Posted by sleepyhead on July 05, 2011 at 11:35:43:In Reply to: One person’s journey - cpap FAIL (s posted by sun dog on June 27, 2011 at 10:25:25:
Sun Dog:
I want to comment on a couple other matters that I did not mention in my first response to your note. First, if you are considering maxillary expansion, you should know, that in adults, expansion for OSA, involves surgery--often on the upper and lower jaw. If you have a base of tongue problem, however, maxillary expansion is likely to do little for you.
You mentioned that you have challenges that are of a sensory nature. Orthodontia, can be challenging for adults--and probably more so, for adults struggling with sensory issues. The expansion procedures (sometimes referred to rapid palatal expansion) involve braces and the expansion appliances are bulky, painful, and can require an extended period in braces.There are some orthodontists that will try expansion treatment without surgery, but this is far from optimal for adults with OSA (especially with the numbers you have). Relapse with expansion can also be quite significant.
If you have base of tongue problems, the optimal treatment for this area of difficulty, is jaw advancement surgery (also known as maxillomandibular jaw advancement surgery or bimax surgery). Maxillary expansion, more often than not, will not satisfactorily resolve OSA on its own. Jaw advancement surgery can be extremely helpful because it expands airway space and minimizes the chance of the tongue obstructing the airway during sleep.
You might consider looking over Kasey Li, MD, DDS website, and getting a consultation with him, to determine how your oral/facial anatomy contributes to your OSA.
Lastly, I recall Dr.Li mentioning that AHI does not always explain severity of OSA symptoms. There are patients of Dr.Li's who have mild OSA (with AHI less than 15) yet are quite disabled by their symptoms. There are other patients of Dr.Li's, who have very high AHI numbers, yet experience few, if any problems with their daytime functioning. I believe you can find this information in the question and answer (surgeon Q & A) section on Sleepnet's NonCPAP sleep apnea site (I believe it is noncpap forum #25). On Sleepnet's noncpap forum, you can also read blogs written by individuals who did not find CPAP helpful, and who tried lots of treatment strategies, including jaw advancement surgery. Good luck.