Surgical Procedures and Options for Obstructive Sleep Apnea : Review and Comparison
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- čas přidán 6. 08. 2024
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Have you had any of these surgeries? What was your experience? Review of several surgical options for OSA and my opinion of them are discussed.
Hypoglossal nerve stimulation (Inspire), Septoplasty, UPPP, LAUP, Tracheotomy, Maxillomandibular Advancement, Hyoid Advancement and I'm sure something else is discussed in this video.
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Thank you!!!
I love my CPAP and he is soooo right about the crappy follow up. My Neurologist doesn't care. The Sleep Clinic team doesn't care. The medical supply team doesn't care. Only if u are experiencing issues do they care. Its disheartening. The only education and support I get is online. Rhanks so much for your content.
I’ve always had trouble sleeping (PTSD3 didn’t help). My samoan cousin was admitted to the hospital for a stomach procedure, the night nurse gave him medication, the next morning they found him deceased from an undiagnosed apnea. My family redirected their attention to me and urged me to get tested. It was some kinda take home device that smelled of cigarettes. Nothing happened with that, 5yrs latter I tried again with a professional and a sleep study to get my family from nagging me. I was told I had a severe apnea. My pressure was so high it was like having a hovercraft on my face. Surgery was suggested, first septoplasty, then teeth straightened(underbite) which was followed by maxilllomandibular advancements. Over 7hrs of surgery and over $100k was supposed to correct my apnea. While the surgery reduced it by half, it did not cure it. They told me that there was nothing left to do and some doctors suggested that an aspect of my apnea may be from a residual neurological response. There was no physical therapy or followed examinations. I was never referred to any special evaluations before or after the procedure. I watch your channel often to be a better steward of my health. I don’t want to die in my sleep yet. Thank you for your channel
Are you over weight
I had a General anaesthetic done twice this year. First failed down through the throat and second try a month later was up through my nose. The anaesthetist found I have polyps up both nasal passages. Made it reasonably uncomfortable for a while before the team could get past the obstructions.
As far as my breathing goes, the ENT said that the polyps could be removed if I forced the issue but he recommended I delay that sort of operation. My sleeping using my CPAP is terrific.
Fun fact: the horrors of tracheotomy prompted Dr. Colin Sullivan to invent CPAP back in the 80s
Thank you very much for sharing all your valuable experience
Thank you Jason for the very thoughtful work you do. The information given may prevent someone from being talked into surgery. As you said, these options not only do not work, but do more harm than good. The horror stories are out there. The support for CPAP therapy is lacking for sure. I do hope more sleep doctors, clinicians and healthcare providers will hear this and rethink their patient care. Please do not stop sharing your views and your caring of your sleep apnea patients. We need more like you.
Thank you Karen! That's very kind of you.
I had the UPPP surgery in 1990 which only worked for a few years when everything grew back. I was finally put on CPAP in 2001 and have slept fine since. The more you need it, the better CPAP works.
You have help me a lot thanks for the advice
Another great video. You are 100% correct that follow up sucks. I could use some assistance as I know use of my unit is not optimal ie. too much pressure (I'm bi-pap), leaking etc. But I use it nightly regardless. I HATE the place I got it from. Really don't know what to do. I'll look into some of your other videos. Thanks!!!
its always good to be informed of possible options to remedy sleep apnea. thanks for the video.
Glad you went over all the options. I’ve thought about a few. Makes me want to stick with cpap use and lose weight to resolve some of the problems. At least for now. Thank you.
In 2000 I had uppp and hyoid advancement. I was cleared by sleep study. But in 2017 I was again experiencing symptoms. Diagnosed with sever sleep apnea, I began using the DreamMachine. I have taken the foam out like you expressly told me not to do. It is working great and I also use the tape you recommended on my mouth. No more jerky tongue. Thanks for all you do!
I have used a specially made oral appliance for sleep apnea. It keeps my jaw forward and no problem sleeping. Used it fir years and only had new one made after some years.
