2nd somnoplasty–one month ago
Question:
Tim, Thanks for the great info on the tongue-locking device. I think I may just try this as well…couldn’t hurt much to try! Best Regards, Tim ———–== Posted via Deja News, The Discussion Network ==———- http://www.dejanews.com/ Search, Read, Discuss, or Start Your Own
Response:
tim_is_h…@my-dejanews.com wrote in message
<7g2bkl$s8…@nnrp1.dejanews.com>… The study above was done at Penn State >University, which is a different school than the University of Pennsylvania. >Although both schools are several hours away from me, I feel fortunate to be >*relatively* close to them, and to the University of Pittsburgh which also >has done a little research on sleep disorders. Outside of Stanford, >Pennsylvania is probably one of the better places to be in terms of sleep >apnea research.
Thanks for the clarification, Tim. It was the Univ. of Penn. that Kevin was at, wasn’t it? Best wishes, Tim W.
Response:
In article <mt8V2.1208$n5.3…@newsfeed.slurp.net>, "Tim W." <t…@NOSPAM.com> wrote: > Thanks for the clarification, Tim. It was the Univ. of Penn. that Kevin was > at, wasn’t it?
Yes, I believe that’s right. University of Pennsylvania is the school that has (in the past and maybe currently as well) worked with MRI imaging and I remember Kevin commenting on this. I do wonder what he’s up to these days…I haven’t seen him on here in a while. Best Regards, Tim ———–== Posted via Deja News, The Discussion Network ==———- http://www.dejanews.com/ Search, Read, Discuss, or Start Your Own
Response:
In article <FaGU2.2347$8j6.18…@newsfeed.slurp.net>, "Tim W." <t…@NOSPAM.com> wrote: – Hide quoted text — Show quoted text -> Joe Talmadge wrote in message <3722874a.8893…@news.doit.wisc.edu>… > >Comput Biol Med 1994 Jul;24(4):295-304 > >Development of the bi-directional ultrasound system for base of > >tongue imaging. > >Kwok W, Wiegand L, Channin DS, Wiegand DA > >Department of Surgery, Milton S. Hershey Medical Center, Pennsylvania > >State University, College of Medicine, PA > >17033. > The Univ. of Pennsylvania does seem to be very active in this area of > imaging the upper airway, as shown here and in their work with MRI.
Tim, just a quick comment. The study above was done at Penn State University, which is a different school than the University of Pennsylvania. Although both schools are several hours away from me, I feel fortunate to be *relatively* close to them, and to the University of Pittsburgh which also has done a little research on sleep disorders. Outside of Stanford, Pennsylvania is probably one of the better places to be in terms of sleep apnea research. Best Regards, Tim ———–== Posted via Deja News, The Discussion Network ==———- http://www.dejanews.com/ Search, Read, Discuss, or Start Your Own
Response:
Joe Talmadge wrote in message <3722874a.8893…@news.doit.wisc.edu>…
Do you know what >suprahyoidal means? >First results on daytime submandibular electrostimulation of >suprahyoidal muscles to prevent night-time hypopharyngeal collapse >in obstructive sleep apnea syndrome.
Joe, Suprahyoidal means "above the hyoid bone". Stimulation of these muscles caused them to maintain better muscle tone, helping the tongue stay in its normal position. I’ve seen a few references to electrostimulation over the last few years and I think it holds promise if they can find an inexpensive and tolerable way to induce the stimulation. I think all the other studies on this subject involved stimulating the muscles while you sleep, to hold the airway open. But this study sounds like the treatment was in the daytime. If I’m understanding it correctly, the daytime stimulation built the muscles up, so that they automatically helped reduce apnea at night with better muscle tone. I’d be curious how long each of the daytime treatments was. When you think about it, no matter where your obstruction is, it doesn’t stop you from breathing freely during the day, right? So if they could make your throat muscles act at night the way they do in the day time…..no apnea! >Comput Biol Med 1994 Jul;24(4):295-304 >Development of the bi-directional ultrasound system for base of >tongue imaging. >Kwok W, Wiegand L, Channin DS, Wiegand DA >Department of Surgery, Milton S. Hershey Medical Center, Pennsylvania >State University, College of Medicine, PA >17033.
