update on husband

[karessamom]

A couple of weeks ago, I made a post reguarding my husband and a recent sleep study (new) he has severe OSA even with the CPAP. Today we just got back from the dr. and we are to consult with a pulmonologist for his Asthma, then he wants to do a UP3 and suggested the possibility of a trache. yiikes!
the problem is they measured his neck and has a 21" neck. he said there was so much tissue in the back of his throat that it was causing the obstruction. of course he also said he needed to loose weight which he's been trying to do but because of his breathing issues with his asthma he can't walk as much or do the things he'd like to do. whether all that tissue in his neck is contributing to the breathing problems during the day remains to be seen. I guess we'll have to see what the pulmonologist says. my question is anyone had that surgery before and what are the pros and cons. we need to do something although i'm not sure the surgery will help but he's been having headaches almost all the time now (the snoring with the cpap and the so so sleeping he can put up with but the constant headaches he can't stand.) and there's agreement from the dr. that the headaches are probably from the high AHI of 85+ with the cpap!

[Janknitz]

Is your husband obese? What is is hemoglobin A1C? UPP surgery will not help if there are underlying issues like diabetes and obesity (although the post surgical period is so painful that most people lose weight from being unable to swallow for a few weeks).

[karessamom]

obese yes we both are but he's been that way for a while hasn't gained more weight for 10 or more years (he's weighed about the same) now we're just having issues. and NO to diabetes. he's been checked although the dr. (ENT) that we saw today said it might be a good idea to get his thyroid checked.

[Sleeprider]

Do you know what kind of pressure your husband currently uses with CPAP? Is he using simple CPAP or Bi-level?

He is getting a lot of professional advise to address his life threatening level of sleep apnea, and considering the results of his treatment so far, it's tough to second guess that. There are some individuals that have posted recently on the forum that have had the surgery and explained their difficulty coping with the surgical pain and side-effects, including difficulties with continuing CPAP. You can find many thread and first-hand stories here by searching for UPPP on the forum search. Here is a recent one

There are machines that are capable of higher pressures than a standard CPAP, and even machines designed as adaptive servo ventilators (ASV) that can resolve apnea in persons that lack respiratory effort. Hopefully his sleep study took a look at ASV and Bilevel as alternative therapies.

Sounds like a difficult time, and I wish you and your husband the best in finding the best solution. I'm sure others with more experience in this area will soon be posting.

[karessamom]

"There are machines that are capable of higher pressures than a standard CPAP, and even machines designed as adaptive servo ventilators (ASV) that can resolve apnea in persons that lack respiratory effort."

It's not that he lacks the effort! the efforts there--the air just isn't getting thru. No CA's it's all obstructive. it's just so blocked there's no air getting thru. that's something else that we will check into about getting the pressures up a little although the dr. didn't seem to think it would help too much until we got the other issues taken care of. he keeps saying he's so congested but now i'm wondering if it's just tissue blockage. they did stick a scope down his nose today and looked at his throat. just a lot of tissue that's built up and the airway openings are very narrow. He said the asthma could have a lot to do with that and after seeing the pulmonologist on Monday we may have some more answers.

[squid13]

If he's having problems losing weight have you considered weight loss surgery first to see if he could lose that weight which would shrink his neck size and body mass. Just a thought.

[palerider]

perhaps some details, you said in the other post that he's on an autoset at 10-15... and leaks are too bad.

so fix the leaks, bump the max pressure to 20 and see what happens... post some screenshots from sleepyhead.

[karessamom]

If he's having problems losing weight have you considered weight loss surgery first to see if he could lose that weight which would shrink his neck size and body mass. Just a thought.

He's not that morbidly obese! yes we're both over weight but I think the weight loss surgery would be worse than the other surgery from what I've heard about it. we know friends that have done the weightloss surgery and had nothing but problems to the point of almost losing a life. I think we have to get the asthma under control then start exercising more and sensible diet. cut out the carbs, fat and "junk" although he does usually have a protein shake already in the morning but I think we need to improve on both our eating habits. and exercise more. he doesn't smoke and never has so that's not an issue

[Wulfman...]

A couple of weeks ago, I made a post reguarding my husband and a recent sleep study (new) he has severe OSA even with the CPAP. Today we just got back from the dr. and we are to consult with a pulmonologist for his Asthma, then he wants to do a UP3 and suggested the possibility of a trache. yiikes!
the problem is they measured his neck and has a 21" neck. he said there was so much tissue in the back of his throat that it was causing the obstruction. of course he also said he needed to loose weight which he's been trying to do but because of his breathing issues with his asthma he can't walk as much or do the things he'd like to do. whether all that tissue in his neck is contributing to the breathing problems during the day remains to be seen. I guess we'll have to see what the pulmonologist says. my question is anyone had that surgery before and what are the pros and cons. we need to do something although i'm not sure the surgery will help but he's been having headaches almost all the time now (the snoring with the cpap and the so so sleeping he can put up with but the constant headaches he can't stand.) and there's agreement from the dr. that the headaches are probably from the high AHI of 85+ with the cpap!

