I can’t be very specific without examining you, but it sounds like you’re on the right course. You have to deal with both the jaws and the soft tissues for maximum effectiveness. Practitioners of the DNA appliance state that they can get significant upper and lower jaw expansion with their device, but it can take 1-2 years to fully treat obstructive sleep apnea. There are no long-term studies using this for obstructive sleep apnea, but it does sound promising. Good luck.

With weight loss and moving to a lower altitude I have lowered my AHI from 40 (NREM) and 60 (REM) to 18 (NREM) and about 30(REM). Cannot tolerate CPap, and developed bite problems from long term use of mandibular advancement device (which worked pretty well!) Am looking at multilevel airway surgery, and possible follow up, if needed, with orthodontics and mandibular advancement.

Your thoughts, Dr. Park?

For the past year, I’ve been using a BiPAP machine for treatment of OSA, but haven’t seen any readily noticeable benefit. Out of frustration with the ineffective therapy, I had a consultation late last month with a local ENT physician regarding possible surgery. He recommended UPPP surgery to help enlarge the airway opening, and described the relationship between the tongue and the chin I raised the subject of mandibular advancement (recommended by an orthodontist years earlier), which the physician agreed could serve to help move the tongue away from the back of the throat during sleep. Since then, I’ve scheduled a consultation (early next month) with a local oral surgeon who performs the mandibular surgery, and have listened to Dr. Li’s presentation on MMA. I’m not anxious to go to surgery, but I am gathering information so that I can make an informed decision on what action to take. At this time, I don’t expect to escape CPAP (my untreated AHI is 103), but something needs to help it work.

Sorry to hear about your disappointing results so far. Since you’re only 4 weeks post-op, it’s too early to assess whether or not your procedure was “successful” or not. Typically, a post-op sleep study is performed anywhere from 4 to 6 months after the procedure. There’s a lot more healing that can happen along with resolution of swelling in the next few months. Your improved O2 saturation shows that there was significant improvement, from levels (60%), to 87%, which is much better. Please note that I never state in any of my articles or posts that an option is a “cure” (except for a tracheotomy). There’s no such thing in medicine. All surgical procedures, even the better ones, have some degree of failure, or in your case, possibly less than optimal results. But again, it’s way too early to assess it’s effectiveness at 4 weeks. Hopefully, you’ll improve even further over the next few months. Good luck.

Thanks for pointing out that complete recovery and healing is different from post-operative recovery, which is what I quoted. Even with the soft tissue procedures that I perform, I usually order a sleep study about 4-6 months later, when everything has settled down.

5- 10 years ago this procedure involved having your jaws wired together for 6 weeks and only after that period could the recovery process begin. So advancements in this area have made this a move less traumatic experience (and definitely worth thinking about if you face a life of using a CPAP … unless the apnea is weight related).

Also, in my experience the tingling is a sign of nerve regeneration and will stop (although I didn’t have it to the degree that it interfered with my sleep, it was just slightly annoying for me).