Question from a newbie downunder

moa999 · Post by **moa999** » Tue Jun 03, 2008 9:00 am

Recently been diagnosed with severe OSA following a sleep test.

HI 54, Low Oxygen 81%, Snoring in REM
30/y male with 26 BMI

Diagnosis was after I went to a respiratory specialist following a persistent cough (believed to be a bad case of hayfever which I have always suffered). Specialist commented I had a small jaw and did I snore (occasionally) or have trouble breathing / sleeping (not that I knew of and I work a job with odd hours that requires attention to detail - been in the role for 7yrs and been promoted a number of times) -- so no symptoms, young, bmi just outside average but severe reading.

Meant to go back for a pressure setting in a few weeks.

Couple of questions.
1. Have always suffered from hayfever, continual blocked nose and believe I am a mouth breather -- will this mean I need a full mask or might a nose mask work?
2. My father has previously had substantial nose and turbinate reduction surgery - is this likely to be part of the problem - should I also get this checked?
3. Has anyone with a small jaw had jaw operations to fix the issue. Respiratory guy mentioned it but said it was a tough operation and seemed to guide against it

Many thanks

Allyboy · Post by **Allyboy** » Tue Jun 03, 2008 9:10 am

You sound like you are in the same boat as me mate, I was 24 when diagnosed and a BMI of 25. With me, I had had operations on craniofaicial issues as a child, which left me with an abnormally small and shallow pallet (hence little space of the air to go in at night).

I had a midface advancement when I was in my teens, which included work on the jaw but that did not seem to make any difference (that was not because of the OSA, it was undiagnosed that point). Whether thats what your GP was refering to or not im not sure though.

Good luck with sorting it out anyway!

dsm · Post by **dsm** » Tue Jun 03, 2008 4:33 pm

To help reassure you. I am a mouth breather & use a F/F mask. I tried all types of masks & although the F/F mask was not my #1 choice it was the only mask I could get regular comfort with & minimal side effects.

Have just been through 10 days where nose congestion was so bad from flu I could hardly breathe through it each day. I do use nasonex spray & in emergencies will use otrivin (Nasonex is avail under prescription in Australia, otrivin, I think, is over the counter at a chemist shop). Otrivin can only be used for about 5 days in a row but its effects are almost instantaneous.

The main thing with mouth breathing when you have to, is to have a good Heated Humidifier. I was using an F&P HC150 (rolls royce of humidifiers).

At age 9 had my nose operated on (IIRC it was to correct a deviated septum ? - but it was so long ago I can't really remember), only that my nose was always a problem for my breathing.

Once I got comfortable with mouth breathing I would find I could get to sleep easily & on many occasion if I woke would find I was back nose breathing ok.

Good luck with your entry into the world of CPAP.

DSM

(Sydney)

ozij · Post by **ozij** » Tue Jun 03, 2008 9:35 pm

The operation he refered to was most probably MMA - Maxillomandibular advancement surgery. It's major surgery - some people need it.

http://www.sleepapneasurgery.com/maxill ... ement.html

The airway is, in essence, confined by the upper and lower jaws. By moving the upper jaw (maxilla) and lower jaw (mandible) forward, the entire airway can be enlarged. This procedure serves as the most effective surgical treatment for obstructive sleep apnea. It is performed on patients with moderate to severe obstructive sleep apnea as the only treatment, or when other procedures have failed. It is also performed in patients with significant jaw deformity that contributes to obstructive sleep apnea.

This procedure is performed in a hospital surgery center under general anesthesia.

Maxillomandibular advancement surgery is four to five hours in duration. Hospitalization is usually two to three days and in general the patient can return to work in four weeks.

In general, the jaws do not need to be wired after surgery as they are stabilized. The integrity of the bite is preserved through the use of small titanium plates and screws, as well as braces (or arch bars) and rubber bands. Chewing is avoided for four weeks. Speech and swallowing are not affected but this procedure is associated with pain, swelling and temporary numbness of the lower lip and chin. Some changes in facial appearance will occur but is usually quite acceptable. This procedure is occasionally performed with genioglossus advancement or nasal surgery.

Before Surgery After Surgery

I would definitely go to an ENT checkup - all those nasal obstructions can have an impact on your OSA, and once cleared may make the therapy successful at lower pressure.

And I wouldn't accept any suggestion to operate on my palate or uvula (UPPP or LAUPP).

O.

dsm · Post by **dsm** » Tue Jun 03, 2008 10:29 pm

Yowch, Just looking at what is involved there make me shiver

Not sure I could face going to that extent. But, I am sure those who have done it are probably so much better off. Breathing and appearance.

DSM

Allyboy · Post by **Allyboy** » Wed Jun 04, 2008 2:28 am

That is very similar to the surgery I had, but with me it was because of something I was born with, rather than to alleviate sleep apnea.

I was a mouth breather but I was able to train myself not to be relatively quickly once I got my mask. I just use a comfort gel, but after a week or so I stopped mouthbreathing, my body just adjusted. Guess I as lucky given some seem to find it hard to adjust.