Sleep apnea

[Lala81]

I consulted an ENT Surgeon on Tuesday.

 

Basically, he explained why surgery may not be suitable for me.

My BMI is about 27+.

Weight loss is the single biggest factor in reducing OSA. Over the years, he say he now seldom does surgery for correction of OSA.

 

Other than structural blockages, tone of the tongue and the volume it occupies in the pharynx matters. Without weight loss, he say the surgery isn't likely to benefit much long term.

 

I asked about UPPP.

https://en.wikipedia.org/wiki/Uvulopalatopharyngoplasty

 

He said there are more complications than most people think. And it's usually most beneficial for low BMI people with severe OSA (this i already knew from reading up beforehand).

This was a paper he published on UPPP Complications years down the road.

https://www.ncbi.nlm.nih.gov/pubmed/17334312

 

He did recommend radiofrequency ablation for my nose turbinates enlargement but beyond that, he just hammered in the need for me to lose weight.

 

Like i said before, going to ENT to ask about OSA surgery is always like asking a fruit seller if the fruit is good.

But this ENT, he's quite honest that weight loss will make more of a difference than any surgery.

 

I'll be going for the RFA for my nose so that i can use my nasal mask better. But other than that, now more than ever, i really need to get my weight down.

[TangoElite]

i need to reduce weight too

 

bmi skyrocketed recent years...

 

time to start working out....

[Lala81]

Which CPAP machines recommended, doc?

 

I'm not very familiar with the brands here.

ResMed is a big brand. 

 

Cos i self imported a philips dreamstation auto cpap via amazon.

For some reason, the link is no longer available on amazon... maybe they are clamping down on sellers over there?

[Hcity]

i need to reduce weight too

 

bmi skyrocketed recent years...

 

time to start working out....

working will not reduce your weight...build up health/muscles yes, reduce weight no...

[mersaylee]

i need to reduce weight too

 

bmi skyrocketed recent years...

 

time to start working out....

A good start...commerce after Tianmo liu lian MU. However, the MU session may be too good to skip future ones. Hahaha.

[Ender]

 

I consulted an ENT Surgeon on Tuesday.

 

Basically, he explained why surgery may not be suitable for me.

My BMI is about 27+.

Weight loss is the single biggest factor in reducing OSA. Over the years, he say he now seldom does surgery for correction of OSA.

 

Other than structural blockages, tone of the tongue and the volume it occupies in the pharynx matters. Without weight loss, he say the surgery isn't likely to benefit much long term.

 

I asked about UPPP.

https://en.wikipedia.org/wiki/Uvulopalatopharyngoplasty

 

He said there are more complications than most people think. And it's usually most beneficial for low BMI people with severe OSA (this i already knew from reading up beforehand).

This was a paper he published on UPPP Complications years down the road.

https://www.ncbi.nlm.nih.gov/pubmed/17334312

 

He did recommend radiofrequency ablation for my nose turbinates enlargement but beyond that, he just hammered in the need for me to lose weight.

 

Like i said before, going to ENT to ask about OSA surgery is always like asking a fruit seller if the fruit is good.

But this ENT, he's quite honest that weight loss will make more of a difference than any surgery.

 

I'll be going for the RFA for my nose so that i can use my nasal mask better. But other than that, now more than ever, i really need to get my weight down.

 

See you over at the other thread..

[Still2016]

 

I consulted an ENT Surgeon on Tuesday.

 

Basically, he explained why surgery may not be suitable for me.

My BMI is about 27+.

Weight loss is the single biggest factor in reducing OSA. Over the years, he say he now seldom does surgery for correction of OSA.

 

Other than structural blockages, tone of the tongue and the volume it occupies in the pharynx matters. Without weight loss, he say the surgery isn't likely to benefit much long term.

 

I asked about UPPP.

https://en.wikipedia.org/wiki/Uvulopalatopharyngoplasty

 

He said there are more complications than most people think. And it's usually most beneficial for low BMI people with severe OSA (this i already knew from reading up beforehand).

This was a paper he published on UPPP Complications years down the road.

https://www.ncbi.nlm.nih.gov/pubmed/17334312

 

He did recommend radiofrequency ablation for my nose turbinates enlargement but beyond that, he just hammered in the need for me to lose weight.

 

Like i said before, going to ENT to ask about OSA surgery is always like asking a fruit seller if the fruit is good.

But this ENT, he's quite honest that weight loss will make more of a difference than any surgery.

 

I'll be going for the RFA for my nose so that i can use my nasal mask better. But other than that, now more than ever, i really need to get my weight down.

