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Contemplating UPPP procedure along with septoplasty & turbinate reduction

I need and value your opinions on these procedures. 

PLEADING MY CASE: 

I have gagged and snorted myself awake since I was very young.  I had my sleep study in 2007 and was diagnosed with OSA.  Since using my CPAP I have not had a decent night sleep in three yrs.  I need sleeping aids to sleep.  I am suffering from menopause.  I cannot take hormone replacement because of clotting history.  My stamina and overall health are failing. 

Currently, myself and the doctors are baffled.  I can't shake this low grade fever.  I had and recovered from strep throat with two complete rounds of antibiotics.  NO CLUE where my body is battling bacteria or virus.  Recently I have developed an intoleration to the silicone cushions on my Liberty Mirage mask.  I use oxygen with my RESMED, M series, autotitrator.  The tissue in my nose burns so bad I find myself throwing the mask off.


Am I wasting my time with these procedures?  Thoughts?

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I had a UPPP with tonsillectomy and it did nothing for my apnea, however the tonsillectomy cleared up my chronic strep throat. I also now choke on small pieces of food, such as peas. If I had known before the surgery what I know now, I would have had a tonsillectomy, but I would never had the UPPP done. I have an excuse for not knowing that UPPP is generally ineffective, because there were no on-line sources of information and all of the information that was available to me came from my sleep specialist and my ENT surgeon. UPPP is "effective" about 40% of the time, and "effective" is defined as a 50% reduction in AHI. Unless your AHI is less than 10, you have less than a 40% chance of reducing your AHI to 5.

I understand that septoplasty & turbinate reduction are worthwhile surgeries and may make it easier for you to use CPAP.
My question would be, despite the above, WHY would you consider UPPP surgery?

I would STRONGLY suggest that you check out Dr Steven Y Park's website and also his posts here in this forum BEFORE you make such a DRASTIC decision about UPPP surgery.
Don't be too quick to jump from the frying pan into the fire. UPPP can't be undone. Its permanent. There's no turning back once its done. You will have to live w/the consequences the rest of your life.
You make no mention of a tonsillectomy. Why? If you are determined to try surgery that would be the most logical first step. Did they do a culture AND SENSITIVITY from your tonsils? Or did they just script antibiotics by guess and by gosh?

What are the anatomical reasons for a septoplasty and turbinate reduction or are these just grasping at straws?

What are the anatomical reasons for considering a UPPP??

I know for some women menopause can be hell. But it doesn't last forever. It just seems like it. Three years can seem a life-time.

Why not switch to a full face mask? There are "mask underliners" (for lack of a better term) that lay between the mask and the facial skin. I think RemZZZs is one brand.

It may be that Padacheek can come up w/a "mask underliner" for the Liberty for you.

Ayr Saline Nasal Gel can heal and soothe the chapped, irritated, pain in the nasal tissue w/in 1-2 days. Nasal pillows do tend to provide more direct air pressure to the nasal passages and thus are more prone to causing chapping of those nasal passages which can feel like pouring salt on a raw wound. (Been there, done that one. OUCH!) Are you using a heated humidifier w/your PAP? Insufficient humidity can also cause that chapping, as can a passover humidifier instead of a heated humidifier. I HAVE to use a heated humidifier or the interior of my nasal passages chap badly.

Why are you using 02 supplementation w/your PAP? I use 2L of 02 supplementation w/my VPAP Auto but I have COPD and that is the reason for it.

Resmed does not make the M Series. The M Series is made by Respironics.

Wasting your time w/the surgeries you are considering would hardly be anywhere near my first consideration!!

Have you tried a second opinion from a different sleep doctor and ENT not affiliated w/your current sleep doctor and ENT? I sure as heck would BEFORE I would resort to surgery. Especially before even considering UPPP surgery.

You really do need to check things out at Dr Park's website. Maybe even talk to him before you do anything drastic.

Sorry for the three posts. They were all supposed to be one post but .... 'puter or sleepguide or web was acting up.
Surgery can be helpful. In most cases it will reduce the severity of apnea. There is no guarantee that you will be able to come off of PAP therapy. My advice would be to research as much on it as you can. Reach out to different surgeons in your area. Find out what kind of success rates they have. Dr. Park's site is a very good place to start. He is one of the best at doing what he does.
Wow...you've had some rough times. Personally wouldn't recommend the UPPP to any member of my family...That being said, if you're not gettting the success with cpap, you need to look at all options. But...please....do your research before going under the knife.
I had UPPP with tonsillectomy. I also had deviated septum repair. To top that all off I had a hyoid suspension (surgery to stretch the tongue and connect it to the adam's apple). None of the above helped cure my sleep apnea. I did it on the opinion of one doctor. My new sleep doctor said with apnea severe as mine surgery should never have been an option. I urge you to carefully search this out before having surgery. Get more than 1 doctor's opinion and still search.

There are things they do not tell about that can happen after having surgery. I choke on pills and food quite often, they even can get lodged in the back of my nose. I have to hack and cough to dislodge them, sorry so graphic just thought you should know. Spicy food is still painful after 2 years.

