CPAP Intolerance Affidavit

CPAP Intolerance Affidavit

Dr. Alamin Karim

9370 SW Greenburg Rd Suite #422, Portland OR 97223

Office: 503-716-6712 Fax: 971-339-0824
I have attempted to use a CPAP device to manage my sleep disordered breathing and find it intolerable to use on a regular basis for the following reasons:

Mask leaks Unable to get the mask to fit properly Discomfort caused by the straps and headgear Noise from the device disturbing sleep or bed partner's sleep CPAP restricts movements during sleep CPAP causes distended stomach, burping and/or IBS symptoms CPAP has caused lack of intimacy in my relationship CPAP does not seem to be effective Pressure on the upper lip causes tooth-related problems I cannot tolerate anything on my face when sleeping due to claustrophobia An unconscious removal of the mask/CPAP apparatus at night Cannot travel with CPAP No electricity for usage of CPAP I am allergic to the material
Due to the reason(s) checked above, an oral appliance is the only treatment I will use to manage my obstrutive sleep apnea.
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