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My husband won’t wear his CPAP machine. Are there alternatives to help him have a healthy sleep? – The Globe and Mail

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The question

My husband has been diagnosed with sleep apnea but he refuses to use the CPAP machine that is supposed to help him breathe at night. He says it is too damned uncomfortable. What should he do?

The answer

Your husband isn’t the only person who’s had trouble adjusting to CPAP, which stands for Continuous Positive Airway Pressure.

An estimated 30 to 50 per cent of those with obstructive sleep apnea don’t regularly use the device which involves wearing a mask that directs air down the throat. But many patients eventually overcome their initial discomfort by experimenting with different types of masks and machines until they find the equipment that suits them best.

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However, a bit of background is worthwhile before reviewing the options.

The first thing you need to know is that this condition is caused by the soft tissues in the back of the throat collapsing during sleep and blocking the flow of air. Those with sleep apnea wake repeatedly throughout the night – in some cases, hundreds of times – to literally gasp for air.

They have no recollection of rousing but will suffer the consequences of poor-quality sleep – including daytime drowsiness and impaired concentration.

To make matters worse, sleep apnea puts a dangerous strain on the heart and other organs, elevating the risk of heart attacks and strokes.

It also interferes with the normal process of clearing toxins from the brain during sleep and may boost the chances of developing dementia later in life.

That’s why CPAP is such an essential – and ingenious – invention. It works by simply producing a stream of pressurized air that props open the throat so breathing isn’t interrupted.

Of course, the downside is that many patients don’t like sleeping with a mask connected to a CPAP machine.

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“One size does not fit all – and that’s part of the problem,” says Mark Boulos, a neurologist at Sunnybrook Health Sciences Centre in Toronto.

Indeed, people come in all shapes and sizes. A mask that works for one person might not be right for someone else. Some masks completely cover the nose and mouth, while others fit snugly under the nostrils.

Some patients might also benefit from a different type of machine. In particular, an “auto” CPAP will adjust the pressure, based on the individual’s breathing patterns.

The companies that sell sleep-apnea equipment usually provide “loaners” so patients can try a variety of models at home. But it often takes many weeks of trial and error to find the best combination of mask and machine.

“You really have to stick with it,” says Boulos. “I tell patients to find a company close to their home so they can conveniently go back and forth multiple times.”

That’s good advice for those who live in urban areas with an abundance of CPAP vendors.

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But it may not be a practical solution for those who live in rural communities or parts of the country where a lack of provincial funding creates other obstacles to obtaining effective treatment.

“There is huge variability in terms of how sleep-apnea care is provided across Canada,” says Najib Ayas, an associate professor at the University of British Columbia.

For instance, Ontario funds sleep labs that test for the disorder and will cover about 75 per cent of the cost for patients to buy a sleep apnea machine.

By contrast, British Columbia doesn’t cover the cost of the equipment and much of the testing is done by private CPAP vendors that use home-based monitoring devices to help make a diagnosis.

This means the same companies testing patients are also selling them sleep-apnea equipment. “This creates a potential conflict of interest,” says Ayas. He notes that patients with mild sleep apnea may not need a CPAP machine, but might be sold one nonetheless.

The cost of the equipment can also be a barrier to treatment for patients who lack public or private health insurance. The price of the same machine can vary from $1,000 to $2,500 across Canada.

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There’s no doubt that it can be hard for some patients to find the equipment that works best for them. Unfortunately, that task can be made more challenging by insufficient support from the public health-care system, says Ayas.

“It seems odd to me that we have a therapy that prevents people from asphyxiating at night, and yet some provincial governments don’t want to fund it.”

Paul Taylor is a Patient Navigation Advisor at Sunnybrook Health Sciences Centre. He is a former Health Editor of The Globe and Mail. Find him on Twitter @epaultaylor and online at Sunnybrook’s Your Health Matters.

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Canada to donate up to 200,000 vaccine doses to combat mpox outbreaks in Africa

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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.

It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.

Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”

Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.

Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.

A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.

On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.

Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”

But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”

“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.

Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.

Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.

Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.

“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.

“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”

This report by The Canadian Press was first published Sept. 13, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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How many Nova Scotians are on the doctor wait-list? Number hit 160,000 in June

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HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.

The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.

Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.

“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”

The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.

A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.

Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.

“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.

Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.

The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.

“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.

This report by The Canadian Press was first published Sept. 11, 2024.

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Newfoundland and Labrador monitoring rise in whooping cough cases: medical officer

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ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.

Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.

Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.

Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.

The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.

“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.

Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.

Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.

Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.

A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.

This report by The Canadian Press was first published Sept. 10, 2024.

The Canadian Press. All rights reserved.

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