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My Interview With Sleep-Apnea-Guide.com

I was recently interviewed by the staff at Sleep-Apnea-Guide.com, which is a great resource for people with obstructive sleep apnea. It was a very in-depth interview where we talked about my work and various other issues important issues. You can read the full transcript here.

Some of the questions I get asked include:

• How did you become interested in sleep apnea surgery?
• As a busy surgeon, how do you have time to do run your website and do your programs?
• How do you decide who can benefit from surgery?
• Why do modern humans have more sleep apnea?
• How do I find the right surgeon to treat sleep apnea?
• Any advice for people who are considering surgery for sleep apnea?

Ask Dr. Park Teleseminar on Obstructive Sleep Apnea

In this Ask Dr. Park Teleseminar, I answer the following questions:

- I’ve had my CPAP machine for 5 years. Should I undergo another sleep study to see if anything has changed?

- Does palatal expansion work for people over 60?

- What do you think about Provent therapy?

- Is it possible to have a dental device lose its’ effectiveness without any weight gain?

- What’s your vision in the multidisciplinary approach to OSA treatment and comorbididies?

- Will restorative breathing correct OSA cases previously recommended for surgery?

- Can sleeping on your side be OK for sleep apnea?

- A recent Chinese study reported OSA in 27% of 5 to 12 year olds. In view of the obesity epidemic here in the US, is the incidence here in the US at least as high, if not higher?

- Should a person’s stuffy nose be addressed before OSA therapy?

- Does CPAP create “dependence,” so that surgical options later on may not work as well due to a weakened diaphragm  or other muscles for breathing?

- Your opinion on the new implants (Pillar and hypoglossal nerve stimulation)

- Does sleeping on a 45 degree incline help with obstructive sleep apnea?

- What can be done to reduce the number of “getups” each night?

- What percentage of OSA is due to tongue collapse (vs. soft palate)?

And much, much more.

Click here to purchase the 60 minute MP3 recording.

Sleep Apnea Surgery Not As Risky As One Thinks

One of the common perceptions about surgery for sleep apnea is that it can be risky in the per0operative period. This is why many surgeons still observe patients who undergo UPPP or tongue base procedures in the intensive care unit overnight (ICU). A new retrospective study looking at almost 1700 procedures of the nose, palate and tongue determined that it’s not as risky as one may think. Patients that underwent tongue base procedures were admitted to a type of ‘step-down” unit for over-night observation. Overall, the complication rate was 7.1%, with most of these being minor and resolving with conservative treatment (typically transient high blood pressure or a drop in oxygen levels). Swelling of the tongue after suspension suture placement also resolved with conservative treatment. Only one patient required re-intubation for tongue base swelling. Complication rates were no different when they analyzed severity of sleep apnea or oxygen desaturation levels.

My personal experience over the last 10 years mirror these findings. So far, I haven’t had the need to admit patients to the ICU after sleep apnea surgery. With good surgical technique and nursing care, most of these patients can be observed on the regular inpatient floors. Of course, there will always be exceptions to the rule, and the decision to admit to the ICU has to be made on an individualized basis. 

Ask Dr. Park: Cutting Edge Surgical Options for Sleep Apnea

This month, I talk about the latest in surgical treatment options for obstructive sleep apnea:

– How to find the right surgeon

– The most common misconception about sleep apnea surgery

– Uvulopalatopharyngoplasty: What you must know

– What is surgical success?

– Pros and cons of surgery

– Information about tongue base procedures: genioglossus advancement, hyoid suspension, Repose suture suspension, Coblation tongue reduction, Robotic surgery, hypoglossal nerve stimulation, maxillo-mandibular advancement, tracheotomy.

– And much more….

 

Click here to order the MP3 recording ($17)

 

 

 

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Expert Interview: Robson Capasso of Stanford University on Sleep Apnea Surgery

This month, I’ve invited Stanford University’s sleep surgeon, Dr. Robson Capasso to talk to us about his institution’s philosophy on sleep apnea surgery. Here’s a short list of questions that are answered on the program:

1. What’s the success rate for sleep apnea surgery?

2. Can you wait until someone is asleep to image the site of obstruction? 

3. What is the progress in getting UARS recognized as a real condition?  How is it diagnosed and managed at Stanford?

4. How do you decide whether to recommend surgery or an oral appliance in a CPAP intolerant patient?  

5. Can you explain the different techniques for performing the MMA, and how successful these are for reversing OSA?  Is it possible to achieve an AHI of zero after an MMA?

6. Do you recommend adult jaw development as an alternative to surgery?

7. Is sleep apnea surgery covered by insurance?

….and many more.

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The Gold Standard Treatment For Obstructive Sleep Apnea

In the sleep community, CPAP is consistently mentioned as the “gold standard” treatment option for obstructive sleep apnea. I find this odd, since the overall success rate for CPAP is disappointing, especially if you look at overall acceptance and compliance numbers. Some people may take exception to what I have to say, but here are the facts:

Theses are only rough estimates, but if you take 100 people who are newly diagnosed with obstructive sleep apnea, only about 1/2 are willing to even try it. Of the people who give it a try, maybe about 1/2 end up using it regularly, and of those who use it regularly, perhaps 1/2 continue to use it for more than 1-2 years. Even if you’re using it regularly, not everyone feels any significant improvement in their symptoms.