In my opinion, those people are sadists and opportunists looking to make a buck!
Lots of U3P/UPPP discussions on this forum about that surgery. Here's a link for a search I just did.

viewtopic/t103296/search.php?keywords=UPPP

From the discussions I've observed, even though to some the surgery was sold as a "cure" for OSA, the patient still has to use their CPAP/Bi-PAP machines.......sometimes with less pressure and sometimes with more. And, most of them regret having it done.

From reading your post, I question whether his therapy is "optimized".

Surgery is a LAST RESORT because it can't be reversed.


Den

.

[karessamom]

wolfman
I don't think we're looking at to cure sleep apnea just make his cpap more effective I do agree last resort we're going to see what the pulmonologist has to say and see if somehow we can optimize his CPAP therapy but the airway is so constricted that he's having troubles even during the day. I am hoping that the pulmonologist can get the asthma under control and this in turn with possibly some adjusted settings on the CPAP it will help.

[Janknitz]

Proceed with caution and be sure you get second and third opinions on the surgery and research it carefully. He needs to have a good understanding of the risks, the difficult recovery, and the REAL chances of success. When you ask the doctor about possibility of success, make sure he DEFINES what he means by success. Be sure to read this: http://doctorstevenpark.com/sleep-apnea ... or-science Is that worth the pain and risks??? What are the lifelong side effects?

A couple of things need to be addressed:
Is the asthma causing inflammation and swelling of the tissues? Talk to the pulmonologist about asthma management to reduce airway inflammation. Be sure to ask the pulmonologist about the possibility that your husband may have gastroesophageal reflux or laryngeal reflux which may be the underlying cause of the airway inflammation. Note that obstructive apnea MAY cause reflux because the pressure gradient when struggling to breathe and open the airway creates a vacuum which sucks acidic stomach contents into the airway. It's a vicious circle!

You may have to tackle all THREE issues together to get some success with CPAP (1--adjustments to CPAP pressure (a bi-level machine can deliver higher pressure than what he has now) and fix the mask leaks,2- reduce airway inflammation with asthma management, 3--reduce any reflux by addressing any underlying GI issues).

I, personally, would not run to surgery without trying first getting mask leaks under control and trying different CPAP pressures (it sounds like that was NOT tried yet) and dealing with any reflux issues that may exist.

When all the options are exhausted, then I'd still think about surgery very carefully.

[Sleeprider]

"There are machines that are capable of higher pressures than a standard CPAP, and even machines designed as adaptive servo ventilators (ASV) that can resolve apnea in persons that lack respiratory effort."

It's not that he lacks the effort! the efforts there--the air just isn't getting thru. No CA's it's all obstructive. it's just so blocked there's no air getting thru. that's something else that we will check into about getting the pressures up a little although the dr. didn't seem to think it would help too much until we got the other issues taken care of. he keeps saying he's so congested but now i'm wondering if it's just tissue blockage. they did stick a scope down his nose today and looked at his throat. just a lot of tissue that's built up and the airway openings are very narrow. He said the asthma could have a lot to do with that and after seeing the pulmonologist on Monday we may have some more answers.

Still a BiPAP machine can power through OA with pressures up to 30 cmH2O inhalation, then relax in exhale to a comfortable lower pressure that encourages good ventilation. CPAP is generally limited to a 20 cm pressure and has very limited ability to relieve that pressure during the exhale. If I was facing this kind of surgery, I would try the auto bilevel machines as a possible means of delivering the necessary therapy pressure and best comfort possible, before resorting to surgery.

Do you know what his current pressures are?

[Logies101]

Be sure to ask the pulmonologist about the possibility that your husband may have gastroesophageal reflux or laryngeal reflux which may be the underlying cause of the airway inflammation. Note that obstructive apnea MAY cause reflux because the pressure gradient when struggling to breathe and open the airway creates a vacuum which sucks acidic stomach contents into the airway. It's a vicious circle!

I agree with Janknitz here, I had severe problems breathing and thought it was my lungs, it was determined to be Acid Reflux Disease. It was causing inflammation and swelling in my airway/bronchial tubes and I literally could not get any air in my lungs. Nexium was prescribed and after one week I could breathe normally again andI had no more problems with it. Now that I am on CPAP I am feeling even better. Leave no leaf unturned when looking for the cause to his problems before he submits to surgery.