediately start snoring and wake up tired, headaches.... You know the drill
I can’t say thanks enough to you sir! Thank you for doing this video!!
My pleasure!
Thank you Dr Vik for giving so much of your time and knowledge. You are so kind and a real gentleman. x
Hi Vik, thank you so much for posting this video. I am currently being referred to carry out a sleep study (I went to the GP today). I believe I've had sleep apnea for a few years now but have always put off getting it looked at. This is partly because I never want to go to the doctor and a general lack of understanding of how detrimental it is to your health. As you were talking it was like pieces of a puzzle coming together and it's made me realise I need to take charge of getting it dealt with. I have a young son and I want to live to see him grow into a man, not lose his dad at a young age. I will ask my GP to refer me to you and really hope you can take me on.
Wow! I agree with everything you are saying. I have been fighting sleep apnea/snoring for 20 years. I have gone through 3 sleep studies and been fitted with 2 different CPAP machines. I have also lost 70 lbs. (current weight is 115 lbs. and 5' 2" tall). I gave up trying to use the CPAP. I would wake up gasping for air and constantly fought with the mask leaking air. I no longer snore every night, but sometimes it is still very loud and keeps my husband awake. Your approach makes SO much sense to me. It is too bad that I live in the USA.
Sounds like you are making good progress, keep going!
Just be aware that not all of the UK doctors are like him. As he said, people are generally being told that they must use their CPAP and lose weight, and that their weight is causing their SA, and not the other way around. It is difficult to find good doctors and treatment in countries with socialized medicine.
I lost confidence in the medical profession completely during COVID, and I'm unhappy that our freedoms in the US are being usurped, but I think it's sad that you think it's unfortunate you live in the US.
(Here's to hoping freedom is restored and protected here.)
And yes, wish there were more doctors as intelligent, compassionate, and understanding, and as good at teaching as this gentleman.
Doctor's and surgeons are heroes and deserve so much more respect than they get.
Wow, very systematic and a great approach. You are exactly the type of Doctor I have been looking for. Please keep up the education videos and sharing of all your knowledge. Unfortunately, I’m in USA and most Doctors are in for the money. You have a desire and compassion with patients in what you do. Thank you👍🏻
Thank you for caring about your patients.
it's kinda my job, but i'll take the compliment, thank you.
you hit the nail squarely on the head. - national guidance-. too many doctors just follow the flow chart and off to the next patient. medicine needs to be personalized to the needs and circumstances of the individual
You seem like such a genuine and caring doctor, I wish that all doctors were like you. I live in Sweden and I suspect I might have OSA but am so scared to go to the doctor because I don’t want them to point the finger at me and tell me to lose weight. I have a history of EDs and have worked really hard to be neutral and ok with my body. I wish I could see someone like you that I know would actually try and treat the problem. Here’s hoping my experience goes well in the future, this information is invaluable tho, and I’ll definitely look through some more of your videos in preparation to speak with my doctor 🙏🏼
I wish I could visit you Doc! I test negative for Sleep Apnea, but have every single symptom. You are doing great work for humanity, and for our spouses!
At last someone who really understands
I got diagnosed with severe sleep apnea AHI of 32.4 and the lowest oxygen level of 82%. With the CPAP my AHI went to 61.7 and my oxygen level dropped to as low as 62%. Not everyone can tolerate CPAP. Thanks, doctor for putting all this information for free online. So manydoctor don't know what to do when CPAP fail.
my ahi was 61 and now it's 0-1 thanks to apap.
Glad that it helped. out of interest did they diagnose trapdoor epiglottis? it often gets worse with CPAP.
@@VikVeerENTSurgeon The epiglottis was fine. The DISE revealed that it is a combination of the soft palate, tongue base and lateral wall collapse in the context of a narrow airway. The CPAP ahi were all detected as central (all my ahi were obstructive during the initial test that diagnosed my sleep apnea). Due to a deviated septum, my nose airway is really narrow and blocked most of the time by allergies. My specialist has suggested the MMA surgery as the only realistic option. For now, I sleep in a recliner which helps enormously.
Thanks again for all the work you do.
@@martinmatte7597 how do you sleep in a recliner? Does sleeping semi setting help?
