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99 posted a discussion

colloidal silver

a humidifier can be used with colloidal silverthis can keep the humidifier clean for day maybe weeks or longer without the need to clean the humidifiersilver colloidal is antimicrobial and you could just top up your humidifier without cleaning and at the same time treat your bodyor you just put silver on it own into the humidifierSee More
58 minutes ago
richard graham posted a status
"I feel like the humidifier is making me feel yucky and I'm waking up hacking and having to clear my throat a lot for a while."
Nov 3
richard graham posted a discussion

what's a good AHI?

I've been using and auto and it says my AHI HAS been between 4 and 6 and wondering what's a good range.
Nov 2
Andy posted a discussion

Resmed S10 AirSense - Anyone have one? Any feedback?

Hi All,I've just ordered a new Resmed S10 AirSense, and I was wondering if anyone here has used one?Any information or input would be appreciated!See More
Sep 29
Andy replied to Andy's discussion Resmed S8 AutoSet II - No Longer Collecting Data??
"Hi All, Well, I went to the sleep doc today, and he ordered a new S10 for me! I still don't know why my S8 is not tracking data anymore. Anyone have any ideas?"
Sep 29
Oscar Lemus updated their profile
Sep 25
liz4cps commented on liz4cps's group Prince William Co, VA support group
"Just found they have a Facebook for the REMedy event, 1st Class Sleep REMedy Wellness Health Fair."
Sep 25
liz4cps commented on liz4cps's group Prince William Co, VA support group
"Reminder: REMedy event is this Saturday, 10 am to 2pm.  Topics include: Nutrition and Weight Management with Sarah Kelly, Registered Nutritionist/Dietitian Oral Appliance Therapy for Sleep Apnea with Drs. Rena Vakay & Lara…"
Sep 25
Kay Day left a comment for Kay Day
"September 1, 2014 My apologies to Sleep Guide for not participating in a long time. In January 2012 I started classes at the local community college (my husband is an instructor there, and my tuition is refunded when my grades are above a C. My…"
Sep 1
Mary Z posted a discussion

Sleep apnea increases risk of osteoporosis

Sleep apnea/osteoporosis study finds “increased” health riskA recently published study may have found a connection between obstructive sleep apnea (OSA) and osteoporosis, marking yet another health…See More
Aug 23
Mary Z replied to ZolliStar's discussion Non-invasion approach that can relieve mild sleep apnea
"Hi ZolliStar, I've heard before that speech therapy, or singing lessons can help sleep apnea.  The problem at that time was there was no way to determine which exercises help.  Getting research done, rather than anecdotal would be…"
Jul 28
ZolliStar posted a discussion

Non-invasion approach that can relieve mild sleep apnea

Some people report that singing -- singing! -- really helps their sleep apnea. Dr. Stephen Park said that myology (which are exercises to strengthen muscles around the inside of one's mouth area) helps some. I think singing would be better.  If you read all the FAQs on this (click below), I think you'll agree that it makes sense for some. Maybe you. More
Jul 28
ZolliStar posted a discussion
Jul 20
liz4cps commented on liz4cps's group Prince William Co, VA support group
"I talked to Kimberlie at the Novant Sleep lab last week (at Prince William Hospital) and she said they would not be holding any meetings this year but are planning to start holding meetings again next year.  I'll let you know when we have…"
Jul 14
richard graham posted a status
"I just have mask called the Wisp. Hope it works. Anybody have experience with it. I have an ultra mirage nasal mask and get leaks at brid"
Jul 9
Andy posted a discussion

Resmed S8 AutoSet II - No Longer Collecting Data??

Hi All,First off, my apologies for not checking in for a long time.I've been using my Resmed S8 AutoSet II for almost 3 years! I feel great, have lost almost 30 lbs, am no longer sleepy during the day, sleep through the night, and have my short-term memory back.Yay!I've told my doctors that I'm the "poster child" for Sleep Apnea and CPAPs! It's been, and continues to be, such an amazing experience that I want everyone to know!Everything has been going well in CPAP-land, but in the last few…See More
Jul 7
hifay replied to richard graham's discussion mouth breathing
"What type of chin straps?"
Jul 6
Ginny Edmundson replied to Ginny Edmundson's discussion Scheduled for evaluation and possible procedure next day
"No real improvement in sleep study.  Just not having to use cervical neck color.  What a bummer. Surgeon wants another sleep study in about a month or so (home one) Not sure if will do or not. "
Jun 22
Mary Z replied to Ginny Edmundson's discussion Scheduled for evaluation and possible procedure next day
"Ginny, how are you doing after the tongue procedure?"
Jun 22
Mary Z posted a discussion

AHI finally under five.