Was diagnosed as a possible Sleep Apnea patient while doing a pre-surgery question session. The person taking the answer wanted to make a referral. I guess my falling asleep while driving was the clincher. Been on CPAP for a long time now. About ready to get my 3rd CPAP machine. I like the F&P Simplus ? mask. I think that's the name. Although I think I'm going to get the new Resmed Full face mask. That looks like a winner to me. Anyway, I always find your videos both educational and entertaining. Keep up the good work. ;o)
Luv you you state the truth straight up. No BS.
I had nasal turbinate surgery and they also replaced the bottom third of my septum using rib cartilage. Tom the better part of a year to completely heal, but I breath much better and my CPAP therapy greatly improved. I definitely still have some issues, but I was really close and then #foamgate struck.
Just a note, that the surgery wasn’t aimed at providing relief from sleep apnea, just repairing all the damage I did to my nose from playing sports, and finally just building a new septum as it was obliterated by a previous surgery.
Septoplasty is one that I would have done on myself if I had a deviation.
@@Freecpapadvice Yep, the only issue I had was my septum was so rigid that I had to switch to a dreamwear nasal gel pillow mask to stop leaks.
Looked up the before and afters of the MMA surgeries. Wow you weren’t lying. Totally different look.
for future videos would be interested in hearing your thoughts on the Vivaer procedure, and Latera implant surgery. These are both minimally invasive and supposedly correct nasal valve collapse.
Back in the early 90's before apnea was much of a thing I brought in a VHS tape of me sleeping to an ear/nose/throat specialist. The result was an operation which I think looks like the UPPP, I have no uvula, and straightened the septum. My apnea which was in the 80's and gave me horrible daily symptoms disappeared over night. 5 yrs ago, knowing that I again had some apnea, (video again. Showed about an AHI of about 20) I ordered a cpap machine from Amazon and my apnea has been mitigated ever since. AHI 0.5-1.6 on the avg.
Hey TLL..I AM a man who has been treated for anxiety/insomnia.. so bad i thought i forgot how to get to sleep..40 years of paying psychaitrist for meds. Then 2 years ago.. i started napping.. 15 20 min.. my fam immmediately noticed. I never have napped unless very ill with flu type chit..and i never woke up felling better.. the same or worse usually.. but these short naps i felt good for 20 min.. then crash tired again.. it progressed to sleeping 22 hours.. eat sleep 8 more.. wake up exhausted..memory gone.. pain throughout my body. Bad Headaches everyday sometimes for 2 weeks. Mem was worst for work and sleeping thru meeting.. appointments.. ect. Fell asleep 2x driving.. with many micro naps until i understood the feeling.. the urge...i chatted with another guy. He said the same .. it felt like andre the giant grabbed the back of my neck and was pusging head to floor... in car.. my chair whereever.. i recognized i need to pull over now.. been woke up by homeless..cops..farmers..thinking i waa drunk...
Ok. Been on search for right treatment.. very hard to get all thr info i need.. like why inspire doesnt fix all apnea events.. did it not pulse tonge.. not enough power? I cant choose this option due to 30-40k for a 50 50 shot... my conclusion.. there is no best fix.. i hate hate medical anything... i have disigned my own products and have shown sig snoring and apnea activity.. i might stay on this path cause i feel i got 70% improvement with my techniques...
good information
Lefty, I have tried 3 surgical procedures to treat my severe apnea including the deviated septum surgery, UPPP, and a more invasive technique to trim the fat around my esophagus and the only one that was successful was the septum procedure. You are spot on when you state that any surgery involving cutting around your esophagus results in increased scar tissue that worsens the problem because you now have to contend with tougher and larger skin obstructions. Looking back I should have avoided the surgery and focused on losing weight to diminish the fatty tissue in my neck which I believe would have been more beneficial for me. the septum surgery is tough as well because you have to mouth breath for a few days while the sutures heal in your nose which may require you to have gauze stuffed up both nostrils for a while, but the result is instantaneously when the gauze is removed. right now i continue to focus on maintaining a healthy weight, doing some form or regular cardio to strengthen my breathing, and do regular check-ups and making periodic adjustments to my mask according to my needs. thank you for making these videos for our community, we really count on you to remove the mystery and confusion for us so we can make informed decisions on this serious problem. we appreciate you!
