- Surgery: pull tongue forward in front (increase tension on tongue), remove tissue from soft palate. Problem is even if they scope you with fiber optics, they can't guarantee surgery will reduce the problem. And the recovery is 3 weeks on soft foods...A tracheostomy is guaranteed to fix the problem, but you wouldn't want to have it done.
- Dental device: pulls lower jaw forward but still allows side to side movement. might be a good first try before surgery (use an oximeter to see if it makes a difference; see below)..
- CPAP or auto PAP machine: the auto PAP operates at a third lower average pressure so it is slightly more comfy. I'm getting the GoodKnight 418P with the software, and the Breeze mask which is the most comfy around. You must breathe only through your nose, but even for mouth breathers, this is pretty natural.
- Newer experimental surgery: removes stuff at base of tongue. Most people don't know about this...still experimental.
- You can sleep with your face straight down (like on a massage table), which isn't very practical. Sleeping on your back (supine) is the worst for sleep apnea for most people.
- Your sleep apnea may be positional...e.g., you are fine if you sleep on your stomach, but not fine on your back.
- be sure to wash out the equipment frequently as recommended by the manufacturer.
- you don't have to go in for a sleep study to set the pressure if you get the software for your unit and it measures events, like the 418P. Based on your body type and the # of events per hour, they can really tell you pretty close to the pressure you need. For my case, they thought between 7cm to 12cm, i.e., my single optimum pressure is somewhere in that range. So you start with that and look at the data, and then increase the min pressure until you only have 3 or fewer events per hour. It's that simple. ResMed you should adjust the pressure for the proper curve, but the devices you have at home don't record the curves with that much resolution. Other people say "you have to look at O2 saturation and the quality of sleep, e.g., how much time in REM, etc. A 1cm pressure difference can make a HUGE difference in the quality of sleep" I'm not sure I buy that at all. The same person said he like the AutoSet T which is an auto-PAP machine and you can only control minimum and maximum pressures, the pressures throughout the night are set by the machine. Of course, you could really narrow that min/max range to 1cm if it really is that sensitive. I suspect there is a lot of randomness in the data. At 5 min/8 max, my RDI was 3.7. At 6/8 it was 2.1.
- the 418P costs around $1500 and the software is around $900. If you get the software you can see if the machine is really doing what is supposed to yourself.
- the units are really quiet but there is a big difference in noise so see the unit before you buy
- i found the full face mask (Mirage) to be very uncomfortable (heavy) and also didn't seem like the quality of the air was that great (sort of felt like I was breathing in my own exhalation even though that is not true). Takes 2 weeks to get used to. unplugging the two ports seems to give "fresher air" (presumably since CO2 is expelled faster) but those ports are used to input O2, not for output and unblocking them just makes the cpap work harder.
- the first night I tried this was not restful. it is easy for the mask to leak if you move. and you must lie on your back with the Mirage.
- if you set it to be in auto PAP mode with wide limits it doesn't work very well. It thought I should have at most 6.2cm but that is below the minimum pressure you'd want. And besides, I had 12 events per hour on that total auto setting. So I need to bring up the minimum pressure to be higher.
- There is a new Mirage Ultra out now. My recommendation is try the Breeze first, then the Mirage ultra, and last try the full face mask if all else fails.
- The newest Breeze mask has a (completely noiseless) round blowhole instead of the (super noisy) square one on the original Breeze. Breeze has hardly any leakage and is very comfortable.
- The CPAP machine can take several weeks to get used to so don't expect a miracle on the first night; it will likely be worse sleep for a couple of weeks until your body adjusts (some people can't tolerate it).
Some experts believe you needn't go to a sleep lab. Here's an excerpt from the article below:
Even after a through evaluation by the dentist and the physician a definitive diagnosis of OSA can only be accomplished by a sleep test called a polysomnogram. During sleep, a polysomnogram measures ventilation, gas exchange, cardiac rhythm, the number and length of apneic episodes, assesses oxygen saturation, determines sleep stages, and detects arousals. In the past , this test could only be done in a hospital sleep clinic. Today, we have mobile sleep technology that allows you to take this test in the comfort of your own home.
Side effects of untreated OSA: MI, CVA, and insulin resistant diabetes
Questions to ask:
- If you recommend UPPP, why not LAUP? Answer: LAUP does nothing for sleep apnea, only snoring.
- Why not try a dental appliance before surgery since although several surgical procedures are used to increase the size of the airway, none of them is completely successful or without risks. More than one procedure may need to be tried before the patient realizes any benefits. Answer: for dental and CPAP, compliance is typically poor and you have to go through a LIFETIME of inconvenience instead of a short number of days of pain.
I purchased a device that monitors O2 levels and pulse...a pulse oximeter. It allows me to review the measurements for the past 12 hours so it's fine for monitoring my sleep. That seems like it would be a quick screening device to see if you have OSA since if your O2 levels fall below 90% during the night, you should go in and be tested (or change your sleeping position).
Another article on sleep apnea
Reviews of effectiveness of various dental appliances
The original paper that tells how to determine whether a dental device will work
Details on how these dental devices work (and mention of Silencer) including MRI images