Surgery Pros and Cons

First off, ignore any replies that say "Turn off the ramp", especially if your machine offers an autoramp. Although you will need to use clinical mode to adjust it, you can optimize the ramp to give you almost normal breathing while you are awake. Usually, this will involve a maximum EPR (or C-Curve or whatever your machine uses) that is not necessarily ideal for your therapy, but great for normal awake breathing.

Secondly, about surgeries, if you do some research, you will find that surgery is mostly unsuccessful at treating sleep apnea. However, a deviated septum is often associated with problems using CPAP, and having it corrected could make your therapy a lot better.

WindCpap wrote:First off, ignore any replies that say "Turn off the ramp", especially if your machine offers an autoramp. Although you will need to use clinical mode to adjust it, you can optimize the ramp to give you almost normal breathing while you are awake. Usually, this will involve a maximum EPR (or C-Curve or whatever your machine uses) that is not necessarily ideal for your therapy, but great for normal awake breathing.

Secondly, about surgeries, if you do some research, you will find that surgery is mostly unsuccessful at treating sleep apnea. However, a deviated septum is often associated with problems using CPAP, and having it corrected could make your therapy a lot better.

Depends on the surgery. An exert of what I previously posted regarding the MMA Jaw advancement surgery.

A meta-analysis by Holty and Guilleminault [5] pooled 53 reports describing 22 unique patient populations (627 patients), and found that the mean AHI decreased from 63.9/hr to 9.5/hr, with a pooled surgical success rate of 86%. Overall, 43.2% were cured (AHI < 5), with a 66.7% cure rate for those with a preoperative AHI < 30/hr. Long-term surgical success was maintained at 44 months. Predictors of surgical success included younger age, lower BMI, lower preoperative AHI, and greater degree of maxillary advancement. Quality of life measures, excessive daytime sleepiness, and blood pressure were noted to be significantly improved as well.

http://www.ncbi.nlm.nih.gov/pubmed/20189852

My other comment - "I know having an AHI below 5 is the ideal goal but keep in mind that the typical person who undergoes MMA has tried everything to no avail. So going from an AHI of 63.9 to 9.5 would be dammed good.""

The Inspire Procedure has a success rate of 78% in getting the AHI below 5. Unfortunately, the sample size is only 116. So anyone having this done needs to ask their surgeon what the particular success rates are for their patients.

As I previously mentioned, the chances of most apnea surgeries increase if all areas of the obstruction are addressed. If you just have tongue surgery but turn out to have obstructions in other areas, you are not going to have a high success rate.

While the MMA is very gruelling and has a much longer recovery than most sleep apnea surgery, because it covers the whole area, the chances of success are alot greater.

Anyone who is looking into surgical options, should read these archives:

http://www.needsleep.net/apnea/apneainf.html

Lot of good information that weighs all the issues to consider. To bad it isn't active as that type of board is badly needed for people who are out of options and are considering surgery.

That one actually works, but the idea of it scares the living crap out of me.

This is my personal opinion and should not be taken as medical advice. I want to emphasize that. However, I have had a horrible experience with throat surgery (tonsillectomy), after which, I have had tremendous difficulty tolerating CPAP and have been forced to resort to an AutoPap being run on a very wide spectrum (4-20, basically). Whereas before the tonsillectomy, I tolerated CPAP therapy at a minimum pressure of 10 better than most CPAPers I have conversed with.

After the tonsillectomy, my APAP pressures still go up to the same ranges they used to go up to before the tonsillectomy, maybe slightly lower but not much lower. Yet I am unable to tolerate higher set sustained pressures anymore or I get bloating I did not used to get before the tonsillectomy.

I am of the opinion that surgeries for sleep apnea (short of the drastic but reportedly super effective tracheotomy) are not very effective at resolving obstructive sleep apnea and oftentimes create more problems than they solve. Its also expensive. And many APAP devices dont seem to work very well after youve had throat tissue cut out.

Now nasal surgery/sinusitis surgery, I have no problem with. Correcting a deviated nasal septum? Removing nasal polyps or cleaning out scar tissue in your sinuses? Might reduce your pressures, you will probably need a new titration afterwards.

But traditional throat OSA surgeries...stay away from.

My tonsillectomy surgery solved one problem...chronic tonsillitis. But it created a new one and that is Im now barely able to tolerate CPAP. Kinda crazy. And all my old CPAP symptoms came back in spades. And the doctors wont admit anything went wrong...doctors stick together and their liability insurance teaches them to "deny deny deny." The only way to get them to settle or admit anything is to take them to court in a jury trial.