Did looseing weight help
You more then the surgierws
@@gallo4796 In my case maintaining a healthy weight certainly increased the benefit of the procedures discussed in this review for me. This strategy is largely dependent on your individual physiology and body makeup however, I believe anyone considering a surgical procedure should combine the two strategies (surgery and weight maintenance) to enhance their chance for success.
I had a badly deviated septum repaired last fall w/ turbinate reduction. It helped my breathing and CPAP trratment but didn't help with untreated SA.
I had UPPP done on 7/5 and am still healing but my airway is much more open and my SPO2 numbers are better than they have been in a long time. I have had 2 sleep studies done (before UPPP) and my AHI was 10.5 and 13.2, so I am not a bad case... just hated using CPAP. One of my problems has always been that my uvula often would swell up to twice the normal size and drop back into airway, cutting of airflow. Basically, even if the UPPP doesn't completely resolve my issue, i don't regret the surgery because I was anxious to get rid of the uvula.
Lastly, doctors now believe mild sleep apnea doesn't pose a risk to the heart and cause other issues. It is only when you get north of 25 AHI that it becomes an issue.
Does losing weight ever result in reversal of OSA??
Excellent video…❤ your content!
What an incredibly informative and engaging video! 😄👏 Your approach to demystifying surgical options for sleep apnea with a touch of humor is fantastic! It's great to see content creators like you provide valuable insights while keeping things light-hearted. 🙌 Laughter can be the best medicine, especially when tackling serious topics like this. 😂
It's clear you recommend a thorough evaluation before considering surgery and that CPAP therapy is often underutilized due to poor follow-up. This is such an important message! 👍🩺
For those curious about how all this ties into the body’s overall well-being, interestingly, the endocannabinoid system plays a role in various physiological processes, including sleep regulation. 🌙✨ While this may not directly relate to the surgical treatments you’ve discussed, it’s part of the fascinating landscape of our health.
Keep up the excellent work, and thanks for contributing your knowledge and firsthand experience to the community! 🌟📚 Looking forward to more videos. Don’t forget to take care of your own sleep too! 😉💤
#CPAPLegend! Great informative video as always. I wanted to quit Cpap so bad but stuck with it. Thanks to Jason!
Back in 1996 I was told by specialists that surgical procedures would not be developed in our lifetime and the trusty Resmed Sullivan V machine was our only hope as it was non invasive and, of course, not a permanent fix so could be improved with technological advances. And they were right. Mine jew, I did have my tonsils removed in 2003 which improved my breathing by 40% but did not eliminate the need for CPAP
More research from the dental/orthodontist community is showing that doing airway dentistry by way of palatal expansion can be helpful. In fact, they're suggesting you do this BEFORE any of the surgeries you discussed in this vid. Check out Mark A. Cruz's videos about orthodontics for midfacial deficiency, UARS, & OSA as well as MARPE/DOME procedures/surgeries out of Stanford. I am considering these options with PAP because the mandibular advancement device permanently caused malocculsion, TMJ, speech issues, etc.
I had the surgery for a deviated septum. They removed my tonsils and then I made them stop. CPAP has been a God send to me
I had the Septoplasty. worst pain and surgery. should be easy but
it was bad and did not fix anything. then had the uvula removed. still snored badly. did not help with OSA. Just recently had the turbine reduction. hands down easies and best surgery. much clearer breathing and way less mouth breathing! Highly recommended. I feel that after the turbine reduction my cpap treatment is way more effective.
But surgery wont eleminate the need of cpap?
I had hyoid suspension and Septoplasty along with turbinate reduction. None of these surgeries reduced my sleep apnea even a bit. I have been using CPAP even before surgery and still using yet I continue to have sleep apnea symptoms
10:39 and this is why I contacted you, wish I had watched this one yesterday. Also note, when you remove the trach it leaves a very attractive scar.
I love my cpap!!
its crazy that you would avoid the inspire...at my hospital, Doctors gave high praise...
You are so right, NO FOLLOW UP.
this was helpful. my dad had a lefort in the 1990's and has had horrible problems with his jaw and ear ever since (abscesses, etc). I'm supposed to have a video visit with a pulmonologist (Sleep Doc Direct) and apparently he sends one or the other machine home for a sleep apnea test. but i'm wondering how those machines ("PAT One" or Alice something) compares to the euipment you're using on your site. Do you have a video about them?