Martin have you tried a boil snd bite. It worked wonders for me for a week then stopped working as not gripping teeth as much
Fascinating, thanks for this breakdown. I have been thinking about this for a while, but it's so difficult to know where to start in dealing with the problem. Information is often the key in life. Subbed.
Subscribed! Been on CPAP for 4 years and I'm fed up. Gained weight, sleep worse etc. This is really helpful content. Thanks!
Hi Vik, great video. Thanks for putting this together. I’ve been fortunate (unfortunate depending on how you view things) to have been receiving NHS treatment on several lifelong health problems since I was little. However, as an adult it is sad to recognise that very few doctors take the clear, considered and logical approach to diagnosing problems (that often impact on other areas of the body/ other specialists’ areas of expertise) that you do.
The answer from many doctors is that the test results are in the ’normal’ range and therefore there is no problem, even though you still feel terrible. It is only when you push for the ‘we don’t normally test this’ blood test, or go private, that the answer comes back with something that shows a reason why you’re feeling unwell.
There is definitely too much silo thinking and a lack of a thorough diagnostic approach with doctors in the NHS today. I would hazard a guess that better diagnosis and different specialists working together would produce a better outcome for patients and would be cheaper for the NHS too.
Have a great 2023 and keep up the good work.
Regards
Jim
Thank you for commenting, and happy new year
I used the same cpap mask for 9 yrs, without a problem, the model was discontinued. Got a new mask about two months ago and I can’t believe how bad it is. This new model is a common style and I don’t think there is any others that would be better, plus they are expensive to try options. I can’t sleep without one, my throat closes as I fall asleep and jogs me awake even when sitting. I wish the mask manufacturers would design better options. Good to hear a surgeon looking at other treatments besides ops.
Love your approach to find the root cause and least invasive treatment. Thank you.
Thank you so much Dr Vik, its most appreciated...Excellent presentation!
There should be more doctors like you. My original pulmonologist made me feel like somehow it was my fault that I had severe anxiety with CPAP. The mandibular device wasn't an option because of other issues related to TMJ and the severity of my OSA. Not once did that doctor review if my nose was blocked or what was really causing the issue. She basically said I have OSA because my neck is short. Which is not medically accurate. I have an obstruction caused by my tongue and have been very successful with Inspire. Thank God I didn't stop with her. I wanted to feel better and kept pursuing more information. I now am very rested and no longer require hypertension medication and my glucose levels are now very normal. This is a silent killer if left untreated.
I read if inspire can trigger incorrectly it can make your tongue dart out uncontrollably
I absolutely love your attitude you really seem to have a good heart
Thank you. Really kind.
What a great Dr., your patients are blessed.
@VikVeer, you are truly compassionate as well as helpful in this educational video.
I wish you were my ENT.
The ones I've seen here in America have been atrocious.
And honestly your rant at the end is one of the most refreshing and important things I've heard a western med doctor say in a very long time.
I'm glad you liked the video. I hope you find someone who can get to the bottom of your problem.
After a life time of stuffy nose at night I finally worked out that eating sugar after 5pm was the cause!!!
Babble all you like, it's so nice to hear a Doctor who really cares & Genuine. Thank you so much 👍
We definitely need more doctors like you in the world. And cool Gizmo pin!
I’m in the US and in Boston with our best hospitals in our nation. This doctor has just given me confidence and I feel less depressed about my sleep apnea. No one has described my condition so well and his compassion is uplifting. I now know how to go back and talk to my doctor and ask the right questions. I’ve had sleep apnea for 3 yrs now and I finally understand. Thank you I don’t feel so hopeless after watching this video
Exactly, we can use some of his language to get through to him. I think I’d ask to send the doc this video.
If you find a good doctor in Boston will you post? I am looking for my adult son with Aspergers who has just been diagnosed with Severe Sleep Apnea (83 AHI/hr). I don’t think he is going to be able to tolerate the cpap, and that is all that was presented as an option.
I live in the Boston area. If I find a good doctor, I will post it here.
Excellent video! Most people even physicians don't understand sleep apnea, "how can you be more tired when you wake up than you were before you went to sleep?" I've been using a CPAP for 12 years now, a nasal prong mask. Not only did the quality of my sleep slowly improve my allergies (dust mites) were immediately so much better and my reflux improved too.
