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7 Common Procedures That Can Worsen Sleep Apnea

Millions of surgical operations are performed every year to improve your health, beauty, and even your smile, but there’s a hidden danger in some of the most common procedures that can aggravate if not actually cause obstructive sleep apnea. Sleep apnea happens when your jaws are too narrow, which constricts the internal soft tissue layer that lines your upper breathing passageways, from your nose to your throat. More than a few times a week, I see patients that underwent procedures in the past that clearly was detrimental to the quality of their sleep. Here are 7 common and uncommon procedures that can affect the way you breathe and sleep.

1. Rhinoplasty

One of the most common procedures that’s performed today is your routine nose job, or rhinoplasty. In most cases a hump is taken down, or the tip is made more narrow. In the process, certain support structures are weakened, with flimsy nostrils resulting many years later. In the 1950, the Goldman tip was one of the more popular styles, where the tip of the nose was made very narrow and lifted up slightly. With any procedure that narrows the tip, a portion of the lower lateral cartilages have to be either removed or weakened. This cartilage is one of the main support structures that keeps your nostril from collapsing inwards.

Initially after the procedure, patients can breathe well, but years or decades later, with constant inspiration and vacuum forces from routine breathing, the nostrils slowly cave inwards, worsening nasal congestion.

We know that nasal congestion can aggravate or cause obstructive sleep apnea. This is why nasal packing after any surgery is a miserable experience, and why you’ll toss and turn whenever you have a cold (from a stuffy nose). If your jaws are already narrowed, you’re more likely to have a nasal hump and narrowed nasal cavity, so worsening nasal congestion can only aggravate breathing problems downstream. Underdevelopment of the midface pulls the upper lip and the lower cartilaginous nose down, creating the classic nasal hump.

Even with contemporary rhinoplasty techniques, it’s important to prevent this from happening using proper technique and by minimizing removal of excessive cartilage.

2. Orthodontics / Headgear

I’m sure you’ve seen children wear headgear in past years, with a brace around the head and wires pushing or pulling teeth. Children with overjets (overbite) were managed by pushing the upper teeth back, thus creating the illusion of a proper bite. The fact is that in these children, the lower jaw is underformed, and the best thing to do is to pull the lower jaw or teeth forward to match the upper teeth.

Additionally, some orthodontists still extract teeth to make room for the remaining teeth. Your smile may be nice, but in the process, your jaw just became smaller. Any amount of narrowing of your jaws creates less room for your tongue, and with muscle relaxation in deep sleep, you’ll stop breathing much more often. It’s bad enough that modern human’s jaws are shrinking more and more (due to a radical change in our diets and with bottle-feeding), but when you start to extract multiple teeth, you’re definitely going to have problems breathing. The back molars also act to support the soft tissues of your throat. So removing your molars can destabilize the soft palate, aggravating more soft tissue collapse, especially later in life.

3. Jaw Surgery

Once in a while, I’ll see patients that underwent lower jaw surgery to push back a prominent lower jaw. In this situation, the upper jaw should  have be pulled forward. Since the base of your tongue attaches to you back of your mandible, any backward movement of your jaw can push your tongue back, aggravating breathing problems while you sleep.

4. Thyroglossal Duct Cyst

The thyroid gland starts at the back of your tongue and migrates down your neck in front of your voice box, and then divides into your right and left thyroid lobes with a small connection between the two over the top of the windpipe. Sometimes, a remnant of that tract from your tongue to the voice box can remain, with cysts or tracts or even thyroid tissue along this pathway. When a cyst develops, you’ll have a midline ball or swelling that won’t go away. The treatment for this condition, called thyroglossal duct cyst, it surgical removal.

The procedure is classically called the Sistrunk procedure, named after the surgeon that originally described it. The critical part of this procedure involves removed the midline 1/3 of the hyoid bone, which is a c-shaped bone that sits on top of your voice box. Unfortunately, you’re also weakening and destabilizing the attachments to the tongue and voice box. Upon questioning the handful of patients that have undergone this procedure in past years (some by me and some by other surgeons), most have said that their sleep quality worsened. If you’re ever going to undergo this procedure, it’s important to reattached or reconstruct the tissues that help to support your tongue and voice box.

