Food for thought for anyone with Mild Sleep Apnea

[ericore]

I have mild obstructive sleep apnea with a Apnea Hypopnea Index (AHI) of 5 or 6; so five or six times per hour my breathing is obstructed. The obstructions of sleep apnea belong to three categories; the nose, the oral cavity and the throat. I can breath fine when lying down which means that when I breath lying down neither my nose, nor oral cavity nor throat are obstructed. In addition, I sleep in a supine position. It therefore follows that the probable cause of obstruction is my collapse tongue which collapses when relaxed. It should be noted that when I weighted 150 lbs, there was no sign of sleep apnea. Signs of sleep apnea began appearing at 165 lbs which was my weight for a few years in which I suffered from sleep apnea. This suggests that fatty tissue accrued along my soft palate and elsewhere have further narrowed my airway thereby facilitating tongue obstruction. It is not easy to determine which tissue is responsible, perhaps even the tongue got fatter. To that end, one solution is eliminate the obvious soft palate tissue, but plan for the worst; it having no effect; thereby leaving only one blind solution; removing a significant portion from the back of the tongue. Cutting the back of the tongue is the ultimate fix as it is the door the closes shut regardless of the rest of the oral cavity anatomy; so let's make sure it can't shut. CPAP works the same way; keep the tongue forward and provides oxygen. But, I did ask if there was any evidence of central sleep apnea, the sleep study specialist said there was none which means my brain is regularly sending the correct signals to breathe while awake and asleep. Meaning I don't need oxygen, just for my tongue to not obstruct.

Now it has been said that generally mild sleep apnea is not treated with surgery, but I find this preposterous. First of all, most young people breath fine. Secondly, most people with obstructive sleep apnea breath properly when asleep otherwise they would be diagnosed with central sleep apnea in the sleep study. Theoretically, anything from the nose down to the throat can be obstructed, but where sleep apnea is new and an onset to increased weight, then in almost all of these cases regardless of the additional fatty tissue that may be abetting the obstruction, the collapsed tongue is the primary cause. When standards were developed it was extremely difficult to remove part of the back of the tongue, combined with marketing and lobbying from sleep apnea vendors, one can imagine how CPAP would have become the “norm”. Fundamentally, it's an effective solution that some can tolerate, and that others cannot. Fundamentally, there is a lack of standards with regard to surgery for sleep apnea; given the proper standards effectiveness would be close to 100%. For example, people with central sleep apnea should not receive surgery to resolve the sleep apnea. Instead in this case, surgery would only be beneficial at reducing the required pressure to keep the airway open. It would would be preposterous to include people with central sleep apnea in the statistics of surgery for sleep apnea. It doesn't make sense, but albeit many studies or data gathering is ignorant of this fact. Their data may be accurate, but data isn't perspective; perspective is everything.

Nowadays, despite divergent standards on surgery for sleep apnea, the techniques have improved tremendously. It has become much more plausible (easier) to reduce the back of the tongue. That being said, CPAP is still the goto as surgery is invasive and albeit more expensive. However, anyone who has endured sleep apnea for a long time will tell you, anything goes; please fix it. This condition negatively effects all aspects of life. Having failed 2 CPAP trials, given the length of time (years), and given my constructive criticism, I think it's time to go surgical.

[palerider]

interesting theories, anything (at all) to back any of that up?

[Julie]

"Now it has been said that generally mild sleep apnea is not treated with surgery, but I find this preposterous. First of all, most young people breath fine. Secondly, most people with obstructive sleep apnea breath properly when asleep otherwise they would be diagnosed with central sleep apnea in the sleep study. Theoretically, anything from the nose down to the throat can be obstructed, but where sleep apnea is new and an onset to increased weight, then in almost all of these cases regardless of the additional fatty tissue that may be abetting the obstruction, the collapsed tongue is the primary cause"

So many assumptions and conclusions based on them! Most young people breathe 'fine'? Why limit things to young people - some of them have apnea too and very often the obstruction is anatomic, not weight based... and what does 'breathe fine' even mean? And why assume if they didn't breathe 'fine' they would be automatically be diagnosed with CSA vs OSA?

Your food for thought has also been proven in very, very many cases to be wrong as people who've had tongue and other related (uvula, palate, etc) surgery come back often less than a year after surgery having reverted to needing Cpap again, often worse off than they were initially as the surgery has made it more difficult to adapt to Cpap.

[49er]

Ericore,

As one who is considering having surgery, the sleep surgeon should be doing a nasoendoscopy of any potential surgical candidate's airway to see where the obstructions are. If there are obstructions in other places besides the tongue for example, having surgery in just that area unfortunately will probably not result in great success.

Have you considered the Inspire Procedure? Unfortunately, I didn't qualify for it but it was my first choice due to the procedure not altering throat anatomy. Might be worth a shot.