Today, when I called my sleep doc and asked if I had apneas/hypoapneas when I slept on
my side. He couldn't answer but he THOUGHT so. I told him after all these years
I really hate cpap gear. He suggested I look into the INSPIRE therapy. My pressure
is set 5-10 and my apneas/hypoapneas are under 1 or 2 using the gear. He said
there's a 70% success rate and gave me the name of a doc. HOWEVER, I have
serious reservations....

What's the word on the street?

Thanks

49er wrote:

WindCpap wrote:First off, ignore any replies that say "Turn off the ramp", especially if your machine offers an autoramp. Although you will need to use clinical mode to adjust it, you can optimize the ramp to give you almost normal breathing while you are awake. Usually, this will involve a maximum EPR (or C-Curve or whatever your machine uses) that is not necessarily ideal for your therapy, but great for normal awake breathing.

Secondly, about surgeries, if you do some research, you will find that surgery is mostly unsuccessful at treating sleep apnea. However, a deviated septum is often associated with problems using CPAP, and having it corrected could make your therapy a lot better.

Depends on the surgery. An exert of what I previously posted regarding the MMA Jaw advancement surgery.

A meta-analysis by Holty and Guilleminault [5] pooled 53 reports describing 22 unique patient populations (627 patients), and found that the mean AHI decreased from 63.9/hr to 9.5/hr, with a pooled surgical success rate of 86%. Overall, 43.2% were cured (AHI < 5), with a 66.7% cure rate for those with a preoperative AHI < 30/hr. Long-term surgical success was maintained at 44 months. Predictors of surgical success included younger age, lower BMI, lower preoperative AHI, and greater degree of maxillary advancement. Quality of life measures, excessive daytime sleepiness, and blood pressure were noted to be significantly improved as well.

http://www.ncbi.nlm.nih.gov/pubmed/20189852

My other comment - "I know having an AHI below 5 is the ideal goal but keep in mind that the typical person who undergoes MMA has tried everything to no avail. So going from an AHI of 63.9 to 9.5 would be dammed good.""

The Inspire Procedure has a success rate of 78% in getting the AHI below 5. Unfortunately, the sample size is only 116. So anyone having this done needs to ask their surgeon what the particular success rates are for their patients.

As I previously mentioned, the chances of most apnea surgeries increase if all areas of the obstruction are addressed. If you just have tongue surgery but turn out to have obstructions in other areas, you are not going to have a high success rate.

While the MMA is very gruelling and has a much longer recovery than most sleep apnea surgery, because it covers the whole area, the chances of success are alot greater.

Anyone who is looking into surgical options, should read these archives:

http://www.needsleep.net/apnea/apneainf.html

Lot of good information that weighs all the issues to consider. To bad it isn't active as that type of board is badly needed for people who are out of options and are considering surgery.

From their site it lists important safety information. And the thing that got me is that you can't have an MRI. How would you know if you might ever need an MRI?
https://www.inspiresleep.com/important- ... formation/

Two questions about Inspire surgery:
--Will YOUR insurance cover it?
--If not, how much does it cost?
It sounds more promising than any other "apnea cure" surgery.
-----Still not enough to overcome my dread of surgery.

id love to share my history of surgires and sleep apnea.

3 years ago i visited an ENT about my deviated septum that i was born with. Could NEVER breathe out of my left nasal and the right one was about 20%.

Before the surgery he gave me a sleep study and thats when i 1st heard of this sleep apnea thing. anywho, i got the septum surgery. it was CAKE. took like 25 minutes and just rested for about 3 days before going back to work. I was able to breathe a lot better! But here is the thing, he told me before the surgery i had a choice to let him do a quick fix or go full blown fix and use plastic surgery to fix my nose 100%. even though i did the quick fix, it not 100% and he always mentions to me everytime i see him.

fast foward 1 year of visting him about other issues and that im still sleepy during the day and using a cpap machine has never helped since i sleep with my mouth open ALWAYS. At this point im 24 years old and my tonsils are so large he wants to take them out. figured why not, they are huge. i have had issues of snoring and this would help. got my tonsils out, long story short the cut where they took the tonsils out broke open 1 week after and i was puking blood like it was water coming out of a sink. rushed back into ER and got phenomena from all the blood that went into my lungs. 29 days/nights in the hoistpal in constant pain, cant walk or eat ANYTHING i spent.

i get out and 1 week later, SAME THING. puking bood and rushed back into ER. back in there for 4 more nights until i was out. 54 pounds lighter and a blood transfusion!