Thanks for sharing!
So kind of you to share all this information Dr. Veer. Amazing video.
I live in the U.S. I have been using cpap since 2018. It is a struggle every night and anxious to go in my bed. It is the first time someone explain very clearly sleep apnea. I wish I can be treated by this wonderful doctor
My sleep study showed only mild apnea although I felt that it was disrupting my sleep to a high degree. Based on reviews and information that you have provided and also other tips, I have arrived at the nightly routine of a combination of a nasal decongestant, a nasal strip and a small piece of micropore tape in the centre of my mouth(leaving a small gap so that I can still breathe a little through my mouth). I sleep much better and only get up once during the night instead of three times. Thank you for all your help.
Great to hear, thank you
Brilliant commentary and not only offers medical insights but speaks to the critical issues with doctor-provided care, especially in the USA. I did a sleep study, and it showed my sleep was pretty terrible getting about 5 hours but at the time I didn't have sleep apnea. The "MD sleep specialist" said I didn't have sleep apnea so there was nothing to be done. Unfortunately, I've found very few doctors that seem to be motivated the genuinely help a patient, probably 15%. I wish more had this philosophy and indeed something critical is missing in medical school. Doctors in the USA seem more concerned with insurance company guidance than providing care as well. Alas!
I don't know the American system, but it sounds difficult to negotiate
I came across this video while scrolling. As a former RT, this is the best video I have ever watched. Lately I have watched more, for lack of a better word, ignorant, videos suggesting taping your mouth shut, stooping the use of CPAP, stating there is no such thing as sleep apnea. One video was done by a wood craftsman who suggested you tape your mouth shut with painters tape, then showed how his oxygen sets improved with his apple watch! I literally screamed. I wrote a comment stating how irresponsible he was, but people believe these snake oil salesmen.
Having watched patients struggle to live a good quality life with sleep apnea, then seeing the change a CPAP or surgery can do, I'm so grateful that you are doing these!
Thank you!
Hahaha, it can be frustrating but I hope I am helping a bit.
This is an amazing video -- life-affirming and energising. I have fairly severe OSA which has been partially addressed by previous interventions but is still a problem. Mr Veer's channel has made me realise that I should -- and *can* -- do more to address the issue and hopefully improve it! Awesome!
The part about wanting to do a sleep studies in peoples own home/bed was interesting. I did my sleep study that way, and it was still deeply flawed. With all that equipment hooked up to me, I wasn't able to sleep well at all. I can't remember for sure anymore, but it may have also prevented me from sleeping in my preferred sleep positions, or at least made those less comfortable. I can't really fall asleep on my back for some reason, or at least it takes several hours of trying and me becoming extremely exhausted to be able to. But after I fall asleep, I tend to roll onto my back in my sleep. Then when I'm on my back, I breath a lot worse and snore a lot more. It's almost like some part of my subconscious knew this and was trying to prevent me from sleeping on my back, but after I'm asleep, that part of my subconscious is no longer active or no longer able to affect my sleeping position. I have tried various contraptions that are designed to prevent you from sleeping on your back, one of them having at least decent success, but none of them being all that great. They are all somewhat painful to use. Also, sleeping on your side is somewhat painful, I mean it puts a lot of pressure on your shoulders, so I don't like to just stay in one side position for too long, even though sleeping on your side is the best for reducing snoring.
