Dave,
Dr Michaelson's website is http://www.advancedentpc.com/. As you can see by my answer to Judy, I don't recommend UPPP. I have had a change in my speech in that I can no longer make guttural sounds (so much for that one college year in German) which I knew beforehand that I was going to loose. The other speech problem is hard to describe. It seems to occur after I've been talking for awhile and the words get a little more difficult to produce and to me sound a little "Porky Piggish" or "Donald Duckish" in character. If I eat something like peanuts, I'll guarantee some will get caught on the backside of my soft palate...a real aggravation. But thank goodness I don't experience liquids coming back through my nose when I drink.
There are air filters available for the trach stents. I've been using a dust mask cupped over mine mainly to prevent the sheets or blankets from flopping over the opening.
When asleep the airflow is shared by both the nose and tracheostomy. When your nose stops up or your upper airway blocks, as in an OSA patient, the airflow is all through the tracheostomy.
Ambien or any sleeping pill is potentially dangerous for an untreated OSA patient. Arousals from an obstructions take longer, putting one at greater risk for complications including cardiac arrest. But under effective treatment say with APAP, that should not present a problem. Doctors should not prescribe sleeping pills without knowing the patients sleep status. In my opinion, insomnia is an indication for a sleep study.

Dave,
I was given the choice of an MMA, but after reading the fine print in some of the case reports, I decided against the procedure because it could not give me an AHI of 0. At best it could accomplish was a reduction in my AHI, but still leave me with apneas. The only procedure that can eliminate all apneas is a tracheostomy (a completely reversible procedure, if say, something better comes along). If the PAP machines have truly failed and your Sleep Dr. is certain of this, then it's time for a trach, in my opinion.
I don't have much information on the latest developments in trach surgery.
Dr. Park can answer those questions, since that's his specialty. My trach was done by Dr Sam Michaelson, ENT in Atlanta. He has his own technique which I understand is slightly different from the standard method used. All I remember is it's done at a 27 degree angle from the outside to the inside and the floor of the stoma is from the inner wall of the trachea itself. This makes more sense to me, at least from an aerodynamic stand point, plus clearance of mucous appears to be much more efficient. Think of the potential difficulties a horizontal trach could present an you can appreciate Dr M's method. There is a procedure in which the sternocleidomastoid muscles are
positioned in such a way around the trach opening (stoma) can be opened and closed by tightening those muscles enough to allow speech.