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madness
Unread post  Post subject: Best surgery options for me?  |  Posted: Tue Oct 10, 2017 10:57 pm

Joined: Thu Jul 27, 2017 12:19 pm
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I have already had turbinate reduction surgery and septoplasty, which has completely opened up my sinuses. I breathe freely through the nose for the first time in my life. However, I still have severe sleep apnea. My first test was at 105 AHI (!) My second test was at 68 AHI. I have been on APAP for a couple months. My apnea is reduced, but not eliminated. With APAP my AHI is usually between 15 and 20. Better than without APAP, but not good enough. I have an appointment to talk to the doc about more surgery options, but I want to go in with some knowledge. We've already played with pressure, ramping, etc, and determined I may need more surgery, thus the appointment. I am not significantly overweight, so weight loss won't help in my case. What options might there be for my situation? Note that I still have my tonsils/adenoids/uvula and I suspect that's the next step the doc will want to take. I am guessing there are more options. Since I am with an HMO, they might have a tendency to not mention more expensive options. :) I am looking for the highest chance of improving my AHI, for the moment without regard to cost or recovery (I'll discuss those things with the doc).


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diamaunt
Unread post  Post subject: Re: Best surgery options for me?  |  Posted: Tue Oct 10, 2017 11:12 pm
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Location: Dallas(ish)
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AFIK, the only significantly successful surgery is MMA.

TMA? (Too Many Acronyms?)

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madness
Unread post  Post subject: Re: Best surgery options for me?  |  Posted: Tue Oct 10, 2017 11:35 pm

Joined: Thu Jul 27, 2017 12:19 pm
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PAP Machine: Philips DreamStation
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diamaunt wrote:
AFIK, the only significantly successful surgery is MMA.



I just looked that up. OMG! Something a bit less severe than cutting my jawbone in half would be nice. :)


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LSAT
Unread post  Post subject: Re: Best surgery options for me?  |  Posted: Wed Oct 11, 2017 12:46 pm

Joined: Tue Sep 05, 2017 9:40 am
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Location: WI
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madness wrote:
diamaunt wrote:
AFIK, the only significantly successful surgery is MMA.



I just looked that up. OMG! Something a bit less severe than cutting my jawbone in half would be nice. :)


Keep working on the CPAP settings and Mask


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madness
Unread post  Post subject: Re: Best surgery options for me?  |  Posted: Wed Oct 11, 2017 1:05 pm

Joined: Thu Jul 27, 2017 12:19 pm
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PAP Mask: F&P Eson 2
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LSAT wrote:
Keep working on the CPAP settings and Mask


I'm not just fiddling with knobs. I have been doing this with the sleep center for three months. Four different masks. My apnea is too severe. I need to at least reduce my AHI to a level that the APAP machine can handle.

"Better living through surgery" :D


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Pugsy
Unread post  Post subject: Re: Best surgery options for me?  |  Posted: Wed Oct 11, 2017 2:47 pm

Joined: Wed Aug 02, 2017 8:01 pm
Posts: 280
PAP Mask: ResMed AirFit P10 or DreamWear Gel nasal pillows
PAP Machine: ResMed AirSense 10 AutoSet for Her
Humidifier: ResMed AirSense 10
Pressure Setting: Depends on the machine as I actually have more than one

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So what are your pressure settings now that are giving your the AHI of 15 to 20 and what is the event category breakdown of the AHI?
How much in each category...central, obstructive, hyponea?
It's real important to know exactly what you are trying to fix before searching for fixes.
If your AHI is predominately central in nature...no amount of cutting will help.


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cindyY
Unread post  Post subject: Re: Best surgery options for me?  |  Posted: Wed Oct 11, 2017 6:29 pm

Joined: Sun Apr 23, 2017 8:34 pm
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Location: Southern California
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Pressure Setting: IPAP 19 EPAP 15

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Have you downloaded SleepyHead? You might want to post some charts for people to take a look. Diamaunt's signature line has the info you would need to download and organize your charts before posting. I wouldn't say your apnea is too severe, you said your second study had you at 68. My avg. AHI was 84 during my sleep study and I consistently get an AHI under 2.0 now (just as a reference, not comparing my situation to yours). It could be that you need a different type of machine.


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madness
Unread post  Post subject: Re: Best surgery options for me?  |  Posted: Wed Oct 11, 2017 9:30 pm

Joined: Thu Jul 27, 2017 12:19 pm
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Pugsy wrote:
How much in each category...central, obstructive, hyponea?


Therapy Efficacy (last week)
AHI 13.52
Obstructive Index 1.85
Hypopnea Index 3.47
Clear Airway Index 8.20
Flow Limitation Index 0.00
RERA Index 0.41


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diamaunt
Unread post  Post subject: Re: Best surgery options for me?  |  Posted: Thu Oct 12, 2017 12:22 am
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> Clear Airway Index 8.20

You need a bilevel ST or ASV to treat that part.

Unless you're being driving into centrals by too much ventilation.

Post a couple charts as shown below.