I am so grateful to you for offering such clarity and compassion. I am female, 77 years old from the US and I have used a bipap for decades. Within the last year, I have developed a very difficult sleep pattern, waking up frequently and getting just under 5 hours sleep every night. I was recently diagnosed with COPD and I am part of the Alpha 1 study (I have one active gene in the pair and one that seems to be on vacation.) I have been frustrated by the inattention to my concerns about lack of sleep because it is affecting my ability to function and live my life and I think it contributed to a recent bout of really severe depression. I have been told that the BiPap cannot be the problem because my AHI is low,even though the masks I try make a great deal of noise. I have been told that either I learn to tolerate the bipap or I will be untreated and have all kinds of heart problems and diabetes. I have been told I am not eligible for alternative treatments because of my weight (oh, the irony!). I had to push the point that perhaps I should have another sleep study since the last one was in 2012. Then I had to sign of waiver saying I understood the sleep study would use the recalled Phillips respironics but that the sleep center had done a bit of this and a bit of that to minimize the risk. And besides, I would have to wait until October. When I asked about he iNap, the PA told me it was not approved by the FDA, but it has been since 2020. As you noted, I am one of those getting rather fed up, but have no intention of ignoring the problem. I am off to the medical suppliers to try yet another mask, and looking around for another doctor. I am doing research on the iNap. I have tried taping my mouth without the bipap--I don't get any more sleep but oddly I feel more alert during the day. Your intelligence, obvious diagnostic sagacity, and compassion are very helpful to me at the moment. I am sending the link to this video the pulmonary specialist, whom I very rarely see. I usually am seen by a PA who is very nice but who is usually reciting a script/protocol he successfully memorized while in training.
Stay away from PAs and NPs. They are poorly trained, but think their doctors.
It is just atrocious that we are supposed to be the most advanced ed in medical care. HAHAHA! All lies. The only way we get we’ll is to figure it out for ourselves and DEMAND the Right care!
You are a wonderful human being...you have inspired hope and wonder in me...thank you for your attention
This is such a great video to see. Almost no one is treating sleep apnea the way you suggest. In my case my sleep study showed 72 events per hour, very severe apnea. I never even saw the Sleep Medicine doctor, and had to request to see an ENT. The ENT told me CPAP is the gold standard treatment. I told him it may be that, but it was only treating the result of my apnea not the cause. No one has investigated what part of my airway is collapsing and why. I want to heal this problem, not just treat it. I have lost 35 pounds and more to go. Learned to play the didgeridoo, voice lessons, laser treatment of my soft palate and tongue to tighten and tone tissues. None of this was suggested or recommended by any medical professional I saw. You are the only one who even has mentioned oromyofunctional exercises. Thank you so much for your channel. I wish more medical people approached OSA like you do. Thank you for providing such valuable information.
So wonderful to hear a doctor who understands causes, and non-compliance, the sense of failure, the opprobrium . . . so sad you're in England and not here. If by any slight chance you know of someone in Melbourne who is open-minded and will Listen, it wd be wonderful. We do have a two-tier system here, where you can wait for a long time and be seen az a public patient (with variable outcomes), or as a private patient, which costs a lot. As an old age pensioner, i havee no choice. So i live with sleep apnoea, have AF, and had a minor stroke, and cannot use the machine.
Same here, I would have used the machine if it worked for me, but the masks that were available couldn't accommodate me falling asleep on my side and the doctor probably should have just recommended that I buy a massage table to sleep face down on. It would have been less expensive than that stupid machine that I couldn't ever use for long enough periods of the night to offset the extra times that I would be awake at night.
It absolutely sucks to have both chronic insomnia and sleep apnea as it can be difficult to get much traction treating either on its own.
I’ve struggled a lot with cpap. Finally got to a point where I’ve been able to use it for about a month with my AHI around 3-4. Still feel like absolute garbage. I think I probably have UARS, but even without it I think the “it’s all good if it’s less than 5” mentality is BS. Watching the LankyLefty on CZcams has helped confirm for me that I should be shooting for as minimal arousals as possible. I will be slowly increasing the pressure on my cpap while analyzing my data through OSCAR so I can really dial it in. Most respiratory therapists can’t be bothered or don’t know how to do that, that’s ok I’ll do it myself. Hoping for an end to my 8+ years of suffering finally.
Thank you for such a clear and intelligent explanation of all of the issues surrounding sleep apnea.
I woke one morning dizzy and vomiting. I've had this happen twice in 5 months. The second time I realised it was due to lack of oxygen. I am moderately overweight and developed sleep apnea some time ago. All my doctor said after examining me was I needed to lose weight!
I decided 3 months ago to invest in a wedge memory foam pillow as ordinary pillows weren't helping. I was also concerned as I have poor circulation and don't want to run the risk of a heart attack or stroke!
