Re: Trach for patient with Dementia?

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Re: Trach for patient with Dementia?

Posted by Shelbyscout on May 26, 2001 at 22:55:59:
In Reply to: Trach for patient with Dementia? posted by GBoogie on May 26, 2001 at 21:00:50:
GBoogie,
I'm sorry to hear that your mom isn't doing well. Unfortunately, the biggest problem with CPAP is patient noncompliance (for a variety of reasons). Whatever your mother's reasons are for not complying with the CPAP treatment, I suspect that they are not due to an altered mental state as much as how uncomfortable and awkward the CPAP equipment is to wear and use.
Honestly, I'm not trying to be insulting, but have you ever tried using CPAP? I think if you gave it a try one night you'd have a lot better understanding of where your mother is coming from. It could be that your mom is just a klutz who can't remember how to set up the equipment each night, or she could be deliberately or subconciously forgetting or making it more difficult for herself as an excuse not to wear it (and hoping you'll tire of setting it up every night and thus leave her alone).
I understand you're at your wit's end, but I don't think you quite need the hospital bed with straps yet :). First I would suggest you drop all of the herbs/melatonin/nytol or whatever else aids in sleep. Often these substances make apnea worse, and the herbs can interfere with other medications and body functions. Melatonin is illegal in many European countries.
I'm sure you've done this, but a close look at any other meds she might be taking and a conversation with your pharmacist could help clear up any other meds that are disturbing her sleep. Also on the list of things you've likely done already, a hearing test might be in order.
A trach is a high maintenance procedure, and there's no guarantee that if/when her cognition improves she will be any more receptive to CPAP than she is now. Some of the intermediate surgeries like GA and hyoid advancement might work quite well for her and wouldn't require any additional upkeep once the surgery site heals. Have you seen an ENT specializing in sleep disorders? In the best of all possible worlds, you'll find an ENT who happens to be a sleep specialist and a geriatric specialist :). In an imperfect world, you could try to coordinate the care between the ENT and her geriatric care specialist or primary care physician.
The key to treating sleep apnea is determining the area of blockage--usually by physical exam, x-rays, and a fiber optic scope. Blockage can occur at the nasal, palatal, or tongue area, but most commonly the tongue. Once the blockage is determined, then the doctor can discuss treatment options. Non-surgical options include oral appliances to pull the jaw forward, and somnoplasty or radiofrequency which is minimally invasive but very effective for mild to moderate cases.
There is a wealth of information below on the different non-CPAP treatment options available. A trach may very well be what your mother needs, but really only a qualified specialist can determine what would be best for her.
Hang in there and good luck,
Shelby

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Sleep Deprivation due to Sleep Apnea and insufficient sleep are common and can present as insomnia, narcolepsy, or idiopathic hypersomnia. In infants and children sleep problems commonly present themselves as ADD or ADHD.