Mental and physical factors in treatment for apnea

[Dormeo]

In a thread that is now closed, a Board administrator has urged that contributors to the forum focus on “physical sleep-related issues.”  That has prompted some thoughts. 

I think this forum is a gem, and I don’t dispute the decision the administrator has made about the thread in question. I’m also pretty sure the administrator would agree with most or all of what I say below.  Still, I do want to try to explain my sense of the reasons we are, and should be, mindful of more than purely physical issues. 

1.  We try to be welcoming, good-natured, sympathetic, and courteous, in addition to informative, knowing that this opens emotional channels that aid communication.

2.  We know that for successful apnea treatment, psychological factors can often be decisive. People are often starting treatment in a state of exhaustion, with cognitive deficits and a gloomy outlook. These are well-known effects of sleep apnea, and they can thwart people’s efforts to persevere with treatment.  Acknowledgement and reassurance are not just decent ways to treat people; they can make a practical difference to people who are in a bad way, helping them to keep going with their therapy. 

3.  We often ask people how they are feeling during the day. Sleepy?  Trouble concentrating?  In low spirits?  Or wide-awake?  Focused?  Cheerful?  The answers to such questions can sometimes tell the experts a lot about what kind of treatment advice to give. 

4. Sometimes it’s hard to separate discussion of what is mental from what is physical. For example, if someone is very sensitive to a particular kind of sound their mask is making, and it has them lying there at night wide awake and fuming with irritation, they need to know about another mask that is quieter.  Or people who are somewhat claustrophobic may need to know about a different kind of mask or collar. 

5.  One goal of therapy is physical: to lower our risks of heart disease, brain damage, and the like. But another is to make our days happier and our minds brighter by giving us restful sleep at night. 

Please let me close with my gratitude for everything all the Board administrators and other members do to help.  It’s a pure labor of love!

[DeepBreathing]

Hi Dormeo. I think we all agree with what you say, and agree that an "holistic" approach to treatment is usually best (regardless of the underlying issues). In the great majority of members here at Apnea Board the approach you outlined above is entirely appropriate.

However I think we need to draw a line beyond which we as well-meaning amateurs shouldn't progress. Severe depression is one such situation - it is a terribly debilitating condition which requires intensive "hands-on" treatment by a trained specialist. Depression combined with expression of suicidal thoughts becomes a medical emergency and should be treated as such. That, I think, is the reasoning behind closing the thread you refer to. The original poster has several times expressed suicidal thoughts in his posts and this is a situation best handled by qualified specialists. While we can give encouragement and support, what is really needed is properly qualified treatment. Hopefully the member concerned will now follow the advice given, and seek professional help.

[Dormeo]

Oh yes, I agree with what you say about the particular thread. It was the more general statement that got me thinking. (Uh oh, here I am using an electronic device right before bedtime.  Note to self: sleep hygiene!)

[SarcasticDave94]

I’ll just post here once:

I can see where Dormeo is coming from, therefore you can say I agree. But then it can also be said that I see where the admin group is coming from, so again it can be said that I agree. The problem, if that’s even the right word choice, is in my view both sides are right, for different reasons of course.

I’m not going to discuss those reasons, the administration must do whatever is best for AB, and that most appropriate action was stated in the other thread. Point those who are suicidal to the appropriate help hotline and that’s it. I’m not asking or suggesting that closed thread be modified or anything of that sort. I myself commented there, and it stands as is. I stand by what I posted, and will not change what was stated, neither was I asked or told to do so.

However, it seems that the thread in question went astray after my own post. So I think I’ll take a vacation from AB, not primarily due to that situation. My own other illnesses are still a problem, such as extreme back pain and not able to get sleep due to not finding any comfortable sleep position even with a hospital bed with air overlay in home. I’d best focus my attention on my medical problems at this time. As administrators seem fit, my titles and duties can remain or be removed as best decided for AB. This is not a goodbye, just see y’all later.

[SuperSleeper]

In a thread that is now closed, a Board administrator has urged that contributors to the forum focus on “physical sleep-related issues.”  That has prompted some thoughts.

No that is not what I said.  I said that contributors ON THAT THREAD should focus on physical sleep-related issues from that point forward, and allow the OP to seek professional suicide-prevention help for the psychological issues he faced since he was having thoughts of suicide multiple times throughout the day for a long time.

I appreciate Dormeo's concern, and the concern of others here as well, but let me assure you that the thread closing had NOTHING to do with any of the individuals who were trying to help the OP.

It had everything to do with what the OP was doing.

For those who raise questions about the way in which the thread was handled, I would simply say:  please do not assume that you know all of the details.

The problem here is that people see what happened in one thread and do not see other facts and they do not know details of this person's history.


I'm between a rock and a hard place.  Do I leave the thread open and risk someone killing themselves? (because the person in question comes here and posts on the forum in an effort to fool themselves into thinking that they can solve all their ongoing suicidal thoughts [multiple times each day] by simply adjusting their CPAP settings)?  Or do I close the thread and risk looking like we're "anti-free-speech" or in some way "control-freaks"?

This person was using the forum discussions here as an excuse NOT to get the PROPER suicide-prevention help they needed.

Get that into your head folks:  this person was consistently and openly seriously talking about KILLING himself, and dismissing any advice to seek professional help, instead blaming all his problems upon a slightly elevated AHI.

Sorry folks, but I'm not willing to LET SOMEONE kill themselves so we all here can simply "feel good" that we've "helped" someone by "encouraging" them in a public internet forum, all the while they are using the ongoing discussions and encouragement here as an excuse as to why they don't need professional help (blaming all their depression and suicidal thoughts solely upon an elevated AHI level).

I'm cutting off his access to the forum here unless and until this person gets professional help.  All the "kind thoughts" and "encouragement" are all well-and-good, but the person in question has ignored the advice to seek professional psychological help, using the posts of well-intentioned folks here to convince himself that ALL of  his problems can be solved if he could just get a properly-adjusted CPAP machine.

Sorry folks, but the issues go FAR DEEPER than simple CPAP settings in this case.

It's not worth someone taking their own life.

No discussion on this.  This thread is closed, and the other ones started by the member-in-question will be removed from view.

Any future discussion on this particular member's situation in any other thread will be removed.

I DO NOT MESS AROUND WITH SUICIDE.