Body in decline from Sleep Apnea / Surgery denial by Insurance

[sleepy-programmer]

A lot of folks here claim that jaw surgery is not effective for sleep apnea. There's more than one type of surgery. I have three doctors I trust who have all told me MMA surgery (moving the lower, or both, jaws forward) is effective at resolving sleep apnea for a patient like me who has severe retrognathia and no other obvious cause. My sleep apnea isn't because of my sinuses or my tonsils. The way one doc put it to me: "you're trying to suck a milkshake out of a tiny straw. You need a bigger straw."

If CPAP is near 100% effective there's really no reason to get this surgery. But can anybody here say that what my doctors have told me about MMA is not true? Asking this here because OP mentions this specific surgery.

[babydinosnoreless]

A lot of folks here claim that jaw surgery is not effective for sleep apnea. There's more than one type of surgery. I have three doctors I trust who have all told me MMA surgery (moving the lower, or both, jaws forward) is effective at resolving sleep apnea for a patient like me who has severe retrognathia and no other obvious cause. My sleep apnea isn't because of my sinuses or my tonsils. The way one doc put it to me: "you're trying to suck a milkshake out of a tiny straw. You need a bigger straw."

If CPAP is near 100% effective there's really no reason to get this surgery. But can anybody here say that what my doctors have told me about MMA is not true? Asking this here because OP mentions this specific surgery.

My lower jaw was broken, moved forward and bolts put in. This was in 1978 I don't know if it was called MMA then but that is what is was. My sleep report from last year states "severe obstructive" sleep apnea. I am on a bilevel machine.

[Fourtay]

A lot of folks here claim that jaw surgery is not effective for sleep apnea. There's more than one type of surgery. I have three doctors I trust who have all told me MMA surgery (moving the lower, or both, jaws forward) is effective at resolving sleep apnea for a patient like me who has severe retrognathia and no other obvious cause. My sleep apnea isn't because of my sinuses or my tonsils. The way one doc put it to me: "you're trying to suck a milkshake out of a tiny straw. You need a bigger straw."

If CPAP is near 100% effective there's really no reason to get this surgery. But can anybody here say that what my doctors have told me about MMA is not true? Asking this here because OP mentions this specific surgery.

My dentist, periodontist, and orthodontists recommended jaw surgery for me originally to fix my malocclusion, which was the furthest priority for me lol. I didn't really care if I had crooked teeth or a crooked bite. But then the sleep apnea started and I was on board for surgery to fix it!
My top jaw is V-shaped and is smaller than my bottom jaw. I have mild retrognathia. The oral surgeon proposed expansion and 5mm forward movement of the upper jaw, and advancement of the lower jaw approximately the same distance if my memory is right. Our consultation was a few months ago, it could have been a little more or less than 5 mm of movement.

I spoke with one of the leading Otolaryngology doctors in my area, this was part of her notes of our visit:

"Mr. ------ presents with mixed sleep apnea with good CPAP compliance with interest in surgical options for sleep apnea. He overall has mild sleep apnea and is able to tolerate CPAP quite well despite struggling with aerophagia and dry mouth. On exam he has significant nasal internal valve collapse and very narrow nasal passages. Discussed with him that nasal valve surgery may improve his daytime nasal breathing but also potentially allow him to use lower CPAP pressures, leading to reduced aerophagia. He has been recommended MMA surgery by his orthodontist for malocclusion and a narrow, highly arched palate. He would likely get a lot of benefit from a sleep apnea standpoint from MMA surgery as well. He is going to consider MMA and/or nasal valve surgery and in the meantime continue with CPAP. "

Additionally, the oral surgeon's notes from our consultation:
"Assessment and Plan:
------ - -------- is a 34 y.o. male who presents with mild mixed sleep apnea with bimaxillary retrusion, multiplanar maxillary occlusal plane. The patient would benefit from maxillomandibular advancement and genioglossus advancement as his posterior airway at base of tongue is narrowed. He is also found to have hypertrophic left inferior turbinate which may be attributing to decreased nasal breathing. He has seen other surgeons for consultation and will notify us if he wishes to proceed in our care. Once notified we will contact his orthodontist to discuss the treatment plan and surgical timing. Physical Exam: Bimaxillary retrusion. Neck supple with trachea located midline. No ant/post cervical LAD. No facial swelling. FOM soft and non-elevated. OP clear/moist with uvula located midline. Maxillary and mandibular orthodontic appliances in place. High maxillary palatal vault. Bilateral posterior crossbite."