 

 

 

I would advice you to reconsider. A few subsequently suffered from phantom turbinates issues.

[Lala81]

I would advice you to reconsider. A few subsequently suffered from phantom turbinates issues.

 

The turbinates are only going to be shrunken, they are still there.

Anyway if its phantom turbinates vs real enlarged turbinates, no difference what. Lol.

[TangoElite]

working will not reduce your weight...build up health/muscles yes, reduce weight no...

 

 

yea, i suppose watching diet and counting calories more useful

A good start...commerce after Tianmo liu lian MU. However, the MU session may be too good to skip future ones. Hahaha.

 

 

haha, i postponed the dieting plan for too long liao, probably time to really get started

[Still2016]

The turbinates are only going to be shrunken, they are still there.

Anyway if its phantom turbinates vs real enlarged turbinates, no difference what. Lol.

 

 

Procedures known to cause symptoms of Empty Nose Syndrome are as follows:

 

Submucosal Resection of the Inferior and/or Middle Turbinates

Outfracture of Inferior or Middle Turbinates

Turbinate Reduction by Somnoplasty

Turbinate Reduction by Cautery

Partial Turbinectomy

Full Turbinecomy

Functional Endoscopic Sinus Surgery

    Surgery of the turbinates and “empty nose” syndrome https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3199827/ Abstract

Surgical therapy of the inferior and/or middle turbinate is indicated when conservative treatment options have failed. The desired goal is a reduction of the soft tissue volume of the turbinates regarding the individual anatomic findings, whilst simultaneously conserving as much mucosa as possible. As the turbinates serve as a functional entity within the nose, they ensure climatisation, humidification and cleaning of the inhaled air. Thus free nasal breathing means a decent quality of life, as well.

Regarding the multitude of different surgical techniques, we confirm that no ideal standard technique for turbinate reduction has been developed so far. Moreover, there is a lack of prospective and comparable long-term studies, which makes it difficult to recommend evidence-based surgical techniques. However, the anterior turbinoplasty seems to fulfil the preconditions of limited tissue reduction and mucosa-preservation, and therefore it is the method of choice today.

Radical resection of the turbinates may lead to severe functional disturbances developing a secondary atrophic rhinitis. The “empty nose” syndrome is a specific entity within the secondary atrophic rhinitis where intranasal changes in airflow result in disturbed climatisation and also interfere with pulmonary function. Results deriving from an actual in vivo study of climatisation and airflow in “empty nose” patients are presented.

 

 

Turbinate Reduction Surgery Side-Effects

Turbinate Reduction Risks Post-Nasal and Turbinate Reduction Risks, Physical Symptoms

• Nose feels too empty/hollow/absent.
• Diminished nasal airflow sensation feedback (‘paradoxical obstruction’).
• Extreme sensation of dryness of the nasal cavities, with or without crusting.
• Not enough moisture/mucus production.
• Dryness of the pharynx, soft palate and back of the tongue (“dry pharyngitis” and “dry laryngitis”).
• Feeling of needing more nasal resistance (or nasal membrane responsiveness) to breathe.
• Increased pulmonary sensitivity to air-borne irritants, strong scents and cold air. Causes much uneasiness in breathing and sometimes even long-periods (can last hours) of severe shortness of breath, depending on the degree of exposure.
• Diminished sense of smell and/or taste. Can be confusing – because although there is diminished sense of smell there is also hyper-responsiveness to light and volatile airborne chemicals, fumes and irritants.
• Difficulty projecting or resonating speech. The voice seems weak and requires some straining to sound loud and articulate well, which causes uneasiness in speech.
• Feeling weak and depleted of energy.
• Very poor quality of sleep. Not necessarily full sleep apnea, but shallow and dry breathing, which often switches entirely to mouth breathing only, waking up a lot very dry, with headaches, severe dizziness and very little REM sleep. 
• Relatively dry skin and eyes. 
• Extremely thick mucous and post-nasal drip.
• Difficulty swallowing due to post-nasal drip
• Significant weight gain. 
• Hormonal and metabolic imbalances.
• Elevated levels of blood pressure.
• Gastroesophageal reflux (GERD).
• Foul smell from nasal cavities.
• Rhinitis.
• Epistaxis.
• Worsening of pre surgical nasal symptoms, such as allergic rhinitis, etc.
• Chronic Sinusitis.

Post-Nasal and Turbinate Reduction Risks, Cognitive Symptoms

• Difficulty concentrating (‘aprosexia nasalis’).
• Difficulty performing mental tasks.

