Dr Suggested Uvulopalatal flap Surgery

[scooter133]

I turned 40 this Past January (5'10" @ 200#). Had Sleep study a year ago and found I had AHI of 49. Went on CPAP the 1st of the year. Cannot say that I've really notices a huge difference. The Morning Headaches were much better, though I'm still tired throughout the day.

I went in to see the ENT. He found that I had a deviated septum large turbinates. So we did the Septum straightening and the turbinate reduction. Waited a bit over 3 months for another sleep study. This sleep study came back with a AHI of 30. He was pretty impressed.

He asked what I wanted to do next... I asked what there was to do and he suggested Uvulopalatal flap surgery, as Uvulopalatopharyngoplasty has more complications and typically the complications outweigh the benefits. That the Stanford University Protocol of the Uvulopalatal flap procedure was less evasive and showed better results. His thought i if he can lower my AHI to just under 20 I could bail on the CPAP.

Anyone go this route?

The CPAP unit I have is OKAY, though makes me feel old (no offense) And Super Sexy (Yeah Right!!). Though the part that really bugs me is all the wonderful things I hear people talk about after being on CPAP. I've been using it since the 1st of the year. Its on at least 6-8 hours a night and at least 28 days a month. I even take it on Business trips and Vacation. I so wanted it to be a life changing experience. So you cannot say I've not given it a go. Its been almost a year and for the trouble of using it, and cleaning it and getting the right mask (stuffy nose, mouth breathings, etc) Just seems like I should of seen some goodness from it rather than seeing it as a pain in the hind quarters.

I have Low Back issues, long before CPAP, so I toss an turn all night. Unless I'm on a sleep med, I rarely sleep on my back, it too painful. I alternate sides every hour or so.

I'm thinking that maybe if the surgery drops me 10-15 AHI points that I can chuck the CPAP.. Or at least give it a break for a few years and not have to deal with it.

Tires, confused and grouchy...
Scott<-

[Goofproof]

Sounds like he has found a source of lifetime income. I wouldn't call a "33%" reduction in AHI success story, when is time you may see less than that. I'll settle in my xpap, it's painless and works. Jim

[kteague]

Only you can decide how much you are willing to endure and risk for a reduction in AHI. It does concern me that your doctor asked you what you want to do next, and that he thought an AHI under 20 was acceptable without treatment. In an 8 hour night with an AHI of 20 that would be 160 events, with any number of them causing sleep stage disruptions and desats. Is that acceptable to you?

Even if this procedure met the goals, you would still have diagnosable sleep apnea and would need treatment. If you were shooting for the possibility of getting your AHI lower that would look a little different, but that's not the case. CPAP treatment is not fun and can be a royal pain.

If you do go this surgery route, I suggest you also research if a dental device could then bring the AHI down enough to put you at a better number. Also, study the details of your sleep study and see if there's any positional element to your OSA. If so, a combination of approaches may get you where you want to go.

[chunkyfrog]

Thirteen was not low enough for me. Below 5 is considered "normal". Many here don't feel good until it's below 2.
20 is still bad for your heart, kidneys, liver, brain, etc; but maybe you are OK with that.
Just saying. Last night, my trusty Autoset gave me a 0.0! Sweet.

[Super Iridium]

The AHI numbers your surgeon is finding "acceptable" are horrifying, and good reason to suspect that you need a new doctor -- maybe one who is not so intent on selling surgical procedures.

Go to a recognized sleep doctor -- NOT a surgeon -- and give the CPAP a chance to work. Like you, I don't love how the machine looks or feels when I'm falling asleep, but I get a great night's sleep with AHI below 2, and often below 1. (Have not yet hit that magic 0.0 figure, but maybe someday!) If you're grouchy about the machine now, you will like it even less when you have all of this surgery and then find that you need the machine anyway. The surgery, by the way, is no walk in the park. I understand from others that after the removal of part of your palate, there's a constant danger that bits of food can get move upwards from your mouth and get stuck in your sinuses, which is both uncomfortable and leads to infections. Thanks, but I'll skip the surgery and just sleep with a plastic tube next to my face.

[xenablue]

I go to a neurologist as my sleep specialist - she is also a surgeon. On our first appointment after my sleep study, she told me she was obliged to tell me about available surgery for OSA, however she said none of these surgeries is a guarantee of curing OSA, nor would she necessarily recommend them. She said if I insisted on surgery, she'd try to talk me out of it UNLESS she was convinced that XPAP therapy wasn't working for me. Her belief is that XPAP therapy is the least invasive, most successful way to treat OSA - as long as the patient is given all the tools to help make it work. This means the right machine and more importantly, the right mask.

