Replies to This Discussion

Permalink Reply by Narciso on July 12, 2009 at 9:09pm

Henning,
Thank you for these new and useful info / insights.

Narciso

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Permalink Reply by Steven Y. Park, MD on July 15, 2009 at 2:54pm

Henning,

I've been meaning to tell you, my wife (who has mild sleep apnea) had obvious expiratory apneas during the third trimester of her last pregnancy. She would be breathing normally, then half-way during exhalation, you could hear a valve shut closed, and after a second or two of a brief pause, air would leak out through her mouth. This would wake her up about half the time. Clearly, in her case, it's the redundant soft palate the gets pushed back up into the nose, obstructing exhalation. There may be other mechanical explanations for different people.

I think Henning brings up a very important point that's basically unknown within the sleep community.

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Permalink Reply by Henning on July 15, 2009 at 4:38pm

Steve,

I am now sure that there is a mechanical cause of expiratory apneas.

At my last examinations, it appeared that it was my uvula who drew with my soft palate up so it gave an obstruction.

After my surgery, there are no problems with my soft palate.

Personally, I do not believe that neither the tounge base or the soft palate in itself may cause these problems.

Perhaps you may get expiratory apneas in the nose. I do not know if this was a problem for me, because I never have had a PES measurement.

But you know my story, and again I must note that a small surgical procedure can change one's life immensely.

Btw. thanks for your help and advice in the process.

Henning



Steven Y. Park, MD said:

Henning,

I've been meaning to tell you, my wife (who has mild sleep apnea) had obvious expiratory apneas during the third trimester of her last pregnancy. She would be breathing normally, then half-way during exhalation, you could hear a valve shut closed, and after a second or two of a brief pause, air would leak out through her mouth. This would wake her up about half the time. Clearly, in her case, it's the redundant soft palate the gets pushed back up into the nose, obstructing exhalation. There may be other mechanical explanations for different people.

I think Henning brings up a very important point that's basically unknown within the sleep community.

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Permalink Reply by James Skinner on July 22, 2009 at 1:56am

Be very skeptical about UPPP as a cure to apnea. Has anyone x-rayed the base of your tounge? Its often the problem. Here is an x-ray of my throat http://james.istop.com/apnea/reports/JamesThroatxRay.jpg

Do lots of research before removing the uvula. Get the deviated septum fixed (I did that) and remove the tonsils.

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Permalink Reply by James Skinner on July 22, 2009 at 2:12am

Henning said:

After that my decision was easy. Six weeks ago I had an operation on my Uvula (She removed about. ¾ of it, so I still have a sweet little one) and got my tonsils removed. This was done in complete anesthesia with a single night's hospitalization. She used the “new” coblation technique, so the pain afterwards was not so bad.

Henning, Can you provide more information on this technique. I have always wondered why the uvula can't just be shortened rather than removed all together

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Permalink Reply by Scott Gray on July 22, 2009 at 8:07am

Just want to say thank you to everyone for your thoughts. I am still on the fence, but I feel like I have a lot more good information than I did before. I am going to sit with the surgeon and go over some of the issues raised in this thread and see what he has to say. Obviously his answers will be biased, but I want the hear them. In good/bad news my CPAP therapy is going better, in that I am wearing the mask longer and feeling better. This is good, but it makes the decision about surgery tougher.

Thanks again.

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Permalink Reply by Judy on July 22, 2009 at 8:15am

James Skinner! What a delight to see you here!

All of you others, especially EncorePro users, James is the developer of the freeware, EncoreAnalyzer, that helps clarify some of the EncorePro/MyEncore data.

And, James, one of these days you might want to tell your story here - w/pictures.

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Permalink Reply by RockRpsgt on July 22, 2009 at 8:17am

Henning I am very interested in this topic. If you could post those studies I would appreciate it. Of the 1000 or so studies that I have done only 1 has had expiratory apneas. I have been told that only about 1% of apneas are expiratory.

Henning said:

To Narciso and the underscored to j n k (and all of of it to others).

There are no recognized terms for expiratory apneas. This term is especially used for infants and babies, where this condition in some cases is linked to sudden death. In addition, you can find a number of other terms for this condition.

It is a condition which is somewhat overlooked.

In one study I found that about 40% of all with Sleep Apnea has expiratory apneas, but most of them have it at the end of the expiration - just before a new inspiration. In this case, you can compare the situation with a "normal" inspiratory apnea.

But some have standalone expiratory apneas (I have not found the proportion), where the apneas occur at the beginning of the exhalation.

You can now ask what the difference between inspiratory and expiratory apneas is. If you are well treated and your AI = 0 then it has no consequences. Hypopneas have no meaning in this context.

There is only one way to diagnose expiratory apneas. This is by combining a PSG study with a PES measurement. This may show whether you have negative (inspiratory) or positive (expiratory) pressure in your esophageal.

This measurement is rarely performed on a normal PSG study, although this should be standard. It is the same measurement to detect UARS.

In untreated apneas there are major differences in inspiratory and expiratory apneas. I will soon give a longer explanation of these differences. But the main difference is that with expiratory apneas you have no desaturations (This is also the only advantage of this type of apneas).

Regarding your question about my first surgery was necessary.

In connection with my expiratory apnea, I am not sure. At this time it was a question on CPAP compliance. But in hindsight, I am very pleased with this surgery because it gave me a much better breathing.

In general, I am of the opinion that ENT Surgeons had to look more aggressively to the situation of Sleep Apnea patients.

With these mainstream surgeries, I think it would help many Sleep Apnea patients with a better compliance.

Henning

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Permalink Reply by Judy on July 28, 2009 at 2:12pm

Hey, Fred! What brand and model bi-level do you have?

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Permalink Reply by Mike on July 31, 2009 at 11:59am

Fred, I have not heard of a "mini-Tracheotomy" procedure. From my understanding, and you should confirm this with an ENT surgeon, having a tracheotomy is a complete cure for Sleep Apnea, in fact the only "cure" for Sleep Apnea. Take a look at this article and the related comments on tracheotomies for more data points on this important topic.

Fred Stellabotte said:

Hello --
I have had all of the Surgery except for the deviated septum. No help at all, I can't fault the Doctor, she told me that the chances of it doing anything were about 50% 50%.

I am having a real bad time with my BiPAP , partly becuase the DME's in North FL do not really know how to set it up and debug issues - but that is for another thread.

At this point, I would really like to get a Tracheotomy. I don't care what I look like, I just want to sleep, .. I am so tired.
Does the Tracheotomy completly fix OSA ? I heard of something called a "Mini Tracheotomy" does any one have any experience with that ?

Thanks
-Fred

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Permalink Reply by Judy on August 8, 2009 at 12:40pm

Everything I've read, a VERY FEW satisfied w/the palate surgery and LOTS who are much worse off for having the palate surgery I can't conceive of myself being desperate enough to agree to it. Nor do I think I would agree to complete removal of the uvula, shaving to reduce its size if that were a problem, yes, but complete removal? I seriously don't think so. Thank God, I'm not a candidate for any of the surgerys except possibly the septoplasty, and I'm not really in need of even that. My heart goes out to those who may actually need such surgeries.

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