CPAP or UPP?

[sleepyhollow]

OK, I am a newbie who is constantly exhausted and have recently had a sleep study with the results of 82 apneas/hr. My ENT says surgery (upp) since my airway is crowded with tonsils and long palette.

Thoughts and experience welcomed?

[bearded_two]

CPAP

[sleepyhollow]

What is your reasoning for CPAP instead of UPP?

[sleepycarol]

Success rate on UPP is not very high. Often times increased pressure is needed due to the surgery.

Not worth the pain and expense in my mind.

[Country4ever]

I would try cpap first too. I keep hearing the surgery success rate isn't the greatest. I think I'd be more inclined to get my tonsils out......but then again, I think we have them for a reason. I'm having some trouble with a weak soft palate, but it would have to get pretty bad to take a chance on the surgery.
Good luck in whatever you do.

[LSAT]

If UPP doesn't work, you would have gone through lots of pain for nothing because you will be on CPAP anyway.
Give CPAP a try first.

[Wulfman]

Here's a link to a search on the discussions about UPPP on this site. (Uvulopalatopharyngoplasty)

viewtopic/t50890/search.php?keywords=UPPP

Please note in this link that the success rate is about 40%.

http://en.wikipedia.org/wiki/Uvulopalatopharyngoplasty

With "severe" apnea (as yours is), at best, it would only reduce the AHI "somewhat" and you'd still have to use CPAP or Bi-PAP......and possibly at higher pressures.

My advice is to RUN from that ENT as fast as you can. He only wants your money and knows you'll still be using this therapy anyway.


Den

[SnoreSnoreSnore]

I concur - giving CPAP a try before committing to surgery is wise. Surgery can sometimes be effective, but any surgery carries risks. If there's an effective way to treat your sleep disorder without taking those risks, you might as well start there. As far as I know, the biggest risk with using a CPAP (aside from looking kind of funny while you're sleeping) is that it won't work for you.

My ENT's early view was that for patients with airway characteristics like mine (which aren't identical to yours), CPAP was the gold standard. There were a couple of surgical options he said would be appropriate for me, but in addition to mentioning the risks inherent in having any kind of surgery, he was clear that any surgical solution would probably prove to be temporary with me and need to be repeated eventually. For those reasons, he promoted CPAP as a first step, and it was good advice for me.

A couple of things I learned along the way might be useful for you:

-- Ask about the different types of masks available and insist on trying more than one. The sleep center I first went to started me on a nasal mask (I don't recall the make or model), and it was never comfortable. I used it for two or three weeks, but when I saw my ENT for a follow-up, I told him about how uncomfortable it was. It had started to bruise the bottom of my nasal septum, which may indicate that I was never properly fitted for it in the first place. The doctor suggested a full-face mask, and the equipment supplier just handed me one without ever doing a proper fitting. The new mask was more comfortable than the nasal mask, but it wasn't sealing well because it was the wrong size. I switched to a different supplier soon after, was fitted with a Mirage Quatro of the correct size, and have had no difficulties related to the mask since.

-- Don't talk yourself out of it. When I was first offered a CPAP, I thought of a hundred reasons to avoid it. It's cumbersome. I'd have to travel with it. I toss and turn in my sleep. It looks goofy. I don't want to sleep hooked up to a machine "for the rest of my life." Ultimately, I had to simply get over all of that and recognize that I needed to do something about my loud snoring and poor sleep because they were negatively impacting my life. I put it in the same category as other adjustments I had made for better health. For instance, I adopted a low-fat diet some years ago to manage cardiovascular risk factors. So what if I reserve a big rare steak for a special occasion instead of having one whenever I want? My life is better now and promises to be better in future years with some simple, prudent diet changes. If my doctor told me I were diabetic, would I choose to gamble with the awful effects of that disease as it advances, or would I incorporate some changes into my life to manage it? After years of drowsy days and waking up in the morning to find that girlfriends had helped themselves to the guest room in the middle of the night, I had to recognize that, for me, adapting to life with a CPAP was a better bargain than the status quo.

-- Stick with it. Partly because of not being properly fitted for a mask in the beginning, it took some time for me to adapt to using a CPAP: two to three months, as I recall. Gradually, I seemed to simply figure it out. I trained myself to thrash around less in my sleep, and I don't think I've pulled the machine off a nightstand more than once or twice. Eventually, it just became part of my routine whenever I was packing for a trip. Refilling my humidifier tank before bed is as automatic as brushing my teeth. I've been using a machine for about four years now, and it's simply habit and is really no burden for me at all. If I had convinced myself that the hassle would be too great or knuckled under to the early frustrations that are part of adapting to something new, I would have cheated myself.

I wish I could tell you that using a CPAP has fixed everything for me, but it hasn't. As long as my machine is properly titrated, I don't snore and consequently don't experience apneas in my sleep anymore, and those are worthwhile developments. My excessive daytime sleepiness remains problematic, but with my apnea under control, we can have a better look into other causes.

Many people find that using CPAP changes everything for the better, and I hope you'll be among them.

Cheers.

[Goofproof]

Air vs Knife, what a no brainer. Jim

[jnk]

Thoughts from a respected ENT surgeon on apnea surgeries:

http://www.sleepguide.com/forum/topics/ ... ment:34997

My personal thoughts on UPPP:

viewtopic.php?f=1&t=41299&p=362611#p362611

[ozij]

Tosilectomy and UPPP are not the same procedure.

Having you tonsils out may mean lower pressure on CPAP -- a good thing.

UPPP on the other hand is not worth much in treating sleep apnea -- and may make the use of cpap even more difficult.

Try CPAP. If it works -- fine. If you need high pressure -- look for an ENT who will only take out your tonsils.

O.