I have been on CPAP since March 2008 and had a good AHI when I started therapy (under 5).Then my AHI started getting worse- for a while it stayed in the 20's, then we got it to the high teens.  Nothing we did would help.  My doctor said it was due to the meds I take.  For a couple of years I just tolerated the high AHI.  I did another sleep study and changed to an ASV machine.  For two years I still had a AHI around 11-13.  Then all of a sudden - a month ago I noticed my AHI was running five or…See More
Jun 22

Tracheostomy for Severe Sleep Apnea

A doctor I spoke to last night argued that severe sleep apnea should be treated more often with a tracheostomy. A tracheostomy is a surgical procedure to create an opening through the neck into the trachea (windpipe). A tube is usually placed through this opening to provide an airway into the upper trachea. This tube is called a tracheostomy tube or trach tube. This airway bypasses the entire upper airway and therefore is 100% successful in curing sleep apnea.

For those who get a tracheostomy for sleep apnea, the tube is capped during the day and breathing and speaking continues as normal. Before going to sleep, one removes the plug, and air is inhaled through the tube in the neck, not through the mouth or nose.

Obviously, this is a drastic procedure that would give anyone pause. That said, so are surgical procedures like maxillomandibular advancement. Furthermore, a tracheostomy is 100% effective in treating sleep apnea -- the AHI will zero out. It is a sleep apnea cure. Maxillomandibular advancement has a significantly lower success rate, and is often considered a success even if it does not "cure" sleep apnea (i.e., if it just reduces the AHI substantially).

Again, I'll stick to CPAP because I'm finding it effective and because turtle necks aren't a good look for me. But for those who have tried and failed with CPAP and everything else, and who have severe sleep apnea, you might want to consider a tracheostomy. Right now, it's not even presented to patients as an option. It should be.

Views: 2593

Tags: Maxillomandibular, advancement, apnea, severe, sleep, tracheostomy


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Comment by BARRETT CRAIG on September 12, 2011 at 7:25am
I've had my trach for nearly 2 years now and have not realized any efficacious results.  I can still feel the back of my tongue drop down and close off my airway, right as I fall asleep.  This of course wakes me out of the sleep.  As a trach patient, I do not understand how the trach is a 100% cure, because the physical act of my tongue closing off my airway is such a shock to my system, that even though there is an alternate source of air through the trach, it is the shock and gag caused by my tongue that interrupts normal sleep.  If there were a seamless transition between nose breathing and the trach, then it would be 100% effective, but I have not experienced this at all. (I even tried wearing nose plugs to force all breathing through the trach).  For this reason, I have decided to try the tongue resectioning, as a last resort.  I had UVPPP surgery nearly 15 years ago, but it made me worse, which seems to be a common thread.  This is my first chance to publicly thank Dr Jones for coming to visit my in the hospital after my trach surgery.  it made the ordeal a lot easier for me.
Comment by Judy on May 22, 2009 at 11:38pm
Welcome to the forum, James Skinner. Good to see your smiling face again! How are YOU doing now after your surgery??
Comment by James Skinner on May 22, 2009 at 11:14pm
You can read more about Dr Jones story at It should also be noted that its also fairly common to experience central apneas after a tracheostomy. Its my understanding that they typically resolve over time however.
Comment by Judy on April 23, 2009 at 6:16pm
Did you have all of the surgeries at once (with the exception of the trach, of course)?? Or in what sequence did you have them? And over what period of time from OSA Dx to having to resort to the trach?
Comment by Judy on April 23, 2009 at 6:15pm
I assume as a doctor you insisted on a fully data capable xPAP each time you tried PAP therapy so that you could monitor your results yourself?
Comment by Judy on April 23, 2009 at 6:14pm
Thanks for the report on your experience w/the tracheostomy, Dr Jones. May I ask did you try CPAP before the various surgeries and then the surgeries and finally the trach? Or the various surgeries first, then CPAP, then the trach? What type of problems did you run into w/the CPAP therapy?
Comment by Mack D Jones, MD, SAAN on March 25, 2009 at 1:46pm
I chose a so called "permanent skin-lined tracheostomy" after four years of failed PAP machines, and unsuccessful surgeries including a UPPP, hyoid myotomy, and two rhinoplasaties. I was given the option of trying a maxillomandibular advancement or "bimax" procedure and actually signed up for it until I read the fine print in some of the published studies. The bottom line is that the bimax surgery can reduce the number of apneas, but cannot eliminate them. An AHI of 1 is "deadly" according to Dr. Barbara Phillips past president of the NSF. I welcomed the tracheostomy as my last chance to put a stop to repeated apneas. It was performed by a surgeon who had done an average of two per month over the previous 16 years.