5. Hysterectomy

Total hysterectomy with or without removal of the ovaries is a common procedure for many women. We know that especially when the ovaries are removed, this creates a state of surgical menopause. I’ve described in past articles that as progesterone naturally drops in normal menopause, sleep quality can diminish, mainly due to the effects of progesterone on tongue and upper airway muscle tone. As the tongue muscle tone slowly drops, obstructions and arousals become more frequent, and you won’t sleep well.

This is also one of the main reasons why hormone replacement therapy (HRT) helps many women sleep better. However, with the recent finding that HRT can increase rates of cancer, it’s not generally recommended anymore. If you’re thinking about undergoing a hysterectomy, be prepared not to sleep as well.

6. Breast Implants

If you’re a woman and like to sleep on your stomach, then getting breast implants can definitely worsen your sleep quality. For a few weeks after this procedure, most surgeons will ask you to sleep on your back. The problem is that when on your back, your tongue will fall back more often, leading to more frequent breathing obstructions and arousals. Until you’re able to go back to stomach sleeping, be prepared to lose a lot of sleep. Unfortunately, some women are never able to sleep on their stomachs again, being forced to sleep on their sides or back.

7. Any Type of Surgery

No matter what type of surgical procedure you undergo, if you’re forced to sleep on your back, then your sleep apnea will be worse. If you never had sleep apnea or sleep-breathing problems, then being on your back may bring on your first experience, especially if you’re a natural side or stomach sleeper.

As you can see, millions of people undergo these procedures every year. Sometimes, the effect on sleep occurs immediately, whereas in others, it can take months or years to surface. If you’re planning any of the above procedures, or if you’ve undergone any in the past, think about how it can potentially affect your quality of sleep. It’s something you should definitely sleep on.

Ask Dr. Park: An Insider’s Guide To Sleep Apnea Surgery

Secrets To Sleep Apnea Surgery…

Are you confused by all the conflicting information about sleep apnea surgery? Does it work? Which procedure is right for you? Which surgeon do you choose? In this Ask Dr. Park Teleseminar Program you will learn about Sleep Apnea Surgery. Even if you’re not considering surgery the good think to learned what the other option are and the rational of offering a surgery.

Learn:

• Why consider Sleep Apnea Surgery?
  

• Are you a candidate Sleep Apnea Surgery?

• In-depth descriptions of different Sleep Apnea procedures.
  

• How to find the right Sleep Apnea surgeon.
  

Click here to purchase MP3 recording.

The Biggest Ear Problems for Sleep Apnea Sufferers

If you have obstructive sleep apnea, chances are, you’re likely to have some sort of an ear problem. There are a number of reasons why you’re going to be prone to various ear problems, but in many cases, the problem is not actually coming from the ear. To better manage your ear issues, you first have to understand your ear anatomy, and the different types of inflammation caused by sleep apnea. In the last part of this article, I’ll go over some tips to help you solve many of your ear-related issues.

What You Must Know About Ear Anatomy

The ear drum is a thin membrane that separates the middle ear cavity from the outer ear canal. Sounds waves vibrate the ear drum, which connects via a sophisticated lever and piston amplifier system that transmits sound waves to the inner ear. Normally, the middle ear cavity should have the same pressure as the outer ear canal. This is made possible by the function of the eustachian tube, which connects your middle ear cavity to the back of your nose. Whenever you swallow or yawn, your palatal and throat muscles open up the eustachian tube temporarily, equalizing pressure between the middle ear and the nose. You can think of the middle ear as a sinus—an out-pouching from the nose into an adjacent pocket of bone or soft tissue.

Whenever you go up an elevator or descend during a flight, the atmospheric pressure either goes up or down, and this creates either positive or negative pressure in your middle ear. With very slight pressure changes, you’ll feels a bit of fullness and hearing loss, but with severe pressure changes, you may even have pain and discomfort. If you keep swallowing, then you’ll keep popping open your ears. As a result, you’ll feel anything from fullness, hearing loss, popping, clicking, buzzing, or even ringing. This is why it’s recommended that you chew gum during descents in flights, or give the baby a bottle to feed.

Causes Of Inflammation

However, if you have any degree of inflammation in your nose, then additional swelling can prevent proper equilibration of air between your middle ear and nose. A number of different causes can aggravate swelling, including viral colds, allergies, weather changes, and even acid reflux.

