my CPAP and surgery story (MMA)

[songhust]

apologize first since English is not my mother tongue.

I started snoring since 2001 ( I was aged 30 by then ), and in the year 2009, I started waking up at 2AM, 3AM with heart beat to 160, and as soon as I woke up, heart beat back to normal.

I struggled with my stupid cardiologist for 2 years ( I even saw sleep doctor advertisement in his office, I was so puzzled when I saw the sleep doctor ads in a cardiologist office yet it never struck me why they did that ), until my family doctor suggested: since your issue is only in sleep, go for a sleep study.

fast forward to 2012, AHI without CPAP 55. I immediately started with CPAP with a pressure at 9, it worked great, my AHI every night is around 3 to 5.

fast forward to 2014, I had MMA surgery as I was super fit, and my doctor told me losing weight, and any other surgery would not fix my OSA because my lower jaw was structurally sitting back too much. My only hope other than CPAP was MMA surgery.

My MMA was done at stanford hospital, by Dr. Li, the best MMA surgeon in the whole world presumably. He also told me success rate for me could be about 85%, but I ended up in that 15%.

4 month after MMA, my AHI without CPAP was 22. I would believe that MMA helped but did not completely fix my OSA.

so now I am back to CPAP. I never tried UPPP surgery and oral appliance, and not considering them as I think they probably won't help much too, maybe can knock down my AHI by a few points, but won't completely fix it to be under 5.

I don't believe MMA is useless. I am sure it worked on many people, the thing is that people with successful MMA probably won't get online.

I am not against or for MMA, just offer a case study.

If people have questions, I will try to answer as fast as possible, but I cannot promise as my days were super packed. apologize first again.


special thanks to Pugsy for his humanity ( relentlessly helping others ) and to grayghost4 for fixing my ASV machine. this board is fantastic and people here are amazing.

[49er]

apologize first since English is not my mother tongue.

I started snoring since 2001 ( I was aged 30 by then ), and in the year 2009, I started waking up at 2AM, 3AM with heart beat to 160, and as soon as I woke up, heart beat back to normal.

I struggled with my stupid cardiologist for 2 years ( I even saw sleep doctor advertisement in his office, I was so puzzled when I saw the sleep doctor ads in a cardiologist office yet it never struck me why they did that ), until my family doctor suggested: since your issue is only in sleep, go for a sleep study.

fast forward to 2012, AHI without CPAP 55. I immediately started with CPAP with a pressure at 9, it worked great, my AHI every night is around 3 to 5.

fast forward to 2014, I had MMA surgery as I was super fit, and my doctor told me losing weight, and any other surgery would not fix my OSA because my lower jaw was structurally sitting back too much. My only hope other than CPAP was MMA surgery.

My MMA was done at stanford hospital, by Dr. Li, the best MMA surgeon in the whole world presumably. He also told me success rate for me could be about 85%, but I ended up in that 15%.

4 month after MMA, my AHI without CPAP was 22. I would believe that MMA helped but did not completely fix my OSA.

so now I am back to CPAP. I never tried UPPP surgery and oral appliance, and not considering them as I think they probably won't help much too, maybe can knock down my AHI by a few points, but won't completely fix it to be under 5.

I don't believe MMA is useless. I am sure it worked on many people, the thing is that people with successful MMA probably won't get online.

I am not against or for MMA, just offer a case study.

If people have questions, I will try to answer as fast as possible, but I cannot promise as my days were super packed. apologize first again.


special thanks to Pugsy for his humanity ( relentlessly helping others ) and to grayghost4 for fixing my ASV machine. this board is fantastic and people here are amazing.

Songhurst,

I am so sorry MMA didn't work for you. But I am curious why you underwent MMA if the cpap was working great for you. What am I missing?

49er

[RogerSC]

Seems as though he took that 85% shot (as described by the surgeon) at seeing if he could get off cpap altogether. I can understand that from the way that he told his story. Not sure that I'd do the same thing because of the risks of surgery, but I get what he was saying.

[49er]

Seems as though he took that 85% shot (as described by the surgeon) at seeing if he could get off cpap altogether. I can understand that from the way that he told his story. Not sure that I'd do the same thing because of the risks of surgery, but I get what he was saying.

Thanks Roger, that makes complete sense.

49er

[kteague]

Sorry to hear the MMA didn't work for you as far as a cure. How did it affect your pressure needs? Hope it at least made your CPAP treatment a bit easier. I'm curious about your experience with the surgery. Was it as bad as I've heard others describe?

[Janknitz]

From what I understand, your doctor will count a more than 50% reduction in AHI as "success" and use you in the statistics that way to sell more people on the MMA procedure. Your idea of "success" was getting off CPAP, but that's not the medical definition. However, most people don't learn that until after the pain and expense. Some improvement in ahi is a good thing, but it doesn't make much difference if you still need CPAP.

Dr. Steven Park is an ENT surgeon, and he has stated that the UPP procedure is largely ineffective.

[49er]

A repost of what I wrote in the "Wean off CPAP" thread.

