Severe Apnea and Last Resort

[Michael208]

Hello all,

I am a 66 year old male. I was diagnosed with severe sleep apnea probably 12 years ago. I have been through the ringer. I failed CPAP three times and I used a dental appliance for years until things got to the point that I just could not use it anymore. I tried a new device and I could not use it.
About 5 months ago I had Inspire put in. It is not working for me. The same ENT that did the Inspire did a sleep endoscopy about four years ago. He said there are a lot of things going on in my throat. I have a small throat with a big tongue and an arched palate. And my throat totally collapses during sleep. He didn't think I was a candidate for Inspire at that time. So, when I went back to him this year for advice about what else I can do he mentions Inspire. I asked him about what he had said before and he said things have changed, I inspire can help with all of these issues. Okay. So, I had the surgery. But it's not helping. I have been back three times and met with the Inspire rep. He's made changes on the Inspire every time but nothing helps. When I spoke to him recently he said it looks like Inspire is not going to be what I need.
I have an appointment with this ENT Monday. I'm thinking that the only thing I can do is have a tracheostomy. I know that there is another surgery that removes tissue around the throat but I'm told that this is not done much anymore because it's so invasive. It has a 50/50 chance of success and is extremely painful. What other choices do I have? Not many that I can see.
Has anyone gone tracheostomy route? How did it go? How do you feel about it? Was it worth it?

Michael

[Sleeprider]

Michael, maybe you can make a simple change to improve your chances of fixing this without tracheostomy. We notice that many of our members have periodic clusters of obstructive sleep apnea, and some of them remain severe all night long regardless of pressure. For those individuals, we often try to use a soft cervical collar to keep the chin from tucking or to help maintain a straighter airway. With this mitigation, most succeed. This is so common, we have a wiki to explain it. Be sure to also read the positional apnea wiki linked in this article. http://www.apneaboard.com/wiki/index.php...cal_Collar

Give this a fair shot. It may take trying different sizes and styles of collar, but It can work as shown by the examples. It is certainly worth a shot vs a tracheostomy.

Two ways to check for this Positional Apnea,

Sit relaxed in a chair and as you fully relax let your chin drop to your chest and note the increased airway resistance that may range from an increased effort to a snore or full blockage.
Another test is to gently push upward on the soft part of your jaw or neck right in front of the throat.
If your airway easily closes from that pressure, positional therapy in the form of a soft cervical collar or wedge may significantly improve your results.

[Michael208]

Thanks Sleeprider. I tried that sitting in my chair and dropping my chin. I don't really think there was a whole lot of difference. But I tried the other thing and the more I pushed up the more resistance to breathing I felt.

[Sleepster]

I doubt very much that you can find a doctor who will do a tracheotomy on you. When you say you failed CPAP what do you mean?

[Michael208]

If a tracheostomy is the only thing that will help me why wouldn't a doctor do it? It's not that I particularly want it. It's a treatment of last resort.
I failed CPAP due to the way that I am made. I have an arched palate, a large tongue, and a small throat, all textbook problems that lead to apnea. I had a sleep endoscopy that showed my entire throat collapses. The pressures on CPAP have to be so high to overcome these things I get air in my belly along with frequent mask leaks and frequent sleep disturbances. Dial down the pressure to alleviate this and the AHI's go up. We even tried BiPAP.