You’re probably very familiar with the effects that a simple cold or allergy can have on your nose and ears. In most cases, you’ll have a few days of discomfort. But in certain situations, your cold or allergy may go away, but your ears will continue to be stuffed for days or weeks. Sometimes, the vacuum pressures that are created can cause fluid to accumulate, giving you what’s called serous otitis media. Rarely, this fluid can get infected and turn into the classic bacterial infection or otitis media. Fortunately, not too many people have true bacterial infections—most never make it past the vacuum pressure or clear fluid stages.

A Vicious Cycle

If you don’t have obstructive sleep apnea, the entire process can come and go within a few days to weeks. However, if you have sleep apnea, due to the additional inflammation that’s created, a simple ear or sinus problems can linger for weeks, and sometimes even months for the following reason: Any additional inflammation in the nose or throat causes swelling which can aggravate more frequent obstructions, leading to stomach juices to come up into the throat and nose, including in the area of the eustachian tubes. Furthermore, frequent obstructions and arousals leads to an imbalance of your involuntary nervous system, where your nose is going to be overly sensitive, especially to weather changes (pressure, temperature, and humidity changes). This is called chronic or non-allergic rhinitis.

For some people using a CPAP machine can blow air into the middle ears, through positive pressure. This can be a frustrating issue that’s difficult to cure completely.

Solutions For Your Ear Problems

So if you have obstructive sleep apnea and are prone to ear problems, what can you do? The first thing to make sure of is that you’re treating your sleep apnea condition optimally. If your CPAP pressure is too low, or your dental device is undercalibrated, or your UPPP procedure was only partially effective, then you’ll still have residual obstructive sleep apnea and are still feeling the effects of intermittent obstructions and arousals.

Second, make sure that your nasal breathing is optimal. By definition, your nasal passageways will be either narrowed, inflamed, or both. Having a chronically stuffy nose can create more of a vacuum effect downstream, which allows the tongue to fall back more often when in deep sleep, due to muscle relaxation. If you’re using CPAP, then it’s likely that your pressures may be too high, which can make it uncomfortable, and even blow air into your ears. Whether through vigorous saline irrigation, allergy avoidance, medications, or surgery, it’s important to make sure you’re able to breathe well through your nose.

Lastly, it’s important to lower inflammation in your throat by making sure you’re not eating within 3-4 hours of bedtime. Having even 2-3 apnea or hypopnea episodes per hour, although acceptable, can still suction up juices into your throat. Since you’re going to suction up normal stomach juices anyway, it’s important to keep the acidity and juice volume as low as possible. The same rule applies to alcohol, since not only does it produce more stomach acid, it also relaxes your tongue and throat muscles, causing you to stop breathing more often.

Ear problems are an inevitable part of having obstructive sleep apnea. By knowing what can cause ear problems and how you can deal with it, you can minimize the discomfort to a point where it’s tolerable or minimal.

Is Your Father Going Through Menopause?

Over the past year, ever since the birth of our third son, Brennan, I've been more tired than usual. Not too unexpected when you have a newborn, right? Add to this having to help my wife tend to the needs of our two older boys, who are 7 and 10. But even now when Brennan is sleeping well through the night, and I'm sleeping about 7 hours every night, I'm still more tired than I used to be, despite running 3 times per week, and being as fit as ever. Could I be going through male menopause?

The Facts of Male Menopause

I wrote last month about how mothers can suffer from poor sleep due to the effects of menopause on sleep quality, but what about fathers? You may have heard about male menopause, or more precisely, andropause. It's not that well known, and even if it happens, it's so slow and insidious that most men don't realize it's happening.

Well, it turns out that men go through a similar transition during the mid-life years. Not only does testosterone slowly drop, but thyroid levels as well. Our traditional medical culture and even holistic and alternative doctors sometimes argue that aging is a deficiency of certain hormones, vitamins or minerals, and that replacement using synthetic or natural supplements is the answer. But is  that the only answer?

Most people think that this is a natural part of aging, along with the typical memory loss, balding, wrinkles and lowered energy and stamina. But what if I told you that I routinely see even young to middle aged men who complain about hot flashes, night sweats, mood swings, insomnia and irritability—or all the prevailing symptoms of menopause?