By the way I am on bpap today with a mouth appliance in place, this still after surgery.

Carl
I have the same sort of choking problem caused by UPPP. I can spend several minutes trying to cough up a piece of corn or a pea. Slow inhale slowly to try not to draw it in deeper, and then a cough to try to expel it -- repeating until it comes out. It used to be terrifying, now it is just very unpleasant and annoying.
I have the same sort of choking problem caused by UPPP. I can spend several minutes trying to cough up a piece of corn or a pea. Slowly inhaling to try not to draw it in deeper, and then a cough to try to expel it -- repeating until it comes out. It used to be terrifying, now it is just very unpleasant and annoying.
Hello Linda,

You posted earlier about trying to locate a mask that is not made out of latex or silicone. Since I didn't see your post for a while afterward and, therefore, responded late, you may not have seen my reply and so I am posting again in case it may be of help to you.
______________________________________

Reply by Renee on March 22, 2010 at 6:11am

Hello Linda ~

I found that I am also sensitive to the material that the masks are made of. I tried both the ResMed Quattro and the Respironics FullLife and, while they both felt soft and comfortable when I tried them on at first for a couple of minutes, I discovered that I was sensitive to the material and I couldn't wear either of them. However, I have found a solution - well, actually, two solutions.

I got Remzzzs from www.remzzzs.com. They are pieces of thin cotton material designed to match the shape of nasal and full face masks. I tried the full face Remzzzs with both the Quattro and the FullLife and the Remzzzs worked with both of them. I have settled on using the Quattro and I will offer you a tip. Although I use an XS Quattro mask, I use a Medium Remzzz - because although most people just want to the Remzzzs for comfort - I want extra cotton material to completely cover the material that the mask is made of.

An interesting tidbit . . . I had gotten Remzzzs prior to receiving my CPAP equipment and had taken them with me to my titration. Since I was completely new to CPAP, I started out without suggesting using a Remzzz. I was having difficulty going to sleep for a variety of reasons (as it goes at a sleep titration) - including that the mask was very irritating and that I had an awful headache – and after a couple of hours the tech came in to adjust the mask for leakage. I happened to ask the tech if we could try a Remzzz and the tech said: "Why not"?. And AS SOON as the Remzzz was in place - the mask felt so comfortable, my headache instantly went away by about 95% and the tech didn't have to make any adjustment for leakage. -- AND I, then, went right off to sleep !

And so, even if I didn't need the Remzzzs due to my sensitivity to the mask material, I would wear them anyway because they provide so much comfort and also since they decrease leakage, I don't have to tighten my mask as much as I would have to without them.

And the second really marvelous solution is that I contacted Karen Moore at www.padacheek.com. Actually I called Karen at 434-985-4003 because I had read a posting about how she will help people with individual problems and I found out from Karen that she makes little "covers" out of natural fabrics for the forehead support of the Quattro - EXACTLY what I needed ! Karen offered the smooth or the softer fabric choice and when I mentioned that I wanted the softer because I needed as much density as possible because of the headache I had gotten from the pressure, Karen offered to make the covers extra dense for me. Of course, I would have to consider that I would, perhaps, have to compensate accordingly for leakage but, for me, it was sure worth it. And so, with Karen's wonderful, personal handiwork - I have comfort and no headaches. My first choice had been to be able to use the Respironics FullLife because there's no forehead support and there's more clear vision; but, because the FullLife is wider than the Quattro, I couldn't adjust the width and the hardness of the FullLife to my pillow and so I had to give up on the FullLife. But, no matter, with Karen's soft forehead support covers, the Quattro forehead support is completely comfortable anyway - so the Quattro has become my choice.

Lastly, when I was trying out the Respironics FullLife mask, I tried using the little "sleeves" or "covers" on the strap in the back of the FullLife on my neck because the strap had to be pulled tight and because, alas, I also had a sensitivity to the material of the strap material. I had purchased a pair of the little "sleeves" from one of the CPAP suppliers online. HOWEVER, I found that I was ALSO completely TOO sensitive to the "sleeves" that I purchased. So, in the future, I will always FIRST contact Karen Moore to find out if she makes WHATEVER I need in natural fabrics - then I will know that it will be ABSOLUTELY COMFORTABLE and the best fit ! Plus, it was enjoyable talking with Karen.

I also use Moleskin on my nose to prevent skin irritation caused by the mask.

Gosh this turned out to be a long posting . . . hope some of this helps !

Best,
Renee
_________________________________________

Posted by Linda on February 23, 2010 at 6:30am

Currently, I am using the Mirage Liberty full face mask by Resmed. I have developed a sensitivity to the nasal pillows and face mask which are latex free, but are made of silicone. I would like to find a similar mask that is silicone free. Any ideas would be GREATLY appreciated! Thanks
Mean 0 pause can be HELL alone;; then to add sleep apnea. Wanna join our own support group? Hang in there honey, Don't rule out natural supports. Herbs etc. Diet and exercise are a factor as well for the meanOpause. Read books. Pray, meditate. LAUGH!!!!