I no longer sleep on my side but at an angle on my back. I never thought for one minute I could sleep this way. However, I proved myself wrong and I wake now every morning feeling refreshed; not fatigued! I also don't feel tired during the day either! I just never ever want to have a recurrence of dizzy spells and vomiting. I'm going away on holiday and have invested in an inflateable wedge pillow. I've tested it out and it works! I don't want to run the risk of falling ill whilst I'm away because of sleep apnea!
Thanks for creating this video. I am very new (2.5 months) to CPAP. Without CPAP I had an AHI approaching 60. With CPAP my AHI is under 0.3 most nights. Also, my O2 saturation drops into the mid 80s without CPAP and in the mid 90s with. So, CPAP works for me. However, I would prefer to not have CPAP, and I was going to ask my doctor about alternatives. You have provided a great layperson introduction to these options and made me a more informed patient.
Kind of you to say, thank you and well done on using CPAP. getting alternatives is just a quality of life thing for you now which is a good place to be.
@@VikVeerENTSurgeon Do you see blood work of high hemoglobin and Hematocrit because of low oxygen during sleep apnea?
I live in the U.S...
I would love to have someone like you on my medical team! My first sleep specialist asked a lot of questions about past sleep habits, and came to the conclusion that i had sleep apnea probably from birth. That makes sense, my mother fell at 7 months, and went into labor, but the doctors managed to stop it... I was born a month PAST my due date. According to my mother, I thrashed around in my sleep from the day I was born.
But I was a thin, active child. In high school, I had an accident in my gym class, and started having migraines. I didn't know it had caused scoliosis... and my doctors missed it too. Then in my 30s I was in a car accident, tore ligaments in my back and dislocated some ribs... and rapidly gained 120 pounds. After some time I actually began to hallucinate !
Now, I'm using a CPAP, but it's only partly successful. I never know how much sleep it will allow me, and every time they "improve" the mask or machine, it's a brand new problem. I've been trying to lose the weight, I'm now diabetic with complications. I average 4 hours a night. I'm tired all the time. But I don't and I won't quit!
Prayed a prayer for you just now. Yes, don't give up! 🌿
@@lisamccall8310 Don't give up! I am having problems getting my practitioner to pay attention to my sleep deprivation and I have been using a bipap for decades. I am now 77. The problem is that our doctors in the US seem to follow a narrow protocol. Keep advocating for yourself and good luck.
I have been using a CPAP for 25 years and now have a smaller, modern CPAP which gives me a reading on my cell phone to tell me how many hours I am getting. My CPAP is set at 11. I would have preferred having an operation earlier in my life. I have lost 20 pounds recently which helps. Of course, I am used to the CPAP after so many years of usage.
Thank you this is so refreshing! Why are other ENT doctors not like you!!! They tell their patients nonsense and don't do a deep dive into proper diagnosis!
You’re an amazing doctor keep spreading your good contents
Speaking as a surgical colleague in a related field, what an excellent presentation sir! The simple logic and elegant explanation of the surgical approach. If only every surgeon took this approach, broadly speaking.
When I first got an apap, it was amazing. I was told it might make sleep difficult for a few weeks and I would need to stick it out, and it was a little *weird* but didn't keep me up or bother me particularly. And it worked pretty well. I have a lot of different issues that cause fatigue, so I can't say how much of it is related to apnea, but my sleep quality did have a marked improvement almost immediately.
But my apap got recalled and I had to go for a year and a half without it before they finally got the new machine to me. But ever since getting the new machine, it MAKES me choke. Google says that's impossible, but it happens every night either as I'm falling asleep or within an hour of doing so. I will wake up, easily taking breaths and getting air, but feeling like I'm suffocating - I'll start hyperventilating until I take the mask off. Someone on reddit suggested that instead of trying to take deep breaths, I should hold my breath for a few seconds and then go back to breathing normally - and this works miraculously well, but it doesn't stop it from happening again and again. I already have terrible insomnia - I can't be waking up in a panic multiple times a night as well. And I've tried adjusting all the settings, but nothing fixes it.
My sleep doctor retired and I found a new one. He wants to do another sleep test (which I'm all for), but when I told him my problems with my apap, he decided before even giving me the sleep test to order a cpap for me. He didn't explain why. Is there something different about an apap that can cause issues like this that a cpap can avoid? Do you think I'll be able to use the machine like I used to use my apap? I'm kind of worried about it, but it's going to be a little over a month before I can do the sleep study (or even talk to this doctor).
