UPPP: DO or DON'T?

markfest · Post by **markfest** » Wed Feb 21, 2007 4:12 am

Hey all,
I'm a 35-yr old male with OSA. Have had CPAP for 4 years. Tolerate it well and have less drowsiness. But still sleep a lot and have trouble getting up. OSA is not due to weight. Just have a narrow airway.
I'm considering UPPP surgery. I have a good chance of it working and I am hoping to get rid of the CPAP. My biggest concern is the possible "side-effect", regurgitation of liquids. Any one who's had the surgery, do you get liquids coming up into or through the nose? If so, how often?
Would greatly appreciate hearing from as many folks as possible.
Thanks!
Mark, in PA

blarg · Post by **blarg** » Wed Feb 21, 2007 7:06 am

Check those "success" rates carefully. The general rule of thumb with UPPP is what goes UPPP must come DOWNNN. I'm serious.

Most people that have a UPPP are cured for a few months and then end up right back where they started.

And what I mean about checking those success rates is check what the actual definition of success is. Usually long term recovery isn't needed to count it as a success, and even with just short term in there, we're only talking 50%.

Given the incredibly painful recovery and low success (what I'd consider an actual success, a permanent cure) rate, personally, I'd say NO.

It's your body, and your life, so please make whatever decision you want, just make sure you know what you're getting into.

The best part?

University of Maryland Medical Center wrote:Failure and recurrence of apnea. In such cases, continuous positive airway pressure (CPAP) is often less effective afterward, although one study found that oral appliances may still help.

So "often" your CPAP will be even less effective if you're not one of those chosen few that actually get a permanent cure.

More Importantly:

Since you tolerate CPAP well, perhaps you should do some snooping around and see if your pressure needs changing, if you'd do better on a different mask, if you're mouth breathing, etc.

What machine and pressure are you currently using?

If your machine has recording capabilities, have you considered getting a reader so you know what's happening at night?

TANSTAF1 · Post by **TANSTAF1** » Wed Feb 21, 2007 7:32 am

The nurse/tech at my sleep center really recommended against surgery. She said it does not last and it builds up scar tissue which makes other solutions more difficult. Fortunately CPAP works fo rme. Have you considered the dental plate alternative?

CowboyDave · Post by **CowboyDave** » Wed Feb 21, 2007 9:18 am

I had this surgery in 2000, it worked for a few years but here I am on cpap. I am in no way qualified to give any medical advice, but DON"T DO IT. I never had a problem with liquid coming up my nose while swallowing, this only happens when the Dr. screws up the surgery.

fidget · Post by **fidget** » Wed Feb 21, 2007 9:27 am

The criteria for the success rate includes patients who were able to have their CPAP pressure rates lowered, not simply patients who were "cured".

Most people wind up back on CPAP within 10 years of UPPP anyway, so IMHO, I'd keep using CPAP if it works, and hope that in the next few years medical experts come up with a better surgical cure.

rested gal · Post by **rested gal** » Wed Feb 21, 2007 11:08 am

"UPPP: DO or DON'T?"

I wouldn't.

Clickable LINKS to surgery, turbinates, Pillar, TAP experiences
viewtopic.php?t=2836

JeffH · Post by **JeffH** » Wed Feb 21, 2007 11:41 am

My vote is no, but you are the one who has to decide.

snork1 · Post by **snork1** » Wed Feb 21, 2007 2:12 pm

I vote no.
I do know someone who made it to the 10 year mark before getting severe apnea again after UPPP. And thats the BEST case I know of.

I am certainly open to "thinking outside the CPAP box" for solutions, but I have NOT been impressed by the UPPP track record.

If you are want to EXPERIMENT on alternatives, you might try dental devices, which are at least reversible if they don't work out.

Check out talkaboutsleep.com, dental apnea treatment forum if you want to investigate dental approaches.

Guest · Post by **Guest** » Thu Feb 22, 2007 3:36 am

Thanks for all the responses!

I hadn't been seriously considering UPPP until recently. Now I'm feeling more cautious again.

One thing I left out is that my sleep apnea is in the mild to moderate category. Does that affect the success likelihood? (Success as in permanent or long-term cure.) Of course, I would address all these things with my doctor if or when I go for a consult, but they don't always tell it like it is.