Post-Nasal and Turbinate Reduction Risks, Emotional Symptoms

• Marked reduction in sense of self and very crippled sense of well-being.
• Irritated and/or depressed mood. Often clinical depression.
• Anxieties.
• Avoidance of social interactions.

[Lala81]

Any treatment or any medicine will have side effects.

If a treatment/medicine has no side effects, it doesn't work.

 

Thanks for the concern. But i think it's quite necessary to improve my compliance with CPAP. Though my compliance is generally high.

Or else it's hard to breathe with a nasal mask.

 

 

 

Procedures known to cause symptoms of Empty Nose Syndrome are as follows:

 

Submucosal Resection of the Inferior and/or Middle Turbinates

Outfracture of Inferior or Middle Turbinates

Turbinate Reduction by Somnoplasty

Turbinate Reduction by Cautery

Partial Turbinectomy

Full Turbinecomy

Functional Endoscopic Sinus Surgery

    Surgery of the turbinates and “empty nose” syndrome https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3199827/ Abstract

Surgical therapy of the inferior and/or middle turbinate is indicated when conservative treatment options have failed. The desired goal is a reduction of the soft tissue volume of the turbinates regarding the individual anatomic findings, whilst simultaneously conserving as much mucosa as possible. As the turbinates serve as a functional entity within the nose, they ensure climatisation, humidification and cleaning of the inhaled air. Thus free nasal breathing means a decent quality of life, as well.

Regarding the multitude of different surgical techniques, we confirm that no ideal standard technique for turbinate reduction has been developed so far. Moreover, there is a lack of prospective and comparable long-term studies, which makes it difficult to recommend evidence-based surgical techniques. However, the anterior turbinoplasty seems to fulfil the preconditions of limited tissue reduction and mucosa-preservation, and therefore it is the method of choice today.

Radical resection of the turbinates may lead to severe functional disturbances developing a secondary atrophic rhinitis. The “empty nose” syndrome is a specific entity within the secondary atrophic rhinitis where intranasal changes in airflow result in disturbed climatisation and also interfere with pulmonary function. Results deriving from an actual in vivo study of climatisation and airflow in “empty nose” patients are presented.

 

 

Turbinate Reduction Surgery Side-Effects

Turbinate Reduction Risks Post-Nasal and Turbinate Reduction Risks, Physical Symptoms

• Nose feels too empty/hollow/absent.
• Diminished nasal airflow sensation feedback (‘paradoxical obstruction’).
• Extreme sensation of dryness of the nasal cavities, with or without crusting.
• Not enough moisture/mucus production.
• Dryness of the pharynx, soft palate and back of the tongue (“dry pharyngitis” and “dry laryngitis”).
• Feeling of needing more nasal resistance (or nasal membrane responsiveness) to breathe.
• Increased pulmonary sensitivity to air-borne irritants, strong scents and cold air. Causes much uneasiness in breathing and sometimes even long-periods (can last hours) of severe shortness of breath, depending on the degree of exposure.
• Diminished sense of smell and/or taste. Can be confusing – because although there is diminished sense of smell there is also hyper-responsiveness to light and volatile airborne chemicals, fumes and irritants.
• Difficulty projecting or resonating speech. The voice seems weak and requires some straining to sound loud and articulate well, which causes uneasiness in speech.
• Feeling weak and depleted of energy.
• Very poor quality of sleep. Not necessarily full sleep apnea, but shallow and dry breathing, which often switches entirely to mouth breathing only, waking up a lot very dry, with headaches, severe dizziness and very little REM sleep. 
• Relatively dry skin and eyes. 
• Extremely thick mucous and post-nasal drip.
• Difficulty swallowing due to post-nasal drip
• Significant weight gain. 
• Hormonal and metabolic imbalances.
• Elevated levels of blood pressure.
• Gastroesophageal reflux (GERD).
• Foul smell from nasal cavities.
• Rhinitis.
• Epistaxis.
• Worsening of pre surgical nasal symptoms, such as allergic rhinitis, etc.
• Chronic Sinusitis.

Post-Nasal and Turbinate Reduction Risks, Cognitive Symptoms

• Difficulty concentrating (‘aprosexia nasalis’).
• Difficulty performing mental tasks.

Post-Nasal and Turbinate Reduction Risks, Emotional Symptoms

• Marked reduction in sense of self and very crippled sense of well-being.
• Irritated and/or depressed mood. Often clinical depression.
• Anxieties.
• Avoidance of social interactions.

