Feb 13, 2009
It's been three weeks since my wife delivered our third son Brennan, and after doing everything we can to exclusively breast-feed him, we've given up. During the first few days, Kathy was doing well, getting into a routine, especially since we had hired someone help us out for for about the first 10 days. Then on day 4, during a visit to the pediatrician's office, it was discovered that Brennan's bilirubin was dangerously high. He was admitted to the hospital for UV light therapy. He did fine, and was able to go home in 24 hours, but the whole ordeal wreaked havoc on his breast-feeding regimen.
Because he was under the lights, Kathy was only able to pump and feed the milk via a bottle through the chamber's holes. Afterwards, he refused to suckle on Kathy. We tried everything, even consulting with a lactation expert, but the stress of not being able to spend the time with Brennan, as well as not having any time to spend with our two other boys was extremely stressful, so we decided to supplement with formula, and breast-feed the the best of her ability.
There's been a lot of research recently about the benefits of breast milk over formula. There's even evidence that the act of bottle-feeding (breast milk or formula) has detrimental consequences on jaw development and possibly increasing the risk for developing sleep apnea later in life. The decision to breast-feed has a lot of emotional, practical and financial issues that all new mothers must deal with. Unless one has unlimited time and resources, most new moms are forced to make sacrifices in one area or another. Does she spend 45 minutes breast-feeding every two hours initially, like what the lactation consultant recommended, or does she skip every few feeds (and give the baby formula) to get in more sleep so she can stay sane? Even with help (her spouse or hired help or relatives), things are not always that simple.
It seems like in the old days, there was a lot more help available, especially in traditional cultures like with our family. You had multiple resources living with you or close by, including your mother-in-law, aunts, sisters, etc. Today, even in traditional societies, everything's changed. The lactation consultant that we saw made this interesting comment: New moms have a much harder time breast-feeding and producing milk whenever there is a deadline to go back to work. Imagine having this deadline, whether it's a few weeks or even a few months, and there's no one to help out.
There were many other circumstances with our situation that prevented the ideal: in addition to the hospital readmission for the elevated bilirubin level, Kathy could not use her left arm at all. During the delivery, the IV was placed in the antebrachial vein (at the bend of her left elbow) which not only caused irritation, but during placement, had bruised the nerve that went to her arm and hand. It's still very difficult to even handle the baby, let alone breast-feed properly.
So what does breast-feeding have to do with CPAP? If you're diagnosed with obstructive sleep apnea (OSA), the gold standard recommendation is continuous positive airway pressure, or CPAP. This is a device that provides gentle positive air pressure through a mask that fits over your nose or mouth. It works by stenting open your airway, preventing multiple obstructions and arousals. Untreated sleep apnea can lead to high blood pressure, diabetes, depression, anxiety, weight gain, heart disease, heart attack or even stroke.
In the ideal situation, CPAP is the best way of treating OSA. Most people do well, but how many people do well depends on the systems that are in place to support using your CPAP machine. Ideally, the patient should be evaluated and counseled in a sleep center where after the diagnosis of sleep apnea, he or she comes back to have a discussion about the results and get counseled about CPAP. The patient should be able to try on various CPAP masks and models in the office and have a period of slow acclimation to the mask. There should be an intense follow-up and feedback routine for weeks to months, to make sure that the patient is effectively using the CPAP. Compliance data should be analyzed regularly and applied promptly to better optimize CPAP usage. Durable medical equipment (DME) vendors should also provide great support and have constant communication with patients and prescribing physicians. Users should also be involved in a community of CPAP users who can give support, as well as to be able to hold the new CPAP user accountable.
In the real world, this almost never happens. With a few exceptions, most people are given a CPAP machine at home, and told good luck. There's very little follow-up, if any. This is why in our country, overall CPAP compliance is dismal. I'm told in other European countries, the overall compliance rate is much better due to the more centralized aspects of their healthcare.
The problem is that there are 4-5 separate entities involved in your care as a CPAP user, and with our current system, there's not too much communication or coordination amongst all the health care providers. Granted, there are exceptions to what I'm describing, with some great sleep doctors and DME vendors. But for the most part, the service, support and follow-up is pretty dismal. This is why overall CPAP compliance is so poor, as compared with other countries.
As you can imagine, many people fall through the cracks, not using their CPAP at all. It's not that common, but there are some patients that take full responsibility for coordinating his or her own care and make the effort to follow-up with the sleep center and DME vendors, almost to the point of being aggressive. They have to be a squeaky wheel to make any progress. In many instances, they are willing to pay extra or everything out of pocket to get what they need, rather than relying on the DME vendors or be restricted to the bare-bones equipment that insurance usually covers for. These patients generally do well.
Then there are the patients who try everything and are still unable to use their CPAPs. Typically, it either due to irritation, discomfort or claustrophobia from the mask, the excessively high pressures or bloating from swallowing air. They go through all the necessary steps to address all of the above issues, but are still unable to use their machines. Some people are fully compliant with their machines, using it religiously, but find no subjective or objective improvement, or sometimes it just makes things worse.
The point of these lengthy comparisons between CPAP and breast-feeding is that there's a lot more that can be done for people to more fully benefit from CPAP and breast-feeding, but at the other extreme, you have to know when to give up and go on to more realistic and practical methods. Not being able to breast-feed or benefit from CPAP in no way implies a failure on the anyone's part. These are two important issues that I'm sure will need to be addressed by many new mothers and newly diagnosed sleep apnea sufferers.