Pills for Cheap

As we saw in the previous chapter, the options for drug therapy in the treatment of sleep apnea are few and relatively ineffective. Some drugs may be appropriate when central apnea is the problem, since they act to repair the mechanisms responsible for a malfunctioning respiratory drive. Protriptyline, for example, stimulates the muscles of the upper airway; it also decreases the time spent in REM sleep, thus minimizing the periods during which most severe OSA occurs. In OSA, however, the causes of the breathing disruption are usually of a physical nature, making drug therapy largely useless. Sleeping pills, commercial or prescription, are no solution. I have discussed the fact that use of sedatives may produce sleep but can also act to prevent the sleeper from waking up enough to begin breathing after an apnea attack. What’s more, such drugs suppress respiratory function even further—in some cases to the point of death.
By the same token, however, to delay treatment, or avoid it entirely, may be just as dangerous. Besides the health risks posed by apnea, such as hypertension and heart disease, there is the documented danger of death directly attributable to breathing problems.
There are options, however, which can provide varying measures of success but, like almost any medical treatment, have their share of drawbacks as well. As we have seen, most apnea is really a mixture of CSA and OSA. Thus the discussion of treatments here will focus on the latter, since in many cases remedying the obstruction will subsequently eliminate the cause of central apnea as well.
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People with BDD didn’t receive more than one third of all the treatments they requested. And they didn’t receive more than half of all the surgeries they requested. The most common reason is that the physician considered the treatment unnecessary (because the person looked fine) and didn’t provide it. So many people had to see a lot of doctors before they could find one who would finally agree to provide the requested treatment.
It can be very difficult, though, to turn down requests for surgery or other medical treatment. Some people with BDD suffer so greatly that it can be very hard to deny them the treatment they so desperately seek. “The doctors and they couldn’t turn me down because I was so miserable.” Another man said, “I can’t believe the doctor did liposuction because now I know I look fine. But I was so unhappy back then that he gave in and did it.”
One man thought he looked like an “alien” and believed he was the third ugliest person in the world (after Gomer Pyle and Tiny Tim). He’d gone to 3 dermatologists and 3 dentists, none of whom agreed to treat him. He’d also seen 16 plastic surgeons, all of whom turned him down. One surgeon told him that if he got all the surgery he wanted, he’d look “mutilated.” Finally, the 17th surgeon agreed to do a nose job, but the patient hated the result so much that he sued the surgeon. When I saw him he was so desperate for more surgery that he was planning to get into a massive car accident that would destroy his entire face.
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It might be well to note that circadian rhythms— a known and accepted physiological principle—are not the same as “biorhythms,” a fad that reached its peak in the 1970s. While circadian rhythms dominate our every bodily function, biorhythms were declared by some to be long-term cycles of physical and emotional health that could be traced back to the date of birth and, at least theoretically, used to project our performance on any given day. “Computers” designed to generate biorhythm charts appeared in shopping malls, restaurants, movie theater lobbies, and turnpike rest stops. In exchange for a quarter the machines purportedly warned people that they would reach a peak or a trough on such and such a day, that they should avoid driving or sexual contact, and so on—sort of a high-tech form of palm reading. Not surprisingly, biorhythms were dismissed as pop science by chronobiologists. In one study, for example, investigators compared reports of thirteen thousand on-the-job accidents, as well as eighty-five hundred airplane mishaps, with the so-called critical days supposedly predicted by the biorhythms of the workers and pilots. No correlation was found.
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