My experience with septoplasty and turbinate reduction

[GaryG]

Hello to all my friends (and I mean friends) here at cpaptalk.com. It's been a while since I posted here and lots has gone on. Let me share my experiences with my septoplasty and turbinate reduction, along with a few alternate suggestions for treatment I've come across.

Yes, aside from a very demanding job at work (I limit myself to only 8 days a week and 25 hours a day as I am no workaholic), and a homelife full of challenges raising two teenage daughters, I am doing just fine. Well, pretty good anyway.

I underwent septoplasty and turbinate reduction back on Tuesday, May 18th about 4 and half weeks ago, and yes, I had it done by none other than Dr. Steven Park, who a lot of you are familiar with.

The first dumb thing I did was try to return to work on Thursday, too early. Shoulda taken a few more days off. Did take off Friday, but still....

The surgery was a snap, not bad at all, the worst part was the anesthesia, which really made me feel loopy for a long period afterwards. Now the type of surgery I had was not as invasive as typical septoplasty (or at least what I was lead to believe was traditional septoplasty) I had nothing stuffed in the nose, and only had to have some gauze underneath to catch some drippings.

My big challenge is that my nose works differently now and I no longer seem to be able to tolerate APAP. After my surgery, I figured it would be a good idea to switch to APAP, as my pressure needs would most likely change. However, one night on APAP 8-12, resulted in immediate ramp up to the high pressure, and resulted in severe aerophagia.

I then tried titrating myself to a tolerant CPAP pressure. I can go no higher than 9.2 now (was at 9.8 or 10.0 before surgery) without experiencing aerophagia. Notice I'm not even discussing AHI numbers. Aerophagia trumps numbers.

I've been experimenting with some tongue exercises (http://ijustwanttosleep.com), which seem promising, and this is a lengthy program, so won't know for sure for a while how that works out. Imagine a speech therapist working with a child, whose parents noticed the kid's sleeping improved dramatically - kind of a sleep apnea aid by accident.

Another alternative treatment that Dr. Park recommended I might consider is the aveoTSD device. http://www.aveosleep.ca/aveotsdhowitworks.html Now these alternatives are possible non-invasive treatments that might be considered.

[SleepingUgly]

What is Dr. Park's explanation for your intolerance of APAP now? How long were you off CPAP/APAP all total before you tried it again and had these experiences?

[-SWS]

Hello to all my friends (and I mean friends) here at cpaptalk.com. It's been a while since I posted here and lots has gone on. Let me share my experiences with my septoplasty and turbinate reduction, along with a few alternate suggestions for treatment I've come across.

Hello, and welcome back, Gary.

I underwent septoplasty and turbinate reduction back on Tuesday, May 18th about 4 and half weeks ago

I'm sorry if you already mentioned this in a past thread... Curious what the septoplasty and turbinate reduction objectives were in your particular case?

My big challenge is that my nose works differently now and I no longer seem to be able to tolerate APAP. After my surgery, I figured it would be a good idea to switch to APAP, as my pressure needs would most likely change. However, one night on APAP 8-12, resulted in immediate ramp up to the high pressure, and resulted in severe aerophagia.

I wonder if there's still enough post-surgical swelling to cause excessive flow-limitations and/or snoring to be registered by the APAP. Either can drive the pressure up.

I then tried titrating myself to a tolerant CPAP pressure. I can go no higher than 9.2 now (was at 9.8 or 10.0 before surgery) without experiencing aerophagia. Notice I'm not even discussing AHI numbers. Aerophagia trumps numbers.

Also called gastric insufflation... I wonder if it's a passive breech of pressurized air or if it's reflexive swallowing. Are you by any chance experiencing post-nasal drainage that promotes swallowing? That, in turn, might facilitate the introduction of pressurized CPAP air into the stomach. Good luck healing and getting better sleep. Thanks for the info too!


So has anyone else heard of septoplasty and turbinate reduction causing aerophagia or APAP intolerance? As either a long term or even long term effect? That's the first I heard of it.

[rested gal]

About the aveoTSD device... I wonder if Dr. Park has ever tried having that stuck on his tongue for a full 8 hour night?

Snork1 reported on his experience with the Aveo TSD device quite a few years ago:

Snork was hopeful:
viewtopic.php?t=6207
Dec 22, 2005 subject: Aveo TSD - a different approac

Snork said it didn't work for him after all:
viewtopic.php?t=16016
Dec 21, 2006 subject: aveoTSD?
"It is just about impossible to hold suction all night, and its a very fine balance between too much suction causes too much tongue web soreness and less soreness, but having it pop off all night."

[Uncle_Bob]

Hi Gary welcome back.

My ENT told me that due to the healing process i could expect there to be some swelling/congestion in the nasal passages for up to 6 weeks.

Since surgery 3 months ago my APAP is using less pressure.

[sleepsurfer]

had my septo and turbinate reduction back in march 2010. BEST THING I HAVE EVER DONE!!!!!!! i can breath freely through my nose at all times. what a friggin relief!!!! i would do it again tomorrow if i had to. now my apap treatment is another story, though. i am still struggling with that. the pap is not really treating my upper airway resistance. but at least i can breath through my nose !!!!!!!!!!!!!!