The surgery went without a hitch and I was completely healed in six weeks. Much to my surprise, my symptoms did not immediately go away (I discuss this in more detail in my book Three months post-op I felt 80% better from that "run over" feeling. For me the trach is not that big a deal. There are several reasons for this, I think. One is that I'm not overweight and my neck relatively thin. My trachea is not buried in a lot of muscle or fat. Another is that my medical background helps me to deal with any gliches that might occur with just plain everyday care which is really pretty simple. That's easy for me to say because I know the anatomy, function, etc. which gives me some advantages.

Oh, before I forget. The tracheostomy is completely reversable. If for some reason you don't like it, the stoma, can be closed. That's in contradistinction to almost all the other surgeries for OSA; they are irreversible. (A couple of suspensions could potentially be reversed). At first I had a stent with a plug. It's made of polyurethane; a soft rubbery tube the diameter of your little finger. Now I use an open stent at night when asleep and a shorter one inch stent with a permanent plug during the day. It has a very low profile protruding about a quarter of an inch. It was custom made to my specs. I clean them with hydrogen peroxide and tap water which only takes a minute or two in the morning and again at night before bed. A plastic film canister stores the one I'm not using.

Most of the time I'm not aware of the stent. Sometimes it leaks air when talking. A slight adjustment corrects it. There is an accumulation of mucous around the stent (this is a good means you are not drying out) which I wipe away with a tissue a couple of times a day. You can buy little squares of absorbent cloth made to fit around the stent interface, but I do ok without them. When taking a shower I pucker up my lips to close my nostrils and blow gently when directly facing the flow of water. That prevents water from entering around the stent (it's not water tight).

The only regrets I have with the trach is I can't go swimming, scuba diving, sailing or fishing out on the water. To me it's not so much a risk of drowning because I'm an excellent swimmer, but it's the risk of getting dirty water down into my lungs which can be result in a very nasty, difficult to treat, mixed bacterial pneumonia. I have had no problem with drying or need for humidification. I live in a humid environment here in Fort Walton Beach, FL and that may a factor. I stay well hydrated, carrying a bottle of water with me where ever I go. There are humidification devices that can be placed over a trach if needed. A trach is a life saving last resort for the treatment of OSA. If I had to do it over again, I would have had the trach much sooner because I had way too many apneas while undergoing those surgeries, none of which could give me an AHI of 0. In my admittedly biased opinion, PAP resistant OSA is an indication for a tracheostomy, your last and final resort.
Comment by Mike on March 23, 2009 at 2:40am
I know that Dr. Mack Jones, a neurologist who suffered from severe sleep apnea had the procedure done. I'm not 100% sure this is his contact info, but by doing a quick Google search I came up with this:

329 Eldredge Rd
Fort Walton Beach, FL

Phone: (850) 862-3040

You can reach out to him and tell him you heard about him from a participant in the sleep apnea discussion he took part in last week. please let us know what happens.
Comment by bonesigh on March 21, 2009 at 11:31am
Actually back in 2007 I was told about this procedure by my doctor but it is not highly recommended because when you have a tracheostomy it is much easier for bacteria, germs etc. to enter the lungs and make you sick. I was told it was best to avoid this procedure and only have it done as a last resort.

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