The Univ. of Pennsylvania does seem to be very active in this area of imaging the upper airway, as shown here and in their work with MRI. I know Kevin was closely involved in some of this. But most of this work is done with the patient awake, not during sleep. The last I heard they were still not imaging regular patients while asleep. Kevin, please correct me if I’m wrong. – Hide quoted text — Show quoted text ->Clin Phys Physiol Meas 1990;11 Suppl A:117-9 >Upper airway imaging. >Douglas NJ >Department of Respiratory Medicine, University of Edinburgh, Scotland, >UK. >Sleep apnoea syndrome, consisting of daytime sleepiness and loud >snoring, is caused by obstruction of the upper airways. This paper >reviews the techniques which could be used for localising and >quantifying the degree of obstruction while the patient is sleeping. >Each has specific limitations and it is concluded that while none is >ideal, magnetic resonance imaging and ultrasound show the greatest >promise.
This one sounds right on target, as it specifically mentions imaging while the patient is asleep. Notice it’s 9 years old–you would think that more research would have been done on this potentially powerful tool for diagnosis and pinpointing the area to be treated. Thanks Joe. I’m going to try and get the full text of this last one. Tim W.
Response:
On Sat, 24 Apr 1999 18:25:17 -0600, "Tim W." <t…@NOSPAM.com> wrote: >It’s interesting you ask, Joe. I was supposed to be a partipant in this >study. I found out that NIH was doing the research study (by looking at >ongoing trials which appear on their website.) ….They would attach a >"gliding" ultrasound device to the outside of >your neck. It could move up and down so as to get a view of your whole >throat. You would sleep for a few hours, and they would make a videotape of >the whole thing, along with their interpretation, to take back to your >doctor. >Sounds great, right? I wanted to know exactly where my obstruction was >before proceeding with any more surgery, but alas….so close and yet so >far.
Does sound great! I think you’re on to something here. I tried to see if there was anything written on the subject. Apparently Penn State might be the place to be (you don’t happen to live in Pennsylvania do you? Also the German paper is interesting, not only because of the 3D ultrasound, but also because of the electrostimulation (it even seems to something along the lines of your comment that all apnea might be central). Do you know what suprahyoidal means? The drawback of this paper is that the procedure was done on someone who really only had mild apnea to begin with. (Maybe they were looking for an early success). Int J Oral Maxillofac Surg 1999 Feb;28(1):21-5 First results on daytime submandibular electrostimulation of suprahyoidal muscles to prevent night-time hypopharyngeal collapse in obstructive sleep apnea syndrome. Wiltfang J, Klotz S, Wiltfang J, Jordan W, Cohrs S, Engelbe W, Hajak G Department of Oral and Maxillofacial Surgery, University of Gottingen, Germany. Daytime submandibular electrostimulation (dSE) of suprahyoidal muscles was applied to prevent sleep-associated collapse of the tongue into the hypopharyngeal airway. By placing the stimulatory electrodes intra- and extraorally, recruitment of stimulated muscle fibers at low current densities was improved. The significant impact of electrostimulation on suprahyoidal muscle force was initially demonstrated in healthy controls as compared to placebo-treated volunteers. The morphology of suprahyoidal muscles was not affected by this treatment. A patient with obstructive sleep apnea syndrome initially presented with a respiratory disturbance index (RDI) of 13.2, an oxygen desaturation index of 23 and a minimal oxygen saturation of 75%. After two weeks of placebo treatment (TENS-stimulation), respiratory parameters remained unchanged. Two weeks of dSE treatment, however, improved the RDI to 3.9, the oxygen desaturation index from 23 to 2.8 and the minimal oxygen saturation from 75% to 88%. 