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What should I do? Surgery? CPAP not working
Here is my situation - I am wondering if I should procede with surgery after struggling with CPAP.
I'm a 24 year old male, who weighs 215lb and was diagnosed with Sleep Apnea with an AHI of 18 and a oxygen saturation of 79% last year in July of 2009. I tried CPAP therapy from September until December and again for 2 weeks in February, but was unable to tolerate it since I was sensitive threw off the mask unconciously in the middle of the night. I have so far tried a nasal mask, a full face mask and 2 nasal pillows. I think I have trouble scratching my face in the middle of the night and I am also a mouth breather, but the full facemask did not work. I usually keep the mask on for 2-3 hours.
I have tried other remedies, such as sleeping on my side, losing 10 pounds and an oral device to some success. The device like a Rematee T-shirt, to keep me sleeping on my side, works with some improvement, although I still sleep on my back anways. The most promising is a cheap plastic oral device (like the Snore-ex), which is similar to the Mandibular advancement device made by doctors. This device, I usually kept in my mouth, but not 100% of the time. I noticed I dream a bit more, which I know is good, but I do still have focus and some daytime sleepiness.
Because of my struggles with CPAP, I had scheduled a surgery in 2 weeks. I know at the very minimum, I would like to take care of my nose with a Septoplasty and Turbinoplasty, which my doctor says will improve my quality of life, possibly allow me to tolerate CPAP or a dental device more, and take 1-2 days recovery. I also suffer from allergies, stuffy nose and a lot of phlegm.
At first, I was recommended by the first doctor, Dr. Liberatore, to remove my tonsils and take care of my deviated septum and enlarged turbinates. Since then, I got a second opinion with Dr. Steven Park, who I consider an expert in the field. www.doctorstevenpark.com
However, I am also considering dropping the bomb and taking care of the other issues, since I want to get a lot better. Dr Park told me with a Uvulopalatopharyngoplasty UPPP, to trim the soft pallet and tounge I can expect a 40% chance of success and 1 week of recovery. However, using Friedman's test, I am a borderline candidate at best for just UPPP, since I have a moderately high tounge position (level 3), and medium tonsils. My doctors biggest concern was that on my back I have tounge collapse.
Because of this tongue collapse issues my doctor wants to do Genioglossus advancement, http://www.sleepapneasurgery.com/genioglossus_advancement.html and tie my tounge with a string to suspend it, along with a hyoid Suspension and the UPPP. This will add an extra week to recovery, make surgery longer, but have an apparent 80% success rate/satisfaction rate.
I'm a 24 year old male, who weighs 215lb and was diagnosed with Sleep Apnea with an AHI of 18 and a oxygen saturation of 79% last year in July of 2009. I tried CPAP therapy from September until December and again for 2 weeks in February, but was unable to tolerate it since I was sensitive threw off the mask unconciously in the middle of the night. I have so far tried a nasal mask, a full face mask and 2 nasal pillows. I think I have trouble scratching my face in the middle of the night and I am also a mouth breather, but the full facemask did not work. I usually keep the mask on for 2-3 hours.
I have tried other remedies, such as sleeping on my side, losing 10 pounds and an oral device to some success. The device like a Rematee T-shirt, to keep me sleeping on my side, works with some improvement, although I still sleep on my back anways. The most promising is a cheap plastic oral device (like the Snore-ex), which is similar to the Mandibular advancement device made by doctors. This device, I usually kept in my mouth, but not 100% of the time. I noticed I dream a bit more, which I know is good, but I do still have focus and some daytime sleepiness.
Because of my struggles with CPAP, I had scheduled a surgery in 2 weeks. I know at the very minimum, I would like to take care of my nose with a Septoplasty and Turbinoplasty, which my doctor says will improve my quality of life, possibly allow me to tolerate CPAP or a dental device more, and take 1-2 days recovery. I also suffer from allergies, stuffy nose and a lot of phlegm.
