Will surgery help me?

What kind of surgeon should I see when contemplating going the surgical route for my sleep apnea? I do have a smaller bottom jaw. What is the ratio of surgical success when it comes to sleep apnea? I would image all surgical procedures are major surgery.

I have lost weight on my neck but not enough. I wonder how a thinner neck will help me?

AnotherMe wrote:What kind of surgeon should I see when contemplating going the surgical route for my sleep apnea? I do have a smaller bottom jaw. What is the ratio of surgical success when it comes to sleep apnea? I would image all surgical procedures are major surgery.

I have lost weight on my neck but not enough. I wonder how a thinner neck will help me?

Unfortunately, most people who have surgery find that it either doesn't work, or it only works for a few months to a few years. Then, they are back to where they were, only the surgery makes cpap difficult to do.

One thing to be very careful about is the definition of success.

When discussing cpap usage, success is defined as an ahi of less than 5. Most sleep doctors use this definition. The doctors who do surgery do NOT use this definition. They define success as a 50% reduction of events. So, unless you start with an ahi of 10 or less, their idea of success is NOT success. Somebody like me with an ahi could be considered a success with a new ahi of 40, yet that would still be severe. And they tell people that the surgery has a 50% success rate. So, 50% of the patients have a 50% reduction in their ahi. Seems pretty low to me.


I know it seems scary or depressing to start cpap treatment, but really it does a great job, and doesn't cause any damage.

Cpap is undo-able, surgery is not.

Good responses. What is ahi mean?

AnotherMe wrote:Good responses. What is ahi mean?

It is the average number of apneas and hypopneas per hour. Do you have a copy of your sleep study? It will help to know how severe your sleep apnea is (ahi, length of events, and oxygen desaturation).

AnotherMe wrote:What kind of surgeon should I see when contemplating going the surgical route for my sleep apnea? I do have a smaller bottom jaw. What is the ratio of surgical success when it comes to sleep apnea? I would image all surgical procedures are major surgery.

I have lost weight on my neck but not enough. I wonder how a thinner neck will help me?

AnotherMe,

If you are seriously considering having surgery, I would go to this site, so you can download this free report about the subject.

http://doctorstevenpark.com/the-truth-a ... ea-surgery

One thing Dr. Park stresses in the report is that before surgery is considered, you should guve pap therapy or dental devices every chance to succeed. And if you have nasal obstruction/congestion issues, they should be addressed with through conservative means, medication, or septoplasty/turbinate reduction surgery.

Now if you feel you have given cpap therapy a full shot, then I would read his document carefully in deciding whether surgery would be appropriate for you. Yes, surgery success is not guaranteed. However, I don't think it is as much of a failure as people on this site believe it to be, particularly if you're not obese.

And if you really have given pap therapy a full shot which I can't tell from your post, then trying the right surgery is still a better option than living with untreated apnea. As with with anything, it is a risks vs. benefits issue and obviously, not having the untreated apnea is not good, particularly if it is moderate or severe.

In doing research in case I need to go down this path (hopefully not but I am trying to be prepared), I am sensing that many times, the low success rates are due to inappropriate procedures being done. For example, in your case, it sounds like you might want to consider jaw advancement surgery (MMA). But if a surgeon suggested something else without carefully examining your airway and knowing ahead of time whether you had a true obstruction, of course, the success rate would be low.

Many people who had surgery and many surgeons have suggested having a sleep endoscopy ahead of time so that the appropriate obstruction can be pinpointed and the right surgery suggestion. A few prominent surgeons have suggested this is not necessary but I wanted to throw it out there for your consideration.

Finally, I would go to http://www.needsleep.net and look at the archives from the non cpap forums. Not up to date but alot of great information regarding surgery from personal experiences that might be helpful.

49er

I'm wondering if a didgeridoo would help open my airways. I know I would have to use it a lot.

49er thanks for the feedback. I will check out the link. The Cpap machine has started working well after I made a new visit to the doctors. Sadly, last night I took it off.
I have to look over my sleep study again. I don't know what I did with it. I will ask the doctor for a new copy since I am going to see him again next month. I think he said I stopped breathing 30 times a minute or was it 30 times an hour. Sigh....
I am not obese. But I do have to lose more weight. I have been losing weight. And I know I have to stop smoking. I relapsed.