3D-sonography showed considerable hypertrophy of the stimulated muscles. These results indicate that dSE may prevent episodes of apnea induced by sleep-associated hypopharyngeal collapse of the tongue. Comput Biol Med 1994 Jul;24(4):295-304 Development of the bi-directional ultrasound system for base of tongue imaging. Kwok W, Wiegand L, Channin DS, Wiegand DA Department of Surgery, Milton S. Hershey Medical Center, Pennsylvania State University, College of Medicine, PA 17033. The use of conventional ultrasound systems to image the upper airway has been limited because ultrasound energy is attenuated by the air column. In an attempt to study upper airway geometry, we developed a computer controlled bi-directional ultrasound system which combines two conventional ultrasound devices with computer image processing to yield images of upper airway structures. Human studies and cadaver studies were performed to evaluate the system. Images acquired by the bi-directional ultrasound system were comparable to images from 3D volume rendered CT scans. This system may provide valuable data in the study of upper airway physiology and pathology. Clin Phys Physiol Meas 1990;11 Suppl A:117-9 Upper airway imaging. Douglas NJ Department of Respiratory Medicine, University of Edinburgh, Scotland, UK. Sleep apnoea syndrome, consisting of daytime sleepiness and loud snoring, is caused by obstruction of the upper airways. This paper reviews the techniques which could be used for localising and quantifying the degree of obstruction while the patient is sleeping. Each has specific limitations and it is concluded that while none is ideal, magnetic resonance imaging and ultrasound show the greatest promise.
Response:
- Hide quoted text — Show quoted text -Joe Talmadge wrote in message <37220195.3525…@news.doit.wisc.edu>… >I was reading something in "Phantom of the Night" (a GREAT book for >those of you who haven’t seen it) and there is a quote in there that >has always puzzled me (p. 52): >>Sometimes when breathing effort resumes after a central apnea, a >blockage will occur. No airflow results because the throat is now >blocked, These apneas are referred to as mixed apneas …" >So what this implies is the central apnea occurs first, then the >obstructive for a mixed apnea. I would have thought it could happen >either way or perhaps more likely to be obstructive first, then >central. Does anyone know more about this? If we take this quote >literally, then maybe the central apnea is causative and what wakes >you up is just the result. Again, a look at the sleep charts would >clear up which came first.
I’ve read this elsewhere, too, Joe. That a central apnea can often turn into an obstructive one, and that’s one reason some researchers believe that perhaps ALL apnea is caused by dysfunction of the central nervous system. It just manifests itself in the two types of apnea. The idea for obstructive is that your brain just doesn’t give the proper signal for the palate, tongue, etc. to retain enough muscle tone to stay open. If that theory were proved to be true, obstructive apnea would really have a "central" cause. Further evidence for this is the fact that sometimes, successful treatment of obstructive apnea will result in an increase in central apnea, as though the obstructive apnea was simply masking the central apnea. Having said that, it’s also true that central apnea does NOT preceed every obstructive apnea, nor even the majority of them. In my case, the sleep study showed a small percentage of central/mixed apnea. I forget the exact numbers but it was under 10%. So they have basically ruled that out for me, but sometimes I still wonder. One of my greatest concerns is that I will finally find success in treating the obstructions, only to discover that central apnea takes it’s place, resulting in no improvement in how I feel. >I’m only bringing this up because I was impressed by what tim_is_here >found for central apnea. but I >was just curious whether if was worth a short trial to see what >happens. (Sounds better than having another round of Somnoplasty at >least).
Clearly worthy of consideration, Joe, if I knew that central apnea was a big part of the picture. An upcoming sleep study might be helpful in clarifying this for me again. I’ve had nasal surgery and the recent palatal somnoplasty since the last study. However, even if this is the case, I really haven’t seen impressive success rates for central apnea treatments, although I’m sure the other Tim has researched this more than I have. I’m concerned, too, about potentially significant side effects. I’ll be very interested in Tim’s results if he proceeds, and wish him the best. >>the NIH is studying the use of >>ultrasound on the neck to view apnea. That is real-time, inexpensive, and >>doesn’t expose you to xrays> >Fascinating… where did you come across this tidbit???
