Need advice for severe flow limitations, restless sleep and nasal surgery

[17WRX]

I have really bad flow limitations. Some on this forum have characterized them as amazing they are so bad. I bought an Air Curve vauto a few months in hopes of improving them but they are still really bad. I can't post any of my charts right now because I just bought a new computer and have not set up oscar yet but trust me they are really bad. 

I went to an ENT doctor recently and asked him about the situation. He checked me out with the fiber optic camera and he said I have a deviated septum, enlarged turbinates and a really big tongue but everything else was normal. Obviously I can't do anything about my tongue surgically but I'm going to have surgery on the septum and turbinates in a month or two and was wondering if correcting these issues can have a positive effect on my flow limitations? 

I've been using PAP for about 5 months now and overall I'm feeling pretty awful most of the time. I wake up very often throughout most nights now and usually feel pretty miserable most days as a result of my poor sleep. Although my AHI is usually under 5 so naturally, my sleep doctor thinks everything is great. She did prescribed me gabapentin to help me sleep throughout the night but it hasn't really worked. 

So my question is has anyone experienced my situation and has been able to remedy these issues with surgery?

[Sleeprider]

Lots of threads deal with UARS and flow limitation, and I'm sure you have been part of those. Tarah has a very good thead that describes her attempts at PAP therapy and the result of nasal surgery http://www.apneaboard.com/forums/Thread-UARS--26783 There is a list of Possibly Related threads at the bottom of this page that looks like it might have some good hits.

I think a review of what settings and pressure support you have tried, and how those results have worked or lacked effectiveness would help here.

[Dormeo]

As Tarah's thread shows, it is entirely possible that the surgery would help. No guarantees, of course.

For what it's worth, when I switched to the VAuto from my Airsense 10 Autoset and got my pressure support up to 4.8, my FLs really improved and -- the key point I want to make -- I felt more rested during the day. (I never feel great because my sleep is interrupted by pain, but that is another story.)

So I really do think that addressing the FLs could be of help to you. I hope the combination of surgery and PS will help you finally get where you want to be.

(One suggestion: when you have a moment, could you update your profile to reflect your current machine and pressure settings?)

[tarah]

Hello, welcome!

I went back and looked at some of your previous data.  Some really bad flow limitations.  And more importantly, you are feeling horrible and waking often. 

You know how awful people feel when they are all congested from a cold and waking up constantly, and snoring, etc.?  If your nose is congested, you are dealing with that every single night for years or decades on end.  It will take a toll physically and emotionally.  It activates the flight or fight part of your brain hundreds of times per night, and most people with UARS have anxiety, gut issues, insomnia, depression, trouble concentrating, low blood pressure, cold hands/feet, the list goes on and on.

I also upgraded to a bilevel, which by increasing pressure support, was able to help me feel marginally better.  I finally got into a competant ENT who said I had almost complete nasal obstruction and things were never going to get better until I dealt with things medically (unlikely to help as much as needed) or surgically.  I had RF inferior turbinate reduction, septoplasty, and ear cartilage graft.  The difference since the surgery (3 months ago) has been remarkable.  I also had another RF middle turbinate reduction (in-office) last week.  I went from waking literally hundreds of times per night to now about 6-8, and it continues to improve as my nasal congestion continues to clear.  If your turbinate hypertrophy is allergy based, you will also need to continue with nasal steroids and nasal antihistamines indefinitely.

Your sleep doctor doesn't know anything if they think that looking at the AHI in someone with UARS is useful in any way.  It's so frustrating because that kind of poor medicine can derail someone from getting the treatment they need for years!  I would encourage you to find a surgeon that you feel you can trust, that is not bringing a gigantic ego to the table, and who is willing to listen to all of your concerns.  The biggest concern when messing with turbinates is empty nose syndrome.  Read about it and question your surgeon about ways to minimmize the chances of it happening.

[17WRX]

The ENT set me up with an allergist for testing next month. Hopefully the majority of my issues come from the physical blockage in my nose but I'll just have to wait and see how the testing goes. I've read the horror stories about the empty nose syndrome and I'll diffenately be addressing that concern with him. But I cannot go on living like this so I'm going to be getting the surgery with him or somone else in the near future. But since you have had the surgery I have to ask how was the recovery process afterwards? Were you miserable for days after the surgery or was it not that bad? The ENT said I would have splints inserted afterwards so I can't imagine that is very pleasant. Regardless I'm going to do it. I'm tired of being tired.

[tarah]

The recovery was not pleasant, but not totally horrible.  Maybe on par with wisdom teeth removal.  You will not be able to use a mask for a while, which for me, generates alot of anxiety at night.  So that kind of sucked.  I did use some narcotics for the first few days, then just tylenol for about a week.  My mom came to help with my 2 little kids for 5 days, and that was very helpful because you can't do heavy lifting for a while.  There will be alot of rebound congestion until they are able to fullly remove all the scabs from the inferior turbinates.  But it has made such a huge difference for me, was all 100% worth it.  Good luck.

[17WRX]

After 9 days how did you feel? I was thinking about staying out of work and sitting around the house for 9 days. Would that be enough? My job can involve a lot of physical activity. Also how soon before they took the splints out of your nose?

[tarah]

I felt completely fine after 9 days.  Actually by about day 3, I went for a half mile walk.  It's more mental boredom than anything because you won't that feel THAT bad after a few days.  

My surgeon does not use internal splinting.  I had a very hard external splint for the first few days, then this really stiff tape on the outside for a few more days.  When all that stuff was finally off, after like a week, then I was able to use my full face mask again and get a decent seal.  You will be really congested until the scabs are off the turbinates, and sleeping was challenging with all the congestion.  My ENT did say to go ahead with the nasal decongestant for the first few weeks after surgery so that I could attempt to sleep as well as possible at night.