I had Vivaer done to reduce my turbinates and address some minor septum issues. I’ve noticed some minor improvement to breathing in daytime and night, but not enough to significantly impact my OSA or snoring. Now I’m just trying to find a CPAP mask that doesn’t hurt my nose or give me acne.
I have questions I just went to the ent and he was very cut happy can you please respond in a way that I can reach out and get some advice on how and what to do about this?
My issue with my C-pap is being teathered to an electrical power source. How about the oral jaw displacement devices as an option to MMA?
I was diagnosed with OSA in 2019. For my entire life, I suffered from a stuffed up nose. I had a deviated septum. In 11/2019, I had a septoplasty and a turbinate reduction. Omg! Best thing I ever did. I did not eradicate the OSA, but it allowed me to freely breath through my nose, and as a result, CPAP works amazingly well for me, which I started in 01/2020.
I was a confirmed mouth breather, but after surgery, I can use a nasal cushion and I have no issues with mouth leaking. Do I like CPAP? Hell no! But I like sleeping and breathing, so....it's life. Overall, I have had significant improvement in sleeping, feeling rested,.and breathing in general.
Amazing outcome! May I ask what kind of turbinate reduction you underwent? I just had a DISE procedure and my swelling turbine almost completely blocked the airway, that leads to lots of mouth leaking and aerophagia.
I'm not sure what "kind" of turbinate reduction, as I was unaware there are different kinds. I had a deviated septum repaired and the reduction which I believe was a basic shaving down of the turbinate areas in both nostrils.
What about the dental option a mold for mouth
Was just watching your INAP video, and “the algorithm” clearly thought I needed to see this one next.
I’ve looked at a lot of these as well, and came to the same conclusions - although less informed by personal experience like you’ve had seeing sleep studies for people after they try these things.
Two things to add on to the great info you’ve already provided -
I’ve *heard* - but don’t know for sure - that one risk in tongue base reduction, is potential permanent motor nerve damage impairing the use of the tongue. Imagine not being able speak well or swallow food well for the rest of your life … because you found CPAP frustrating. I want to be clear though, this is only something I’ve heard about, I have not read about it in clinical literature.
On MMA surgery, yes - very difficult surgery. Thank you for emphasizing that, sometimes some people think it’s not that bad. And the risks of permanent sensory nerve damage seem to go up if you’re older - the surgeon I consulted with said that at my age, chances of permanent sensory nerve loss in my lower lip and chin was close to 100%. No thanks. CPAP sucks, but I can stick to it for now.
In terms MMA being “more successful” - that is a bit tricky, and there’s a bit of verbal sleight-of-hand going on sometimes with oral surgeons, because they claim it has a 90-95% “surgical success” rate. However, for oral surgeons, “surgical success” is considered a 50% reduction in AHI and AHI below 10. Obviously, that is not “clinically cured” rate - and as a result a lot of people who go through the surgery still have clinical sleep apnea at the end with an AHI in the high single digits (like the Inspire cases you saw). Dr. Sorush Zaghi published a retrospective study a couple years ago looking at 500+ patients, and found that the true “clinical cure” rate (AHI < 5) was slightly below 50%.
Still, it’s probably the highest on the scale of surgical options in terms of effectiveness.
Whenever the algorithm recommends one of my videos.....CZcams got it right. 👍🏼
What about torrid bone removal. Will that work
Was evaluated for deviated septum and the ENT doctor said my nose had been broken 3 - 4 times. Doctor did not want to do the surgery, because I stood a good chance of breaking my nose again. Suspect this is because I have partially controlled epilepsy and had status epilepticus (non-stop seizures) 3 - 4 times, and was found on my face on the floor each time, waking up with my nose bleeding. Luckily, my deviated septum gives me no problem with CPAP!
Luckily for sure!
I had the Inspire implanted in Sept. 2020. It did not work for me. I am back on cpap, I have found out that I have Palatal Prolapse. Have any experience with long nasal stints?
