what surgeries do they have when cpap doesnt help

i have cpap. regular n bipap. used dozens of masks. tried min to max air pressure. the cpap makes me smother. so i cant use it. so im asking what surgeries can i get for treatment. i sleep only breathing thru my nose. i had a deviated septum and turbinates removed. that didnt work either. r there any surgeries that can widen my nasal passages. i used a sutra neti string and i noticed my passage ways are very narrow. also the doc said my tongue is high n the back. so im lookin for solutions. tired of being tired. cant think any more and its getting worse. thanks

Perhaps you should ask your doctor... we are not doctors nor do we play one on tv. We are patients that use cpap machine and have found through trial and error that surgery does not work.

neworleans48 wrote:i have cpap. regular n bipap. used dozens of masks. tried min to max air pressure. the cpap makes me smother. so i cant use it. so im asking what surgeries can i get for treatment. i sleep only breathing thru my nose. i had a deviated septum and turbinates removed. that didnt work either. r there any surgeries that can widen my nasal passages. i used a sutra neti string and i noticed my passage ways are very narrow. also the doc said my tongue is high n the back. so im lookin for solutions. tired of being tired. cant think any more and its getting worse. thanks

It would be beneficial if you would fill out your equipment profile and also include the machine and humidifier settings.

If your pressure is too low and/or your humidifier setting is too high, that could account for the "smothering" feeling.


Den

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neworleans48 wrote:i have cpap. regular n bipap. used dozens of masks. tried min to max air pressure. the cpap makes me smother. so i cant use it.

Sounds like your machine was set for 4-20. A lousy setting.

Most people feel smothered at 4, and if you need pressure much higher than 4, it will take awhile to get to the needed pressure and actually provide treatment. Most people with an apap get a set range rather than the whole range that the machine can do. It usually starts at the low end of what works for that person and goes up a bit for when the needs are higher. For example, 11-13 is what I use most of the night with great success. My machine is set for 11-17 so that when I do have higher needs (sleeping on my back, REM stage, and/or muscle relaxer for back pain), my pressure can up to where it needs to be (usually around 15).

If my machine started at 4, I wouldn't last 5 minutes. In fact, on the 3rd day of treatment, I disabled the ramp because it did start at 4. I now have it start at 11, and it feels very comfortable for me.

I would highly recommend checking your sleep summary report (get it if you don't have it) and/or your data from your machine. It is possible that your machine doesn't have all that data, but if you have a bipap, you probably have a machine with data.

Your doctor *might* help you, but some don't care about data, and most have never used a cpap machine and don't realize that the lower pressures are often very uncomfortable. It is quite possible that you have never had your machine set to the appropriate levels for actual therapy as well as usable comfort.

You can also post your sleep summary and data here for assistance. Just remove your personal info before you post it.

neworleans48 wrote: i sleep only breathing thru my nose. i had a deviated septum and turbinates removed. that didnt work either. r there any surgeries that can widen my nasal passages. i used a sutra neti string and i noticed my passage ways are very narrow. also the doc said my tongue is high n the back. (emphasis added)

Neworleans48,

The problem that is causing your OSA is not your nose. That's why the nasal surgery didn't work as far as fixing your apnea problem. The narrow nasal passages may aggravate things, but they are not the cause of your apnea.

The problem is further down in your airway. One clue is that your tongue is "high in the back"---in other words, the back of your tongue is relatively large for your mouth size and when you fall asleep, it more than likely relaxes and falls back into your upper airway, which blocks the airway and hence no air can get into your lungs. The CPAP/APAP/BiPAP machine is supposed to provide enough positive airway pressure in your airway to make it difficult for the tongue to fall back and block the airway.

You likely have other structural issues in your throat that also lead to your upper airway being blocked further down than the nasal passages themselves: You may have an overlong soft palate that falls back and blocks the airway. You may have a small airway to begin with, so that it doesn't take much relaxation of the muscles around the upper airway to lead to a collapse. You may have lots of excess neck tissue if you are overweight and that too can leave the upper airway more vulnerable to collapse when your muscles relax in sleep.

I point this out only because you seem to be focusing so much of your attention on the nasal passages themselves. While a clogged nose can definitely aggravate OSA, it does not cause it. So fixing the nasal problems won't cure the OSA.

It's also worth noting that a clogged nose can definitely make CPAP harder to tolerate. Fixing the nasal problems may help with tolerance issues, but it's not the only thing that leads to folks having a tough time tolerating CPAP.

Finally you asked about surgery for OSA: The "standard" surgery offered to an OSA sufferer is called uvulopalatopharyngoplasty (UPPP). It's quite invasive and painful, but more importantly, it is not particularly reliable as a fix for OSA. You can read about UPPP surgery here and here and here. Commonly cited numbers are that UPPP effectively reduces the AHI by 50% in about 30% of patients. To put it another way, in 70% of the patients who have UPPP surgery, the AHI is reduced by less than 50%. It is quite likely for someone who has really severe OSA before the surgery to still have clinically moderate to severe OSA after the surgery as well; and hence it is is not uncommon for people who go through UPPP surgery to find out that they still need the dang xPAP afterwards.

Be VERY careful about surgery. There are lots of chop happy surgeons willing to cut on anyone for sleep apnea. They claim "success" rates for patients who still need CPAP, but have a lower AHI in test.

Many apena surgery patient are very unhappy with the outcome. There can be lifelong side effects.

UPPP is especially bad in terms of being oversold and not working that well.

Try really hard to make CPAP work. You might find help here you won't get from your doctor. Many doctors are just assembly line salesmen who have no real idea of how to make CPAP work in the real world.

neworleans48 wrote:i have cpap. regular n bipap. used dozens of masks. tried min to max air pressure. the cpap makes me smother. so i cant use it. so im asking what surgeries can i get for treatment. i sleep only breathing thru my nose. i had a deviated septum and turbinates removed. that didnt work either. r there any surgeries that can widen my nasal passages. i used a sutra neti string and i noticed my passage ways are very narrow. also the doc said my tongue is high n the back. so im lookin for solutions. tired of being tired. cant think any more and its getting worse. thanks

Hi neworleans48,

I agree with all the concerns about surgery.

Have you looked into dental devices? If this option appeals to you, here is a link to a study showing the success rates for various apnea severity levels so you can see what your chances are of getting the AHI to 5 or below:

https://advancedbrainmonitoring.app.box ... 7pjn8s11y4

Generally, if you have mild to moderate apnea, they are better than if you are in the severe range. There are a few apnea lower severe ranges that had a greater chance of success.

You also need to keep these additional caveats in mind. If you have nasal issues, it may be tougher to get dental appliance therapy to work. However, at the same time, if it was effective, your nasal issues might improve due to your apnea being treated.

And you may be paying for this out of pocket since many insurance companies will not cover this.

Anyway, if you are interested, before you go see any sleep medicine dentist, please visit this forum and look for posts by sleepdent who is very informative and will lessen your chances of seeing folks who are charlatans which you sadly have to look out for.

http://www.apneasupport.org/sleep-apnea ... n-f20.html

If you want to continue with pap therapy, then I totally agree with all the excellent posts that have been written on how to make it work.

49er