Aging As A Consequence of Poor Sleep

In my book, Sleep, Interrupted, I describe a sleep-breathing paradigm where all modern humans are on a continuum, where we're all susceptible to sleep-breathing problems to various degrees.

As you age, it's expected that overall, you'll keep moving up this continuum to the point where sleep breathing problems become much more serious as in obstructive sleep apnea. Not only do we sag and bulge on the outside as we get older, it also happens on the inside, including your upper airway. And as your airway becomes narrower, the more trouble you'll have breathing while sleeping, and this in turn will make you wake up more and obstruct more.

Women experience more dramatic changes in hormone levels (particularly progesterone) that affect upper airway patency, but levels of testosterone and even small amounts of progesterone can also influence upper airway muscle tone in men as well; Not to mention the typical weight gain that occurs in the middle years, leading to even more narrowing of the upper airway. Adding any degree of inflammation to the upper airway (such as from a cold, allergies, or reflux) can cause more frequent obstructions and arousals. Poor sleep efficiency leads to weight gain, and weight gain narrows the throat.

Sleep Apnea And Aging

It's a given that as you age, your upper airway begins to narrow gradually, aggravated intermittently with additional narrowing from inflammation. This is also why men begin to develop cardiovascular disease as they get older. Women are somewhat protected before menopause, but afterwards, they begin to catch up when it comes to rates of heart disease. As you slowly move up the sleep-breathing continuum, your risk of developing obstructive sleep apnea increases, and once it begins, a vicious cycle begins, where poor sleep aggravates weight gain, and weight gain aggravates poor sleep.

Poor sleep (by causing a physiologic form of stress) also causes major hormonal changes by lowering your thyroid levels, as well as your reproductive hormones. So naturally, if you test for thyroid or testosterone levels, it may come back on the low side. Not too unexpectedly, supplementing with replacement hormones helps in some cases, but not all the time.

We know that untreated obstructive sleep apnea (OSA) can aggravate or cause routine medical conditions such as diabetes, high blood pressure, depression/anxiety, heart disease, heart attack and stroke. Your risk of car accidents also increases anywhere from 3 to 10 times normal if you have OSA. Add to this all the other common expected conditions that you may experience as you get older: frequent bathroom trips, balding, erectile dysfunction, hearing loss, and even Alzheimer's.

Taken at face value these seemingly disparate symptoms of old age aren’t all that unexpected. However, if you look at them from the perspective of my sleep breathing paradigm, you’ll begin to see how it’s your breathing and not necessarily your age that’s making you feel sick and tired.

Too Many Bathroom Trip—Risky For Your Health

It's been shown that going to the bathroom frequently at night is not because you're making too much urine, but because you stop breathing and you think you have to go to the bathroom. One recent study showed that going to the bathroom two or more times per night increases your chances of dying by 50%. There have even been many anecdotal reports of hair regrowth after definitive treatment for sleep apnea. Erectile dysfunction (ED) is a very well-known complication of sleep apnea. Having ED can predict the presence of sleep apnea in the majority of patients.

Brain Damage From Poor Breathing While Asleep

Untreated sleep apnea also increases your chances of microscopic strokes and small vessel blockages in multiple, critical areas of the brain. One recent study showed that sleep apnea patients have 20% smaller brain volume in the Mammary bodies. Another showed smaller brain tissue densities in critical areas of the brain that controls memory, executive function, breathing and respiration. Untreated sleep apnea patients have much more viscous (thick) blood that can stagnate and clot in small vessels in the brain. One area that's particularly sensitive are the small vessels that supply the high-frequency sensing areas of the inner ear.

All these issues begin when you're young, but begin to manifest in your middle years, progressing to full-blown medical complications when you reach your 60’s and 70’s. As you can see, how narrow you upper breathing passageways are determines how quickly you age or how often you become sick. Now that I'm in my mid-40s, if I don't get at least 7 hours of sleep, or if I eat later than usual, I definitely feel worse the next day. This is why it's important to do everything possible to breathe well at night while sleeping, in addition to a healthy lifestyle that includes a good diet, regular exercise and smart decisions when it comes to your sleep.

