UPPP Experience

Hello everyone,

I will be going for septoplastry surgery in August in the UK, and I will be consulting yet new specialist about whether or not to go for UPPP. I have considered doing UPPP when I was first diagnosed with moderate-to-sever OSA. But I have put this idea to rest I when read couple of books that claimed the success rate to be 50-60%, beside some of scary complication related to swallowing/drinking.

I wanted to get some feedback from any of the forum participant if he/she has gone for UPPP and whether it cured their OSA, had complications, and what would their advice be for people considering it. The last doctor I talked to told me about recent technology that uses ultra-sound to do the cutting where he claim that it is not as invasive as the original approach that was used in the past...

your feedback is very much appreciated.....


newcpap

My dentist had laser surgery for his apnea--he still has the apnea.

Watch out what the definition of "success" is. Some people claim "success" if your AHI is reduced by 50%. You might still need CPAP.

People with successful UPPP probably don't end up on this forum.

I'm very skeptical of UPPP in general. Google up the horror stories of people who've had UPPP. Be careful about chop happy surgeons with delusions of grandeur or visions of dollars dancing in their heads.

I'm skeptical too... I investigated options to cpap in January after my diagnosis of OSA; finally decided that UPPP and mandibular advancement were not things I'd even consider... I read so many horror stories about UPPP complications and food going up your nose instead of down your throat... not worth it, and cpap is the gold standard, as well as a non-invasive approach...

newcpap wrote:Hello everyone,

I will be going for septoplastry surgery in August in the UK, and I will be consulting yet new specialist about whether or not to go for UPPP. I have considered doing UPPP when I was first diagnosed with moderate-to-sever OSA. But I have put this idea to rest I when read couple of books that claimed the success rate to be 50-60%, beside some of scary complication related to swallowing/drinking.

I wanted to get some feedback from any of the forum participant if he/she has gone for UPPP and whether it cured their OSA, had complications, and what would their advice be for people considering it. The last doctor I talked to told me about recent technology that uses ultra-sound to do the cutting where he claim that it is not as invasive as the original approach that was used in the past...

your feedback is very much appreciated.....


newcpap

I've had UPPP (LAUP) and MMA surgeries. Not worth it and I regret doing it. I'm still back to using CPAP. Sometimes the UPPP can actually make CPAP tolerance *worse* o be very careful. It's rare that patients report satisfactory results with UPPP.

I had septoplasty and UPPP. It did not fix my apnea.

That being said, there might still be a reason to do it. In my case, my nose was sufficiently messed up that I had breathing difficulty during the day (the surgery definitely fixed that). Also, I was "gambling" that since I have mild apnea, the surgery might resolve it.

We never did proper in-lab studies before or after (yeah its kinda dodgy), so I don't know the surgery's effects on my AHI. However, my take-home sleep study used to show RDI ~14 before, and another take-home sleep study showed RDI < 5. So maybe it helped.

But I was sufficiently sleepy enough to see another doctor who did everything properly and prescribed CPAP.

I had a reduction of turbinates, a trimming of my uvula, a tonsillectomy, a lingual tonsillectomy, and a base of tongue reduction. (Naming the specific procedures seems slightly more useful to me than the "UPPP" umbrella term.)

The collective impact was no improvement in my apnea, although I snore much less and I suffer from less morning breath.

I had basically had done what Brianin had tho no tongue base procedure but did have the deviated septum fixed. This was five years ago and the best thing I ever did. Sleep like a baby, dream wonderful dreams etc, etc. Two things, today a competent Dr. will do only do a partial uvula reduction, not removal. Second, strip naked and look at yourself in the mirror. Are you fat? Go have a BMI test. If you are obese, start a juice only diet, research juicing, and lose the fat. I did a 21 day juice fast, lost 30 lbs, it reprogrammed my eating habits, my blood pressure dropped 25 points and my cholesterol 50 points. My belief is, if you're fat, surgery most likely won't work. If you gain weight after the surgery, apnea will return. It just dawned on me reading the post surgery studies regarding cure rates. All the studies I read used "obese patients sleeping on their backs." The surgery cure rate was abysmal and these are the studies all the naysayers quote. Pretty obvious to me why. I truly believe, in the majority of cases, obesity is the major contributing factor. APNEA is just one of the symptoms of obesity just like high BP, diabetes etc.
Anyways, and again, I took control of my health, kicked the c-pap to the curb and have never been happier. Hard? Yes it was but to live with an air tube pasted to my face for the rest of life was not an option when I could do something about it. Lot's more details I'll share if anyone is interested.

I'm not saying whether it works or not, but I think one thing to take in mind is that I'm sure people who it did work for are no longer browsing these forums. So I would take that into factor when considering the extent of the replies.

I agree with you KarD and that's why I posted my story. I'll add, you have to decide if CPAP is just not for you. If it's not, you have to tell your medical provider CPAP does NOT work for you under any circumstances, make up your own story, and FORCE your way to surgery. If you can access a dedicated sleep surgery center eg. Stanford Sleep Center etc. all the better. Health plans don't want to spend money on you; give you a band-aid and send you on your way. If you force the issue they will eventually yield. I forced Kaiser Permamenty to do mine and they are as close to government HMO care as you can get. If you have to see another ENT in your plan, do it.