 

 

[Still2016]

Any treatment or any medicine will have side effects.

If a treatment/medicine has no side effects, it doesn't work.

 

Thanks for the concern. But i think it's quite necessary to improve my compliance with CPAP. Though my compliance is generally high.

Or else it's hard to breathe with a nasal mask.

Doc, I have access to a panel of specialists including Dr. Ang Peng Tiam oncology group and ENT specialists.

 

I've asked and consistently advice NOT to do anything surgical with the oropharyngeal region. CPAP machine can improve or change anytime but once surgery is performed it is permanent. Please do consider carefully as these procedure have lifetime implications.

 

CPAP are design to assist but if it is not helping you then you may consider nasal prongs instead of mask. You may want to set the pressure higher to 20 which may help. DEVILBLISS has auto function which I am sure many others have too. My take is explore all the possibilities of the CPAP machine before you do under the knife. An increase in pressure should open up the nasal passage.

 

Just concern but ultimately you make the decision.

[Lala81]

Doc, I have access to a panel of specialists including Dr. Ang Peng Tiam oncology group and ENT specialists.

 

I've asked and consistently advice NOT to do anything surgical with the oropharyngeal region. CPAP machine can improve or change anytime but once surgery is performed it is permanent. Please do consider carefully as these procedure have lifetime implications.

 

CPAP are design to assist but if it is not helping you then you may consider nasal prongs instead of mask. You may want to set the pressure higher to 20 which may help. DEVILBLISS has auto function which I am sure many others have too. My take is explore all the possibilities of the CPAP machine before you do under the knife. An increase in pressure should open up the nasal passage.

 

Just concern but ultimately you make the decision.

You are contradicting yourself.

 

I'm talking about rfa to nasal turbinate...

You yourself said don't operate on oropharynx. Nasal is nasal. Oropharynx is Oropharynx.

 

It doesn't matter what pressures u set it on. The obstruction at that level is a physical obstruction.

 

Auto cpap usually is between 4 to 6 up to 20 cm water. Yes my machine is auto.

Nasal pillows won't make a difference. In fact it's highly likely if you increase the pressure, the nasal pillows will leak. Cos of the design.

You are saying that an increase in pressure can compress something that has the consistency of flesh. U gotta have some freaking high pressures to be able to do that.

[Still2016]

You are contradicting yourself.

 

I'm talking about rfa to nasal turbinate...

You yourself said don't operate on oropharynx. Nasal is nasal. Oropharynx is Oropharynx.

 

It doesn't matter what pressures u set it on. The obstruction at that level is a physical obstruction.

 

Auto cpap usually is between 4 to 6 up to 20 cm water. Yes my machine is auto.

Nasal pillows won't make a difference. In fact it's highly likely if you increase the pressure, the nasal pillows will leak. Cos of the design.

You are saying that an increase in pressure can compress something that has the consistency of flesh. U gotta have some freaking high pressures to be able to do that.

sorry meant oro~nasopharynx

 

choice is yours

 

wish you speedy recovery

[Lala81]

http://www.channelnewsasia.com/news/health/untreated-sleep-apnea-may-worsen-markers-of-heart-health-and-diabetes-8947424

 

 

Health

Untreated sleep apnea may worsen markers of heart health and diabetes

15 Jun 2017 07:52AM

 

Reuters Health) - - Properly treating a common sleep-related breathing disorder may have benefits for the heart and for blood sugar, a new study suggests. If people with obstructive sleep apnea don't use machines at night to help keep the airway open, measures of their heart health and blood sugar worsen, researchers found. "One of the longstanding debates in our field" is whether sleep apnea actually causes heart issues and problems with blood sugar, "or if they’re just associated," said senior author Dr. Jonathan Jun, of Johns Hopkins University in Baltimore.
In obstructive sleep apnea, the airway intermittently collapses or becomes blocked during sleep. The blocked airway causes pauses in breathing.

In the past, researchers have tried to find a direct link between sleep apnea, heart health and blood sugar by comparing patients instructed to use CPAP machines at night to keep the airway open with patients who were instructed to sleep without using these machines. But one of the major issues with those studies is that people may not actually use the CPAP machine, Jun told Reuters Health by phone. For the new study, the researchers recruited 31 people with moderate to severe obstructive sleep apnea who were known to regularly use their CPAP machines.

The participants slept two nights in the lab, using their CPAP on only one of the nights. The researchers obtained blood samples while participants slept. "We are looking at real time changes," said Jun. "We’re getting blood every 20 minutes."