I still have sleep apnea. the quick fix septum surgery helped a lot but i wish i did the plastic surgery one instead and still can but im taking a break from hospitals for a whileeee.


the tonsillectomy, ehhh. I dont know if it helped at all. i mean they were enlarged so them coming out should of helped

DeeCPAP wrote:Today, when I called my sleep doc and asked if I had apneas/hypoapneas when I slept on
my side. He couldn't answer but he THOUGHT so.

Do you have a copy of your report? Side vs supine sleeping info is a part of the report. If you don't have the report, request it. The doctor doesn't have to guess - they just have to read the report. They were probably talking to you without those results in front of them and they see too many reports to go on memory. I would get those answers before considering the other options out there. Don't know statistically how likely it is your apnea could be positional, but I'd want to know exactly what I was working with.

Actually, there was a study of 116 people from the Inspire trials who reduced their AHI by 78% after three years. So if I was going to have this surgery, I would ask the surgeon what percentage of his/her patients showed the same results as this trial.

And I would also want to know how many of these procedures the surgeon has done. To be honest, I am not sure what the idea number but I still think you can tell how experienced the person is as at the procedure by asking this question.

While obviously there are patients who might not reach the ideal below 5 AHI goal, if they are down to this option after trying everything else and at least reduce their AHI around 10 or less, it is still better than not having any treatment at all.

OkyDoky, makes a good point about how if you had this procedure, you wouldn't be able to have an MRI. But as with anything, it is weighing all the issues. If you're a patient who has failed big time with pap therapy and or dental devices, yeah not having an MRI could be an issue. However, it sounds like it is still better to face that problem if it should become an issue vs. not being treated for the sleep apnea.

49er

DeeCPAP wrote:Today, when I called my sleep doc and asked if I had apneas/hypoapneas when I slept on
my side. He couldn't answer but he THOUGHT so. I told him after all these years
I really hate cpap gear. He suggested I look into the INSPIRE therapy. My pressure
is set 5-10 and my apneas/hypoapneas are under 1 or 2 using the gear. He said
there's a 70% success rate and gave me the name of a doc. HOWEVER, I have
serious reservations....

What's the word on the street?

Thanks

49er wrote:

WindCpap wrote:First off, ignore any replies that say "Turn off the ramp", especially if your machine offers an autoramp. Although you will need to use clinical mode to adjust it, you can optimize the ramp to give you almost normal breathing while you are awake. Usually, this will involve a maximum EPR (or C-Curve or whatever your machine uses) that is not necessarily ideal for your therapy, but great for normal awake breathing.

Secondly, about surgeries, if you do some research, you will find that surgery is mostly unsuccessful at treating sleep apnea. However, a deviated septum is often associated with problems using CPAP, and having it corrected could make your therapy a lot better.

Depends on the surgery. An exert of what I previously posted regarding the MMA Jaw advancement surgery.

A meta-analysis by Holty and Guilleminault [5] pooled 53 reports describing 22 unique patient populations (627 patients), and found that the mean AHI decreased from 63.9/hr to 9.5/hr, with a pooled surgical success rate of 86%. Overall, 43.2% were cured (AHI < 5), with a 66.7% cure rate for those with a preoperative AHI < 30/hr. Long-term surgical success was maintained at 44 months. Predictors of surgical success included younger age, lower BMI, lower preoperative AHI, and greater degree of maxillary advancement. Quality of life measures, excessive daytime sleepiness, and blood pressure were noted to be significantly improved as well.

http://www.ncbi.nlm.nih.gov/pubmed/20189852

My other comment - "I know having an AHI below 5 is the ideal goal but keep in mind that the typical person who undergoes MMA has tried everything to no avail. So going from an AHI of 63.9 to 9.5 would be dammed good.""

The Inspire Procedure has a success rate of 78% in getting the AHI below 5. Unfortunately, the sample size is only 116. So anyone having this done needs to ask their surgeon what the particular success rates are for their patients.

As I previously mentioned, the chances of most apnea surgeries increase if all areas of the obstruction are addressed. If you just have tongue surgery but turn out to have obstructions in other areas, you are not going to have a high success rate.