Proven Weight Loss Strategies for Sleep Apnea Sufferers

My wife just commented to me that just by eating dinner about one hour earlier than usual for the past few weeks, she's automatically lost about 2-3 pounds. We normally eat about 3 hours before bedtime, but by the time we finish dinner and have fruit for dessert, it's about two and a half hours before we go to bed at 10PM. Even our children now seem less tired and more alert during the day. Although we decided to make this change to increase our sleep quality, my wife's weight loss was an unexpected side effect. So how does this apply to sleep apnea sufferers?

The Sleep Apnea Stereotype

At almost every sleep apnea lecture that I've seen in my career, the speaker almost always puts up a picture of Joe the fat boy from Dickens' The Pickwick Papers. If you read any scientific study about obstructive sleep apnea, it almost always starts with, "…typically seen in middle aged or older obese men who snore heavily with large necks."

Although described 30 or so years ago in these stereotypical men, now we know that it can occur even in young, thin women who don't snore. But many overweight people, especially as they get older, will snore or have obstructive sleep apnea. It's estimated that overall, about 24% of men and 9% of women will have it, but by the time you reach your 70 to 80s, the incidence about 55%. Being overweight is still a major risk factor for development of obstructive sleep apnea. If you're overweight and have sleep apnea, then it's much harder to lose weight than if you didn't have sleep apnea. Let me explain why.

How Hormones Affect Your Appetite

It's been proven that poor sleep (quality or quantity) can promote weight gain through various mechanisms. Leptin is one major hormone that provides information about energy status to your brain—essentially, it tells your brain that you have enough energy. Low levels of leptin causes hunger. Normally, leptin increases after you eat, but sleep deprivation lowers this hormone, making you hungry. As leptin drops, your cortisol levels will also increase. As I've mentioned numerous times in my book, Sleep, Interrupted, poor sleep efficiency cause a low-grade physiologic stress reaction that increases your cortisol levels. This hormone also makes you more hungry. Other studies have shown that not only will you be more hungry, you'll tend to crave fattier, sugary, high carb foods.

You can imagine how once this process starts, it's a vicious cycle: Poor sleep makes you more hungry, so you eat more or snack close to bedtime. More frequent obstructions causes your stomach juices to be suctioned up into your throat, causing more inflammation and swelling. These juices can then go into your nose and lungs, causing further inflammation and swelling. Weight gain then narrows your throat further, aggravating sleep apnea, which makes you sleep less efficiently.

First Steps Toward Losing Weight

So what can you do if you have sleep apnea and are overweight? Is it hopeless?

Fortunately, there are steps that you can take that if followed properly, can not only help most people lose pounds, but also sleep better in the process. The first and most important thing is to eat as early as possible before bedtime. I know I keep repeating this, but you'll be surprised by how many people continue to eat late or snack just before bedtime. Three to four hours is the general recommendation to avoid eating before going to bed. The only thing you can have is water within this timeframe. The same goes for any kind of alcohol, since alcohol relaxes your throat muscles, aggravating obstructions and arousals.

The second most important thing to do is to make sure that you can breathe well through your nose. If your nose is stuffy, the challenge is in figuring out what's causing your nasal congestion, since there are a number of different reasons. In many cases, there's more than one reason. This is a huge topic that I cover in my Ask Dr. Park teleseminar called Un-Stuff Your Stuffy Nose. I also have various articles and blogs about this issue on my website at doctorstevenpark.com.

Needless to say, you also have to eat healthy and exercise regularly. I'll leave the specific recommendations for other respective experts in this area. One thing to point out, though, is that if you lift weights or engage in any activity that bulks up your upper chest and neck muscles, remember that your upper airway is unprotected, and that that any degree of neck muscle enlargement and press in on your upper airway. This is why many bodybuilders and weightlifters snore.

Eating earlier helps to reduce inflammation and swelling in your throat, and better nasal breathing lessens the vacuum effect that's created in the throat when you breathe in while sleeping. These two steps alone (along with eating healthy and regular exercise) will help many people, but to various degrees. For some, making these conservative changes alone may be enough, but with others, they will need some form of formal treatment for their obstructive sleep apnea. I won't get into the treatment options for sleep apnea since that's a HUGE topic in itself. For more information about sleep apnea treatment, I have lots of practical information on my website or you can find one comprehensive resource by reading my book, Sleep. Interrupted.

