Posted by Captin Cannuck on May 08, 2008 at 05:44:32:

In Reply to: Trying to understand new CPAP posted by Accx4 on May 02, 2008 at 15:23:31:

I will answer a few questons also.

You asked why CPAP is being pushed and asked if there are other options. Your answer is that yes, ther are other options. The other option is surgical. You can check out the other forum on this site for info from people who went the surgical route. Basically, surgery is a mixed bag. My opinion is that soft tissue surgery (such as UPPP) is very high risk. They tend to work for a while and then the airway is altered due to scar tissue formation. Soft tissue is kind of like plasticine or "play-dough".

Nevertheless, there is one surgery for sleep apnea that has shown excellent results consistantly. It is called MMA (maxilo-mandibular advancement, also called "bimaxilary advancement" or "bi-max"). THis basically involves breaking the upper and lower jaws and pulling them forward by about one centimeter. Since your tongue is attached to your chin, it pulls the tongue forward and out of the airway. That kind of surgery works especially well on people who have a recessed jaw (e.g. a weak chin), but it has been found effective in most people. I had that, and the results are good. As I said, I would caution you away from soft tissue surgeries. Some people, including myself, have gotten worse. A lot of the lower level doctors only know how to do these soft tissue surgeries. It takes special training to do MMA surgeries by contrast. Since many ENTS know learned how to do UPPPs and simple surgeries in the pharnyx area such as sommnoplasty etc, they recommend them to people in spite of the poor results that these operations have. So, basically, in my opinion, when they move bones, results are much more stable and much better. When they move tissue, results are unstable and poor.

The goal of surgery is to modify the airway to widen it. A key area is at the base of the tongue. It has been found in the last 10 yrs that the base of the tongue is an area where most people with sleep apnea obstruct. The tongue is a very heavy muscle. At night, the force of gravity cause it to fall and obstruct the airway. This is why MMA is so much more advantageous than other forms of surgery. For more on this, I recommend you read a book called "the Promise of Sleep" by William C. Dement. The Chapter on Sleep Apnea explains this. There is good info on CPAP also by the way.

CPAP is being recommended to you because it is good. It has been found to be one of the best (if not the very best) treatment of sleep apnea in most people. As you can see in your case, it reduced your apnea by about 80-85%. One of the best features of CPAP is that it is non-invasive. In other words, they don't have to operate. If it doesn't work, you are no worse off. Basically, CPAP works as well as surgery in most people. In some people CPAP is not enough. Surgery is available for them. In my own case, CPAP helped big-time, but it was not quite enough. For that reason, I had MMA. The results were excellent.

One last word. If you explore surgery, do your homework carefully. The best place to explore options is the doctors and surgeons at Stanford University in Palo Alto (near San Fran) California. They are regarded as being the most elite. The doctor who does the "Ask the Expert" section in this website is one of them. Others are mentioned in the book "The Promise of Sleep". Drs. Powell, Riley, Li and Troell have written extensively on MMA surgery for sleep apnea. A consult with them costs about 1300 bucks. The MMA procedure costs between 50-80 thousand dollars. Insurance pays in many cases, but they don't like to. Many people have to fight with their insurance company.

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