[SleepingUgly]

had my septo and turbinate reduction back in march 2010. BEST THING I HAVE EVER DONE!!!!!!! i can breath freely through my nose at all times. what a friggin relief!!!! i would do it again tomorrow if i had to. now my apap treatment is another story, though. i am still struggling with that. the pap is not really treating my upper airway resistance. but at least i can breath through my nose !!!!!!!!!!!!!!

What do you mean when you say the apap is not treating your UARS? Was it treating it before the surgery?

[sleepsurfer]

no, not really. i have been trying different pressures, but my ahi stays the same. 2.5 to 4.5 on average. and i can no longer use nasal congestion as an excuse.

[SleepingUgly]

no, not really. i have been trying different pressures, but my ahi stays the same. 2.5 to 4.5 on average. and i can no longer use nasal congestion as an excuse.

2.5 to 4.5 is considered "normal" in this artificially categorized system.

[sleepsurfer]

my ahi is only part of the story. i have upper airway resistance. my rera index was about 20/hr during my sleep studies and my ahi was about 2. so being that i'm not any less sleepy, cpap isn't helping much.

[GaryG]

What is Dr. Park's explanation for your intolerance of APAP now? How long were you off CPAP/APAP all total before you tried it again and had these experiences?

He didn't have an explanation, thought it highly unusual. After surgery I waited 3 days before trying APAP.

At Dr. Park's suggestion, I talked to my local sleep doc Tuesday night. We agreed that it was worth trying the APAP again. Well, I did last night on 4-12, and was able to tolerate it now, and had a median of 6.4 a 95 perentile of 8.8 with a max of 9.4. yes my numbers were good. But I'm going to try APAP again tonight.

With such low pressure numbers, I wonder if maybe I don't have sleep apnea anymore. I asked for a retitration, so we'll see what happens.

[GaryG]

Hello, and welcome back, Gary.

Thanks

Curious what the septoplasty and turbinate reduction objectives were in your particular case?

Many nights I was having difficulty breathing while using CPAP, and felt that anything that would make it easier for me to breathe thru my nose would be worth it. I can't deny that since at titration, my AHI was 13, I figured there was an outside chance I might get under 5... and well... But that was NOT my prime motivation.

I wonder if there's still enough post-surgical swelling to cause excessive flow-limitations and/or snoring to be registered by the APAP. Either can drive the pressure up.

I think there's something to it. My experience on APAP 1 night 4 weeks later was totally different. Gotta try this a little more.

Also called gastric insufflation... I wonder if it's a passive breech of pressurized air or if it's reflexive swallowing. Are you by any chance experiencing post-nasal drainage that promotes swallowing? That, in turn, might facilitate the introduction of pressurized CPAP air into the stomach. Good luck healing and getting better sleep. Thanks for the info too!

No post-nasal drainage. Clean as a whistle now.

So has anyone else heard of septoplasty and turbinate reduction causing aerophagia or APAP intolerance? As either a long term or even long term effect? That's the first I heard of it.

I'm guessing this might be related to healing process in some way. But yes, both Dr. Park and my sleep doc both thought this was very unusual.

[GaryG]

About the aveoTSD device... I wonder if Dr. Park has ever tried having that stuck on his tongue for a full 8 hour night?

Snork1 reported on his experience with the Aveo TSD device quite a few years ago:

Snork was hopeful:
viewtopic.php?t=6207
Dec 22, 2005 subject: Aveo TSD - a different approac

Snork said it didn't work for him after all:
viewtopic.php?t=16016
Dec 21, 2006 subject: aveoTSD?
"It is just about impossible to hold suction all night, and its a very fine balance between too much suction causes too much tongue web soreness and less soreness, but having it pop off all night."

I just put it out there. Dr. Park does not recommend it strongly, it's just another option he's having certain patients experiment with.

[GaryG]

Hi Gary welcome back.

My ENT told me that due to the healing process i could expect there to be some swelling/congestion in the nasal passages for up to 6 weeks.

Since surgery 3 months ago my APAP is using less pressure.

Thanks Bob. Good to hear this. Now I'm sure the big question is, how do I feel now compared to before my surgery. And the problem is, life does not stand still, and there are variations in all of our lives and lifestsyles, and a few weeks prior to the surgery, my job at work got more demanding, and I am working longer hours (which means later dinners, and eating later at night, which by itself is a nono), and so my feeling lousy and tired can really legitimately be related to simply only sleeping 5-6 hours a night on average vs the 7-8 I was a few months ago.

Lifestyle is a BIG deal when it comes to CPAP/APAP treatment and Sleep Apnea. And I am abusing myself currently with my workload. Which doesn't help. (But at least I have a job...)

[GaryG]

Well, I'm able to tolerate the APAP, and it looks like my pressure was somewhat higher on the next two nights. Too early to make conclusions, but the main point worth sharing is after the surgery, our noses are healing, and so it will take time to assess the impact on our pressure settings.