Sleep More, Lose Weight

Lastly, most people in general are sleep deprived. Lack of sleep, in addition to inefficient sleep due to sleep-breathing problems, can also cause similar weight promoting issues. A great example is when Glamour magazine asked women volunteers to try to get consistently 7.5 hours of sleep every night for 10 weeks. Many women lost anywhere from 6 to 15 pounds, all just by sleeping more. Studies have shown that lack of sleep (5 hours or less) per night is a major risk factor for significant weight gain.

So whether or not you are overweight, the recommendations outlined above will help you to breathe better and sleep better. Even if you are thin and don't have obstructive sleep apnea, following these recommendations can the onset of sleep-breathing problems and ultimately lessen the risks that can go along with obstructive sleep apnea. If you are overweight, this is the first step toward losing unwanted pounds.

An Insider’s Guide to Septoplasty

The septoplasty operation is one of the most misunderstood surgical procedures that lay people, and even many physicians have. Some people even equate septoplasty with having a nose job, which is not true. Although, some people use having a crooked septum as 

an excuse to undergo a rhinoplasty, septoplasty, done correctly, can help patients breathe better, and more importantly, sleep better.

Understanding the Anatomy

In order to fully appreciate if septoplasty is the right procedure for you, you must understand the anatomy of how it’s done.

The nasal septum is the midline cartilaginous structure that divides the two halves of your nasal cavity. The part in the back of the septum is made of bone. Whenever the septum is crooked to a significant degree, your nose can be stuffy, and a septoplasty can be offered if medical therapy doesn't work.

However, having a crooked septum doesn't mean that you'll have a stuffy nose, or that you'll need a septoplasty. No one has a perfectly straight septum. There are other parts of your nasal anatomy that contributes to your ability to breathe, which includes your nasal turbinates and your nostrils. The turbinates are wing-like structures that jut in from the side-walls of your nose that look like wings. They normally warm, filter, smooth and humidify the air that you breathe. Inside this structure is the bone and the outside is a mucous membrane lining. The middle part is made of very vascular tissues that can swell tremendously when filled with blood. This is regulated by your involuntary nervous system. This nervous system normally swells and shrinks the turbinates, alternating from side to side, every few hours (called the nasal cycle).

Do You Have Flimsy Nostrils?

The other structure that is often overlooked is your nostrils. For most people, breathing in causes a mild vacuum effect that causes a mild collapse and a constriction of the nostrils. But in some people with either flimsy or weakened nostrils (from a prior rhinoplasty), they collapse very easily, even with a slight bit of inspiration. If you are one of these people, you may benefit from nasal dilator strips (Breathe-rite is one brand). Sometimes these strips are not strong enough, or it can irritate the skin. Another option is to use internal nasal dilators which work much better. Some of the more common brands are Breathewitheez, Nasal Cones, and Nozovent.

What's Involved with Septal Surgery? 

The septoplasty procedure can be done in conjunction with a turbinate procedure. There are many ways to perform a septoplasty, but the most important point is that it should be done well. The septum is covered on both sides by a mucous membrane. After an incision is made inside the nose on the mucous membrane, this layer is peeled away from the septal cartilage. The other side is also entered, which creates two tunnels on either side of the septal cartilage. The crooked part of the septal cartilage is next removed. Some surgeons either soften the cartilage or flatten it out and place it back, and others leave it out completely. In many cases, a small portion of bony spur that juts out at the base of the septal cartilage is also removed. The last part of the operation is where different surgeons use different techniques. Traditionally, thin plastic sheets with or without soft sponge-like packs are placed against the septum on both sides to keep the mucous membrane together for proper healing. If a large clot of blood forms between the two mucous membrane layers, the remaining cartilage may lose it's blood supply and literally melt away. 

Because the entire procedure in done inside the nose (or endoscopically), there is no swelling, bruising or changes to the outside of the nose or face (unless a rhinoplasty is done simultaneously).

What to Expect After Surgery

Nasal packing, if placed, are removed anywhere from 1-3 days after the procedure. Many patients report that this is one of the most uncomfortable parts of undergoing this procedure. Some surgeons, like myself, don't use any packs or splints using the following method: compressing the two mucous membrane layers by sewing the two layers together using an absorbable suture, like a quilting stitch. This way, nothing needs to be removed, and you're breathing much better right after the surgery. It's expected with this procedure that your nose will get clogged up after a day or two with accumulation of blood, mucous and debris.

