Pillar and GA(tongue advancement)

[Guest]

I'm considering these two procedures to address my OSA. I had my nose/throat scoped, and the conclusion was that both the palate and tongue were part of the problem.

My RDI is 31.1, 6'2", 200lbs, 39yrs, otherwise in good health.

I plan to have these procedures done seperately, so that I can gauge their results independently.

I found a dr. on my insurance plan who can do the Pillar procedure. He said the procedure would not be covered by insurance. This is a relatively new procedure. Has anyone had a positive outcome in getting their insurance to cover it?

[snork1]

I was told my pallete and tongue were part of the problem, but the pillars would NOT take care of my particular pallete problem and even the ENT was hesitant to do the tongue procedure unless CPAP absolutely does NOT work.

The real bummer about the surgery options, is you may not know if ANY of it does any good OR NOT, until it is ALL done.

I am still waiting for them to iron out the bugs, and using CPAP in the meantime.

[Sleepy Stoboy]

SunnyTime,

Did you already have the procedure? There was a SunnyTime on another board who did.

I think your chances are somewhere between slim and none to get it approved for payment. Be prepared to pay anywhere between $700 and $2000 for the procedure.

You have a chance to petition it for payment based on the FDA approval. But until there are CPT codes in the system for it, you're at the mercy of your PPO or HMO to make a judgment call.

I knew going in it would be at my expense. I'll post my 90 day sleep study results next week so everyone can see the before and after. I know I've had improvement, but I'm still waking up. Should be interesting to see the results.

[PaulY]

quote:

---

Originally posted by Sleepy Stoboy:
SunnyTime,

Did you already have the procedure? There was a SunnyTime on another board who did.

I think your chances are somewhere between slim and none to get it approved for payment. Be prepared to pay anywhere between $700 and $2000 for the procedure.

You have a chance to petition it for payment based on the FDA approval. But until there are CPT codes in the system for it, you're at the mercy of your PPO or HMO to make a judgment call.

I knew going in it would be at my expense. I'll post my 90 day sleep study results next week so everyone can see the before and after. I know I've had improvement, but I'm still waking up. Should be interesting to see the results.

---

Stoboy,

I am anxiously awaiting the results of your 90-day PSG. It'll be nice to see another success story. (measuring "success", of course, as treating the palatal obstruction the pillar implants were intended to address)

-PaulY

[Sleepy Stoboy]

Paul,

I do think that's what I'll see. About four weeks after the implants, I began dreaming like I used to years ago. Lots of dreams, compared to next to none before. Sleeping for longer stretches, but still 3-4 known awakenings a night. I think I'll see improved REM sleep, some improvement in RDI, but definitely a treatable level of apnea left.

I'm on night 5 of the TAP. No effect yet, but I have been reasonable on the adjusting. It is hard to be patient...but I will...

[PaulY]

quote:

---

Originally posted by Sleepy Stoboy:
Paul,

I do think that's what I'll see. About four weeks after the implants, I began dreaming like I used to years ago. Lots of dreams, compared to next to none before. Sleeping for longer stretches, but still 3-4 known awakenings a night. I think I'll see improved REM sleep, some improvement in RDI, but definitely a treatable level of apnea left.

I'm on night 5 of the TAP. No effect yet, but I have been reasonable on the adjusting. It is hard to be patient...but I will...

---

Stoboy,

Good news on the S-L-O-W advancement. Honestly, as much as I've been stressing going slow.....I myself *didn't* - and I paid for it BIG time.

I thought I was going to be tough about it (and was desperate for some sleep), so I cranked it up big time on my first two nights. On the second morning, my dentist barely made out what I was saying frantically on the phone. He realized, though, that I overdid it and immediately prescribed the spray in the picture below:



(If you ever get pain during these first few weeks, make sure your dentist is willing to prescribe Flouri-Methane!)

Flouri-Methane

The hard part? No pharmacy anywhere had the stuff. It had to be ordered from the manufacturer especially for me. The harder part? Because of its high potential for being used in explosives, it could not be transported by plane.

I had to wait for days to get a rushed ground shipment. I suffered for those two days like you would not believe.

I stopped using the TAP for about a week or two until my jaw came back into alignment after MUCH exercises and plenty of this spray.

Needless to say - after starting back up on the TAP - I went S-L-O-W on the advancement.

-PaulY

[ January 31, 2005: Message edited by: PaulY ]

[Sleepy Stoboy]

Whoa...good thing you caught me. I was going to start doing the adjustments tonight with a power wrench, not the little allen wrench they give you.

Just kidding...good advice...so just out of curiousity, how many turns did you advance it when you found yourself at the mercy of those killer drugs?

[sehay]

PaulY

What type of pain did you have for the first two nights - TMJ or your teeth?

I believe I have TMJ pain that either 3 extra strength Tylenol or 2 Ibuprofen seem to take care of. The pain is slowing getting better with time but late at night when I'm tired the pain come back. If you had TMJ, did it affect your ear? My ear aches and has a feeling that it's leaking fluid but everytime I check it's not.

The funny fact is that when I'm wearing the TAP my jaw/ear does not hurt, it hurts after I take it out.

When you had your sleep study done and the tech titrated your TAP, can you tell me how advanced it was? Do you have the TAP or the TAP II? On my TAPII there are marks on the side of the hook and channel. I know that everyone is going to be different but I am just curious how advanced the jaw really needs to be.

Just wonder what your condition was all about.

