Sleep Apnea

[john999]

I am not sure I have much of a chance of ever getting SC'ed for OSA, but I did have a recent sleep study. I had 157 apneas and 115 partial apenas in 280 of sleep. My oxygen saturation fell to 70%. I am scared to close my eyes because the doctor has told me I have profound OSA and that I am going to die. The CPAP has not worked well for me. Now my DMII is getting worse. I am overweight 6'1"/ 240 lbs. I used dental device and provent with no result. What treatment options do I have that I don't know about?

John

[VADDS]

I believe your original question was about alternative treatment modalities for OSA. I mentioned max-man advancement. It is very effective for Obstructive apnea. Below is just one Abstract from the current literature. If you are as desperate as you say, I suggest you ask for a referral to a VHA Facility that has the Oral Surgery Staff to perform this type of surgery

"Although nasal continuous positive airway pressure therapy is considered the first-line treatment of obstructive sleep apnea, surgery has been shown to be a valid option for patients who are intolerant to positive pressure therapy. In the past 20 years, maxillomandibular advancement has been widely accepted as the most effective surgical therapy for obstructive sleep apnea syndrome. Maxillomandibular advancement has been shown to enlarge the pharyngeal and hypopharyngeal airway by physically expanding the facial skeletal framework. It has also been shown that the forward movement of the maxillomandibular complex increases tissue tension. This decreases the collapsibility of the velopharyngeal and suprahyoid musculature and improves lateral pharyngeal wall collapse, all of which have been shown to be significant components contributing to the upper airway obstruction in obstructive sleep apnea. The outcome of maxillomandibular advancement has been extensively reported, with success rates of 57% to 100%. A recent meta-analysis of 627 patients from 22 studies showed an overall success rate of 86%. The long-term follow-up of 56 patients for 43.7 months from 3 studies showed a surgical success rate of 89%. These data are similar to my experience with an 89% success rate in more than 600 maxillomandibular advancement procedures performed.

Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserve"

[john999]

Thanks Vadds

My private doctor who really is the most respected guy in sleep disorders in my area told me that even those who get special OSA surgery usually end up still using the mask. I have talked to pulmonologist, ENT, Psychiatrists and dentists about my problem. Everyone has an answer but I would like them to spill as little of my blood as possible.

I did have surgery on my foot about 3 years ago. I developed a severe staff infection ten times worse than the conditon for which I had the operation. I came close to losing my foot. I am moving slowly when it comes to any doctor cutting on me again.

John

[Testvet]

John, they issued me a BiPap back in Nov after a trip to ICU and they didn't have one at Dorn VA so they found one available at Lexington Medical Center across town and they asked if we objected to them transferring me there for treatment, of course not it is about 5 minutes from my house thats where I go when I have a heart attack for emergency care and fee basis ends up paying the bills I prefer Lexington to Dorn, but my carbon dioxide levels keep soaring and making me lethargic, I have been on O2 since June 2011 24/7 2 liters, I have a connection from my air machine that hooks into the bipap when I go to bed.

All of us are different I have major issues sleeping due to nightmares, bad back sicatica, oxygen problems etc a lot of factors, if I try and sleep with no medicinal aid I might get 45 minutes lucky I will get 2 hours, if I take 2 mg of clonazepam I can get about 6 hours, but I wake up feeling like I am lost, I found the best med for me is a generic from K Mart diphenhydrmine HCL they are 25 mg tablets and I take 4 about an hour before I want to sleep/lay down I do this normally about 1 am then my wife has to put the BiPap mask on me I can't work my fingers on the back of my head to hook the clasp and she switches the oxygen line from my air hose to the machine, I am able to pop the clasp when I wake up about 5 or 6 if I am real lucky I might actually sleep until 7 or 8, she puts my glasses and the air hose on my computer chair so after I take the mask off I can switch the hose from the BiPap back to the compressor line

normally she is up half the night on her computer about 4 feet from the hospital bed I sleep in that is in our computer room I know taking the antihistamine is NOT recommended but 2 of the pills don't enable me to sleep but the 4 do, the doctors gave me 5 months to live in April 2011 and I have been using these sleeping pills for more than 10 years I prefer to take the risk and get some real sleep that helps me than to be cautious and not take the antihistimens they have some that add aspririn I won't take those it is to much aspirin but the bottle I get is 400 pills of 25 mg labeled smart sense and cost about 8 dollars to me 8 bucks for some real sleep for 3 months is cheap I am not recomending YOU do it, I am telling you what I found that works for me 2 might work for you or 3 might work ask your doc and then you make up your mind what you are willing to do in order to sleep those masks come in 3 sizes from the VA small medium and large I found I do have to shave the beard messes up the seal

sleep is something I found I need 4-6 hours is better than 45 minutes but then there are those nights no matter what I only get one or 2 hours but they seem to be few and far between.

talk to your wife and your doc before you do it if you decide to try it your wife may appreciate you getting some sleep too :) I am less cranky lol

[ArNG11]

Man I am so sorry to read about your situation. I have sleep apnea but it is hardly nothing compared to some of you guys severity. I use the Resmed Swift FX with a humidifier and it has worked wonders for me. I haven't swerved into the ditch on the way to work since using it. Heck my apnea is obstructive and I am at 6 events per hour with hypoapneas lasting 29 seconds with a desat of 87%. Compared to this post I thank my lucky stars, however, I'll share what has worked for me. I am fairly sure you have heard it before but I'm willing to give my experiences in the hope that maybe it might help. I have changed my diet completely. I don't drink sugared drinks. Don't eat late at night, past 7pm. Stopped drinking coffee and energy drinks and drink the amount of water recommended for my weight. I try to exercise every day, even if it's just a mild paced, limping walk around my 4 mile grid. I went on a RX diet pill to help with the weight loss as I can't exercise as vigorously as I need to. I try to routinely go to sleep at the same time every night even if I'm not tired. We are creatures of habit so eventually your body will get the hint. I use the CPAP with out fail, with the humidifier, as long as I don't fall asleep before I put it on. I use a nasal steroid, um Fluticasone Propionate, 2x's a day, once in the morning and once before I go to bed. Oh I also use a mouth guard at night. Also had my adenoids removed. I hope maybe something I have written down on here will help your situation. Good fortune to you.

[johnjjr]

John,

I'm on a BiPap for severe OSA. I have a deviated septum and too much flesh in the soft upper palate. A double whammy so to speak, and like you I don't like the idea of going under the knife at my age. My ENT suggested Breathe-Rite strips to open up my nasal passages. They work well enough so that I can get 4 to 5 hrs. decent sleep most nights. Still have to use the machine though.

[john999]

Johnjjr and all

My nose just closes up due to collapse of my nasal passage much like when you suck too hard at a straw. The only thing that will fix the nose is he surgery if I go there. I do have complex sleep apnea some being central and some being OSA. I am trying to get off the clonazepam and my pain meds since I know they make it worse. Last night I tried the Resmed Quattro and when I got it tight enough to stop the major leaks it hurt so bad I ended up ripping it off. I used padding but that hurt the seal. I do use allergy pills to help get me sleepy. I sometimes fear that even if I get my nose fixed and all the rest I will still suffer from the apnea.