MSE/MARPE (pallette expansion for adults) look like a good way to open nasal airway volume and make room in the mouth for the tongue (so it doesn't have to press back into the throat and block the airway.) This is for people with narrow upper jaw/pallette. Better tongue position and increased nasal breathing can only help to reduce sleep apnea.
I would just opt for surgery honestly. I tried MSE and it didn't work for me, was a bit of a waste of money and time.
What if you have a leaky anecdotal evidence??
Forget that! I'm sticking with my PAP therapy... lol
What do you think about nightlase?
I had an at-home sleep study done in February this year. It was determined that I didn't meet the criteria for OSA (REI 2.7 and 4.6 supine), but can't even get a physician to explain the results until June this year, via Zoom. I tried to look up as much info online as I could. One of the pieces of info that I can't find anywhere online is the "snore index". My total was 17.0% with 38.8% supine. What does this mean and what is "normal"? Any thoughts on UARS? I'm a tall, thin, fit 46 year old female who is fatigued and my oropharyngeal airway size is 68 squared mm. I know that most people should have an airway size of between 250-350 squared mm. I have an elongated soft palate and Class II occlusion with a retrognathic jaw. I clench my teeth at night, but found that wearing a night guard hurts my TMJ. I'm trying to get an in-lab sleep study done but again, have to wait a few months to speak with a physician since our healthcare system is overloaded. Thanks!!
I'm going for an MMA (double jaw surgery) to help my breathing issues, it will also help my recessed jaw and lip incompetence (courtesy of chronic mouth-breathing as a kid). They're also going to pull my chin forward a bit. I've seen videos of the surgery and it's GNARLY. Your entire jaw is just floating unconnected from the rest of your skull... Quite fascinating to watch though.
What about the iNap device?
What about lingual tonsil surgery? Mine are enlarged.
Just found out yesterday that all I get is 80% oxygen. Getting a CPAP now, i so hope I get better
I guess i need to get a cpap machine.
What about balloon sinuplast?
Had a UPPP almost 40 years ago and still dealing with horrible side effects resulting in pulmonary fibrosis.
Ron bishop what is the side effects
@@loveistime8418 I was left with little control to swallow correctly. Good and liquid were always going "down the wrong pipe" so the coughing and aspiration allowed stomach acid particles into my lungs. Now 38 years later I've scaring in 40% of my lower lungs. Add into that, allergies and high eocinophils brought me to treatment with OFEV and Fasenra plus O2 daily.
Seeing as I have over 100 events an hour when unassisted.... over 90 of them are obstructive. I'm also extremely obese.
Other than the weight loss, continuimg to struggle with cpap, and seeing if i can ever get my consistently obstructed nose looked at.....
I wonder what else i should try
What is the CPAP failure rate of people with more severe compared to someone that has moderate apnea? I was hooked the very first night I got my CPAP. I couldn't believe how much better my sleep was and I only wore it for 3 hours that first night.
I don't think I've ever seen it broken down my severity of diagnosis.
I had the pillar procedure in 2007. At that time it was presented to me as extremely effective, with a promise of 95% success rate. What a joke. Three thousand dollars later no change. Have been on cpap now for several years with great results.
That's really unfortunate to hear, but sadly not surprising. Glad to hear that you're having positive results with CPAP.
Excellent summary of all the other options. Not for me! Most distressing though, the CPap machine AHI isn't accurate? On the high or low side?? I live by checking the AHI every morning!
The machines typically will tend to record a higher than actual AHI count. If you look at your data, you will likely find that it's counting junk events as apneas. Example: it's just you rolling over, arm going numb, or waking for some reason other than an obstructive event. To be sure, the machines are great. It's a wonder they can do the things they do. I'm not saying the machines are liars when it comes to AHI, that's just the current state of consumer grade xPAP technology. They err on the side of caution, but lose AHI accuracy in the process. So your actual AHI is quite likely better (lower) than what the machine says it is.
@@JDHood Cool! I seem to always wind up around 6-8 AHI, somtimes climbing to 11. Hopefully, if the maching counts high, I am doing fine.
