Health
My husband won’t wear his CPAP machine. Are there alternatives to help him have a healthy sleep? – The Globe and Mail
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.
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.
“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.
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.
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.
Article content
Grande Prairie RCMP issued a warning Friday after it was revealed fentanyl linked to a deadly overdose was mixed with a chemical that doesn’t respond to naloxone treatment.
The drugs were initially seized on Feb. 28 after a fatal overdose, and this week, Health Canada reported back to Mounties that the fentanyl had been mixed with Bromazolam, which is a benzodiazepine.
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Mounties say this is the first recorded instance of Bromazolam in Alberta. The drug has previously been linked to nine fatal overdoses in New Brunswick in 2022.
The pills seized in Alberta were oval-shaped and stamped with “20” and “SS,” though Mounties say it can come in other forms.
Naloxone treatment, given in many cases of opioid toxicity, is not effective in reversing the effects of Bromazalam, Mounties said, and therefore, any fentanyl mixed with the benzodiazepine “would see a reduced effectiveness of naloxone, requiring the use of additional doses and may still result in a fatality.”
From January to November of last year, there were 1,706 opioid-related deaths in Alberta, and 57 linked to benzodiazepine, up from 1,375 and 43, respectively, in 2022.
Mounties say officers responded to about 1,100 opioid-related calls for service, last year with a third of those proving fatal. RCMP officers also used naloxone 67 times while in the field, a jump of nearly a third over the previous year.
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Health
CFIA continues surveillance for HPAI in cattle, while sticking with original name for disease – RealAgriculture
The Canada Food Inspection Agency will continue to refer to highly pathogenic avian influenza in cattle as HPAI in cattle, and not refer to it as bovine influenza A virus (BIAV), as suggested by the American Association of Bovine Practitioners earlier this month.
Dr. Martin Appelt, senior director for the Canadian Food Inspection Agency, in the interview below, says at this time Canada will stick with “HPAI in cattle” when referencing the disease that’s been confirmed in dairy cattle in multiple states in the U.S.
The CFIA’s naming policy is consistent with the agency’s U.S. counterparts’, as the U.S. Animal and Plant Health Inspection Service has also said it will continue referring to it as HPAI or H5N1.
Appelt explains how the CFIA is learning from the U.S. experience to-date, and how it is working with veterinarians across Canada to stay vigilant for signs of the disease in dairy and beef cattle.
As of April 19, there has not been a confirmed case of HPAI in cattle in Canada. Appelt says it’s too soon to say if an eventual positive case will significantly restrict animal movement, as is the case with positive poultry cases.
This is a major concern for the cattle industry, as beef cattle especially move north and south across the U.S. border by the thousands. Appelt says that CFIA will address an infection in each species differently in conjunction with how the disease is spread and the threat to neighbouring farms or livestock.
Currently, provincial dairy organizations have advised producers to postpone any non-essential tours of dairy barns, as a precaution, in addition to other biosecurity measures to reduce the risk of cattle contracting HPAI.
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Health
Toronto reports 2 more measles cases. Use our tool to check the spread in Canada – Toronto Star
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Canada has seen a concerning rise in measles cases in the first months of 2024.
By the third week of March, the country had already recorded more than three times the number of cases as all of last year. Canada had just 12 cases of measles in 2023, up from three in 2022.
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