As reported in The Journal of Clinical Endocrinology and Metabolism, on the night without CPAP, patients' obstructive sleep apnea returned. On those nights, patients had low levels of oxygen in their blood, poor sleep and an increased heart rate. Additionally, their blood samples showed increases in fatty acids, sugar and a stress hormone known as cortisol. 

The researchers also saw increases in blood pressure and in arterial stiffness, which has been linked with a risk for heart problems.

"These were obese patients and patients with relatively severe sleep apnea. They also had other medical problems," Jun pointed out. People who fit that description may be experiencing the same changes during the night if they sleep without their CPAP machine, he said.

Glucose and fatty acids rose in the overall group without the CPAP machines, but participants with diabetes may be more vulnerable to the glucose elevation, Jun warned. He said the study can't say what would happen to people with milder sleep apnea.

Because obesity has been tied to an increased risk of sleep apnea, it's been difficult to know if it’s the sleep apnea or the obesity itself that’s causing those problems, Jun noted. The new study, he said, "advances that idea that other conditions and not obesity itself are driver of those levels." 

SOURCE: http://bit.ly/2sXLJaU The Journal of Clinical Endocrinology and Metabolism, online June 8, 2017.

Source: Reuters

Read more at http://www.channelnewsasia.com/news/health/untreated-sleep-apnea-may-worsen-markers-of-heart-health-and-diabetes-8947424

[Lala81]

Underwent my RFA in late May. Went for follow up visits for last few weeks. Nasal congestion is a thing of the past.

 

Lost about 7+kg since April, find the weight improvement only improves my OSA marginally. Maybe about 10-20%. Still using CPAP every night.

Compliance so far hasn't been an issue for me. But mask leaks and the discomfort of the frame is something u have to live with.

 

There are good weeks/days and bad weeks/days. i had 1-2 weeks that were lousy but this week seems to be a good one.

[Nissan8888]

http://www.channelnewsasia.com/news/health/untreated-sleep-apnea-may-worsen-markers-of-heart-health-and-diabetes-8947424

 

Hi everyone,

 

Thanks for your numerous posting and sharing ; I have learnt much from all the information shared in this forum.

Just want to emphasize that OSA or sleep apnea is a much neglected condition that will affect a person's health adversely in many ways.

If in doubt, just consult your GP or doc at polyclinic for referral to see the ENT/sleep specialist at the various hospital.

 

My journey with OSA is as follows:

 

Last year 2016 around May, came down with tightness of chest after waking up from sleep. I had known for many years that  I had been snoring loudly in my sleep and family members have recorded the snoring episodes which shocked me when I listened. I was sleepy too throughout the daytime and concentration was poor. Sleep was not refreshing most time.

Subsequently, I was tested at a restructured hospital and diagnosed with severe OSA ( AHI was 31 ).

Surgery was not recommended but cpap use was recommended.

Was told by my ENT doctor that surgery may not solved apnea permanently.

Thus the gold standard is still to use  cpap therapy.

It took me 6 months to get use to it. A good night sleep is indeed precious (deep REM sleep).

May I encourage all to continue with the cpap use despite the uncomfortable feeling, prices of machine, masks and accessories.

 

Hope my sharing is helpful.

Have a good night sleep everyone.

 

Cheers !

[Lala81]

Hi everyone,

 

Thanks for your numerous posting and sharing ; I have learnt much from all the information shared in this forum.

Just want to emphasize that OSA or sleep apnea is a much neglected condition that will affect a person's health adversely in many ways.

If in doubt, just consult your GP or doc at polyclinic for referral to see the ENT/sleep specialist at the various hospital.

 

My journey with OSA is as follows:

 

Last year 2016 around May, came down with tightness of chest after waking up from sleep. I had known for many years that I had been snoring loudly in my sleep and family members have recorded the snoring episodes which shocked me when I listened. I was sleepy too throughout the daytime and concentration was poor. Sleep was not refreshing most time.

Subsequently, I was tested at a restructured hospital and diagnosed with severe OSA ( AHI was 31 ).

Surgery was not recommended but cpap use was recommended.

Was told by my ENT doctor that surgery may not solved apnea permanently.

Thus the gold standard is still to use cpap therapy.

It took me 6 months to get use to it. A good night sleep is indeed precious (deep REM sleep).

May I encourage all to continue with the cpap use despite the uncomfortable feeling, prices of machine, masks and accessories.

 

Hope my sharing is helpful.

Have a good night sleep everyone.

 

Cheers !

Yup. I'm still on cpap. I will use it for the rest of my life too.

 

There are good and bad nights.