Feel free to PM me if you have questions or want to talk more.

49er

I have mild obstructive sleep apnea with a Apnea Hypopnea Index (AHI) of 5 or 6; so five or six times per hour my breathing is obstructed. The obstructions of sleep apnea belong to three categories; the nose, the oral cavity and the throat. I can breath fine when lying down which means that when I breath lying down neither my nose, nor oral cavity nor throat are obstructed. In addition, I sleep in a supine position. It therefore follows that the probable cause of obstruction is my collapse tongue which collapses when relaxed. It should be noted that when I weighted 150 lbs, there was no sign of sleep apnea. Signs of sleep apnea began appearing at 165 lbs which was my weight for a few years in which I suffered from sleep apnea. This suggests that fatty tissue accrued along my soft palate and elsewhere have further narrowed my airway thereby facilitating tongue obstruction. It is not easy to determine which tissue is responsible, perhaps even the tongue got fatter. To that end, one solution is eliminate the obvious soft palate tissue, but plan for the worst; it having no effect; thereby leaving only one blind solution; removing a significant portion from the back of the tongue. Cutting the back of the tongue is the ultimate fix as it is the door the closes shut regardless of the rest of the oral cavity anatomy; so let's make sure it can't shut. CPAP works the same way; keep the tongue forward and provides oxygen. But, I did ask if there was any evidence of central sleep apnea, the sleep study specialist said there was none which means my brain is regularly sending the correct signals to breathe while awake and asleep. Meaning I don't need oxygen, just for my tongue to not obstruct.

Now it has been said that generally mild sleep apnea is not treated with surgery, but I find this preposterous. First of all, most young people breath fine. Secondly, most people with obstructive sleep apnea breath properly when asleep otherwise they would be diagnosed with central sleep apnea in the sleep study. Theoretically, anything from the nose down to the throat can be obstructed, but where sleep apnea is new and an onset to increased weight, then in almost all of these cases regardless of the additional fatty tissue that may be abetting the obstruction, the collapsed tongue is the primary cause. When standards were developed it was extremely difficult to remove part of the back of the tongue, combined with marketing and lobbying from sleep apnea vendors, one can imagine how CPAP would have become the “norm”. Fundamentally, it's an effective solution that some can tolerate, and that others cannot. Fundamentally, there is a lack of standards with regard to surgery for sleep apnea; given the proper standards effectiveness would be close to 100%. For example, people with central sleep apnea should not receive surgery to resolve the sleep apnea. Instead in this case, surgery would only be beneficial at reducing the required pressure to keep the airway open. It would would be preposterous to include people with central sleep apnea in the statistics of surgery for sleep apnea. It doesn't make sense, but albeit many studies or data gathering is ignorant of this fact. Their data may be accurate, but data isn't perspective; perspective is everything.

Nowadays, despite divergent standards on surgery for sleep apnea, the techniques have improved tremendously. It has become much more plausible (easier) to reduce the back of the tongue. That being said, CPAP is still the goto as surgery is invasive and albeit more expensive. However, anyone who has endured sleep apnea for a long time will tell you, anything goes; please fix it. This condition negatively effects all aspects of life. Having failed 2 CPAP trials, given the length of time (years), and given my constructive criticism, I think it's time to go surgical.

[49er]

"Now it has been said that generally mild sleep apnea is not treated with surgery, but I find this preposterous. First of all, most young people breath fine. Secondly, most people with obstructive sleep apnea breath properly when asleep otherwise they would be diagnosed with central sleep apnea in the sleep study. Theoretically, anything from the nose down to the throat can be obstructed, but where sleep apnea is new and an onset to increased weight, then in almost all of these cases regardless of the additional fatty tissue that may be abetting the obstruction, the collapsed tongue is the primary cause"

So many assumptions and conclusions based on them! Most young people breathe 'fine'? Why limit things to young people - some of them have apnea too and very often the obstruction is anatomic, not weight based... and what does 'breathe fine' even mean? And why assume if they didn't breathe 'fine' they would be automatically be diagnosed with CSA vs OSA?

Your food for thought has also been proven in very, very many cases to be wrong as people who've had tongue and other related (uvula, palate, etc) surgery come back often less than a year after surgery having reverted to needing Cpap again, often worse off than they were initially as the surgery has made it more difficult to adapt to Cpap.

Julie,

With all due respect, what you are reporting about surgical failures is strictly anecdotal and nothing more. There are so many issues to having surgery that can make or break things.

And once again, you are forgetting that if someone has struggled with pap therapy for months to no avail, the issue is no longer surgery vs. cpap. It is now what is the non pap therapy alternative that is supported by the evidence and is appropriate for their situation.