This operation is usually performed as an outpatient procedure, so you'll go home a few hours after surgery. It's usually performed under general anesthesia, but can also de done under local anesthesia with sedation for certain situations. Most people can go back to work after a day or two. Heavy straining or lifting should be restricted for about one week. In my practice, I see the patients about 2 days after the surgery, when the nose is cleaned of all the accumulated debris. Some people need a second cleaning 1-2 weeks later.

Typically, it may take a few weeks to months to feel the full benefits of this operation. During the first few weeks, crusts will build up and fall out as wounds heal. This is also the time when the swelling from the surgery goes away. Afterwards, scarring and tightening of the soft tissues can take weeks to months. You may have your ups and downs in the first few weeks, but you should see consistent improvement by 3-4 weeks. 

Most people don't use any pain medications, but one is prescribed just in case. You'll probably be more bothered by the sore throat from having a breathing tube placed during intubation.

What Are The Risks?

Complications are rare, but with any surgical procedure, there is a small chance of infection or bleeding. There is also a small risk any time someone undergoes general anesthesia, which includes, allergic or medication reactions or airway problems. In terms of overall risk, it's riskier when you cross the street. Other very rare complications such as smell loss or a hole in your septum have been reported. 

A septoplasty, if done properly, is one of the most gratifying procedures for both the patient and the surgeon. Success rates are very high. However, there are a few percent of patients where nasal congestion still persists, or it comes back after a few weeks to months. In this situation, there are two main possible reasons: there is persistent turbinate swelling due to inflammation, or you have flimsy nostrils. There are treatment options for both theses conditions.

5 Things You MUST Know About Sleep Apnea Surgery

Sleep apnea surgery is one of the most controversial subjects in sleep medicine. There are heated debates within the sleep community as well as in online forums and support groups. Sleep apnea surgery is definitely not for everyone, for some, it can be a life-changing experience. Here are 5 important issues that you must be aware of before considering any form of sleep apnea surgery:

1. Does sleep apnea surgery work?

Yes, but only when done properly. Just like with CPAP or dental devices, if you don't use it properly or use it at all, it won't work.

One of the most common misconceptions about sleep apnea surgery is the relatively low success rate of the uvulopalatopharyngoplasty (UPPP) procedure, which is often quoted at 40%. But performing this operation is like bypassing only one blocked heart vessel when you have 3 other vessels that are blocked. For some strange reason, ENTs are overly obsessed with the soft palate, since this is where snoring usually comes from and we have the most research and procedures for the soft palate.

We now know that if you address the entire upper airway together (nose, soft palate, tongue), then your success rates are much better, approaching 80%. Why only 80%? There's only so much you can do with the soft tissues within the small space within smaller jaws (which is the main anatomic reason for sleep apnea). The more aggressive you are, the higher the success rate, but the more chance of pain and complications.

If you go to the next level and enlarge your jaws (upper and lower), then success rates can reach 90 to 95%.

To put things into perspective, if you bypassed everything with a tracheotomy (placing a breathing tube below your voice box), then you'll have a 100% "cure", but obviously, this is not a very practical option.

One question you must ask then, is, what's the meaning of success? In surgery, one common definition is that the final AHI (apnea hypopnea index) on a formal sleep study drops greater than 50% of the original and the final number has to be less than 20. One of the main criticisms of sleep apnea surgery is that even if "successful", you may still have mild sleep apnea. Surgeons will argue that it's better than not using CPAP at all.

2. Not All Surgeries Are The Same

There are probably dozens of procedures for sleep apnea from various nasal, soft palate and tongue operations to skeletal framework procedures. These can range from minimally invasive to major surgery. The problem is that by definition, they'll all work to a certain degree. For example, procedures for a stuffy nose have been shown to "cure" sleep apnea in 10% of patients. But for the most part, none of these options by themselves have very good success rates.

The key is to examine the upper airway for each individual and figure out where the obstruction is and take care of it simultaneously. Most people have more than one area of obstruction. Surgeons at Stanford have about a 75 to 80% success rate with soft palate and tongue base procedures. This is called multi-level surgery for sleep apnea. You have to look at the airway from the tip of the nose all the way to the voice box.