It’s interesting you ask, Joe. I was supposed to be a partipant in this study. I found out that NIH was doing the research study (by looking at ongoing trials which appear on their website.) My ENT agreed to refer me, and I was accepted as one of the last three patients in the study. When I called to arrange a date for testing, I was told their equipment had just broken down, and they weren’t sure whether to have it repaired or not. They thought they could maybe borrow similar equipment from another department, and would let me know when they were ready to resume testing. That was around last November, and for all I know, they could have cancelled the remainder of the study, since they only had a few of us left to test. But they told me they were very pleased with the results to that point, and it was definitely showing site(s) of obstruction. The protocol included taking an afternoon nap at the NIH, after having stayed up all night the night before. They would attach a "gliding" ultrasound device to the outside of your neck. It could move up and down so as to get a view of your whole throat. You would sleep for a few hours, and they would make a videotape of the whole thing, along with their interpretation, to take back to your doctor. Sounds great, right? I wanted to know exactly where my obstruction was before proceeding with any more surgery, but alas….so close and yet so far. When I realized it was on indefinite hold, I proceeded with somnoplasty. I’ve been keeping an eye on NAPS to see if they report the study–until then, I suppose there is still some chance they’ll call me back. Tim W.
Response:
On Sat, 24 Apr 1999 09:29:27 -0600, "Tim W." <t…@NOSPAM.com> wrote: >The sleep study showed mixed apnea, but primarily obstructive. A home study >showed the same thing, and I know I often wake up in the midst of >obstructions, so I’m confident that the obstructive element is the biggest >part, or at least a big part, of what’s going on.
I was reading something in "Phantom of the Night" (a GREAT book for those of you who haven’t seen it) and there is a quote in there that has always puzzled me (p. 52): "A central apnea occurs when the sleeper’s brain does not signal the muscles to breath. Although there is no blockage of the throat, there is no attempt to breath. Sometimes when breathing effort resumes after a central apnea, a blockage will occur. No airflow results because the throat is now blocked, These apneas are referred to as mixed apneas …" So what this implies is the central apnea occurs first, then the obstructive for a mixed apnea. I would have thought it could happen either way or perhaps more likely to be obstructive first, then central. Does anyone know more about this? If we take this quote literally, then maybe the central apnea is causative and what wakes you up is just the result. Again, a look at the sleep charts would clear up which came first. I’m only bringing this up because I was impressed by what tim_is_here found for central apnea. I’m not trying to play doctor (and clearly you’re too bright and knowledgeable to let anyone mislead you), but I was just curious whether if was worth a short trial to see what happens. (Sounds better than having another round of Somnoplasty at least). – Hide quoted text — Show quoted text ->>It seems to me, however, that if you were having this problem, even >>with the CPAP on, the sleep study might be able to show this as well. >If you were obstructing on inhalation the next >>thermistor reading after an apnea event should be a spike down as you >>inhale the cold air. Obstructing on exhalation should produce a spike >>up as you exhale the warm air (Am I even close on this >>Kevin???).Again, a good talk with the technician could clear it up. >This is a great idea Joe. You’d have to look at breath-by-breath data, >which normally isn’t given to the patient. But I’m currently leaning >towards getting another sleep study after healing is complete from the >current somnoplasty, and I’ll ask to view this data or at least have them >look at it from this perspective. I actually have the breath-by-breath data >on the home study I did, but when I originally viewed it, I didn’t know how >to interpret the spikes. Are you sure inhale is down and exhale is up? >I’ve moved since then and am not sure where the data is, but now I’m REALLY >curious to find it again.
Actually I have no idea whether up or down is exhale. This is a common problem in all diagnostic data (I have this problem myself — after all the filters, invertors and amplifiers etc … in the circuit, you can quickly loose track of positive and negative). I was thinking of this before and I just don’t know enough about it. You can correlate it to the belts around your chest, but how do you know whether up corresponds to chest expansion or contraction. It all depends on how the leads are inserted and what else is in the circuit. I would think (Kevin, you out there??) that there would be a standard way to put them in, or some other marker that lets the tech record which direction corresponds to what. >I’m still having some >>problems with the cephalometric X-rays. I would assume that you cannot >>do real-time imaging with the X-rays nor would you want to because of >>the very high dose you would get, is this true?? >I don’t know the answer to this Joe, but the NIH is studying the use of >ultrasound on the neck to view apnea. That is real-time, inexpensive, and >doesn’t expose you to xrays. Sounds like a winner to me, but when will I be >able to have it done at my local clinic? Probably not for years, even >though the technology is already there.