[Julie]

It's always interesting to hear how new converts to beliefs are always the ones defending them the hardest.

[JDS74]

Ericore:

Could you post a little more on what CPAP therapy you tried and why it was a failure for you?
Perhaps there may be some other approaches to CPAP therapy before the surgical approach.

In any event, I wish you well and hope that if/when you get the surgical intervention, all goes well and it fixes the problem.

[stienman]

CPAP almost always works, when the therapy is adhered to. This is why people call it the "gold standard" for sleep apnea therapy.

Surgery is not only risky, but it has a poor track record of solving the problem. Some estimates indicate that people who have surgery to correct obstructive sleep apnea find success in only 25%-30% of the cases, the rest end up requiring cpap even after surgery.

Typically surgery is advised when people are unable to tolerate PAP therapy.

In other words, you are saying, "Surgery is a good alternative to PAP since it's better than having something on your face every time you sleep"

The doctors, however, are saying, "Surgery is available for those unable to use PAP, because as bad as surgery is, it's better than not being treated at all."

Consider the following article on the subject:
http://www.health.com/health/condition- ... 24,00.html

It's your body and your choice, I suppose, but I don't think you fully understand the consequences and side effects of surgery. I'd suggest you look very carefully into them so you aren't surprised when surgery affects how you eat, talk, swallow, salivate, etc.

There's a reason doctors avoid surgery and prefer PAP therapy, and it's not because they're withholding a permanent, safe, easy, effective cure. Surgery is far from permanent, safe, easy, and effective for most people, and thus it's usually reserved as an option of last - not first - resort.

[zen42]

You may also consider exercise. I believe there are a few studies showing that an
aerobic exercise program reduces sleep apnia about 40% even if no weight is lost.
It helps my AHI some but not nearly enough but in your case with an AHI of 6 it
might be all you need.

[Noctuary]

CPAP always works, when the therapy is adhered to. This is why people call it the "gold standard" for sleep apnea therapy.

Or not.

[chunkyfrog]

ericore: you sound like you have already made up your mind.
I know different. Cpap works wonderfully for me, and similarly for so many others.
--but not everyone.
You may do what you choose, but . . .

[BlackSpinner]

I can breath fine when lying down which means that when I breath lying down neither my nose, nor oral cavity nor throat are obstructed. In addition, I sleep in a supine position. It therefore follows that the probable cause of obstruction is my collapse tongue which collapses when relaxed.

Theoretically, anything from the nose down to the throat can be obstructed, but where sleep apnea is new and an onset to increased weight, then in almost all of these cases regardless of the additional fatty tissue that may be abetting the obstruction, the collapsed tongue is the primary cause.

Completely wrong. The muscles of the throat can collapse when you are asleep and it can have absolutely nothing to do with weight, in fact sleep apnea can cause weight gain. Sleep is not the same as awake, your whole body is controlled differently.

[stienman]

CPAP always works, when the therapy is adhered to. This is why people call it the "gold standard" for sleep apnea therapy.

Or not.

You're right, I added an "almost" in there.

[WearyOne]

I can breath fine when lying down which means that when I breath lying down neither my nose, nor oral cavity nor throat are obstructed. In addition, I sleep in a supine position. It therefore follows that the probable cause of obstruction is my collapse tongue which collapses when relaxed.

Theoretically, anything from the nose down to the throat can be obstructed, but where sleep apnea is new and an onset to increased weight, then in almost all of these cases regardless of the additional fatty tissue that may be abetting the obstruction, the collapsed tongue is the primary cause.

Completely wrong. The muscles of the throat can collapse when you are asleep and it can have absolutely nothing to do with weight, in fact sleep apnea can cause weight gain. Sleep is not the same as awake, your whole body is controlled differently.

So true. When we sleep, all of our muscles relax, including those in the throat. And that's somethign you can't duplicate while you're awake. There can also be more than one cause of a person's obstructive apnea (OSA)---for instance a collapsing airway from relaxing throat muscles AND a tongue that falls back into the throat.

The tech who did my sleep study was a very thin man who had severe OSA. He said he had always been thin. So even though weight CAN be a factor in OSA, many normal-weight and thin people have it as well.

Each person, of course, has to make his or her own decision, but with there being so many risks involved with any surgery, make really sure this is the direction you want to go. (Have you looked into oral appliances?)

[sptrout]

Off subject a little (not directly SA related), but every person that I know (granted, only 3) that has surgery the past five years has returned home with MRSA or other antibiotic resistant disease. This alone would make me think long and hard about having any surgery where there are proven alternatives. Never forget that a hospital is well known to be one of the most dangerous places a person can set foot in unless in an emergency situation. Another deadly place; a doctor's office because of prescribing the wrong medication, or adverse reactions to medications. I will stay with the proven, and does no harm, XPAP method.