Phase 1 Surgery Followup PSG (It's good news!)

Swordz · Post by **Swordz** » Fri Oct 20, 2006 7:31 pm

History:

Initial sleep Study in April 2005, therapeutic study in May 2005. OSA severe w/ AHI of 52/hr. Prescribed APAP and heated humidifier. Tried APAP but never could fall asleep with it. Septoplasty & turbinate reduction November 2005. Dental device (Somnomed MAS) tried in early 2006, but quit due to severe TMJ. MMA consoltation in Feb 2006, with surgery being reccomended by Dr. At same apt, degenerative jaw condition found. 2nd APAP attempt in April 2006, but still intolerant. "Phase 1" surgery on July 10th, 2006, consisting of modified UP3, further turbinate reduction, tonsellectomy, and genioglossus advancement (GA). Followup sleep study was Oct 10th, with results reported to me today.

Results:

AHI reduced from 52/hr to ~10/hr. Sa02 increased from 84% from previous studies, to no less than 93% during sleep. "There was 1 central event, 14 hypopneas. The apnea plus hypopnea index was within normal range at 3 per hour, and this is markedly improved compared with more than 50 per hour on the baseline study." Stage 1 sleep is 18%, and Stage 2 is 60%, Stage 3/4 14.7%, and REM was 5.9%. Dr. stated, "PLMD was present, with 127 PLM's averaging 25.7/hr, but very few of those caused arousals." "Sleep Efficiency poor for Unknown reasons" listed by Dr, but I'm skipping caffiene before bed, windows are darkened, no TV, etc.

The surgery was an overwhelming success in my opinion. The Dr. said my best results would be an AHI of around 20/hr, but I've eclipsed that with ~10/hr. My oxygen levels at night are much better too, and I've noticed that with less headaches and much less groginess in the morning. My numbers overall are much better, but I'm not feeling that much better. I believe that my sleep stages are still not where they should be, so I'm looking into medication to enhance Stage 3/4 time. I am starting Lexapro next week for anti-anxiety/depression, so that might give me a "lift" as well.

The last two years have been SOOOO tough, but I'm very happy that I've gone through what I have. School has been really tough, and not to mention life overall as well. Family and friends are somewhat supportive, but none of them really know the everyday struggle as they don't have OSA.

I am getting braces within the month to correct my overbight. After the year of braces, I will probably still look into MMA. I want to get my #'s to 0, and that can only be accomplished through MMA, which is my last surgical option(aside from Pillar.)

Hopefully my results and story are encouragement to those who have trouble with CPAP. Surgery is an option, but it must be thoroughly checked out and all options must be looked at seriously. Whoo hoo! Almost apnea free!

- Cory

One question though, the study states there were 10.5 arousals an hour, but it says "apnea plus hypopnea index was within normal range at 3 per hour". Is the 10.5 AHI or 3/hr?

Jere · Post by **Jere** » Fri Oct 20, 2006 9:08 pm

Cory -

This is great news! I am sure you had a difficult recovery from these procedures and it sounds like it was worth the trouble and pain. Good luck in the future.

J

dsm · Post by **dsm** » Fri Oct 20, 2006 9:43 pm

Cory,

Exciting feedback !. Very pleased to hear it has gone so well.

Re the arousals, don't confuse them with AHI. AHI of 3 is excellent.

DSM

ozij · Post by **ozij** » Sat Oct 21, 2006 12:34 am

Hi Cory,
That's great news, and thanks for keeping us updated.

Dr. stated, "PLMD was present, with 127 PLM's averaging 25.7/hr,
but very few of those caused arousals."

I'ld insist in looking into those PLMDs - possibly a trial period of medication to reduce them. Between a "few arousals" caused by PLMDs and another few caused by your AHI, you may be getting more arousals than necessary. You've done you best to bring the breahting distrubances down, see if you can't get the doc to at least try to reduce the PLMDs.

And keep telling us how you're doing!

O.

Pad A Cheek · Post by **Pad A Cheek** » Sat Oct 21, 2006 7:03 am

Hey Cory,

That is fantastic that you are headed toward healing. I would say you have been persistant. You stand as an example of how to research and seek out the best solutions for your own health.
Usually we hear of surgeries gone wrong. I am glad it is working for you.
You have been through so much, I think you deserve every bit of success you have achieved.

I hope you have complete success and it lasts a lifetime.

Way to go Cory.

Karen Moore

CollegeGirl · Post by **CollegeGirl** » Sat Oct 21, 2006 7:55 am

PADACHEEK wrote: You have been through so much, I think you deserve every bit of success you have achieved.

I hope you have complete success and it lasts a lifetime.

Way to go Cory.

I'll second that. I'm so glad it's working out for you, Cory - I'm keeping my fingers crossed for ya.

rested gal · Post by **rested gal** » Sat Oct 21, 2006 11:31 am

Cory, I'm so pleased to hear how well things are going for you! Very good! Always appreciate your coming back to keep us updated.