Fascinating… where did you come across this tidbit??? (you never cease to amaze me how much you know about this stuff). Joe
Response:
tim_is_h…@my-dejanews.com wrote in message
<7fnban$g3…@nnrp1.dejanews.com>… >Tim, what is the tongue advancement device that you use? And if it’s better >than CPAP for you, why do you choose to only go half the night with it?
Tim—I just posted my experience with dental devises under the current thread "Dental Devises". I use something called a "Tongue-Locking Device", but it causes jaw pain when I use it all night. Therefore I limit it to about 4-5 hours of sleep. By the way, I found out about these devises from the sleep disorders textbook I told you about. There’s a chapter on dental devices, along with pictures of each one. They briefly describe a dozen or so different ones, and include published research on effectiveness, although overall research has been scant on this topic. >And isn’t your (partial) success with the tongue advancement device indicative >of a possible base of tongue problem in your case?
Yes–at least I thought so when I first discovered that this helped. But upon reflection there are some other possibilities. The device holds my mouth open about 3/4 of an inch, and extends my tongue about 3/8 of an inch beyond my front teeth. This creates more space between the tongue and palate. If an oversized palate is the problem, the device could be compensating by adding more space around the palate, or it could be stopping the tongue from pushing the palate against the back of the throat. Or, as you surmised, it could simply be keeping the base of the tongue from obstructing against the back of the throat. Because the tongue and palate interact so intricately with each other, it’s hard to tell which is the primary cause and which is secondary. In addition, the simple action of keeping my mouth open could actually be doing more than the extension of the tongue is. It causes me to breath through my mouth (the TLD has breathing holes at the front). So I’m not sure why it’s helping or exactly where, but I just know it does, and it’s probably the best $100 I’ve ever spent. Tim W.
Response:
Joe Talmadge wrote in message <371f618c.68321…@news.doit.wisc.edu>…
do you know for a fact that it’s not central >apnea? The only way the tech knows if you have a central apnea is from >the bands around your chest and stomach.
The sleep study showed mixed apnea, but primarily obstructive. A home study showed the same thing, and I know I often wake up in the midst of obstructions, so I’m confident that the obstructive element is the biggest part, or at least a big part, of what’s going on. >It seems to me, however, that if you were having this problem, even >with the CPAP on, the sleep study might be able to show this as well.
If you were obstructing on inhalation the next >thermistor reading after an apnea event should be a spike down as you >inhale the cold air. Obstructing on exhalation should produce a spike >up as you exhale the warm air (Am I even close on this >Kevin???).Again, a good talk with the technician could clear it up.
This is a great idea Joe. You’d have to look at breath-by-breath data, which normally isn’t given to the patient. But I’m currently leaning towards getting another sleep study after healing is complete from the current somnoplasty, and I’ll ask to view this data or at least have them look at it from this perspective. I actually have the breath-by-breath data on the home study I did, but when I originally viewed it, I didn’t know how to interpret the spikes. Are you sure inhale is down and exhale is up? I’ve moved since then and am not sure where the data is, but now I’m REALLY curious to find it again. I’m still having some >problems with the cephalometric X-rays. I would assume that you cannot >do real-time imaging with the X-rays nor would you want to because of >the very high dose you would get, is this true??
I don’t know the answer to this Joe, but the NIH is studying the use of ultrasound on the neck to view apnea. That is real-time, inexpensive, and doesn’t expose you to xrays. Sounds like a winner to me, but when will I be able to have it done at my local clinic? Probably not for years, even though the technology is already there. Sure would like to see that Powell paper already >and see how they did the "rigorous testing". (You said it would come >in April or May— I only see the March issue of The Laryngoscope — >check out www.laryngoscope.com).