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madness
Unread post  Post subject: Re: Best surgery options for me?  |  Posted: Thu Oct 12, 2017 1:27 am

Joined: Thu Jul 27, 2017 12:19 pm
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diamaunt wrote:
> Post a couple charts as shown below.


There are a lot of charts in SleepyHead. Which charts do you need?


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Pugsy
Unread post  Post subject: Re: Best surgery options for me?  |  Posted: Thu Oct 12, 2017 5:00 am

Joined: Wed Aug 02, 2017 8:01 pm
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PAP Mask: ResMed AirFit P10 or DreamWear Gel nasal pillows
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Pressure Setting: Depends on the machine as I actually have more than one

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On the left side hide the calendar and turn off the pie chart (Preferences/Appearance tab) so that the statistics move into view.

On the right side just these graphs.
Events
Flow rate
Pressure
Leak
Don't need any other graphs.
Graphs can be moved and resized easily so you can get all you need in one image.

So you end up with AHI and machine settings and statistics on the left and 4 graphs on the right looking like this.
I didn't hide the calendar on this one but it's all I could find as and example quickly.
Image


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Pugsy
Unread post  Post subject: Re: Best surgery options for me?  |  Posted: Thu Oct 12, 2017 5:07 am

Joined: Wed Aug 02, 2017 8:01 pm
Posts: 280
PAP Mask: ResMed AirFit P10 or DreamWear Gel nasal pillows
PAP Machine: ResMed AirSense 10 AutoSet for Her
Humidifier: ResMed AirSense 10
Pressure Setting: Depends on the machine as I actually have more than one

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You are using a DreamStation Auto machine
Are you using Flex relief? If so at what setting?
If you are using Flex...try turning it off and see what happens with the Clear Airway/Central apneas.

Are you sleeping soundly when these centrals seem to be being flagged or do you have lots of awake time with mask on?

Quit looking at surgical options...they won't fix centrals at all.
Centrals are from the brain not sending signals to breathe. The airway is already open but the body simply isn't breathing.

They are fixable with a different type of machine though if we can't get lucky and fix them by turning off pressure support.


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diamaunt
Unread post  Post subject: Re: Best surgery options for me?  |  Posted: Thu Oct 12, 2017 11:13 am
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Joined: Wed Mar 02, 2016 2:26 am
Posts: 1438
Location: Dallas(ish)
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Pressure Setting: 18/13-25/19

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madness wrote:
diamaunt wrote:
> Post a couple charts as shown below.


There are a lot of charts in SleepyHead. Which charts do you need?

It's detailed in the links in my sig, below.

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how to post:
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madness
Unread post  Post subject: Re: Best surgery options for me?  |  Posted: Thu Oct 12, 2017 12:35 pm

Joined: Thu Jul 27, 2017 12:19 pm
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PAP Mask: F&P Eson 2
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Pressure Setting: 6-12

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Pugsy wrote:
Are you using Flex relief? If so at what setting?
If you are using Flex...try turning it off and see what happens with the Clear Airway/Central apneas...


Flex is set to 3 currently.


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Pugsy
Unread post  Post subject: Re: Best surgery options for me?  |  Posted: Thu Oct 12, 2017 3:04 pm

Joined: Wed Aug 02, 2017 8:01 pm
Posts: 280
PAP Mask: ResMed AirFit P10 or DreamWear Gel nasal pillows
PAP Machine: ResMed AirSense 10 AutoSet for Her
Humidifier: ResMed AirSense 10
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Okay with Flex set to 3 on a Respironics machine the maximum reduction available during exhale is 2 cm.
It's not a huge amount of pressure support (pressure support is simply the difference in pressure between inhale (IPAP) and exhale (EPAP))
Sometimes for some people...very small number of people...the fact that there is a difference between inhale and exhale can cause a bit of breathing instability that ends up affecting the carbon dioxide levels (doesn't let them get high enough to tell the brain to send the breathe stimulus).

People sometimes think it is low oxygen levels that trigger the brain to tell the body to breathe but it's actually the carbon dioxide levels in the brain...they need to be up to where ever they need to be or high enough so the brain knows to tell the body to breathe.

When the brain doesn't send the "breathe" stimulus then we don't inhale or exhale. We do nothing. Hold your breath for 10 seconds....that's pretty much what a central apnea is. The airway is open but there is no air flow because you are holding your breath.

Sometimes pressure support will cause a little breathing instability and cause too much carbon dioxide to get blown off before it reaches a level in the blood stream for the brain to send the trigger to breathe...so the central apnea happens.

Now why this can happen(PS causing centrals) for a really rare number of people I don't know all the mechanics behind it. It just does.

Are you one of those people? Don't know but it's worth turning Flex off and see if it makes any difference in the number of centrals you are seeing. You might get lucky and have the centrals pretty much disappear...or you might not and then we get to have the other discussion about the other type of machine.

You've been on some form of cpap therapy for quite some time haven't you????? Over 6 months????

So turn off Flex and see what happens with the central apnea count.


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