[Diagnosis] Need Advice from Sleep Endoscopy Results

[doickle]

Hi all,

I recently had a nasal surgery to fix a deviated septum, turbinate reduction, and balloon sinuplasty.

Since we were going in to do all of these things I asked the Dr to do a Sleep Endoscopy so he might determine what the actual cause of my OSA is.

The results were that it is my tongue and epiglottis that relax and block the airway.

So my question to all the experts is, Aside from CPAP which I have been using successfully for the past few months, what can I do/use in addition to CPAP to help tone the muscles and expand the airway during sleep.

Any ideas are welcome, I don't think my case is serious enough to warrant a surgery.

Thanks

[Sleeprider]

Most of us use positive air pressure to stint the airway and that works. I'm not aware of any conditioning program that is advocated for airway improvement. Be careful you are not persuaded to get surgery when CPAP works fine. There are serious complications, a lot of pain and a difficult recovery with UPPP. Most surgically treated individuals still require CPAP, but the surgical complications can include difficulty using CPAP and aerophagia (air ingestion). Unless you are so restricted that it affects your daytime function and even CPAP pressure can't prevent apnea at night; get the heck out of the ENT office!

[DeepBreathing]

There has been a lot of talk (though I don't know of any clinical trials) that playing a wind instrument can help. The didgeridoo is supposed to be particularly good. From my clarinet days I recall there was some throat work involved in getting a nice round tone so that might also be appropriate.

However I doubt that any of these approaches will obviate the need for CPAP, which is a proven, simple non-invasive treatment.

[chill]

I like my ENT.  She fixed my deviated septum, gave me a turbinate reduction, and told me suck hose for the rest of it.     Some are a lot more cut-happy.  What I have heard of the surgeries sounds much, much worse than curling up with a nice, life saving mask.

[woozie38]

Hi doickle,
Every one of our muscles (except the diaphragm) relax when we sleep & there's nothing can be done about it.  Toning up the muscles of the throat may even make the situation worse.
The results of any surgery can never be guaranteed either, & it is so with upper airway procedures. The nasal septoplasty & turbinate resection are in many cases, important & necessary, but others such as UPPP are of doubtful benefit, painful & hard to recover from.
However there is a procedure called "Robotic resection of the tongue base" that although carries no guarantee of success, is nonetheless recommended by ENT's. But, unless you have medical insurance to cover the cost, it's too expensive for most patients.
Here in AU it costs $5000 just to turn the machine on. The ENT will have his regular experienced team of anesthetist, assistant surgeon & nurse who all must be paid. Then there's hospital & theatre fees too. There would be no change out of $10,000 and no guarantee of a satisfactory outcome. Put simply - you pays your money & takes your chances. Best of luck with your quest for better sleep.

[holden4th]

Hi doickle,
Every one of our muscles (except the diaphragm) relax when we sleep & there's nothing can be done about it.  Toning up the muscles of the throat may even make the situation worse.
The results of any surgery can never be guaranteed either, & it is so with upper airway procedures. The nasal septoplasty & turbinate resection are in many cases, important & necessary, but others such as UPPP are of doubtful benefit, painful & hard to recover from.
However there is a procedure called "Robotic resection of the tongue base" that although carries no guarantee of success, is nonetheless recommended by ENT's. But, unless you have medical insurance to cover the cost, it's too expensive for most patients.
Here in AU it costs $5000 just to turn the machine on. The ENT will have his regular experienced team of anesthetist, assistant surgeon & nurse who all must be paid. Then there's hospital & theatre fees too. There would be no change out of $10,000 and no guarantee of a satisfactory outcome. Put simply - you pays your money & takes your chances. Best of luck with your quest for better sleep.

I'm going to have to respectfully disagree with your first sentence (think sphincter and other pelvic floor muscles as an example).

I wonder if some of the vocal exercises done by singers could be useful?

[Beej]

There are some articles out there on the web about exercises one may do.

Breathing from your diaphragm:

First, try this while lying on your bed or the floor:

Place one hand on your abdomen and one hand on your chest.
Take a deep breath in and notice which hand moves.
If it was the hand on your abdomen, congratulations that is how diaphragmatic breathing works. The lungs expand outward and down, pushing some of the abdominal contents out of the way.

If it was the one on your chest, now try to keep that hand stationary while you breathe, and inhale with moving your abdomen.
It may take you some practice before it feels natural.

Advanced technique:

While standing, place your hands on the sides of your waist and back.
(You may be able to feel some of your lower ribs.)
Inhale a comfortably full breath, using the diaphragm, too.
Do you feel the lower sides and back of your body moving outwards?
If yes, you have used some of the accessory muscles for the respiratory system.
(Asthmatics often use the accessory muscles when trying to compensate for airway restriction.)

With practice, it can be possible to take such a large breath that your circumference will increase 3 inches or so when you inhale.

[dosco]

I like my ENT.  She fixed my deviated septum, gave me a turbinate reduction, and told me suck hose for the rest of it.     Some are a lot more cut-happy.  What I have heard of the surgeries sounds much, much worse than curling up with a nice, life saving mask.

I just visited my ENT a couple of days ago ... he did suggest I consider "repair" to my deviated septum, although the septum issue isn't really a huge contributor to apnea. He had some concerns that nose-breathing problems (usually an issue for me in the winter) might result in compliance issues. He's pretty young and relaxed, so he didn't really put any pressure on me for the surgery. Plus, my apnea is reasonably well controlled with PAP therapy ... my compliance is generally OK although it tends to wax and wane over the year.

[xxyzx]

Hi all,

I recently had a nasal surgery to fix a deviated septum, turbinate reduction, and balloon sinuplasty.

Since we were going in to do all of these things I asked the Dr to do a Sleep Endoscopy so he might determine what the actual cause of my OSA is.

The results were that it is my tongue and epiglottis that relax and block the airway.

So my question to all the experts is, Aside from CPAP which I have been using successfully for the past few months, what can I do/use in addition to CPAP to help tone the muscles and expand the airway during sleep.

Any ideas are welcome, I don't think my case is serious enough to warrant a surgery.

Thanks

i read that gargling twice a day can help
unverified whether that is really true

[sneef]

get the heck out of the ENT office!

When i was shopping around for the best place and price for a Sleep Lab test i was offered differing options from differing hospitals.

A guy at my insurance company told me to have a Neurologist run the lab, and i did. He specializes in Sleep.

But at other hospitals the tests were administered by ENT doctor or pulmonologist at another.

What type of doctor is best to keep in contact with during ongoing CPAP treatment?