While the MMA is very gruelling and has a much longer recovery than most sleep apnea surgery, because it covers the whole area, the chances of success are alot greater.

Anyone who is looking into surgical options, should read these archives:

http://www.needsleep.net/apnea/apneainf.html

Lot of good information that weighs all the issues to consider. To bad it isn't active as that type of board is badly needed for people who are out of options and are considering surgery.

Inspire sounds kind of promising. Wouldn't sign on the dotted line though. It does sound like it could conceivably work, whereas some of these things are very hit or miss (and perhaps mostly miss), not talking re: well-established sorts of surgeries which might benefit you otherwise like deviated septum or a tonsilectomy.

Having had cancer, I don't want to ever shut the door to an MRI.

Try harder to make CPAP work. Unfortunately, you'll probably have to learn to manage your own therapy, because the medical mafia isn't very good about helping out with problems. That's why this board is here.

Let someone else be the guinea pig for these apnea surgeries. Once they get the bugs out of them, you can get them and stop CPAP. If you get surgery now, you may suffer from the side effects and still need CPAP. It may even interfere with you using CPAP later.

If you try hard and simply can't make CPAP work, you might try the surgeries, but really try hard. The surgeries aren't easy or all that successful. Even the ones that have a high "success" rate don't have long term results. I'm also very skeptical about how "success" is defined and measured.

MMA really worries me about too much hype, being more serious than it's marketed as being, and not having good long term data.

Exceptions: If you have a deviated septum or tonsillitis that needs repair even without the question of apnea, go for it.

I do have high hopes for a better, long term surgical/mechanical solution. I just haven't seen it yet.

archangle wrote:Try harder to make CPAP work. Unfortunately, you'll probably have to learn to manage your own therapy, because the medical mafia isn't very good about helping out with problems. That's why this board is here.

Let someone else be the guinea pig for these apnea surgeries. Once they get the bugs out of them, you can get them and stop CPAP. If you get surgery now, you may suffer from the side effects and still need CPAP. It may even interfere with you using CPAP later.

If you try hard and simply can't make CPAP work, you might try the surgeries, but really try hard. The surgeries aren't easy or all that successful. Even the ones that have a high "success" rate don't have long term results. I'm also very skeptical about how "success" is defined and measured.

MMA really worries me about too much hype, being more serious than it's marketed as being, and not having good long term data.

Exceptions: If you have a deviated septum or tonsillitis that needs repair even without the question of apnea, go for it.

I do have high hopes for a better, long term surgical/mechanical solution. I just haven't seen it yet.

Archangle,

Again, let me repost previously what I wrote on the MMA.

Depends on the surgery. An exert of what I previously posted regarding the MMA Jaw advancement surgery.

A meta-analysis by Holty and Guilleminault [5] pooled 53 reports describing 22 unique patient populations (627 patients), and found that the mean AHI decreased from 63.9/hr to 9.5/hr, with a pooled surgical success rate of 86%. Overall, 43.2% were cured (AHI < 5), with a 66.7% cure rate for those with a preoperative AHI < 30/hr. Long-term surgical success was maintained at 44 months. Predictors of surgical success included younger age, lower BMI, lower preoperative AHI, and greater degree of maxillary advancement. Quality of life measures, excessive daytime sleepiness, and blood pressure were noted to be significantly improved as well.

http://www.ncbi.nlm.nih.gov/pubmed/20189852

My other comment - "I know having an AHI below 5 is the ideal goal but keep in mind that the typical person who undergoes MMA has tried everything to no avail. So going from an AHI of 63.9 to 9.5 would be dammed good.""

If you have contrary evidence, please post a link.

And as I keep mentioning regarding any surgery and not just MMA, you have to look at it not as an equal option to pap therapy. Any sleep surgeon worth his/her weight won't operate unless the patients have given pap therapy a try for a least six months

The issue is if the person can't or won't use the machine, they are not being treated for their apnea. So then it comes down to weighing the best option which involves several factors. I am not going to claim that surgery will be as effective as pap therapy but to claim it never or hardly works is just not accurate.

Even the UPPP, which I would be very reluctant to do, works 40% of the time. And someone posted a link awhile back that showed that if the person met specific criteria (sorry, can't remember what), the success rate went up to 80%.

49er

49er wrote: Archangle,

Again, let me repost previously what I wrote on the MMA.

Let me repeat.

I'm still skeptical about the medical mafia hype you're quoting. Doubly so on the UPPP info.