Surgery for Snoring & OSA

In this episode, I discuss surgical management of obstructive sleep apnea, once you have exhausted all other conservative options. Treatment for snoring will be discussed as well. If you haven’t listened to the previous segments on airway resistance syndrome and obstructive sleep apnea, it will be helpful. Click to download mp3 file or click here to listen in your browser  

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2 thoughts on “Surgery for Snoring & OSA

  1. Dear Dr. Park,
    I have Medicaid Healthfirst. I am writing to you to ask for your help in finding a surgeon who does the Maxillomandibular advancement in New York, for people with Obstructive Sleep Apnea; an ordeal I have been going through for close to five years.

    In September 2014, I noticed I was waking up after less then my usual seven or more straight hours of sleep. I had no idea why. Over the next year I gradually decreased in continuous sleep hours; eventually down to four. In the mean while, my GP doctor, at the time, just gave me Ambien; later trying the timed release form of it, until the insurance stopped approval; then I went back to the regular 10mg form. When a friend suggested a sleep study he had done, I told my doctor and he discounted it as being “for Sleep Apnea.” I assume this was because I am thin.

    Eventually, I went in 2016, to the Sleep Disorders Institute of NY. My “sleepover” study confirmed OSA with 19 apnea incidents per hour.
    I had a dental device made that summer. It was a complete waste of time.

    Then, I did a CPAP sleep study at Maimonides, titrating at 7, and was given an Rx for a CPAP set at 4. But, I decided to return to the Sleep Disorders Institute, and was given a machine set as an APAP, set at 4 through 20. My apneas went down to less than one per hour. But, it did not keep me asleep. I then began splitting the Ambien, taking the other half after my premature wake-up to try getting a little more sleep. To this day, my first wake-up could be anywhere from 90 minutes to 2 & 1/2, 3 & 1/2 or 4 hours.

    In November 2017, I went to an ENT, who proposed doing the DISE procedure. The video showed that my epiglottis was causing an obstruction, he was considering doing the hyoid suspension procedure, but wanted to wait till I had chance to stay at my friend’s house upstate in a quiet environment, as I have a bad living situation in near Times Square, and suffer from life long anxiety, (for which I take Ativan). But, they moved away, and the ENT changed jobs.

    In May of 2018, I could no longer tolerate the APAP, after a year and a half of using it; switching from the nasal pillows, to the nose mask, and then the full face mask didn’t help.

    While the ENT took some time to resettle, I went to another ENT, who sent me to their Maxillofacial surgeon to do a Genioglossus Advancement. But, given the risks, I didn’t feel comfortable doing that.

    I saw the first ENT again, now at his new office, and told him I didn’t want the Hyoid procedure, but was interested in the Maxillomandibular advancement, realizing it had more risks. He told me it had the highest success rate.

    I am now affected much more by tiredness during the day: and I assume that my apnea numbers are way up again.

    Thank you for your time.

    Sincerely,

    Jonas Conrad

  2. Mr. Conrad,

    Sorry to hear.

    Sorry, but as far as I know, only major hospitals that take medicaid will have oral surgeons that do the MMA. I’m not familiar with any surgeons personally.

    I can’t say without examining you, but in general, I usually address the epiglottis first and then try CPAP again, since the epiglottic collapse can prevent CPAP use due to a valve-like closure.

    Good luck,

    SP