Marc's Public Blog - OSA, Obstructive Sleep Apnea and MMA Surgery

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This page has a few of my blog posts about my issues with OSA, Obstructive Sleep Apnea, which basically means not being able to breathe at night and having restless nights, night after night.
Because my sleep apnea scored low but somehow the impact on me was fairly high, it took a while to diagnose, and I tried several things before eventually getting Maxillomandibular Advancement Surgery (MMA) to fix my airway for good.

I made this summary page after the fact, so it starts with a few sleep studies I likely did 5 years later than I should have.

Table of Content for osa:

More pages: December 2011 May 2011 March 2011 December 2010 August 2010 July 2010 January 2010 December 2009 July 2006 April 2006 November 2005 March 2004

2010/01/27 Dealing with OSA, obstructive sleep apnea
π 2010-01-27 01:01 in Osa
Some of you already know that I've had sleep issues, probably since at least 2000, 10 years now. It took about 5 years for me to decide that it was bad enough that I should do something about it (i.e. it wasn't so bad, but it was increasingly nagging and robbing me of a quality of life, a little bit at a time) and for the last 5 years.
I'm actually a fairly mild case compared to other patients, but it impacts me enough (usually randomly) that I want to do something about it.

RDI: respiratory disturbance index, number of complete cessations (apnea) and partial obstructions (hypopnea) of breathing occurring per hour of sleep. More than 5 is not normal, bigger is worse.

REM, NREM RDI: REM and non REM RDI indexes. REM sleep is when you dream, and when the body is mostly paralysed which makes sleep apnea worse since the muscles and tongue relax, which in my case will cause the tongue to go back and further close the airway.
It is still not well understood how important REM sleep actually is, but it seems to have somewhat important needs, some most likely linked to memory.

Oxygen blood saturation (SO2%) is vital to good health and proper body functions. Normal range is 95-100%. 90% and below is considered not good. Here are some details:

85-95%: zone of minimal sensory impairment
75-85%: zone of minimal mental impairment
65-75%: zone of increasing sensory & mental decrement
55-65%: zone of potential collapse

Results are below.
(TAP3 means my sleep appliance, or retainer like device that keeps my bottom jaw more forward when I sleep wherewas notch means how far said appliance is pushing my bottom jaw forward)

RDI REM RDI NREM RDI avgSO2% minSO2% #1 2005/05/11 11.9 18.8 11.1 96% 87% before surgery (mary sleep study)

#2 2006/10/11 11.8 35 7.3 97% 88% after tonsilectomy (stanford sleep study)

#3 2007/09/17 7.6 9.2 2.2 96% 81% TAP3 notch 1 (stanford sleep study)

#4 2009/10/27 7.0 10.3 6.1 97% 93% w TAP3 notch 3 (take home study)

#5 2009/10/30 15.4 31.7 10.9 96% 91% w/o TAP3 (take home study)

#6 2009/12/14 17.2 19.1 10.5 96% 90% w TAP3 notch 3 (stanford sleep study)

Some notes:

  • #1 was my first sleep study to see where I was at and from which I decided to have surgery to improve things (tonsils removed to make more room in the airway, and improvement of my nose airflow too).
  • #2: Stanford was more precise in 2006 than the first place I had my sleep study at, which could half explain why having my tonsils removed didn't actually help my scores at all, but with those results, the surgeon admitted that in my case the surgery may not have helped me too much (it was only a 40% shot in my case anyway).
  • #3 shows some improvement from the sleep appliance. That was good news.
  • #4 and #5 were taken with a sleep at home test which isn't nearly as accurate as the stanford tests but still do show that the sleep appliance is clearly improving my scores, the only question being by how much and whether the resulting scores are good enough (which is all relative).
  • #6 is my last sleep study. That one is actually disheartening: the scores are about as bad today with the sleep appliance as without 4.5 years ago (even if the scores aren't quite on the same scale since stanford has now gotten better at sensing even smaller problems, yielding to higher scores).
  • What now?
    I have had CPAP recommended to me more than once, which is basically a respirator-like device that shoves air into your nose via a tube while you try to sleep. I'm personally not interested in that, I don't want to sleep with a machine for the rest of my life.
    There is also provent which is a passive device that makes breathing out hard and helps your airway being more open. It is unfortunately just a small improvement at best, and my airway and OSA problems are only going to get worse with age, so this is just delaying the problem just a bit longer.

    What's left is MMA, which basically involves sawing the top and bottom jawbones and moving the entire jaw forward to where it should have been in the first place. This is really the only way to improve my airway since my problems are really linked to my bottom jaw being too far back to start with, and my airway being too small as a result.

    Since I already know a local surgeon who is likely one of the best in America (stanford is where many of the world specialists are), it seems that this is just the logical next step for me to take, and I am looking into it now.

    More pages: December 2011 May 2011 March 2011 December 2010 August 2010 July 2010 January 2010 December 2009 July 2006 April 2006 November 2005 March 2004

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