Obstructive Sleep Apnea

Whoever has this condition stops breathing many times during the night and usually snores. The muscles in the throat relax during sleep and block the airway. People with uncontroled obstructive sleep apnea are a real danger behind the wheel to themselves and to others. I have obstructive sleep apnea and I didn't realize I had it until I went to the doctor after falling alseep at the wheel at 70mph and waking up heading toward the ditch. My sleep apnea isn't controled because I have trouble using the machine. I also do not drive. I feel I'm too dangerous on the road to drive. I also have low vision and I'm unable to pass the driver's test. The written test is no problem, it's backing up.

Masks

There are two types of machine, one is called Continuous Positive Air Pressure (CPAP) and the other is Bilevel Positive Air Pressure (BPAP). I use the BPAP because I couldn't tolerate the CPAP. The BPAP adjusts the pressure automatically while you breathe in and out. Both machines depend on a plastic tube hooked to the machine and to a mask you wear. There are many different types of masks and can be used with either type of machine.

I tried several masks until I found one that I could tolerate. It doen't cover half my face, it looks like a beefed up canula like they use in the hospital to deliver oxygen. However, I'm still having trouble sleeping with the machine. I'm now considering surgery. I'm really tired of being tired.

Oral Appliance for Obstructive Sleep Apnea

While I was researching the different surgical options, I came across this nonsurgical option. An oral appliance fits into your mouth very much like a sports mouth guard. This can be used if the machine isn't being tolerated. It's for mild to moderate sleep apnea and for snorers who don't have sleep apnea. There are more than 40 different types of appliances available on the market, but most can be divided into 2 types, tongue retaining and mandibular repositioning.

A tongue retaining device uses a suction bulb to pull the tongue forward and keep it from falling back and obstructing the throat. It sounds rather uncomfortable to me, but I wouldn't know until I tried it.

A mandibular repositioning device pushes the lower jaw forward and since the tongue is attatched to the lower jaw, it keeps the tongue from falling back and obstructing the airway. Sounds a bit more comfortable. It's adjustable and made out of soft plastic.

Surgery

Palatal restoration is a minimally invasive procedure performed in a doctor's office that implants 3 small woven implants into the soft palate for support. This procedure has an 80% success rate and usually the patient can eat normally the same day of the surger. Over the counter pain medication should be all that's needed for pain.

A uvulopalatopharyngoplasty (UPPP) is inteneded to enlarge the airway by removing the uvula (the fleshy thing that hangs down in the back of the roof of your mouth), tonsils, adenoids, and part of the palate (roof of the mouth). This surgery has only a 40.7% success rate.

A tracheotomy is a surgical procedure that bypasses the obstruction by cutting a hole in the throat. The hole is closed during the day and open at night to allow air into the lungs. They have been experimenting with a new mini procedure that relies on a small computer chip to regulate the flow of air into the lungs at night. The hole is much smaller and easier to conceal.

A laser midline glossectomy and lingualplasty reduces the tongue and palate. Does not change the dental bite and involves only soft tissue.
The maxillomandibular osteotomy or advancement (MMO or MMA) is a more aggressive surgery involving moving the facial structure forward to keep the tongue from falling back and obstructing the throat. Usually done only after the soft tissue surgery has failed.

A two-part inferior sagittal mandibular osteotomy and genioglossal advancement with hyoid myotomy and suspension (GAHM), is a next to last resort (a tracheotomy is the last resort) and a very lengthy surgery.

The radio frequency tissue ablation (RFTA) or Somnoplasty is a minimally invasive and done in the doctor's office under local anesthetic. You can usually resume normal activities the next day.

The tongue suspension procedure or The Repose Bone Screw System, sounds terrible, but is a minimally invasive procedure that is reversible.

Otolaryngologists are specialists in the ears, nose, and throat. There are many subcategories in this specialty. We want to find an otolaryngologist whose specialty is sleep apnea.

Dale L. Edwards