Alternatives to PAP therapy

I know this is a CPAP forum and not just and OSA forum, but I was wondering if anyone had any idea of how often OSA sufferers have success with surgical or other alternatives to CPAP and who the best candidates are the these different approaches?

Unnecessarily Slow and Painful Death! Jim

Possibly from allowing quacks to cut you up.

Most surgeries are very iffy - seem to work for a few mos, and then it's back to needing Cpap. Things however like nasal turbinate surgeries work ... for nasal turbinate problems, but don't cure Cpap. And neither do any of the other tricks and gimmicks out there... which is why we're still here .

Let me pose a question to you.
If surgery was the solution rather than PAP - in your estimate, wouldn't surgery centers for apnea sufferers be popping up like those dealing with minimally invasive back surgery? Or, do you think the link in the news section at the top of the page (http://www.satprnews.com/2017/12/28/pos ... 2016-2024/) points to information that is bogus?

Edited to include a section from another post:

Regarding the surgical solution: I, too, considered it a lot (looking for the cure) not one person supported it as the cure, not even a couple of surgeons who would have done the job. After time, it became so obvious to me that it was not the cure that had someone advised it as a good solution, I would have thought it was probably self serving and virtual quackery. Your situation may be different and the outcome you want may be as well, but, personally, I would think long and hard before doing it. At this point, PAP is second nature in my daily life - just as taking your shoes off before removing your socks.

Anesthesia is a risk I'd rather not take. So much can go wrong. Also, my brother- in-law had his uvula removed and it didn't work. So he is back where he started, on CPAP.

JimW159 wrote:Let me pose a question to you.
If surgery was the solution rather than PAP - in your estimate, wouldn't surgery centers for apnea sufferers be popping up like those dealing with minimally invasive back surgery? Or, do you think the link in the news section at the top of the page (http://www.satprnews.com/2017/12/28/pos ... 2016-2024/) points to information that is bogus?

"Mack the Knife". seldom cures Sleep Apnea, but he fools a lot of the "CAN'Ts" into Surgery at least it's one solution you "CAN'T" undo!

Good Article, finally someone got it right.

I had UPPP, turbinate reduction and septiplasty surgery around 20 years ago. It relieved some of my symptoms for several years. However, when I was in the hospital for knee replacement three year ago, the nurses noticed my blood oxygen would drop considerably when I slept. One of my doctors scheduled me for a sleep study after I recovered from the knee surgery and I am not on a BIPAP machine.

Josiah wrote:I know this is a CPAP forum and not just and OSA forum, but I was wondering if anyone had any idea of how often OSA sufferers have success with surgical or other alternatives to CPAP and who the best candidates are the these different approaches?

The word "surgery" for OSA can have a multitude of meanings, categories and implications. Some turbinate or deviated septum surgery has proven to help some users. However, if the category is "UPPP", that can be a whole different ballgame. These forum pages are full of stories of folks who were convinced by some surgeon that UPPP surgery could "cure" OSA. In most cases, the patient ended up back on CPAP or even Bi-Level therapy and sometimes at higher pressures. They deeply regretted having the surgery.

If you wish to read them for yourself, go up to the Search line and put in "UPPP" and start reading. 133 pages of links as I just checked.


Den

.

I'm going to grossly generalize here. About 50% of people who undergo the common upper or lower pharyngeal surgeries for OSA will have "success" defined as an AHI reduction by at least 50% from untreated baseline and a postsurgical AHI less than 20. This is not a result most of us would accept as successful for PAP, but it is the common definition used for surgery.

There are some surgeries that are much more likely to work than that. For example, if you have a small tongue, are not overweight, have otherwise favorable anatomy, and the only thing working against you are huge tonsils, then tonsillectomy has ~ 85% likelihood of success according to the previously mentioned definition and better than 50% of resulting in normalization of AHI.

What about the mouth pieces?