Joe, I was told by someone at Somnus last December that they thought it would appear in Laryngoscope but weren’t absolutely certain. It’s Dr. Powell/Riley’s office that originally gave me the time frame, but it’s apparently been delayed. If someone wanted to get an update, actually calling Dr. Riley’s office (Stanford Sleep Disorders Clinic), would probably get the most accurate information on when and where the tongue somnoplasty report will appear. Carry on…thanks again, Tim W.
Response:
On Wed, 21 Apr 1999 22:22:35 -0600, "Tim W." <t…@NOSPAM.com> wrote: > CPAP is >able to reduce my apnea by about one-third, so its help is substantial, but >the majority of the problem remains. A titration study showed that the help >I got from CPAP came at a relatively low pressure of 7 cm. Then they tested >all the way up to 15 cm and the apnea level stayed the same at every >increment in between. Perhaps there is more than one site of obstruction >and CPAP treats one site but not another. I can tolerate the lower >pressures and would be content with that if it worked more effectively. >Same with the "tongue-locking" device.
It’s now a lot clearer why you’re frustrated that nothing seems to be working. As I’m still on the steep slope of the learning curve, I hope you don’t mind if I ask a few (obvious) questions. If it was anyone else who said that they still have apneas even though they are using CPAP, one would immediately suspect that they have central apnea. BUT, this would show up on a sleep study test. I’m sure you’ve already gone down this road, but do you know for a fact that it’s not central apnea? The only way the tech knows if you have a central apnea is from the bands around your chest and stomach. Perhaps in your case the movement is so slight even with breathing, that in the absence of breathing they didn’t notice the difference. Or maybe they read them wrong .. or maybe they weren’t working properly. I’m a great believer in looking at the data yourself — is there anyway you can question the technician about this? If that’s not the problem, let me ask about the "obstruction on exhalation" again. Do you think you’re having this problem even with the CPAP? On thinking about this some more, I was wondering whether the CPAP would clear the obstruction and prevent this from occurring? It seems to me, however, that if you were having this problem, even with the CPAP on, the sleep study might be able to show this as well. I have no practical experience with analyzing polysomnogram data (but I am fairly experienced at interpreting other kinds of data) and I know that often times the data is noisy, unpredictable and does not at all correspond to the nice theoretical models we come up with. Keeping all this in mind however, the thermistor attached to your lip should tell us something. If you were obstructing on inhalation the next thermistor reading after an apnea event should be a spike down as you inhale the cold air. Obstructing on exhalation should produce a spike up as you exhale the warm air (Am I even close on this Kevin???).Again, a good talk with the technician could clear it up. I can see now why you would like an MRI. After all, just go to sleep with the CPAP on in the MRI chamber and you can probably get some good real-time imaging of the obstruction source. I’m still having some problems with the cephalometric X-rays. I would assume that you cannot do real-time imaging with the X-rays nor would you want to because of the very high dose you would get, is this true?? Finally, I was thinking the same thing as Tim_is_here, that if the device to move your tongue works, perhaps it is the back of the tongue that’s the problem. Sure would like to see that Powell paper already and see how they did the "rigorous testing". (You said it would come in April or May— I only see the March issue of The Laryngoscope — check out www.laryngoscope.com). Sorry to hear about all the problems with the infection. Sure does make it seem that the Somnoplasty was the cause. Which brings up a another point — that it is still worth being skeptical about the procedure — especially since it didn’t seem to do you any good. Take care, Joe
Response:
HBHB2 wrote in message <19990418163659.27331.00002…@ng-fy1.aol.com>… >As of several weeks ago there had been no peer reviewed studies on the efficacy >of somnoplasty for the treatment of OSA. If there has been please have your >doctor get the published atricle for the newsgroup.