You are not alone. I HEAR it gets better also. X months and at least the kinks in my CPAP are being worked out. If it were so easy with the hormones (eye roll)
Sorry I missed your previous post. I will looked into the Remzzzs...looks like they don't make anything for my mask. I have seen the PadaCheek.com awhile back. I decided to make a pattern for my straps and made my own sleeves. I made them out of cotton fleece and they work great. No more lines on my face in the morning. I tried the RESMED full face mask originally. Leaks everywhere because of my dippling and tiny features around my mouth. I love my Mirage Liberty full face with the nose pillows. It fits great, but the burning sensation in my nose is almost unbearable. I will keep looking for a cover of some kind for the nose cushions. I appreciate your time and willingness to help me in this matter. I will definately make a very informed decision if I choose to have the UPPP surgery. Everyone has been helpful to me in pointing out their experiences and thoughts. I guess I can dream of being CPAP free for now.

Thanks for the

Renee said:
Hello Linda,

You posted earlier about trying to locate a mask that is not made out of latex or silicone. Since I didn't see your post for a while afterward and, therefore, responded late, you may not have seen my reply and so I am posting again in case it may be of help to you.
______________________________________

Reply by Renee on March 22, 2010 at 6:11am

Hello Linda ~

I found that I am also sensitive to the material that the masks are made of. I tried both the ResMed Quattro and the Respironics FullLife and, while they both felt soft and comfortable when I tried them on at first for a couple of minutes, I discovered that I was sensitive to the material and I couldn't wear either of them. However, I have found a solution - well, actually, two solutions.

I got Remzzzs from www.remzzzs.com. They are pieces of thin cotton material designed to match the shape of nasal and full face masks. I tried the full face Remzzzs with both the Quattro and the FullLife and the Remzzzs worked with both of them. I have settled on using the Quattro and I will offer you a tip. Although I use an XS Quattro mask, I use a Medium Remzzz - because although most people just want to the Remzzzs for comfort - I want extra cotton material to completely cover the material that the mask is made of.

An interesting tidbit . . . I had gotten Remzzzs prior to receiving my CPAP equipment and had taken them with me to my titration. Since I was completely new to CPAP, I started out without suggesting using a Remzzz. I was having difficulty going to sleep for a variety of reasons (as it goes at a sleep titration) - including that the mask was very irritating and that I had an awful headache – and after a couple of hours the tech came in to adjust the mask for leakage. I happened to ask the tech if we could try a Remzzz and the tech said: "Why not"?. And AS SOON as the Remzzz was in place - the mask felt so comfortable, my headache instantly went away by about 95% and the tech didn't have to make any adjustment for leakage. -- AND I, then, went right off to sleep !

And so, even if I didn't need the Remzzzs due to my sensitivity to the mask material, I would wear them anyway because they provide so much comfort and also since they decrease leakage, I don't have to tighten my mask as much as I would have to without them.

And the second really marvelous solution is that I contacted Karen Moore at www.padacheek.com. Actually I called Karen at 434-985-4003 because I had read a posting about how she will help people with individual problems and I found out from Karen that she makes little "covers" out of natural fabrics for the forehead support of the Quattro - EXACTLY what I needed ! Karen offered the smooth or the softer fabric choice and when I mentioned that I wanted the softer because I needed as much density as possible because of the headache I had gotten from the pressure, Karen offered to make the covers extra dense for me. Of course, I would have to consider that I would, perhaps, have to compensate accordingly for leakage but, for me, it was sure worth it. And so, with Karen's wonderful, personal handiwork - I have comfort and no headaches. My first choice had been to be able to use the Respironics FullLife because there's no forehead support and there's more clear vision; but, because the FullLife is wider than the Quattro, I couldn't adjust the width and the hardness of the FullLife to my pillow and so I had to give up on the FullLife. But, no matter, with Karen's soft forehead support covers, the Quattro forehead support is completely comfortable anyway - so the Quattro has become my choice.

Lastly, when I was trying out the Respironics FullLife mask, I tried using the little "sleeves" or "covers" on the strap in the back of the FullLife on my neck because the strap had to be pulled tight and because, alas, I also had a sensitivity to the material of the strap material. I had purchased a pair of the little "sleeves" from one of the CPAP suppliers online. HOWEVER, I found that I was ALSO completely TOO sensitive to the "sleeves" that I purchased. So, in the future, I will always FIRST contact Karen Moore to find out if she makes WHATEVER I need in natural fabrics - then I will know that it will be ABSOLUTELY COMFORTABLE and the best fit ! Plus, it was enjoyable talking with Karen.

I also use Moleskin on my nose to prevent skin irritation caused by the mask.

Gosh this turned out to be a long posting . . . hope some of this helps !

Best,
Renee
_________________________________________

Posted by Linda on February 23, 2010 at 6:30am

Currently, I am using the Mirage Liberty full face mask by Resmed. I have developed a sensitivity to the nasal pillows and face mask which are latex free, but are made of silicone. I would like to find a similar mask that is silicone free. Any ideas would be GREATLY appreciated! Thanks

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