Question:
In the past month or so I have started experiencing moderate to severe
sleep apnea problems. Over the last 15 years or so I recall waking up
occasionally from a deep sleep gasping for air. Never has it
progressed to the point where I had a hard time drifting off to sleep,
but now it has.
My doctor examined my nasal passages and declared them a "mess". Since
I have never had my tonsils out I also have a limited pathway in my
throat. I am a bit overweight (about 20lbs for my height). Nothing
too extreme there, but I could stand to lose a few.
First Question: My doctor has ordered a sleep study. I am a bit
reluctant to do this because of the out-of-pocket cost involved. So my
first question is: Are sleep studies worth the time and money to have
done? The way I see it...I don't really need one. Why? Because I
already know I have a problem with sleep apnea and I see no value in
paying a lot of money to get one done since I already know there is a
problem.
Second Question: My doctor seems to want to treat this obstructive
sleep apnea out of the gate with surgery on my nasal passages.
Apparently I have broken my nose at some point in the past and I have
quite a bit of blockage that is probably a large contributing factor to
my apnea. However, I am more inclined to wonder if there is another
way to treat my situation without resorting to surgery right off the
bat? Aren't there other things to be tried before going down the
surgical route?
Third Question: How successful is surgery on the sinus/nasal passages
in preventing or curing obstructive sleep apnea? I've always been a
"mouth breather" and not so much a "nose breather" anyway...
Answer:
It's a reasonable question.
You need a sleep study for several reasons:
a) it's the only thing to authoritatively diagnose your
condition. It's THE diagnostic test to determine that the
cause of your issues is in fact obstrutive sleep apnea. We
can be sure you have some sort of a problem, but the sleep
study is the diagnostic test. While we know that you have
a problem, there are currently no numbers to quantify how
bad a problem you have without having a sleep study.
b) if surgery is going to be done, your ENT will want the
data from a complete sleep study to now the extent of the
airway constriction so they know what to do and how
aggressive to be. And also to establish a baseline of the
"before" picture to gauge the efficacy of the surgery if
any.
c) if surgery is not being done, you need a sleep study
to do a CPAP pressure titration.
d) Your doc would also want to be able to quantify how bad
your pulse ox is dropping at night to scare the shit out of
you about the health ramifications if you would foolishly
decide to not treat the condition at all (though you don't
seem to be in that foolish boat).
CPAP with a full face mask might be an option for you, especially with
your mouth breathing. Press your doc on this as "can't we try this
first?" if you would really like avoid an invasive surgery.
Remember, if you're talking to a surgeon, those guys know typically
how to do one thing: cut. And of course that's what they'd like to do
if they feel it has a decent chance of relieving your issues.
The benefit of CPAP is that it's non invasive. It is a lifestyle
change though, and many frustrated CPAP users will try surgery for a
permanent fix that doesn't require a goofy mask on yer head for the
rest of your life.
Consider that perhaps you're a mouth breather cus not a damn thing can
get through your screwed up nasal passages. :-)
Takes one to know one. I always mouth breathed in my sleep before my
hugemongous tonsils were removed, because it was just too damned hard
to breathe through my nose during sleep and get enough air. Now
miraculously that I can easily breathe through my nose, I'm now a nose
breather at night. I have a lot less tartar problems, less nasty
morning breath, and a lot fewer canker sores too as a result. My
dentist says my mouth tissue looks a whole hell of a lot healthier to
boot.
The surgery I had was a tonsillectomy (I had very large tonsils,
according to my ENT), and a UVPP (uvulopaletal flap surgery where they
essentially fold up your uvula to the top of your mouth and get it out
of the way forever). That surgery does not have a tremendous track
record for curing the issue, but in my case these two things cut my
CPAP pressure in half. I still use cpap, but it's a lot less of a
pain that if it were pushing against all that crap in my airway.
In your situation where they can point to a lot of crap in your nasal
cavity that might be causing your airway to obstruct at night, I might
give that surgery some strong consideration. Ask your doctor on their
opinion of the odds of it addressing the issue, and the potential
risks of the surgery, how many he's done, etc.
I agree with a lot that David H said, about the sleep study being the
correct diagnosistic tool.
In addition, do your research on UPPP surgery. There are a lot of people who
feel it is expensive, painful, and only minimally helpful. Some people who
have had the surgery still need to use CPAP equipment, just at a lower
pressure. And some surgeons consider that successful! Get info.
On the other hand, some other surgery has been helpful for people in the
*use* of CPAP, and that is surgery which unblocks the nasal passages, and
perhaps gets rid of big tonsils. Mouth breathing can be a problem in proper
(CPAP) treatment.