I also have to use nasal spray and humidifier to breathe through my nose. I haven't tried a nose and mouth mask. Currently have Swift Air nasal pillow. I like that best. Also tried gel masks, different brands and styles. Will get auto-test machine to check for apneas and pressure. Thanks for that suggestion.

Also, I had recently gotten braces off when I first knew I had apnea. Orthodontist did not recommend dental device.

Thanks again for your help.

Mark

snork1 · Post by **snork1** » Thu Feb 22, 2007 9:22 am

and no matter what, IMHO do go to an ENT and see if you can get that nose working. CPAP was TOTAL frustration for me before I had nose surgery to get my nose breathing working.

Of course once I got the nose working and discovered my apnea was THEN mild and caused by a simple obstruction and not fat, then I was able to switch to a dental device, which has been working great FOR ME ever since.

josh · Post by **josh** » Thu Feb 22, 2007 11:34 am

I had the UPPP done almost 2 years ago, and it made things worse for me! I too have sleep apnea most likely due to a narrow airway, and not due to weight (in fact I am a little underweight). I have been on CPAP for a little over 2 years now, and I don't think it works as well as it could. I am almost 100% compliant, but I don't necessarily believe the treatment is working for me. I am going to have a dual jaw advancement, very soon. (I have braces right now in preparation for it).

The UPPP supposedly has a 50% success rate, and recovery sucked! (For me at least). Before the UPPP I was at 37 events per hour, after it went to 56. A word of caution .

The surgery I am going for supposedly has a 75-85% success rate. And you have to use the term "success" carefully. I read somewhere that a successful surgery is a 50% reduction in AHI. For me, that would mean that an AHI of 28 would be a success...which is still severe. But I am going through with it for the chance to cure it...if it is due to a narrow airway, AND they open the airway up, what do I have to lose? Besides, I may look like Jay Leno afterwards ;p.

Good luck in your decision!!

Oh yeah...some things about the surgery...I don't have fluids that come up my nose. I can say this though...I can no longer pur like a cat, snort like a pig, roll my "r's" in spanish, et cetera. When they say "trim" the Uvula...they are taking the whole thing out!!! lol.

Remember...this is just a data point. There is that other "50"%.

blarg · Post by **blarg** » Thu Feb 22, 2007 8:22 pm

And just to be painfully clear, 50% success means half of the people that have the surgery have a 50% reduction in AHI IN THE SHORT TERM.

I've only heard of one person that actually had lasting success with a UPPP, and 3 years later they were back on CPAP anyway. Oh, and at a higher pressure.

Check out dental devices, Pillar Implants, ANYTHING before you let them slice your soft palate up.

markfest · Post by **markfest** » Sat Feb 24, 2007 3:41 am

[quote="snork1"]and no matter what, IMHO do go to an ENT and see if you can get that nose working. CPAP was TOTAL frustration for me before I had nose surgery to get my nose breathing working.

snork1 · Post by **snork1** » Sat Feb 24, 2007 10:49 am

[quote="markfest"][quote="snork1"]and no matter what, IMHO do go to an ENT and see if you can get that nose working. CPAP was TOTAL frustration for me before I had nose surgery to get my nose breathing working.

Snooter · Post by **Snooter** » Sat Feb 24, 2007 2:36 pm

My lay person understand of OSA is that basically there are two causes. Upper and lower airway blockage. The upper is caused mainly by the uvula and the lower by the base of the tongue. UPPP may help with the upper airway blockage.

Several years ago, before I realized I had OSA I had a UPPP performed. The doctor did it as an outpatient operation for $600. A little painful, but not the end of the world. Especially if it worked. I thought it would help with my snoring and I think it did. But years later I had a sleep study done and here I am. Before going to CPAP I went to see an ENT and he told me my tongue was the problem. I wouldn’t mind going back for more surgery even if it had only a 30 to 40 percent chance of working. But currently it looks pretty expensive since insurance won’t cover it.

On your question of the side effects of UPPP. Other than the maybe two weeks of minor pain, I do not miss my uvula.

Snooter

UPPP: DO or DON'T?

UPPP: DO or DON'T?

No

if your nose doesn't work, CPAP won't work

Re: if your nose doesn't work, CPAP won't work

Re: if your nose doesn't work, CPAP won't work

Mask

Additional Comments: Equipment isn't correct, S9 ASV w/H5i