July 04, 2005

• This site and others like it might contain reviews of models you're interested in. Depending on what your pressure setting is, you may want ramping; that's where it starts low (mine starts at 6) and after a preset time switches to your actual prescription setting (7.5.) The delay lets you fall asleep before the higher pressure kicks in - I don't mind the pressure, but I do mind the noise. I haven't tried bipap... it sounds like a good idea; my pressure is low enough that exhaling isn't too hard. (And I like the funny whistling, though Ms. Helper differs...) As for a humidifier, I would suggest getting just the basic pap for now, and seeing if you have a problem. Here in the northwest, it doesn't get overly dry in the winter so I haven't needed one. (My concern with the humidifier is that I'll end up needing hoses more often to ward off mold&mildew...) If you find you need one, better to pay for the add-on (most devices support a number of addons) rather than paying upfront. Call your insurer to ask about their coverage for used devices. Remember that you generally do not have to do business with whoever your doctor has suggested. If you find the distributor's prices too high, poke around online. You'll need to get the prescription from your doctor, as most companies won't sell you one without.
• I had an adult tonsillectomy and I feel compelled to share this with you. The pain was excruciating for 4 days after the surgery and very uncomfortable for another 3 days. When I say "excruciating" I mean it - a fractured arm years earlier was not as painful. Maybe get a second opinion about having all the surgery at once?
• I've heard the same mlis from an number of other folks and have prepared myself for the worse. I have a pretty high tolerance for pain, but will tell my ENT that I have a very low one. I wanna get a script for Demerol or something like it. If I have to get the surgery done, I have to get it done. But I’m not gonna suffer needlessly.
• Another thing to consider since you're having all this surgery is that you may well not need the positive pressure after the procedure. If your obstruction is secondary to the anatomy around your pharynx, and the surgery relieves the obstruction, then I'm not sure you'll need CPAP at all. Have you considered waiting a few weeks postop, and then repeating the sleep study? Most insurers are unlikely to pay for multiple sleep studies, but if the alternative is paying for a pap they might go for it. And as someone who's training in pulmonology in LA, I would recommend the humidifier. A sizable majority of people have problems with drying like nose bleeds and such. Some people swear by BiPap, but the truth is, most people just don't like using either. The compliance rates on CPAP, BiPap and the like aren't very good. So if you're lucky with the surgery, maybe you won't need either. Like I said, I'd consider a wait and see approach. Also, yes. Tonsillectomy can be one of the most obnoxious procedures for a week or two following surgery. But if it does resolve your OSA, I guarantee you won't regret it.
• squidranch -- You sure about that surgery? I just got diagnosed with sleep apnea, and my doctor recommended against the surgery. In his professional opinion, the surgery doesn't have a high enough effectiveness rate to make it worth the gamble. He equates it to getting laser eye surgery 10 years ago. According to my doc, the effectiveness rate is about 50%. I'm told the CPAP works really well, and isn't hard to get used to...
• Heh, Dr. P pre-empted me with an opposite opinion! What's your insider's take on what my doc told me, Pynchon?
• Well, the thing about surgical efficacy is really dependent on the patient. I could quote you numbers that may seem mediocre (perhaps 50% is right on average), but that's partly a matter of poor patient selection. There are DEFINITELY some patients who will benefit and they might be easy to spot. What I mean to say is if someone opens their mouth and has enormous tonsils, and you look in their nostrils and you see giant polyps... well, their statistics are better than someone who has no such anatomical obstructions, but instead has no neck and weighs 400 pounds. Because the underlying causes for the disease are so varied, their are definitely patient subsets that might benefit from surgery, while other would benefit from weight loss, or still others simply won't get much relief without positive pressure. I hope that made sense.
• just saw this yesterday, and thought it was maybe worth a mention...

  Snoring, Sleep Disturbances May Predict ADHD One group of boys under the age of 8 who had the worst sleep-breathing problems during the first study were approximately nine times more likely to have developed new hyperactivity four years later than were boys of the same age who had not had such sleep problems.

