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Re: Alternative to CPAP

Posted by Charlotte NC on July 19, 2005 at 04:16:46:

In Reply to: Re: Alternative to CPAP posted by sleepy-in-seattle on July 15, 2005 at 20:18:44:

Sleepy makes a lot of excellent points. The only part that I would have said slightly differently is the UPPP part. While it is true that many people don't get a cure from UPPP, I'm not sure that MMA alone would be the ultimate surgery for everyone. UPPP and tonsillectomy are procedures for the "upper airway" and MMA addresses the "lower airway". In my simplistic layman's way of thinking about this, I imagine that some people have anatomies that would require both upper airway and lower airway to be addressed. On the other hand, I believe that UPPP has become a "standard" first surgery, but perhaps some people would be better off to skip it and go directly to MMA. Unfortnately, the diagnostics to decide who should have which procedures are not that advanced. Add to that the fact that there are many docs who do occasional sleep apnea related surgeries, so don't have the expert skills of the specialists, and you can start to see why UPPP is a standard firt surgery. Even my doc, whom I consider an expert in the field, was forthcoming in telling me that often there are multiple points of our anatomy that contribute to apneas, but it's difficult to precisely tell how much each part contributes.

In my own case, I went from 43 AHI to 19 AHI after UPPP, tonsillectomy, septoplasty, and turbinate reduction (all in one surgery to address the upper airway). I can also say that I have WAY more room in the back of my throat now than I had before. Like you, sleepychallenged, I wouldn't have been considered significantly overweight, I just have a lot of crowding--big tonsils, big tongue, etc. My tongue continues to be a problem that I need to address (hyoid advancement and repose tongue suspension haven't helped). I need to follow up with doc to see what other options I have besides CPAP. I imagine that they are dental device, somnoplasty of the tongue, and/or MMA. Would I have been better off to skip the upper airway surgery and go straight to MMA? I don't think anybody knows for sure. Perhaps. But then it seems to me (again, these are my layman's thoughts) even if I had significant movement foward with the MMA, I might still have some obstruction from large tonsils, saggy palate and uvula.

I think that many people end up disappointed with the results of UPPP because they don't get a cure, and that gets translated into "UPPP doesn't work". In my own case, it goes without saying that I wish I could have had only one surgery and been without apnea, but cutting them in half seems like an accomplishment. Perhaps MMA alone would have cured me, but I'm not sure if any of the experts could tell me the answer to that question with absolute certainty.

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