""The MMA surgery looks better.

http://respiratory-care-sleep-medicine. ... rgery.aspx which is by Dr. Park

""A meta-analysis by Holty and Guilleminault [5] pooled 53 reports describing 22 unique patient populations (627 patients), and found that the mean AHI decreased from 63.9/hr to 9.5/hr, with a pooled surgical success rate of 86%. Overall, 43.2% were cured (AHI < 5), with a 66.7% cure rate for those with a preoperative AHI < 30/hr. Long-term surgical success was maintained at 44 months. Predictors of surgical success included younger age, lower BMI, lower preoperative AHI, and greater degree of maxillary advancement.
Quality of life measures, excessive daytime sleepiness, and blood pressure were noted to be significantly improved as well.""

I know having an AHI below 5 is the ideal goal but keep in mind that the typical person who undergoes MMA has tried everything to no avail. So going from an AHI of 63.9 to 9.5 would be dammed good.""

I love you guys to death because everything I have learned about pap therapy is due to you all. However, for a board that prides itself on scientific evidence, you all seem to grab on to any anecdotal report that supports your belief about something which is that surgery is evil. By the way, I do it too so I am pointing the finger at myself also, ok?

But speaking of anecdotal evidence, I know of someone who had the UPPP procedure who is doing very well. So I could point to that and say, see, this a perfect example of how wonderful UPPP is. Of course, that would be wrong for me to do. And by the way, not matter how desperate I was and I am (another post), I would never have a UPPP.

I do agree that if you are considering sleep apnea surgery, you do have to ask the surgeon what their interpretation of a success rate is. No ifs ands buts about it.

Finally, again I want to stress that pap therapy should always be tried first before any surgery. But again, it doesn't work for a certain percentage of people no matter what they do.

49er

[sventory]

Hmm I am curious songhurst, do you know your initial jaw measurements? I am in the same boat as you I think in terms of recessed lower jaw, and my doctor is advocating for MMA surgery. My back to front measurement airway is 8.5mm. I am told normal is 20mm. So I am also considering it. Also do they know what exactly is causing your apnea? Is your tongue falling back, is it your soft pallette collapsing? Or something else. And why did the surgery not work? Is the same thing still occuring or is it something else now? If your airway is much wider it should be much better.

[Guest]

Hi, I might as well put my 2 cents in here also. I was told by my doctors when I was 30 that I must have the surgery. My dentist said so also. I decided not to have the surgery after all because it sounded so awful and I did not want my jaw broken because of the history of osteoporosis in my family. At the time, I did not know my current husband, who is a doctor. Before retirement, he the was the head of a Urology department at a major university hospital. He has always maintained that one should NEVER have surgery if there is another way forward. Too much risk, the rewards are often not what they were made out to be, and that there are always unintended consequences, often many years later. I have learned over the years that doctors will often NOT recommend the same things for themselves and their family members that they will recommend for their patients.

[songhust]

I was hoping to get rid of CPAP even CPAP works great for me. I think due to my personality, I would chose surgery. but many people may not chose so.

my airway was about 9mm before surgery I think, I did not measure the airway after surgery but appears to be a lot wider from x-ray. My problem is that my tongue continues to collapse even after surgery. so the surgery did not change my cpap pressure, I used to be pressure at 9 before surgery, at 9 after surgery too.

the surgery caused my mount shut for one month, only eating liquid food. overall no big deal for me. but different people would have different perception. If you go through this, you might call it hell.

[jagzoo]

Hi songhurst,
Just a note - please don't apologize for your English! It is excellent! You put many of us native speakers to shame.

[Fresh_air]

Those of you who have had the surgery, do you like your facial profile better now?

And do you have any remaining numbness of the lips, chin, cheeks, or inside the mouth?

[songhust]

sventory: please prepare at least 20+ questions before you decide go with surgery, and if you cannot come up with 20+ questions, maybe surgery can be delayed for a later date. I see you already asking lots of questions. some people would do incremental surgery: first oral appliance, then UPPP, then MMA, some people go straight to MMA. some will settle with CPAP, I personally do not think one ways is superior than the other, many cases, personality plays a factor. As long as you have a thorough and informed progression, even prognosis was not in your favor, at least no regrets.

Dr.Li does not believe airway measurement is a good indicator for the success or failure of the surgery, I agree to certain extent.

goole " joe's mma surgery", the first few link should give you more information about the surgery experience.

jagzoo, thanks for your encouraging words. it was warm.

Janknitz, 49er: I respect your opinions. totally agree with you guys in certain respects.

Fresh_air: MMA can be a cosmetic surgery, depending on the purpose.Your probably will get different answers from different people. I am a male, happily married, so answer is: yes, I like my current new facial profile, it is mine and I love everything of mine, regardless how others say, and my wife happens to agree with me,
the residual effects can vary from person to person. I have read ( from internet ) that some upper jaw numbness, lip numbness till 1.5 years after surgery. For me, mostly nothing after 1.5 years.

[Julie]

I can't see that airway measurement would be the whole story because of muscle tone differences between people, age affecting that, inadvertent tiny contractions changing things during measurements, etc. etc. It doesn't 'measure' how much the fallen-back tongue affects things on a given night in a given person or how other surrounding tissue reacts to Cpap air pressure at any time.

[Fresh_air]

Songhurst, I was thinking of the cosmetic side of the surgery more as a positive side effect of fixing the bite or upper air way issues--the main reasons why people choose to go through with this type of major surgery.

How about sensation inside your mouth? Do you have scar tissue on the roof of your mouth and gum lines that is numb? And how large of an area are the scars?