FrederickRose wrote:I'm going to grossly generalize here. About 50% of people who undergo the common upper or lower pharyngeal surgeries for OSA will have "success" defined as an AHI reduction by at least 50% from untreated baseline and a postsurgical AHI less than 20. This is not a result most of us would accept as successful for PAP, but it is the common definition used for surgery.

There are some surgeries that are much more likely to work than that. For example, if you have a small tongue, are not overweight, have otherwise favorable anatomy, and the only thing working against you are huge tonsils, then tonsillectomy has ~ 85% likelihood of success according to the previously mentioned definition and better than 50% of resulting in normalization of AHI.

My AHI at my lab test was 150 based on 3 hours sleep with 450 events, so half of that, and I'm good to go? DELUSIONAL!!!

Wallow in De-Nile, it's your life, mine is under control with XPAP, I'm not going to let a few confused brain cells let a Knife wielding Dr. slice and dice me. Jim

With all the bad things I hear about these surgeries, I would, as a minimum, ask the doctor for a money back guarantee. I think you would see most surgeons skitter away like a snake.

Tried to read a bit over on PubMed but it's hard to tell which studies (and results?) might be slanted to either prove or disprove based on business interests. Even if a device reduces events by a percentage, those persons with a low AHI to start might find an oral device gives an acceptable degree of relief. One study I saw said AHI and CPAP pressures are indicators of likely success on an oral appliance. The lower the AHI and the lower the pressure needed to correct that AHI the better the chances. If you are not prone to TMJ issues and money is not an obstacle, you could go ahead and get a dental device and a follow-up sleep study while wearing the device so you can know how effective it is for you. If nothing else, maybe it would be acceptable enough for use when traveling. For instance, I would not want an AHI of 6 on a regular basis, but would probably accept it for a few days when traveling if my oxygen stays up. My history of TMJ pain makes it not worth the risk for me. We just have no idea if or how well it might work for you.

kteague wrote:Tried to read a bit over on PubMed but it's hard to tell which studies (and results?) might be slanted to either prove or disprove based on business interests. Even if a device reduces events by a percentage, those persons with a low AHI to start might find an oral device gives an acceptable degree of relief. One study I saw said AHI and CPAP pressures are indicators of likely success on an oral appliance. The lower the AHI and the lower the pressure needed to correct that AHI the better the chances. If you are not prone to TMJ issues and money is not an obstacle, you could go ahead and get a dental device and a follow-up sleep study while wearing the device so you can know how effective it is for you. If nothing else, maybe it would be acceptable enough for use when traveling. For instance, I would not want an AHI of 6 on a regular basis, but would probably accept it for a few days when traveling if my oxygen stays up. My history of TMJ pain makes it not worth the risk for me. We just have no idea if or how well it might work for you.

My sleep specialist (MD) went over dental devices as part of my initial consultation. As kteague said, they seem to work only in mild cases and with folks without TMJ.

MrsRinPDX wrote:

kteague wrote:Tried to read a bit over on PubMed but it's hard to tell which studies (and results?) might be slanted to either prove or disprove based on business interests. Even if a device reduces events by a percentage, those persons with a low AHI to start might find an oral device gives an acceptable degree of relief. One study I saw said AHI and CPAP pressures are indicators of likely success on an oral appliance. The lower the AHI and the lower the pressure needed to correct that AHI the better the chances. If you are not prone to TMJ issues and money is not an obstacle, you could go ahead and get a dental device and a follow-up sleep study while wearing the device so you can know how effective it is for you. If nothing else, maybe it would be acceptable enough for use when traveling. For instance, I would not want an AHI of 6 on a regular basis, but would probably accept it for a few days when traveling if my oxygen stays up. My history of TMJ pain makes it not worth the risk for me. We just have no idea if or how well it might work for you.

My sleep specialist (MD) went over dental devices as part of my initial consultation. As kteague said, they seem to work only in mild cases and with folks without TMJ.

The also have a very good way to get data to see if you are doing OK!, NONE! Jim