[Fourtay]

I finally got the SD card reader in the mail today. Here are a couple of the nights in the sleepyhead program. I don't know how many nights I should post. I chose last nights and another night this month that looked remarkable.

[Fourtay]

Additionally, I have a supported O2 Monitor, I will charge it up and use it tomorrow.

I was looking through the statistics section on the sleepyhead software and I noticed something interesting.

In the section that notes all prescription changes, all the way at the bottom where my first machine setting was, it had 29 days at 1.99 ahi which was my lowest so far for that large of a sample size. I just found that interesting. Though, I feel better now at CPAP 9.8 than I did with APAP 7-14 pressure I think.

The biggest change I noticed was going from the Phillips Respironics to the Resmed. Resmed is so much better IMO.

[palerider]

The biggest change I noticed was going from the Phillips Respironics to the Resmed. Resmed is so much better IMO.

And yet, the Resmed isn't actually doing anything for you in CPAP mode.

Put it in autoset mode, min 9 max 20 and let's see what that baby can do.

[Fourtay]

And yet, the Resmed isn't actually doing anything for you in CPAP mode.

Put it in autoset mode, min 9 max 20 and let's see what that baby can do.

Hi palerider
Thank you for your time.
I am a total novice on the forums here. I would like to learn to better use the sleepy head program. Is there a specific item that catches your attention on the sleepy head report to indicate the current settings being insufficient?

[palerider]

And yet, the Resmed isn't actually doing anything for you in CPAP mode.

Put it in autoset mode, min 9 max 20 and let's see what that baby can do.

Hi palerider
Thank you for your time.
I am a total novice on the forums here. I would like to learn to better use the sleepy head program. Is there a specific item that catches your attention on the sleepy head report to indicate the current settings being insufficient?

The groups of apneas, they may be REM related, like many people, you may need more pressure during REM.

Your machine can respond and help you, but not with it's current settings.

[Fourtay]

I switched the machine last night to 9-15 auto. However i am unable to tolerate the pressure as I wake up every 30 minutes having to release the trapped swallowed air. It seems any pressure higher than 10 gives me a good bit of aerophagia. I have tried sleeping at an incline, using carbonated beverage before bed but it doesn't help.

At 9.8 cpap setting I will have aerophagia once a week or so. There seems to be varying degrees of aerophagia, sometimes its once every couple hours I have to sit up vertical in bed to release the stomach air, sometimes when it's bad its every 30 min or so.

Usually it's the most severe if I adjust the pressure up to test a higher setting.

I used to have stomach acid flow into my mouth while asleep and then be abruptly awakened by the sharp taste. It's been about 6 months since that happened last.

[palerider]

I switched the machine last night to 9-15 auto. However i am unable to tolerate the pressure as I wake up every 30 minutes having to release the trapped swallowed air. It seems any pressure higher than 10 gives me a good bit of aerophagia. I have tried sleeping at an incline, using carbonated beverage before bed but it doesn't help.

At 9.8 cpap setting I will have aerophagia once a week or so. There seems to be varying degrees of aerophagia, sometimes its once every couple hours I have to sit up vertical in bed to release the stomach air, sometimes when it's bad its every 30 min or so.

Usually it's the most severe if I adjust the pressure up to test a higher setting.

I used to have stomach acid flow into my mouth while asleep and then be abruptly awakened by the sharp taste. It's been about 6 months since that happened last.

Ok, try 9-11 tonight. and post a chart so we can see how much time you were over 10.

[Fourtay]

I went ahead and changed it to 9-11 last night. I had some aerophagia but it wasn't unbearable.

[palerider]

I went ahead and changed it to 9-11 last night. I had some aerophagia but it wasn't unbearable.

That's not too bad, in the fight against aerophagia.

You might even try 8-11, your AHI may go up a little, but your aerophagia may go down.. (relief during the times the pressure is lower.)