3. There's No Cure for Sleep Apnea

Unless we all undergo tracheotomies, there's no way to prevent breathing pauses at night. Modern humans' upper airway anatomy is thought to be predisposed to breathing problems at night, which only gets worse as we age. I talk about why this problem has gotten much worse in recent years in my book, Sleep, Interrupted. All of us are on a continuum, where various factors (anatomy, age, weight, inflammation, etc.) contribute to forces that make our tongues and palates to collapse. The older we get, we'll either gain weight, which narrows our breathing passageways, or our throat tissues will sag and collapse easier.

Surgery will shift the line of this continuum downwards, but it won't bring it down completely. This is why it's important to incorporate a healthy diet and lifestyle and exercise regimen into any sleep apnea treatment regimen.

For most people, lowering the numbers significantly will make you feel much better. But sometimes, the numbers will go down dramatically, but you may not feel any better. This just goes to show that there may be other issues besides sleep apnea that have to be addressed. You've had sleep apnea for years or decades. Just by fixing your sleep apnea won't immediately fix problems that can arise from sleep apnea, such as hormonal problems, weight gain, or memory problems and brain fog.

4. Surgery is the Last Resort, But Don't Rule It Out

Admittedly, there are many people who rush to surgery prematurely, but there are also many others that aren't even offered surgery due to misconceptions by physicians. There are also many patients that are turned off by all the conflicting information that's available on the internet.

Before you even think about surgery, make sure you've tried or considered all the other options thoroughly. Most people who fail CPAP do so because of poor counseling, support and follow-up by the medical system. Just like everything else with life, your chances of success depends on which doctors you see. The follow-up and support offered by your CPAP equipment vendor can also play an important role in whether or not you'll benefit from CPAP. The same issues also apply with dental devices for sleep apnea.

This is why it's important to educate yourself about all the treatment options, and not to give up too easily. Too many people give up at this point, and don't consider any further treatments. Surround yourself with a group of trusted doctors and professionals that forms a team. Use their expertise and guidance to find a way to make things work. If nothing works for you, don't rule out surgery just for the sake of avoiding surgery. Learn and educate yourself about surgery before rejecting it.

5. How to Find the Right Surgeon

Finding the right surgeon for your sleep apnea condition can be challenging. Everyone claims to specialize in snoring and sleep apnea surgery. Who are you to believe?

First of all, find someone who's comfortable performing a wide range of procedures in all the three areas of the upper airway (nose, soft palate and tongue). Are they familiar with the minimally invasive procedures as well as the standard options? No everyone will be an expert at all the procedures, but it's important to know about all the other options as well as well as to make appropriate referrals when necessary.

There are a variety of "minimally invasive" procedures out there, especially for the soft palate, but these procedures have to be offered very selectively. Even if successful initially, is your surgeon prepared for relapsed that are likely years later? Is the goal of surgery only to cover up the snoring, or will it treat the underlying anatomic causes?

If your surgeon recommends palatal surgery "just to see," without addressing the entire upper airway from the nose to the tongue, go for a second opinion. If you do decide to undergo a palatal procedure (with or without tonsillectomy), be prepared for a 60% failure rate, which means that the tongue needed to be addressed as well. Sometimes, more needs to be done to the soft palate or the nose has to be addressed. Everyone is different, and the treatment recommendations have to be tailored to the individual.

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For a more detailed free report on The Truth About Sleep Apnea Surgery, click here.

5 Surprising Facts About Maxillomandibular Advancement Surgery Revealed

Expert Interview with Dr. Kasey Li

Dr. Park Interviews world renowned expert on maxillomandibular advancement surgery, Dr. Kasey Li. During this 60 minute call, Dr. Li shares his wealth of experience and knowledge about this procedure.

 

 

Discover:

• The real truth about sleep apnea surgery and if the MMA procedure is right for you
• How to avoid the #1 mistake many sleep apnea patients make when undergoing surgery
• The one thing you must consider prior to having any surgery for sleep apnea, including the MMA procedure
• The do’s and don’ts of finding the right surgeon

Buy your copy of this audio recording today, available in two easy-to-access formats:

 

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