No. It's actually REALLY terrible. It's also terrible at identifying events which is what the algorithm relies on to make pressure adjustments. It's certainly worth a deeper dive.
There is usually a problem with your overall therapy if the AHI number is that high.
CPAPs are crap at detecting flow limitation. You'll have to eyeball it yourself. Many people are screwed by this
I have had the U triple P, multiple cpaps and masks AND the inspire implant which I hate! I am having it removed in April. I have tried to go back to CPAP but it isn't working either. My pressure is so high that it put way too much pressure in my ears. I quit breathing 63 times an hour. I cannot do a trachiotomy. Not sure what else to do.
Have you considered jaw surgery
I love my CPAP. (Even if it has cancer foam.)
Friendly reminder that there is only a recall in the US due to its lawsuit culture. The rest of the world keeps on truckin'
@@cebruthius cause the rest of the world relies on what the US does for the most part, dude
👏👏 HELLO SCALPEL PEOPLE!
Why do I get more information and time from you for free on CZcams than I get from either my RRT or doctor? Hmm. Perhaps it has something to do with how the insurance system works.
BTW, I was about to get three comparative consultations in India (since standard government medical insurance covers no options in Canada, and that in only some provinces, other than being the BIonic Man [CPAP]) for life). You have sobered my ethusiasm to bring out the knife. Maybe hauling around in airports and taxis this albatross of machinery is still best. It certainly works. But a dentist suggested four procedures/treatments to handle the multiple causes.
What I see as the problem is money. Even expanding the lower oral cavity for my tongue (using Invisalign) was over 5K CAD. And I was a little taken back when the local DDS referred me to a surgeon for that Frankenstein jaw surgery when I expressed interest in whatever is most effective. Great opportunity to get addicted to pain killers! So you look more macho. Not the primary goal. I think I will try one session of LAUP as a test.
Did he talk about turbine reduction?
That MMA surgery is crazy
Studies show that UPPP + Hyoid advancement cuts down on apenic events by 50%. Hyoid advancement works even if the mandible "falls back" as the tissues causing obstruction are advanced forward.
50% decrease in AHI isn't something that I'd recommend for my family, so it's not something I'd recommend for others. Then it has the added negative of making soft tissue fibrous so that future CPAP use (when they realize the surgery was a bad idea and didn't work) extremely difficult.
@@Freecpapadvice 50% is absolutely huge, esp if you drop down from 50 to 25 AHI. The rest can be achieved by an oral appliance or Inspire.
I've seen videos of people after the mandibular surgery. They look like they got beat up by Mike Tyson in his prime for 3 hours. And it takes weeks for that swelling to calm down 😂😂😂😂
Imma be honest, it does seem to work and if someone avoids use of cpap for the rest of their life because of it, I'd say it is worth looking like an assault victim for a few weeks.
I dont know who to believe, does he work for cpap,
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I want to get the hell off cpap and reverse my apnea
"Gives your tongue a little stiffy"
Never say those words again. 😂
Thank you for all this information! I vaguely remember my sleep doctor mentioning surgical solutions, but I had no idea what any of them were or how they worked. I cringed for every one! Thanks!
Like Viagra for your tongue😁😁
Like the t-shirt
That's his good one
😂
I'm young and thin, have very mild apnea have and daytime breathing difficulty (probably due to untreated silent reflux and floppy soft palate).
I had DISE, UPPP (with preserved uvula) & tonsillectomy 6 months ago.
improves my breathing, worsens my sleep (apparently the issue is the tongue based to begin with).
I think it reduces my CPAP pressure while at the same time increases the leak because it's harder now to maintain the seal between the back of my tongue and the soft palate. Alongside nasally voice and swallowing issues (hopefully comeback in a year), wouldn't recommend this procedure to anyone.
Why is this information being suppressed? ....my doctors are all ignorant of minimally invasive surgical options like Airlift
Turbinate Reduction
I had my tongue shaved, my nose redone with pig cartridge and my tonsils and abnods taken out in 1 surgery. Couldn't eat for a month. Found out the tongue shave was black band in Australia. Very, very painful. All my food had to be pureed. Not good. Would never ever have these surgeries in my life time again. Not that I have that choice.
1:30, 7:00