No, an XPAP machine isn't sexy (although with some imagination......?) but with the right attitude, some patience and perseverence, it can work for the majority of people.

Cheers,
xena

[chunkyfrog]

Mask fantasy choices:
Courageous firefighters, Top gun pilots, Astronauts, Sideshow performers, Close encounters of the very weird kind.

[VVV]

The CPAP unit I have is OKAY, though makes me feel old (no offense)

That's OK. Forum members are still happy to help the young, inexperienced and naive.

[VikingGnome]

Don't have UPPP. My brother-in-law had it done 10 years ago because he refused CPAP (claustrophobic). The surgery is extremely painful. The recovery time was 3 months. During that time, he had to learn how to swallow differently. At first, every time he swallowed a liquid it came out is NOSE. He couldn't swallow liquid in public for at least six months. Couldn't eat solid food for 2 months.

WORST. He continued having OSA after surgery. It didn't cure a thing. He never went back for followup sleep study because he didn't want to wear a mask and all those wires that freak him out. 10 years later? He snores loudly. My sister says he stops breathing quite often during the night. And he still have problems drinking liquids sometimes.

He had his surgery done at UC-DAVIS which is very close to Stanford. So I'm sure he got a top notch surgeon. Unfortunately, very few people actually have improvement with UPPP. I wonder why they even do them anymore and why insurance even pays for it.

[jzap]

Just a few thoughts:

1. CPAP not sexy... ...This gets mentioned on this forum every few weeks. I don't know bout anyone else, but in my experience, these activities take place when I am awake, and I don't need the machine.

2. Choice 1. Painful surgery followed by months of painful recovery, with the possibility that it won't make any difference in my AHI
Choice 2. Breathing air through a hose (Might be a bit inconvenient and annoying)

3. While my results may not be typical, I finally saw my 7 and 30 day AHI both go below 5 after 3 months and two bumps in pressure (my first sleep study resulted in an untreated AHI of 64). Some mornings I now wake up and think, "this thing isn't working", until i break the mask seal and get a rush of air, and, "Yep, its working".

I still don't have the fantastic burst of energy that others have described, but there have been other beneficial effects, and I'll take breathing through a hose over surgery any day.

[archangle]

I turned 40 this Past January (5'10" @ 200#). Had Sleep study a year ago and found I had AHI of 49. Went on CPAP the 1st of the year. Cannot say that I've really notices a huge difference. The Morning Headaches were much better, though I'm still tired throughout the day.

I went in to see the ENT. He found that I had a deviated septum large turbinates. So we did the Septum straightening and the turbinate reduction. Waited a bit over 3 months for another sleep study. This sleep study came back with a AHI of 30. He was pretty impressed.

FIND

ANOTHER

DOCTOR

Find one who doesn't profit from surgery.

What is your AHI with your CPAP?

His thought i if he can lower my AHI to just under 20 I could bail on the CPAP.

FIND

ANOTHER

DOCTOR

The CPAP unit I have is OKAY, though makes me feel old (no offense) And Super Sexy (Yeah Right!!). Though the part that really bugs me is all the wonderful things I hear people talk about after being on CPAP. I've been using it since the 1st of the year. Its on at least 6-8 hours a night and at least 28 days a month. I even take it on Business trips and Vacation. I so wanted it to be a life changing experience. So you cannot say I've not given it a go. Its been almost a year and for the trouble of using it, and cleaning it and getting the right mask (stuffy nose, mouth breathings, etc) Just seems like I should of seen some goodness from it rather than seeing it as a pain in the hind quarters.

Have you been using the SleepyHead software and checking your results? What are your pressure settings?

Even if you don't feel the difference, a high AHI is probably killing you slowly with the death of a thousand cuts.

I'm afraid that if you go with more surgery, you'll be wearing the CPAP again in a few years, if not immediately, and will also have the side effects from the surgery.

[johnthomasmacdonald]

scooter123 says: "makes me feel old (no offense) And Super Sexy (Yeah Right!!)"

I don't get this, I find that my nasal prong sticking out my nostrils connected to a hose wrapped around my head, a dental appliance causing my lower jaw to jut out and my mouth all taped up with duct tape so that my comment in all conversations is: Urrrumph! has been the ultimate babe magnet - quite dashing hannibal lecterish or so I've been told - I'm starting to hit on victoria secret models that have given up on Mark Sanchez

I think what you are doing is great - but i'd get a second opinion on the surgery - i'd also consider adding a dental appliance - on its own it brings my ahi from 21 to below 5 but i still use the cpap to get it even lower ( but i can use a MUCH lower pressure which has made all the difference in my case in my being able to tolerate it - slept over 9 hours last night