Surgical Intervention for UARS or dental appliance

[ofarchesandants]

While this letter was written to Dr. Baarry Krakow based on his post on UARS, I am interested in hearing comments from everyone. ) thanks. )

I've been reading with great interest the post on UARS from a year ago. While no one at the Stanford sleep lab has ever mentioned UARS to me, it would explain why i have such a major sleep deficit impairment despite so few dips in pulse oximetry, few to no apneas, no snoring and no leg movements and hypopneas in the 10 range. What i was told was, "You have a minor case of SDB but there is no correlation between the number of events and how you feel. Some people have few events and feel horrible and some have many and don't notice during the day." There may be some truth to that statement but it seems to me, if your counting arousals and flow limitation (another thing never discussed with me) then you would see an increase in that correlation.

So my query is, would people (and as i read more and more I'm thinking I'm one of those people) who suffer primarily from flow limitation causing brain arousal be likely to benefit better from surgery. It seems i have heard those with the least flow limitations are the ones who benefit most from a surgical intervention which would seem to make sense to me. And the Stanford lab did tell me i could "possibly" benefit from tonsillectomy, and a couple other minor procedures not to mention the more major ones. I'm not asking for advice on what i should do mind you but just trying to figure out what concepts are worth exploring further.

The same thing goes for the possibility of using a dental appliance which again i seem to hear works better for flow limitation than for hypopnea/apnea. For me if that is true it would seem a potential option for the wilderness expeditions i do. I'm in the wilderness for weeks at a time and even if continuing to use CPAP at home, trying to take and care for equipment in a wilderness setting for extended periods seems impractical so maybe the dental device could substitute in those situations.

Finally given your UARS issues and that bilevel worked better for you, I'm curious if you have tried the dental appliances yourself or surgical options and if not why and if so what was your experience? And what about for your patients. I see that you use breathrite strips which i do as well inside my mask and seems to help greatly. In my mind that seems to strengthen the argument for surgical intervention.

It is possible all my questions are based on faulty info and faulty assumptions but that in part is what i am trying to figure out. Especially given my titration study for CPAP was a horrid experience with no restful sleep and finally a removal of the mask half way into the process. The past few months on my auto pap which was prescribed due to my intolerance has not proved much better though i must admit much of that was due to improper masks so the jury is still out on how much benefit I'll see.
thanks for any thoughts,
cheers,
Gregg )

[Snoredog]

where is SAG's dart board. It's part of the "Big Secret" you have to buy the book. Ask RG she knows, has something to do with ugly socks.

But I think if you read the same blog page as you put here you also know they look at the inspiration wave form for any flattening or change from a normal flow waveform.

If you are using a Respironics machine they monitor that same waveform very carefully, if so many people have that condition and it can be corrected, why hasn't Respironics or someone else come up with a machine to resolve it?

Because the machine cannot remove resistance breathing such as from a spur, polyp or enlarged turbinate causing that resistance in your nose. Have the surgery on your throat or use a dental device it won't do anything for the nasal resistance if that is where it is coming from.

If you went to Stanford and they didn't spot UARS, just think how some other Sleep clinic might spot it that that never seen or subscribed to that UARS theory. I assume you also read the part about what the AASM says about UARS and the reason most insurance doesn't cover it.

Another question you might ask Dr. K, about (with thousands of patients supposedly treated by this), why hasn't a single one of those patients come by here to offer up a testimonial? Most would still be using a xPAP machine and needing assistance at some point.

Anyone can come here and "plant" a story to sell books. I say put your money where your mouth is, put up a Before and After hypnogram and SHOW us where treatment eliminated those supposedly spontaneous arousals so they are a misnomer.

In the mean time, I'd search for a Penn & Teller magic kit. Have a problem breathing through your nose? Go see a good ENT, for an evaluation. Ask your GP for someone that is really good, if you went to Standford you are in the bay area, look up Dr. Laramore in San Ramon Medical Center, he is about the best around with a ton of experience. He won't operate on you unless he thinks it would help, he also knows the hacks in Palo Alto that do that surgery as he no longer does it himself, but he can refer you to some good ones if that is the case. Dr. Larmore also consults with Dr. Michael Cohen, whom I assume knows Dr. K knows since most of his techs come from Stanford, know the ones that did my PSG's did.

http://www.healthgrades.com/directory_s ... nformation

If anything, go see him for a 2nd opinion (FYI: most insurance will pay for a 2nd opinion visit)