HBHB2, The only published study so far included snorers AND mild apnea patients. (less than 15 events/hour). To my knowledge, you’re quite correct that no published studies have looked at moderate or severe apnea patients and their response to somnoplasty on the palate. Several ENTs, however, are experiementing with the palate procedure for apnea and are claiming good results. A study has been done on apnea patients in regards to somnoplasty on the tongue, and it should be published in a peer-reviewed journal shortly. > You would probably benefit >from an adjustable mandibular appliance depending on your oral >condition.
Actually, I’ve tried a couple. The jaw advancement didn’t help at all, but the tongue advancement device I tried does help, at least as well as CPAP and a little better. So I spend part of the night with CPAP, and part of it with the tongue device, but still have significant apnea with both. Tim W.
Response:
- Hide quoted text — Show quoted text -Joe Talmadge wrote in message <371c0770.2678…@news.doit.wisc.edu>… >On Tue, 20 Apr 1999 04:13:39 GMT, talma…@facstaff.wisc.edu ( Joe >Talmadge) HAD A SYNAPSE MISFIRE and wrote: >>Just to make sure I understand correctly… are you having the >>Somnoplasty because the CPAP doesn’t work well enough for you >>(why is that, do you know?) or because you want to get rid of the >>CPAP? >About 10 minutes after I posted this, I smacked myself on the forehead >and said, "It’s the obstruction on exhalation dummy". The short-term >memory must be going. >Joe
Same here, and I’m not too hot with the long-term version either! CPAP is able to reduce my apnea by about one-third, so its help is substantial, but the majority of the problem remains. A titration study showed that the help I got from CPAP came at a relatively low pressure of 7 cm. Then they tested all the way up to 15 cm and the apnea level stayed the same at every increment in between. Perhaps there is more than one site of obstruction and CPAP treats one site but not another. I can tolerate the lower pressures and would be content with that if it worked more effectively. Same with the "tongue-locking" device. Tim W.
Response:
In article <e2yT2.405$0r5.2…@newsfeed.slurp.net>, "Tim W." <t…@NOSPAM.com> wrote: > I think I mentioned that I thought I had a sinus infection that came about > when my somnoplasty site got infected, but the ENT suspected an unrelated > tooth absess instead, and referred me to a dentist. I went to the dentist > this week, and he didn’t see an absess, nor did he suspect a sinus > infection, but suspects "internal root resorption" of a tooth. Which will > probably require a root canal and crown, but he wants to refer me to an > endodontist for their opinion. They all feel its unrelated to the > somnoplasty, but the timing was certainly curious that it would start > hurting at exactly the time the somnoplasty infection was going on and my > whole palate was red and swollen, etc. Plus I’ve never had that problem > with a tooth before, and in fact haven’t had any dental problems for years. > To be honest with you, I’m not sure I really want to see any more doctors > for awhile.
I certainly can understand how you feel. I of course wish you the very best luck with whatever you decide to do. Best Regards, Tim ———–== Posted via Deja News, The Discussion Network ==———- http://www.dejanews.com/ Search, Read, Discuss, or Start Your Own
Response:
In article <TayT2.413$0r5.3…@newsfeed.slurp.net>, "Tim W." <t…@NOSPAM.com> wrote: > HBHB2 wrote in message <19990418163659.27331.00002…@ng-fy1.aol.com>… > > You would probably benefit > >from an adjustable mandibular appliance depending on your oral >condition. > Actually, I’ve tried a couple. The jaw advancement didn’t help at all, but > the tongue advancement device I tried does help, at least as well as CPAP > and a little better. So I spend part of the night with CPAP, and part of it > with the tongue device, but still have significant apnea with both.
Tim, what is the tongue advancement device that you use? And if it’s better than CPAP for you, why do you choose to only go half the night with it? And isn’t your (partial) success with the tongue advancement device indicative of a possible base of tongue problem in your case? Best Regards, Tim ———–== Posted via Deja News, The Discussion Network ==———- http://www.dejanews.com/ Search, Read, Discuss, or Start Your Own
Response:
On Tue, 20 Apr 1999 04:13:39 GMT, talma…@facstaff.wisc.edu ( Joe Talmadge) HAD A SYNAPSE MISFIRE and wrote: >Just to make sure I understand correctly… are you having the >Somnoplasty because the CPAP doesn’t work well enough for you >(why is that, do you know?) or because you want to get rid of the >CPAP?
