Posted by Captin Cannuck on January 07, 2008 at 10:10:28:

This message is in response to Richard,who is having a hard time adjusting to CPAP. Richard said that CPAP was not working adequately for him.

A couple of things:

1. MASKS:
First, about the irritation to your nose caused by rubbing of the mask. You have the option of switching masks and machines to find one that is most comfortable for you. RESMED has a mask called the Activa with moves with you while you sleep. I found it quite comfortable.

2. YOUR OTHER OPTION, OTHER THAN CPAP: MMA SURGERY

I advise doing your very best to adjust to CPAP. It is the treatment of choice for OSA and usually provides good results. Nevertheless, some people simply cannot do it. In other cases, CPAP is helpful, but not quite enough to provide full results. This was my case. I used CPAP, and found that it was helpful. It allowed me to sleep, although I continued to have some events. With CPAP, I was much much better off than without it. I can't stress how much it did help me. Nevertheless, it provided only limited help in my own case. I started looking into surgery. I found out that there is one very successful surgery for sleep apnea, which is especially beneficial for people with a retrograde lower jaw (a weak/small lower jaw). It is called bimaxillary advancement or Maxilomandibular Advancement (abbreviated as MMA). Basically this entails cutting the upper and lower mandibles and bringing them forward. At the same time, the surgeon does another operaton on you chin where he pulls your tongue forward (your tongue is attached to your chin). The two operations are done at the same time. The success rate is very high. This operation usually results in an AHI stat of less than ten. In many cases, people can get less than five. In other words, it can sometimes be considered "a cure". In other cases it provides people with a very significant drop in AHI. It has a 90 % success rate. I underwent that surgery on Nov/08/07 and I can tell you that I no longer need CPAP anymore. My apnea jolts are completly gone, and I am sleeping well now. In my case it was very successful. I feel that I have been pretty much cured. This is the good news. The bad news is that it it is highly specialized and very expensive (cost is about 50K to 70K). You have to find a surgeon with a lot of experience doing this particular procedure for sleep apnea. The surgeons at Stanford Univ. are highly regarded in this area, there is also a Dr. P. in Atlanta and recently there are good reports of a doctor doing this at the Mayo Clinic. If you are Canadian, seek out Dr. G at Dalhousie Univ dept of Oral and Maxilofaical surgery (He was my surgeon, and I can vouch for him bigtime!).

In closing, I guess, I would encourage you to continue with CPAP if you can get by with it. I think it is too early to resort to surgery for you yet, but you will know that it is a viable option. As I said, CPAP is considered the treatment of choice and usually provides adequate results in many (but not all) people. If you chose surgery, tread carefully. Some surgeries are to be avoided if possible, especially the so-called "soft tissue surgeries", such as UPPP, LAUP. Soft tissue surgeries generate a lot of scar tissue, and they have poor outcomes over the long term. Surgeries where they advance bones such as MMA surgery is much more reliable and has far higher outcomes. Again, the issue is money (fighting with insurance companies, etc.), and you would need braces pre-surgery and would have your jaw wired shut post surgery.

Best of luck,

Follow Ups:

• Re: If you can't adjust to CPAP(for TG) Alamo Joe 07:30 1/18/08 (0)

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