Thank You All and Goodbye!

[Madalot]

Intriguing.

That wasn't worded well. I actually meant an oral appliance to give me a little more room. In other words, mild advancement. I have already had an endoscopy and they didn't find anything anatomical issues in my throat so hopefully just a little more room along w/ the other things will be enough. If not, plan C.

For what it's worth, I respect your decision and right to pursue other treatments. For some people, alternative treatments DO work.

I have a family member that simply refuses to do cpap. This person opted for an oral device. They had it specially made by a dentist to treat snoring & sleep apnea. Device made and used and a new sleep study performed to see *IF* it was effective. It was NOT and did nothing for either the apneas OR snoring.

My family member is out $3000+ for this device and the dentist is now saying they never said it would treat the apneas or snoring (the literature DOES claim it will treat these issues).

Just be very careful before forking over this kind of money for an oral device.

[jnk]

I think sleep tests may get scored, uh, aggressively, in order to qualify a patient for trying PAP therapy. In fact, I think that is often the right thing to do in order to get what is needed out of insurance. The downside is that those suffering from what might be something less than true OSA will have that diagnosis in their medical file, if they have reason not to want it there. Answering the question "have you ever been diagnosed with any of the following conditions" will be a tricky question for them to answer for the rest of their lives, even if the arrest--oops, I mean diagnosis--gets 'expunged' from their 'records.'

If someone with an AHI over 20 or so (even if 'only' hypopneas) doesn't want to give PAP the full shot, I would probably try to influence them to decide otherwise, based on the statistics in the studies floating around suggesting the possible dangers of that choice for overall health and safety. If the AHI is less than 10 or so, though, and the old Epworth ain't very high either, then I would tend to leave it to the judgment of the person completely and would not try to influence the decision too much unless asked my opinion directly.

But hey, that's just me.

I do find the idea of a re-score to be fascinating. Kinduva polysomnographic MacCam, if you will.

[Zzzzzzzzzzz...]

Yeah? Like what?

I might now have to buy one outright but that is ok. I am willing if these other options don't work.

I'd be happy to sell you my S9 Autoset as a parting gift!

Z

[teachcsg]

Interesting. Good for you for being persistent.

Good luck!

[sylvie]

Interesting. Good for you for being persistent.

Good luck!

Dittos, Monk. The best to you. I've chosen the palet expansion route, in hopes to accommodate my tongue. As my holistic dentist says, I have a 6-foot tiger in a 3-foot cage. I might still have to use CPAP, but the pressure might be lower, or it might work completely. You have to try if it's possible. But I know there will be definite physical/facial benefits no matter what.

[Suddenly Worn Out]

One thing to think about with all that throat surgery. I have read repeatedly, at different places, over and over again, that having UPP and other throat clearing surgeries will do one thing you dont want. If you do end up going back to CPAP and end up on some sort of auto device (APAP, autoBipap), removing those tissues destroys a lot of the stuff the mechanisms for the autoCPAPs use to detect apneas and hypopneas. And will make APAPs and autoBipaps much less effective (about unuseable, in fact).

To me, that is something to think about. Very hard. As I use high pressures, my APAP and autoBipap both go up way up now that I am on testosterone replacement therapy. Last night I got a 90th percentile of 16.5!!! Before testosterone my typical 90th percentile or 95th percentile would have been 13ish.

As far as a deviated nasal septum and nasal allergies, Im all with you on that. I have a severely deviated nasal septum myself and tendencies towards sinusitis. I use a corticosteroid nasal spray longterm and was on one long before I ever got on CPAP. I'd be for correcting the deviated nasal septum and well, nasal allergies is easy to treat...you just get a prescription of a nasal corticosteroid spray like Nasacort AQ. It is excellent and works well.

But I have repeatedly read and been told that surgeries like UPPP 1) simply dont work nearly as well as some ENT surgeons would have you believe and 2) if you end up on CPAP and use an auto device of any type, the auto devices wont work that great with all that tissue removed. You will pretty much be restricted to straight pressure CPAP based upon a sleep titration study in a sleep lab....something I personally would not want to rely on longterm. As my weight changes or as I add or remove certain prescription drugs.

For example, without my APAPs and autoBipap, with my recent "being ordered" onto Androgel 1.62%, I would most likely been forced to go thru the hassles of another sleep study. And a retitration at a higher pressure. A single set pressure. That is a huge hassle IMO, expensive and you are as the mercy of your insurance company and your sleep doc's level of advocacy for your plight. Two things I dont like to rely upon, btw.

I decided someday I might get my deviated nasal septum corrected (maybe, I dont know if its really worth all the pain, hassle, cost and at my age, recovery time). But I aint ever messing with uppp surgery or similar throat surgeries. The only one I have read that truly works is the one where they break your jaw and reset it to change the shape of your airway.

Anyway, good luck and btw, CPAP aint that bad I love mine.

Eric

[So Well]

Intriguing.

That wasn't worded well. I actually meant an oral appliance to give me a little more room. In other words, mild advancement. I have already had an endoscopy and they didn't find anything anatomical issues in my throat so hopefully just a little more room along w/ the other things will be enough. If not, plan C.

Of course. Just wanted to give you a little "shot".

deviated septum fixed, allergies treated, positional therapy, oral appliance.

Good plan!

Even with CPAP I needed septum correction, turbinate resectioning and allergy treatment. I also stay aware of the positional effect and try to roll from my back to my side in the early morning hours when I am going through lengthy REM sleep and my apnea is most severe.