I freaking love this guy!!! He gets it! I'm one of those that have given up after trying, on and off, for over 20 years with severe sleep apnea. UNTREATED, yet well known to a few Doctors I've seen. Must I come to London to see you or are you ever in the USA? Do you do video consults? Any recommendations for someone living in the USA? I've found nobody even close to your level here and unfortunately mine is not one of those "simple" fixes that throwing a cpap prescription at solves. It's been a 20 year severe daily and nightly struggle with no end in sight and at this rate will cause my death. Any suggestions? Thank you!
Thank you so much for your compassion, it is rare!
Fabulous video thank you. Finally good to hear a doctor that cares & gets it.
You are so welcome! And thank you so much for your support. Merry Christmas
Thank you. I'm going for my sleep test tomorrow, but I just wanted to say thank you. I have been extemely fatigued for over a year and diagnosed with CFS. I heard about a sleep test and decided we should do that, just in case I might have apnoea or something. My partner says I sound like a dinosaur at times. But in between all that I suddenly gained 10 kilo's in about 2-3 months, out of the blue. I dont eat biscuits or sweets and I rarely snack. I went to see a doc at the hospital who quite nasty said to me: I dont care, you must be taking in more KCAL than burning it off, you are just fat and should lose weight. I was disgusted, the whole reason I went there was because I do not over eat, I dont snack yet I've gained 10 kg. Jezus if I gained 10 kilos in a few months and its not medical I wished I had enjoyed it! Anyway I'm just glad you view things from the other pov.
I’d love to find a doctor with this approach in Jacksonville FL! I feel CPAP was pushed onto me with barely enough understanding of my specific issue.
Thank you for this excellent video. I really respect your approach.
I started doing these exercises on Thursday. Last night, Saturday, I slept for the first time in 2 years without waking every hour. I am so very hopeful! Thank you for this video.
I sleep way better with the CPAP, which I've been using for almost 5 years. I got a ResMed 10 after the DeathStationGate. My AHI started around 12 and is now less than 1. I did not lose any weight from using the CPAP, though. I lost nothing the first four years, and I gained some during the start of the pandemic. I've lost 30 pounds this year through careful diet and a LOT of exercise.
I suggested to both my ENT and sleep specialist that I thought menopause was the reason I had developed sleep apnoea and they disagreed. I was always a slim female and didn’t snore but since menopause I started snoring, gained weight and then was diagnosed with severe sleep apnoea. I have straight septum, small turbinates but “severe narrowing of airway by bulky base of tongue and posteriorly displaced and flattened epiglottis”. I use a CPAP but not every night (sometimes I fall asleep before I’ve put it on). No other therapy was suggested by my ENT.
Many doctors are too unimaginative to think anything outside of their rigid training is possible. Many doctors have inflated egos and aren't as smart as they think they are. It's a damn shame
Perhaps go to a sleep centre rather than one person. I'm nothing without the team around me.
Being a doctor can be hard and a lot of us run on confidence. i'm sorry that it sometimes slips into arrogance. it's really hard for us to keep that balance and stay on the correct path.
Wow. Thank you again. As a dentist, I always look for these signs!!
Brilliant - I'm glad that it was helpful.
Thank you for being so up front! I tried c-pap for 2 years and gave up. Now, I’m losing weight to try to help.
Dear Vik, thank you for your amazing videos.
I was recently diagnosed (Nov. 2022) with Severe Sleep Apnoea and have been researching about the condition since. Your videos and explanation has been enlightening. I agree with Donna, your philosophy towards your patients' care is amazing that I wish I'd have known you before I was referred to a semi-local sleep clinic.
Since you're talking about steps towards diagnosis & treatment, may I ask your opinion of diagnosis solely based on a one-night pulse oximetry data? I have been researching the correlation between AHI & ODI, the scientific papers I've read seems to be quite positive on the correlation between AHI & ODI. The papers seems to suggests that diagnosis based on ODI alone is deemed to be quite reliable. However I still find the investigation done towards my diagnosis seems to be incredibly minimal and now I am prescribed APAP therapy ranging from 4.0 to 11.0 cmH20!