Pstar wrote:Pretty obvious to me why. I truly believe, in the majority of cases, obesity is the major contributing factor. APNEA is just one of the symptoms of obesity just like high BP, diabetes etc.

Hogwash. There are plenty of thin apneacs, and darn few people who report that they cured their apnea by losing weight.

Losing weight is probably a good thing in general. However, giving false hope that weight loss will cure apnea just encourages new apneacs to say "I'll just lose weight and then I won't need CPAP." There are already far too many people who won't use CPAP without giving them false hopes that they can fix it without CPAP.

archangle wrote:

Pstar wrote:Pretty obvious to me why. I truly believe, in the majority of cases, obesity is the major contributing factor. APNEA is just one of the symptoms of obesity just like high BP, diabetes etc.

Hogwash. There are plenty of thin apneacs, and darn few people who report that they cured their apnea by losing weight.

Losing weight is probably a good thing in general. However, giving false hope that weight loss will cure apnea just encourages new apneacs to say "I'll just lose weight and then I won't need CPAP." There are already far too many people who won't use CPAP without giving them false hopes that they can fix it without CPAP.

I never said losing weight will get the majority of people, or anyone for that matter, off cpap. I said gaining weight is a contributing factor to developing apnea. That is supported by countless ENT's.
I never said apnea does not effect skinny people.
Finally, there are many. many people who have cured their apnea via surgery AND weight loss. Your statement this is a false hope is nonsense.
My point is to do your own research, see the Dr's who are versed in up to date surgical procedures and not simply listen to people like you I remember aggressive naysayers like you when I was doing my research and if I had listened to them I'd still be just like you, trying to sleep with a hose strapped to my face.
Finally, if cpap works for you or anyone else, GREAT, stick with it and have a great life. My advise is for those who cpap does not work and they want off it asap.

Thank you all for the feedback. I have couple of comments to add and one follow up question to ask:

1. I agree with archangle in that being overweight is not major contributor to sleep apnea ( I guess I have to disagree with pstar on this one!). Just before I was diagnosed with OSA, I've lost around 45 lbs and that didn't help with any of the OSA symptoms that I have been having for 10 years during my journey looking for answers. In addition, there are leading doctors in the field who say that the main factor in OSA is the anatomy of upper airway which yields to genetic factors being more relevant than the weight. But I guess we all agree that being overweight is not good for health overall, not only OSA.

2. There are multiple studies that showed that reducing one's weight by 10% reduces the AHI by 50% (which seems to be the definition of success according to some doctors). However, curing OSA to me would be reducing the AHI to Zero.


My question to the folks who went for the surgery (either UPPP or anything beyond the septoplasty). I understand that the surgery didn't cure your OSA, but did you have any of the scary complications we all read about such as:

-Having to re-learn how to drink/eat
-Long recovery period with a lot of pain
-Difficulty using nasal cpap due to air leak from your mouth
-...etc

I appreciate your feedback on this point justinjustin, Sleeper Agent, BrianinTN....?



newcpap

newcpap~

I'll reply from the view point of success.

Btw, I think your second point speaks to the direct relationship between obesity and apnea. Check out you tube videos on people who lose lots of weight. Their face and neck shrink greatly in size and many say the first place many lose weight is in the head region. Fat accumulates all over the body, not just the belly etc.

~did not have any trouble eating/drinking. It's common to have a foreign sensation in the back of the throat until your brain learns to ignore the change to your anatomy.

~days 1-3 minor/moderate pain. days 4-7 pain peaks, mostly when swallowing and waking up with dry throat. days 8-9 pain rapidly diminishes. day 12-14 nearly gone. Pain meds and little tricks make the journey much easier. I didn't think it was much worse than a bad strep throat. There are UPPP journals around with all the tricks.

~make sure the Dr. only reduces the uvula size and not removes it. I don't think anyone removes it anymore anyways. I used the cpap due to the swelling after surgery and had to ramp up the pressure to open the swelled up airway. I was getting blow by. As the swelling diminished, I lower the pressure more and more and one day I took a 4 hour nap and realized I slept with an unobstructed airway the whole time. I then used it less and less than finally packed it away.

I highly recommend nose strips and a dental device. Everything you do to open the passages after surgery is good. I had to get out of the habit of pressing my tongue against the roof of my mouth, I habit I developed while using my nose mask on the cpap which made a better seal. The problem is that dropped my tongue further down my throat.

See my responses in red

My question to the folks who went for the surgery (either UPPP or anything beyond the septoplasty). I understand that the surgery didn't cure your OSA, but did you have any of the scary complications we all read about such as:
I had both of those procedures in 2007 including removal of the uvula. The septoplasty I would recommend as unobstructed breathing through both nostrils was a godsend. UPPP makes me want to go screaming into the night.

-Having to re-learn how to drink/eat
Yes, for months. In fact, I used to choke on my own saliva. Sometimes I still do.

-Long recovery period with a lot of pain
YES! I would rather have an appendectomy - again. And if you have central apneas, like me, the surgery will never work.

-Difficulty using nasal cpap due to air leak from your mouth
Due to seasonal allergies and sinus congestion, I use a FFM. Flonase helps. Took a while to get used to it but now claustrophobia is gone and I have embraced the full face.

-...etc
My pulmonologist told me that titration on someone that had UPPP can be very difficult - much more so than someone who has not had the surgery.

- Flappy