AnotherMe wrote:I'm wondering if a didgeridoo would help open my airways. I know I would have to use it a lot.

49er thanks for the feedback. I will check out the link. The Cpap machine has started working well after I made a new visit to the doctors. Sadly, last night I took it off.
I have to look over my sleep study again. I don't know what I did with it. I will ask the doctor for a new copy since I am going to see him again next month. I think he said I stopped breathing 30 times a minute or was it 30 times an hour. Sigh....
I am not obese. But I do have to lose more weight. I have been losing weight. And I know I have to stop smoking. I relapsed.

Hi AnotherMe,

You have nothing to lose by trying the didgeridoo, except the money spent if it doesn't work.

It sounds like if I am inferring things correctly, that there are still things you can do to make pap therapy work. For example, regarding taking off the mask, is it comfortable and if not, have you looked at different ones to try? By the way, if you could use the link in my signature block to fill out your equipment profile, that would be helpful as it would enable members to better tailor their responses to your situation.

And quitting smoking could definitely help optimize your therapy. And even if you end up going the surgery route (hopefully not), this would be mandatory so you might as well start now. I know from seeing family members struggle so much how difficult it is so I wish you all the luck in the world.

49er

I say if a doctor (a good one...) can convince you, and is confident that surgery will eliminate sleep apnea and the need for cpap therapy, then go for the surgery. To me, cpap therapy should be the last resort.

Sheriff

Sheriff - you were kidding, right?

Julie wrote:Sheriff - you were kidding, right?

I wondered the same thing Julie.

49er

Even with my AHI of 13, I would not go for surgery--not even if insurance paid for it.
6.5 AHI would still be a rotten way to sleep. I feel yucky when it gets over 2.
Edit: My dentist had a laser procedure; he says he gets a lot of food and liquids come up his nose.
He really dislikes it; and it "didn't help his apnea."

chunkyfrog wrote:Even with my AHI of 13, I would not go for surgery--not even if insurance paid for it.
6.5 AHI would still be a rotten way to sleep. I feel yucky when it gets over 2.

Good point CF. But if someone had an untreated high AHI and was not sleeping on the pap machine in spite of their best efforts and surgery got it down to 15 and they were sleeping through the night and feeling much better, in my opinion, it would be worth it.

Sure, having an AHI under 2 would be ideal but everything has to be evaluated in context. If someone can't make pap therapy work and have tried everything possible, they need to look at the best alternative to reduce that AHI as much as possible whether it is a dental device, combination dental/pap therapy, or surgery. Not doing anything is not an alternative in light of the great health dangers in having untreated apnea.

Somewhat related: I am also seeing an option of dental devices that one wears at night to hold the jaw in position for sleep apnea. Is this a viable thing to consider?

Oops, Just noticed 49'ers comment. How effective are these dental devices?
(Sidenote: I think I ignored 49'er because I live in SEAHAWK COUNTRY! Richard Sherman is GOD!)

MyJanine wrote:Somewhat related: I am also seeing an option of dental devices that one wears at night to hold the jaw in position for sleep apnea. Is this a viable thing to consider?

Oops, Just noticed 49'ers comment. How effective are these dental devices?
(Sidenote: I think I ignored 49'er because I live in SEAHAWK COUNTRY! Richard Sherman is GOD!)

On an off topic note MyJanine, I chose 49er because it was easy to remember and not because I am a 49ers fan. But as a Redskins fan, I still remember that playoff game against your boys in 2012. LOL!

You might want to click on the link in my signature comparing fixed rate vs. adjustable appliances. If you have mild apnea, adjustable appliances mostly have a 75% chance of getting the AHI down below 5. For moderate apnea, it is 60%. There are exceptions to the rule as you will notice.

Now, there is some thought in other circles that the success depends on the structure of the jaw and less on the severity of the apnea. Dr. Park has his patients do a jaw thrust while lying down if I remember correctly. If they find they can breath really well, that may be a sign the dental appliance would be successful.

No matter what, I think the key is to find a very exceptional dental sleep medicine specialist which is easier said than done. I would go to this site and find members in your area.

http://www.aadsm.org/

Not a guarantee you will find the right person but I still think this is better than picking the dentist who decided to start making dental appliances on the side for extra money.

Best of luck.

49er