About 10 minutes after I posted this, I smacked myself on the forehead and said, "It’s the obstruction on exhalation dummy". The short-term memory must be going. Joe
Response:
tim_is_h…@my-dejanews.com wrote in message
<7fddhd$ld…@nnrp1.dejanews.com>… >Tim, are your plans still to go ahead with base-of-tongue somnoplasty if you >don’t get the results you want from the palate?
I’m not sure, Tim. The doctor brought up a possible third palate procedure being next, but if I don’t feel significant help after two, I doubt that a third will help. As far as the tongue procedure, I’d like to see a published study, which I believe is going to be appearing in Laryngoscope Journal, but is already a couple months overdue. I might see about having a sleep study before considering that option further. I think I mentioned that I thought I had a sinus infection that came about when my somnoplasty site got infected, but the ENT suspected an unrelated tooth absess instead, and referred me to a dentist. I went to the dentist this week, and he didn’t see an absess, nor did he suspect a sinus infection, but suspects "internal root resorption" of a tooth. Which will probably require a root canal and crown, but he wants to refer me to an endodontist for their opinion. They all feel its unrelated to the somnoplasty, but the timing was certainly curious that it would start hurting at exactly the time the somnoplasty infection was going on and my whole palate was red and swollen, etc. Plus I’ve never had that problem with a tooth before, and in fact haven’t had any dental problems for years. To be honest with you, I’m not sure I really want to see any more doctors for awhile. Tim W.
Response:
Tim, are your plans still to go ahead with base-of-tongue somnoplasty if you don’t get the results you want from the palate? I wish you the best in any case. Tim ———–== Posted via Deja News, The Discussion Network ==———- http://www.dejanews.com/ Search, Read, Discuss, or Start Your Own
Response:
As of several weeks ago there had been no peer reviewed studies on the efficacy of somnoplasty for the treatment of OSA. If there has been please have your doctor get the published atricle for the newsgroup. You would probably benefit from an adjustable mandibular appliance depending on your oral condition.
Response:
On Sat, 17 Apr 1999 07:36:50 -0600, "Tim W." <t…@NOSPAM.com> wrote: > It’s still too early to >draw conclusions and I hope to have a sleep study after this is over, but I >know I’m still waking up with significant apneas, even when sleeping with >CPAP. My apnea was termed "moderately severe." (30+ events in NREM sleep, >60+ in REM) >Tim W.
Tim W! Just to make sure I understand correctly… are you having the Somnoplasty because the CPAP doesn’t work well enough for you (why is that, do you know?) or because you want to get rid of the CPAP? Take care, Joe
Response:
A little over a month ago, I had a second somnoplasty treatment on my palate. I’m undergoing this procedure primarily for obstructive apnea, not for snoring. The only complication the first time was extreme swelling which necessitated cortisone medication. The second time I developed an infection at the somnoplasty site. (The lesions generally are only inside the palate, but this one accidentally extended all the way to the surface and got infected) Antibiotics successfully treated the primary infection, but it appears that the infection has spread to the sinuses OR to the root of a tooth. The ENT has referred me to a dentist to check this out further, as he suspects a possible tooth absess which he feels is probably unrelated to the somnoplasty. In any case, the somnoplasty lesion now appears to be healed. Even when infected, the pain was tolerable or treated with a couple ibuprofen. I still have some swelling, and slight redness of the palate area, and am told that full healing takes two months and maximum benefit is not achieved until then. At this point, I’d say the first somnoplasty (done in January) helped some, but not as much as I had hoped, and so far I haven’t perceived any benefit in my sleep from the second procedure. It’s still too early to draw conclusions and I hope to have a sleep study after this is over, but I know I’m still waking up with significant apneas, even when sleeping with CPAP. My apnea was termed "moderately severe." (30+ events in NREM sleep, 60+ in REM) Tim W.
