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Alternatives to CPAP… Do They Really Exist??
I recently stumbled onto this website, and immediately found it extremely interesting to get an insight into the lives of people living daily with OSA. As an oral & maxillofacial surgeon practicing in NYC, whose practice mainly focuses on the treatment of OSA and snoring, it is not always easy to understand the struggle that my patients face daily.
In my practice, I offer patients a variety of treatment options, from conservative treatment with oral appliances, to surgical treatment. Most patients come to me because they cannot tolerate CPAP, and many have already tried some sort of surgical procedure, which has not worked. From my experience, it seems that patients consider surgery as a last option because they do not believe that their expectations can be met. However, I find surgical results to be fairly predictable. Most patients are very familiar with ENT procedures, but few are familiar with the treatment options that oral & maxillofacial surgeons offer. In fact, we complement each other very well, as we actually focus on different parts of the airway, and the airway has to be comprehensively evaluated to really figure out the cause of OSA. When clinically indicated, I find that a combined approach often has the most predictable result in patients with OSA.
I have browsed through some of the previous discussions, and have not found too many topics on oral appliances or surgical treatments. Therefore, I would be happy to answer any questions that you may have on these 2 topics, which I believe can be very attractive options to people who do not want to use CPAP. I will therefore let you guide this discussion if anyone finds it interesting. Feel free to browse my website if you’d like to know more about me, and then let me know if there are any specific questions that you may have which I can answer! My website address is www.ParkAvenueFaces.com
Views: 1531
Replies to This Discussion
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Permalink Reply by RockRpsgt on
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The Rocky Mountain Sleep Conference had a great lecture on oral & maxillofacial surgeries. I found it very interesting.
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Permalink Reply by Dr. Ruben Cohen on
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Mike,
Would really like to hear more about what's going on with you! There are treatment options out there...
Mike C (STILL at the Beach!) said:Since ALL my Scripps Hospital doctors have told me no more APAP or ANY "PAP"...I will be watching this thread like an old hawk. Especially since NO options have been offered and 1 heart attack already and now having severe Sinus tach going untreated. Well, I hope I just stumble upon SOME answer? Really sucks having the best health insurance around PLUS Medicare and here I am, left untreated. In an economy where everyone needs money?????
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It sounds like you have a lot going on. What did your sleep study show?
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Permalink Reply by Ginny Edmundson on
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My ENT used the numbers 50/50 chance of improvement for anyone with apnea. If there is something else besides CPAP along with a neck killing chin strap (since I can not find a full face mask that fits my face) that had better odds I would probably go for it. Apparently my tongue falls back blocking my airway, thus the need to wear chin strap with nasal pillows. 2 weeks ago had septoplasty with turbinate reduction hoping this might help something!!! I could tolerate the CPAP much more if I did no thave to use chin strap. Had $600 oral appliance made and it did not seem to work. Maybe will work better post this surgery??? I so hate going to bed at night!!
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Ginny, thank you for your reply! You present a typical situation that I see often: In your own words, you wrote that your "tongue falls back blocking my airway" yet you just had a septoplasty with turbinate reduction. I'd love to be believe that your surgery will help correct your OSA, but unfortunately your nasal cavity is separate from the area where your tongue is located. If your tongue is blocking your airway, then you need a procedure that will keep your tongue in an anterior position and will prevent it from collapsing your airway in your sleep. That procedure is called a genioglossus advancement: The genioglossus muscle is a muscle in your tongue which, when repositioned anteriorly, will prevent your tongue from collapsing posteriorly and blocking your airway during sleep. You can read more about this procedure on my website.
Success of OSA surgery, based on the literature that I am familiar with, varies from 60 to 90% depending on the procedure performed and the studies that you read. In general, I do not like to quote statistics, because as I have stated before, success rates largely depend on proper patient selection, matching each patient with the correct procedure that will have the best chances of resolving the patient's symptoms.
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The lecture I recently attended gave a 93% success rate for this type of surgery. It's amazing how many pts I have seen since that I believe would benefit from this.
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Hi Rock~ How "rough" is it to go through this type of surgery??? Remember, I am a wimp! :)
RockRpsgt said:The lecture I recently attended gave a 93% success rate for this type of surgery. It's amazing how many pts I have seen since that I believe would benefit from this.
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Even if I were to have the surgery mentioned on your website (and I don't know if it is offered anywhere near I live!) I would still have needed the septoplasty plus turbinate reduction as my nose was stuffed up for parts of every day, not just when trying to sleep. I wish I were brave enough to try what your site mentioned and I wish I knew if it was offered in Western NC anywhere. AND... the big if....would Medicare cover it????
Dr. Ruben Cohen said:Ginny, thank you for your reply! You present a typical situation that I see often: In your own words, you wrote that your "tongue falls back blocking my airway" yet you just had a septoplasty with turbinate reduction. I'd love to be believe that your surgery will help correct your OSA, but unfortunately your nasal cavity is separate from the area where your tongue is located. If your tongue is blocking your airway, then you need a procedure that will keep your tongue in an anterior position and will prevent it from collapsing your airway in your sleep. That procedure is called a genioglossus advancement: The genioglossus muscle is a muscle in your tongue which, when repositioned anteriorly, will prevent your tongue from collapsing posteriorly and blocking your airway during sleep. You can read more about this procedure on my website.
Success of OSA surgery, based on the literature that I am familiar with, varies from 60 to 90% depending on the procedure performed and the studies that you read. In general, I do not like to quote statistics, because as I have stated before, success rates largely depend on proper patient selection, matching each patient with the correct procedure that will have the best chances of resolving the patient's symptoms.
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Hi Mike~ I have private insurance until July! I just was looking at one website and it's percentages for success with the genioglossus advancement were 50 something to 70 something.
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I see my ENT Friday for f/u surgery appointment. I may mention to him to see what he says aout it. Who does it? etc??? The photos of it look gross!!!
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I have been doing these procedures for a long time, and as far as I know, we have always been able to get them approved by medical insurance companies.
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If I knew Medicare would pay ( I will be on starting in JUly) I would opt for a trip to NYC!!! :)
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