At first, I was recommended by the first doctor, Dr. Liberatore, to remove my tonsils and take care of my deviated septum and enlarged turbinates. Since then, I got a second opinion with Dr. Steven Park, who I consider an expert in the field. www.doctorstevenpark.com
However, I am also considering dropping the bomb and taking care of the other issues, since I want to get a lot better. Dr Park told me with a Uvulopalatopharyngoplasty UPPP, to trim the soft pallet and tounge I can expect a 40% chance of success and 1 week of recovery. However, using Friedman's test, I am a borderline candidate at best for just UPPP, since I have a moderately high tounge position (level 3), and medium tonsils. My doctors biggest concern was that on my back I have tounge collapse.
Because of this tongue collapse issues my doctor wants to do Genioglossus advancement, http://www.sleepapneasurgery.com/genioglossus_advancement.html and tie my tounge with a string to suspend it, along with a hyoid Suspension and the UPPP. This will add an extra week to recovery, make surgery longer, but have an apparent 80% success rate/satisfaction rate.
From my perspective, I want to get better soon and stop struggling. I suffer from attention problems ADHD and mild/moderate depression in addition to my oxygen saturation going to 79%. I'm hopeful that my ADHD will improve once my sleep does, but it has not with the oral devices/side sleeping. However, I am currently looking for jobs, so I'm thinking that I cannot take 2 weeks off, but I might be able to get away with it. I want to go ahead with the nasal surgery and see what happens. Does anyone have any advice with what I should do - should I do all the sugeries, just the nasal surgery, or try the dental device or struggle with CPAP?
Any input would be appreciated. How painful is surgery and what was your experience? The reason I wish I could use CPAP is my titration showed my AHI drop to 0 and REM sleep normalize. I also might want to try a APAP, even though my pressure is low because I have spoken to people who said that worked... also I liketo drink every once in a while. Dr. Park says I have some options, but also says I am in the 10% that he says is the right fit for surgery. .
Thanks,
Tyson
Views: 247
Replies to This Discussion
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Permalink Reply by D. W. Conn on
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Tyson,
I work in sleep and had an awful time at first adjusting to my full face mask. It did take about 3 months to wear it through out the night. Then again Mask does not work for everyone. 2 things I would try are have a retitration of CPAP. Practice with your mask while awake watching TV do not strap it on just hold it up to face. Our bodies know how to react to less...such as drowning or suffocation but more can cause the same symptoms and anxiety. It could be just that you need time to adjust.
Talking and working with your physician is a very good thing. There are alternatives that may work for you.
Just remember with the UPPP weightloss or weight gain can at times bring back the apnea.
Persistence is the key.
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Permalink Reply by Tim on
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Assuming that you would also have a tonsillectomy as part of the UPPP, I am curious about how he figures that recovery is only a week. I understand that 10 days is normal recovery time for tonsillectomies, and that is how long my throat hurt after my UPPP / tonsillectomy. Recovery from UPPP / tonsillectomy is very painful and reasonable amounts of opiates are largely ineffective with a UPPP / tonsillectomy. Even in cases where UPPP is effective, the effectiveness is temporary, and usually lasts for up to about five years. My surgeries didn't allow me to retire my CPAP.
Surgeries that open nasal passages can be very helpful in helping to be able to tolerate CPAP, and I understand that the recovery is not that bad.
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Permalink Reply by Carl Speas on
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I had these surgeries you have mentioned. My doctor told me i would have a 90% chance of complete recovery from OSA. I tell you I went through 2-3 weeks of pure Hell. The pain was horrendous. I have numbness under my chin and neck 1 year later. To top it all off, the surgeries did not work. It only raised my oxygen level from 60% to 70%. I now use a bipap machine, Hybrid mask and a mouth appliance together. Also did the doctors tell you that having surgery makes harder to get cpap to work later? Surgery will make it harder for them find the right pressure with cpap. My only option from here on out is a trach if the bipap does not work. My new Doctor told me I would not be as bad as I am now if I would have not had the surgeries. He said anyone with severe sleep apnea should not opt for surgery, it rarely works.He said surgery should a last resort.
I wish you well and much success. I would consult with more than one doctor before surgery. I wish i had sought more than one opinion.
Carl
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