As you can see, out of all the possible people who are candidates for CPAP, only a small fraction ever end up benefitting at all. It’s shocking how many CPAP machines sit in the closet after only a few weeks use. In controlled research studies, compliance can be quite high, even up to 60 or 80%, but in the real world, it’s probably more like 20-30% long-term.

Despite the grim statistics, CPAP is still the best option that we have. Millions of people benefit from its’ use significantly, and in many cases, it’s a life-saver. There’s also so much more that can be done to educate and support new CPAP users so that more people are able to use and benefit from it.

The frustrating thing is that there are alternative forms of treatment that can be just as good, if not better than CPAP. But in most cases, they’re simply dismissed as being not effective.

The first treatment option that’s available that should be considered the real “gold standard” is tracheotomy. This is where a hole is surgically made just below your voice box into your windpipe, essentially bypassing your entire upper airway. This has essentially a 100% cure for obstructive sleep apnea.

The two other major options for sleep apnea are oral appliances and surgery. The criticism by certain sleep doctors against these two options is that it never gets the AHI down to normal levels. But even a 50% drop in the severity of your breathing pauses is much better than not using your CPAP at all. This was borne out in one Veterans Administration study that showed that the UPPP procedure (with a historical 40% success rate) had a higher overall survival rate years later compared to people placed on CPAP. Surgical “success” is a controversial topic, and I’ve talked in detail about my logic for offering surgery at all.

It’s clear that there are certain camps that are strong proponents for each of the three major treatment options (CPAP, dental devices, and surgery). Each has it’s advantages and disadvantages. CPAP should always be considered first, but the two other treatments should at least be offered once you’ve exhausted all your CPAP options. Advanced orthodontics is another emerging treatment option but we’ll have to see results from more studies.

One interesting observation is that for people who are happy with their surgery, they forget about the fact that they have obstructive sleep apnea. They just go on with their their normal (and more productive) lives. They’re not reminded every night that they have sleep apnea, as what happens with oral appliances or CPAP. For others, CPAP is a normal part of life, like brushing your teeth before bedtime, and are not bothered at all. Notice how different people deal with their treatment options differently.

In my mind, it’s not about which option is better, but customizing your treatment plan based on a systematic process that starts with CPAP, and making sure to go on to other options if CPAP is not working. Unfortunately, too many people give up after trying only CPAP. Ultimately, there is no gold standard.

What’s your feeling on this admittedly controversial topic?

Ask Doctor Park: Q&A

In this Ask Dr. Park teleseminar I  answer all your individual questions. Some of the more common questions included:

- What are my options if I can’t use CPAP?

- What if I’m using CPAP 100% of the time and my machine says I have no apneas, and I don’t feel any better?

- Is sleep apnea linked with fertility problems?

- What are the treatment options for central sleep apnea?

- Does sleep apnea get worse as you get older?

- Can losing weight cure sleep apnea?

- And many more questions.

Please click here to purchase the MP3 recording.

More Sleep Apnea Bites the Dust

I had a crazy day today with a packed schedule full of patients, but the one thing that made it worthwhile for me was the feedback I got from three different patients about either how well they were sleeping, or how their lives were changed as a result of sleep apnea treatment.

While rounding at the hospital early this morning to see my post op patient, she was doing remarkably well one day after her multiple soft palate and tongue procedures for obstructive sleep apnea. She was already swallowing liquids pretty well, and ready to go home. She also noted that despite the pain and the poor sleep environment of being in a hospital with all the noises and distractions, she felt more refreshed than normal when she woke up this morning.

Another patient that I hadn’t seen in 6 or 7 years came in for ear wax removal, and just happened to thank me for changing his life. I had no idea what he was talking about. He reminded me that I had sent him to a dentist for his sleep apnea and he has been successfully using his dental device all this time.

A third patient came in one month after routine nasal surgery and remarked that his breathing is not only normal, but he’s not snoring anymore, and his sleep is much more refreshing and he’s dreaming more.

These are some of the examples of patients that have found success with either CPAP, oral appliances, or with surgery. Some people find success after their first option, while others go through everything before finding a solution that works.

Admittedly, not everyone that I see has great results like that ones above, but the vast majority do, while the remainder have partial or limited success.

This is what keeps me going, knowing that I’m able to help people breathe better and sleep better, regardless of which option they choose. It’s truly a privilege for me to be able to help people in this way.

What’s your success story? Please share your story with me in the comments box below.

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.

An Innovative Obstructive Sleep Apnea Clinical Trial

For most people with obstructive sleep apnea, CPAP and oral devices work very well. However, some people can't tolerate or benefit from these two options. For these people, surgery may be another option. 

There are numerous types of surgical procedures for obstructive sleep apnea. The more useful ones involve modifying the breathing space behind the tongue. Clinical trials have now begun testing a new way of treating tongue collapse, using a nerve stimulator based on pacemaker technology. I'm honored to be part of an innovative, IRB approved, national multi-site study of this investigational device. Please take a look at this brochure for more information. 

 

Please contact me if you have any questions @ doctorpark@doctorstevenpark.com.

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