"Mild oral appliance" - yes, it might make my CPAP therapy more effective. If I ever get in a position where my insurance will pay most of one I will give it a try. Might be able to lower my pressure.

It sounds like you have an appreciation for the condition and how it can wreck your life and are committed to making good choices. Good luck with it!

(BTW, Are you NightMonkey reincarnated?)

[portiemom]

"NORMAL" exactly what did you mean by that?......Anyway, I wish you well!!!!

[Goofproof]

Along with your plan, I would add O2 monitoring at night, all night, to make sure you stay well. Jim

[49er]

Dental device? Its better than nothing, certainly. But again it is not the gold standard for SDB. CPAP/APAP/BIPAP are the gold standard.

Not correct.

A local sleep medicine doctor who was recommended by Dr. Krakow (For various reasons, I didn't go see him) said on his website that a dental appliance is accepted first line therapy for mild and moderate apnea.

I also think it depends on the appliance used. A sleep medicine dentist, Dr Luisi, on the other apnea board has said that research backs the TAPIII as the most effective dental appliance.

The Monk - I wish you all the luck in the world. Stay in touch.

49er

[deltadave]

I hope this clarifies things for those passive/aggressive sorts.

Not exactly.

If you have no appreciable EDS; and

what few hypopnea on the sleep study have now been removed; and

the remaining RERAs do not appear to be pressure-responsive; then

why pursue an SDB diagnosis at all?

[SleepyToo2]

Dental device? Its better than nothing, certainly. But again it is not the gold standard for SDB. CPAP/APAP/BIPAP are the gold standard.

Not correct.

A local sleep medicine doctor who was recommended by Dr. Krakow (For various reasons, I didn't go see him) said on his website that a dental appliance is accepted first line therapy for mild and moderate apnea.

I also think it depends on the appliance used. A sleep medicine dentist, Dr Luisi, on the other apnea board has said that research backs the TAPIII as the most effective dental appliance.

The Monk - I wish you all the luck in the world. Stay in touch.

49er

Point of clarification. There can be more than one accepted first line therapy. This would include PAP devices, and oral appliances, for some patients. However, there is generally only one "gold standard" treatment, which remains the PAP device as far as I know. There could also be a "gold standard" oral appliance - which may happen to be the TAPIII. That will not change PAP as the gold standard treatment for apnea.

[49er]

Dental device? Its better than nothing, certainly. But again it is not the gold standard for SDB. CPAP/APAP/BIPAP are the gold standard.

Not correct.

A local sleep medicine doctor who was recommended by Dr. Krakow (For various reasons, I didn't go see him) said on his website that a dental appliance is accepted first line therapy for mild and moderate apnea.

I also think it depends on the appliance used. A sleep medicine dentist, Dr Luisi, on the other apnea board has said that research backs the TAPIII as the most effective dental appliance.

The Monk - I wish you all the luck in the world. Stay in touch.

49er

Point of clarification. There can be more than one accepted first line therapy. This would include PAP devices, and oral appliances, for some patients. However, there is generally only one "gold standard" treatment, which remains the PAP device as far as I know. There could also be a "gold standard" oral appliance - which may happen to be the TAPIII. That will not change PAP as the gold standard treatment for apnea.

Fair points and perhaps it is just a matter of semantics.

My bigger concern is that people on this board unfairly disparage dental devices without any solid evidence. I do agree that caution is warranted and that alot of research is necessary to chose the right dentist and device but to simply imply they hardly ever work is just not accurate.

As one who is having a horrific time getting cpap to work in spite of my best efforts, I am concerned that people in similar situations will decide not to pursue dental appliance options when that might be a good choice for their situation.

49er

[deltadave]

Well again, in a review of the OP's data:

I slept only 3 three hours spread over the 7+ I was there and never left Stage 1 sleep. Somehow out of that mess, they diagnosed me w/ moderate apnea. The data is interesting. 24 hypopneas, no apneas, no snoring and no O2 de-sats below 90%. My avg O2 was 95%. I did have a lot of RERA's, however.

If all the hypopneas are now removed and the RERAs are not pressure-responsive, then why treat at all?

If the hypopneas were improperly scored (and don't forget, the NPSG needs to be confirmed epoch-by-epoch by the board certified sleep specialist, so don't throw the initial scorer under the bus, the ultimate responsibility is the sleep physician's) then why not look at the RERAs as well? If there is not clear evidence of increased effort in the RIP belts (assuming they're using RIP belts), then there's no RERAs either.

And with no indicated snoring, I'll bet you can throw some/most/all of the RERAs out, too.

[jnk]

I slept only 3 three hours spread over the 7+ I was there and never left Stage 1 sleep. Somehow out of that mess, they diagnosed me w/ moderate apnea. The data is interesting. 24 hypopneas, no apneas, no snoring and no O2 de-sats below 90%. My avg O2 was 95%. I did have a lot of RERA's, however.

If he actually never left stage 1, then for all practical purposes, they diagnosed his awake breathing. Right?

And who knows what would have happened in 2, 3, or (supine) REM!

So they found a way to finagle the numbers to find out his response to therapy.

Since that didn't seem to pan out for him, they agreed to start with a clean slate and move on, it seems.

I would sign off on that. Of course, naturally, I would have to forge someone else's signature for it to mean anything if I ever tried to sign anything medical. But I'd still sign it. With disappearing ink. Like they did.