Swordz wrote:I believe that my sleep stages are still not where they should be, so I'm looking into medication to enhance Stage 3/4 time.

I'm no doctor, but I think a low percentage of REM would be of more concern than trying to get more stage 3/4.

Your study showed only 5.9% REM. That's very little REM.

Your study showed 14.7% stage 3/4. Not as worrisome, imho.

The following was posted by sleepydave on another apnea message board. He manages an accredited sleep lab and is an RT, RPSGT. He was answering someone's question about their sleep study and what were "normal" percentages:
____________________

By sleepydave:

Normal sleep% are:
Stage 1 - 5%
Stage 2 - 55%
Stage 3/4 - 20%
REM - 20%

Stage 1 is only a transition state from wake to stage 2 and has no real rest value. A lot of it means inability to initiate and/or maintain sleep.
Stage 3/4 (SWS) decreases as a function of age, or if you're subject to constant arousals, as in OSA. You may still be having some SWS, but isn't scored as such because it fails to meet scoring criteria.

Sleep Architecture: These are examples of hypnograms showing sleep architecture during a full night's sleep.

jskinner · Post by **jskinner** » Sat Oct 21, 2006 7:34 pm

Swordz wrote: I am starting Lexapro next week for anti-anxiety/depression, so that might give me a "lift" as well.

Congrats on your great progress. I'd be very careful with Lexapro. SSRI's are notorious for affecting sleep (causing insomnia) so you wouldn't want to end up making things worse sleep wise.

Guest · Post by **Guest** » Sat Oct 21, 2006 8:21 pm

Jere wrote:I am sure you had a difficult recovery from these procedures and it sounds like it was worth the trouble and pain.

Yah, the GA procedure was the worst of the 4. I lost about 14 lbs, and got down to 153 lbs. It's amazing what you can gain back and more once you can eat again! I drank fifteen 20oz bottles of water in a day to stay hydrated and to heal quicker. I'm thinkin it helped, if not, just made me pee alot.

ozij wrote:I'ld insist in looking into those PLMDs - possibly a trial period of medication to reduce them. Between a "few arousals" caused by PLMDs and another few caused by your AHI, you may be getting more arousals than necessary.

I'm definitely looking into the PLMD's and the lack of REM sleep. Any recommendations on meds for PLMD? I take no meds, so I'm pretty much clueless about my options.

PADACHEEK wrote:You stand as an example of how to research and seek out the best solutions for your own health. Usually we hear of surgeries gone wrong.

I believe my owe my success for being persistent and looking into all my options. Oh, and my Dr. being Harvard-trained doesn't hurt either! Hopefully the people that look into surgery will see my success. It seems that alot of people frown upon surgery without looking at thier options.

rested gal wrote:I'm no doctor, but I think a low percentage of REM would be of more concern than trying to get more stage 3/4.

Your study showed only 5.9% REM. That's very little REM.

Your study showed 14.7% stage 3/4. Not as worrisome, imho.

I take back what I said about stage 3/4, and completely agree with what you said. I'm thinking that my PLMD's and my lack of REM is what is still keeping me so fatigued. I asked med advice from Ozij, and I'll do the same for you. Are you aware of anything that treats both PLMD and lengthens REM? I would hate to have to take more than one med...

jskinner wrote:I'd be very careful with Lexapro. SSRI's are notorious for affecting sleep (causing insomnia) so you wouldn't want to end up making things worse sleep wise.

I checked out the clinical studies on Lexapro, and while insomnia is present, it didn't seem to an overwhelming side-effect. The Lexapro is something I'm going to see if it's worthwhile or not. If nothing else, I can quit it and try another if I don't see good results.

Swordz · Post by **Swordz** » Sat Oct 21, 2006 8:22 pm

Oops.. Guested! (Above was me!)

jskinner · Post by **jskinner** » Sat Oct 21, 2006 8:39 pm

Jere wrote:
I checked out the clinical studies on Lexapro, and while insomnia is present, it didn't seem to an overwhelming side-effect. The Lexapro is something I'm going to see if it's worthwhile or not. If nothing else, I can quit it and try another if I don't see good results.

Be careful with SSRIs, they can be very hard to get off of once you have started. Withdrawal can actually be worse than the actual reason they where prescribed. Do you have any proof that your serotonin levels are low? Blocking the normal reuptate process can be harmful if done to much (and there is currently do way to test when you have the right level). Have you had your Cytochrome P450 2D6 checked to make sure you can metabolize the drug properly?

ozij · Post by **ozij** » Sun Oct 22, 2006 12:17 am

Cory, I have idea of medication names given for PLMD - didn't , but people on the forum have mentioned specific medications for it, with good results.

I think Derek, Sleepless on LI were among them - you'll find links with the search button.

Good Luck
O.

Phase 1 Surgery Followup PSG (It's good news!)

Phase 1 Surgery Followup PSG (It's good news!)

The hard fight for your health

Re: The hard fight for your health

Re: Phase 1 Surgery Followup PSG (It's good news!)

Re: Phase 1 Surgery Followup PSG (It's good news!)