  (YMMV, IANAD, etc)
• Maybe because they've been sleep-deprived for those four years?
• Dude there may be a non-surgical intervention - Singing therapy. Apparently theres a 2 year trial here in the UK which aims to teach soft pallet control and is endorsed by the ENT experts see a report Here. Here is the main site singingforsnorers.com .
• Singing for snoring Part II also see BBC News report. Good Luck - anything to avoid the knife!!
• You might consider not having such apparently major work done all in one go, perhaps consider only having the deviated septum thing done.. to be honest with you, from what I know about tonsils (I have trouble with mine) I'm not quite sure they should be interfering with your breathing unless they are inflamed or enlarged.. don't want to see you endure needless pain. Proviso: I am by no means an expert, I just don't quite understand what the tonsilectomy will achieve. Hate the idea of people going through needless operations.. could you get a second opinion?
• Tonsils are useless, so getting rid of them is a nice way for the hospital to charge the insurance company more. Yes, I can be quite cynical, but I've had years of practice.
• Tonsils aren't useless, they're an important part of the body's immune system.
• My tonsils are inflamed and have been for a number of years. A sore throat has been an annual occurance at casa de calamari ever since I can remember. I frankly don't know why they didn't rip the little fuckers out when I was a kid. To remove them now would signifigantly clear my airway and could very well help with the apnea.
• Squidranch, whatever you decide to do, I must chime in with the surgery issue in that you should prepare yourself for a very painful recovery. I had just one tonsil removed last August and had to take off of work for two weeks. Two weeks! I thought it would just be a few days. I am pretty opposed to taking opiate-type painkillers for myself and ended up practically existing on liquid Percoset (it was the only painkiller that took the edge off the pain; I tried four before discovering it). Just hearing about all that you are having removed makes my toes curl in sympathy for you. I really do hope it helps you with your apnea. Two good things that came of it for me, however: I lost weight because not only was eating painful but I had no appetite for anything but the sweet sweet Percoset; also, I was ever grateful for my Netflix subscription, as I plowed through many a movie with my laptop sitting atop my stomach while laying on the couch. That was kinda nice.
• Squidranch, whatever you decide to do, I must chime in with the surgery issue in that you should prepare yourself for a very painful recovery. I had just one tonsil removed last August and had to take off of work for two weeks. Two weeks! I thought it would just be a few days. I am pretty opposed to taking opiate-type painkillers for myself and ended up practically existing on liquid Percoset (it was the only painkiller that took the edge off the pain; I tried four before discovering it). Just hearing about all that you are having removed makes my toes curl in sympathy for you. I really do hope it helps you with your apnea. Two good things that came of it for me, however: I lost weight because not only was eating painful but I had no appetite for anything but the sweet sweet Percoset; also, I was ever grateful for my Netflix subscription, as I plowed through many a movie with my laptop sitting atop my stomach while laying on the couch. That was kinda nice.
• Whoops, sorry for the double post. Computer went wonky for a second.
• Wedge: Thanks for that link, interesting info there.
• I wonder if I can start a program called "snorring for singers". After all, I am an expert. Even though I hear from pretty much every one that has had it done that an adult tonsilectomy is excruciatingly painful, I think that I will still go through with the surgery. I am sick and tired of not only the snorring and sleep apnea, but of the reoccuring colds that always start and stay in my throat. Nonetheless, I appreciate all your feedback on this.
• BTW, thanks drpynchon for your insight. I myself have a deviated septum, polyps, inflamed tonsils, and an enlarged uvula and soft palatte. I am 6'4" and about 25 pounds overweight. I have a large neck, but not from fat. I workout quite a bit and am asked quite often if I am a football player, so that gives you an idea of my body type. The woman at the sleep study center said that a large neck, even from muscle build up and working out can cause sleep apnea and she has seen a number of men like myself with the condition. It seems like I am a prime candidate for surgery and that more than likely doing so will at the very least reduce the condition for me.
• Squidranch, is someone available to look after you while you recover? One of my friends has the sleep apnea/ADHD combination and had soft palate surgery. His doc advised him to stay with family afterwards, and a good thing too. It wiped him out something fierce.
• As to the equipment, I never needed the humidifier or the ramp up. I just got used to the full pressure pretty quick. You want to make sure that whoever provides the device can provide followup tweaking as well, therefore a non-standard provider may not be the best. Just my $.02. And as for football players, one team doctor I saw interviewsd on ESPN said that 70-80% of all NFL players had serious sleep apnea and that 100% of all defensive and offensive lineman did. So yoiur geneal bodyshape can be indicitive of apnea. Good luck and I hope you sleep well soon. Feel free to email if you have specific questions about using...
• Thanks for your concern shinything. My sister, chechebell has volunteered to be my nurse. The way it was explained by my doctor is that I will go in for a pre-op meeting on Monday where I will get a prescription for pain killers, have my surgery on Wednesday, go in on Friday to have the packing in my nose removed and by the next Monday I'd be able to return to work. It sounds from other's experiences that my recovery might take a bit longer than that. Fortunately I have scheduled it during summer hiatus so I should be fine.
• I've heard that chewing gum a few days after surgery can help alleviate the pain post-tonsillectomy. Supposedly, all of the muscles around your (ex)tonsills seize up (in fear? anger?) after the surgery, and chewing gum helps relax them. It's supposed to hurt a lot when you first start chewing, but relieve the pain pretty quickly. (I've not used this advice myself -- my insurance will only pay to take my (always swollen, often infected) tonsils out if I have actual tonsillitis 3 times in 12 months. Last year I had it 3 times in 13 months! However, the advice helped a friend of mine.)