On one hand I am thankful for the diagnosis, as it explained quite a lot about how I have been feeling. I am also thankful for the APAP treatment as it has improved my day-to-day function - especially since I'm a full time carer of a husband with terminal cancer, who is in the last week(s) of his life.
However, I am edging to being quite unhappy as to how the Sleep Clinic is operating.
(1) They have not even communicated with my GP about the diagnosis. I had the Pulse Oximetry Sleep Study on 03 Nov. 2022. The next day was told over the phone that I have Severe Sleep Apnoea and need to be booked in for a 45 minute appointment to discuss the Sleep Study Result & be issued with CPAP machine. Note that this appointment was not until 05 Dec. 2022!!! I spent that whole month worrying about the diagnosis, what the consequences is and getting quite anxious every time night falls and I have to go to bed.
(2) At the appointment I was told my AHI [sic] was 39.36 and my minimum SpO2 was 77%. I was told that on average I 'stopped' breathing for 13 seconds and the longest recorded event was 102 seconds. Note that I later found out what the CNS called AHI was actually ODI. So really I was diagnosed with Severe Sleep Apnoea with an ODI of 39.36.
(3) I have only ever had dealings with the CNS and he is very dismissive of my questioning e.g.
----- [3.1] when I ask him to clarify how they made the decision on the diagnosis he kept repeating the same explanation that "OSA is the airway being blocked and hypopnea is when the airway becomes narrow... and this is what you have, this is the reason it is called AHI!"
----- [3.2] when I asked whether I should get a referral to an ENT to try and find the root cause of my Apnoea, he said "you can but it won't help much as I think your problem is genetics. plus CPAP is the best and only treatment for sleep apnoea."
----- [3.3] I was issued with a full-face mask, which looked incredibly daunting, so I ask how long I should allow myself to get used to the mask and whether they offer a different type of mask for me to potentially try, to which he replied "why would you want to? this is the best mask available, plus you have sleep apnea because you often stop breathing and when you stop breathing you'll breath through your mouth. so this is the mask for you!"
(4) Note that at this point all the Sleep Clinic had at their disposal with the one-night pulse oximetry study data. There was no nasal cannula, nor chest/abdomen strap nor anything else to monitor the brain waves. Plus no one at the clinic has even cared to look into my mouth, let alone check my airway and yet they're very reluctant to engage an ENT!
(5) The clinic seems to never answer their phone, even when I leave messages they never call back. I once heard the admin staff, who answered the phone said "I can't even enjoy my tea in peace, the phone keeps ringing!"
I mean, I have approached my GP to refer me to your clinic, but she is quite hesitant to do so especially given that she haven't received any communication from the Sleep Clinic! She suggested parking the idea until we hear from the Sleep Clinic, as she could then contact them to query things. She was surprised herself to learn that the Sleep Clinic haven't engaged with ENT at the hospital and are actively discouraging me to seek referral to one. In fact, I found it unnerving to find out that my current GP did not know that the Sleep Clinic I was referred to even exists. She said that she usually refer to the Sleep Disorder Centre @ Queen Victoria Hospital. Full disclosure, my referral was made by a different GP, albeit from the same practice, back in April. But by August, I found out that he has left the surgery.
Anyway, sorry for the lengthy 'comment'. I wish there are loads more ENT & Sleep Specialist like you out there!!!
I hope you get to the bottom of the situation. sleep clinics have been really strtched since covid, so please let them sort it out for you. otherwise I will look forward to seeing you.
Sleep apnea is one of the most intense things I've dealt with , you can lose days of sleep from paranoia of gasping for air
Hi Dr Veer, I’m from Germany. 🇩🇪 I’m really getting too much problem with OSA. Is it possible to get treatment from your hospital, if I come from Germany 🇩🇪 to London? I’m actually having too much problems with my sleep since months and not getting any good treatment here. I feel like I'm going to die. 😭😭
Very informative and spot on re emotional issues one faces with weight gain and feelings of failing as one struggles with daily life impacted by tiredness , anxiety or chronic depression. I love my cpap machine- it’s made wonders to my living however I know it can be better for my family and myself. A year of solid exercise has assisted so much and I feel ready for further interventions.