Stoboy

Welcome to our TAPPER club. I may have to do the same as you in reverse. First the TAP then the implants. I'm still snoring when I sleep on my back. I need to find an ENT (I guess) that can tell me if it is the soft palate that is still causing the snoring. My husband says that he no longer hears me stop breathing. That's a good sign. I have an appt with the pulmonologist 2/22 then need to schedule a sleep study.

Aside from the jaw and ear pain that I described above I have not missed a night of wearing the TAP. I'm sleeping better and so is my husband.

Your best monitor will be your wife. My husband told me that he noticed a dramatic difference immediately about my snoring and breathing (as long as I slept on my side and even when I do snore on my back he says that the level of noise is reduced about 90%).

Sehay

[PaulY]

quote:

---

Originally posted by Sleepy Stoboy:
Whoa...good thing you caught me. I was going to start doing the adjustments tonight with a power wrench, not the little allen wrench they give you.

Just kidding...good advice...so just out of curiousity, how many turns did you advance it when you found yourself at the mercy of those killer drugs?

---

Heheh.

I think the first night I went 3 turns, was sore most of the next day. Then on the second night I think I got it up to 8. That's when I was totally in pain and couldn't even move my jaw to talk. Breathing hurt.

This spray was cool, though. You spray your jaw while stretching it out and back and the pain would go away for a couple of hours.

Put away that power wrench! You're about a week to two weeks away from the most amazing sleep you've probably ever had. It will get incrementally better as you reach the finish line.

-PaulY

[Guest]

I'm the same SunnyTime that is posting to other sleep forums. I'm branching out, spreading my wings. :-) I found this board while surfing the net and liked the openness of the discussions.

I haven't had the Pillar or GA procedure yet. I'm still researching/investigating the best road to take. I think the Pillar procedure will be paid by insurance providers at some point in the future. A differnet ENT I talked to charges $950 for the procedure. If insurance companies will pay for Viagra won't they pay for Pillar? ha ha ha.

My ENT also said he could do a combination of a UPPP with somnoplasty to the base of the tongue. He said this would be major surgery and only gave a 50/50 success rate. He also said that the procedures may not be long lasting, as scar tissue develops and the mouth/throat will adjust over time. Since I am compliant with CPAP (2+ years), he suggested I stay with that until newer more successful procedures are developed.

I'm also researching the TAP oral device. It would be in the same ballpark as CPAP, but would be easier to lug around for travel.

Since I have benefited from CPAP, I still wake up a couple of times per night, does that increase your odds that you will have a successful surgical outcome? It seems like most of the people who go the surgical route did not benefit from CPAP. That would imply that those people may not benefit from any surgical procedure as well thus lowering the overall success rate of the procedure. I'm trying to rationalize if I would more likely be in the 50 percent success camp, since I've benefited from CPAP?

[Sleepy Stoboy]

Hi SunnyTime,

They're all tough decisions- I think that's the toughest part of having sleep apnea. Sure will be nice when the gold standard is one that is widely accepted, effective, simple and permanent.

Everyone can offer different advice. Here's mine: I really never got to the point of seriously considering UPPP. The effectiveness rates are all over the place, and few are north of 50. There are a lot of regretful people out there who've had them, which leads me to believe that a big part of the problem is the inability to profile the palate as a significant or sole part of the problem. I chose pillar over UPPP as conceptually they do the same thing. If you believe that, then cost is the prohibitor for pillar, and permanent alteration, pain of surgery and side effects are the prohibitor for UPPP.

I did explore GA/hyoid/repose, but hyoid's effectiveness in studies is also hit and miss, and the GA/repose advancements were too new for me to take on. I only saw one study on GA and that had a 67% effectiveness rate. Could be promising, hard to say.

One of my life's principles is that often the best decision is no decision. I see TAP and autopap as being in the "no decision" category. You can buy yourself and the medical community time with safe, effective treatments that have strong support in the SA community.

What I've learned from this forum is to research diligently, listen to all sides, get as many consultations as you can afford, and then create a treatment plan that fits YOU. Sounds like you're getting awfully close to where you want to be on CPAP. With all of the time you've invested there, you may want to read this forum extensively and see if you can't improve your CPAP experience with the help of these fine folks. I am amazed at how much improvement some people have had by soliciting help from the key people on this forum.

Best of luck in your search!

[Guest]

Stoboy,

I think were in the same boat. I'm looking for the best solution with the least downside. It's frustrating in that the analytical side of me wants to research all of the available options and make an informed decision, but the impulsive side wants to jump right in and get this overwith.

I made an appointment to see a dentist about the TAP oral device. If it can get me to <5 RDI as CPAP does, then that would be a step in the right direction.

Thanks for your support. Take care.

[PaulY]

quote:

---

Originally posted by sehay:
PaulY

What type of pain did you have for the first two nights - TMJ or your teeth?

I believe I have TMJ pain that either 3 extra strength Tylenol or 2 Ibuprofen seem to take care of. The pain is slowing getting better with time but late at night when I'm tired the pain come back. If you had TMJ, did it affect your ear? My ear aches and has a feeling that it's leaking fluid but everytime I check it's not.

The funny fact is that when I'm wearing the TAP my jaw/ear does not hurt, it hurts after I take it out.

When you had your sleep study done and the tech titrated your TAP, can you tell me how advanced it was? Do you have the TAP or the TAP II? On my TAPII there are marks on the side of the hook and channel. I know that everyone is going to be different but I am just curious how advanced the jaw really needs to be.

Just wonder what your condition was all about.

Stoboy

Welcome to our TAPPER club. I may have to do the same as you in reverse. First the TAP then the implants. I'm still snoring when I sleep on my back. I need to find an ENT (I guess) that can tell me if it is the soft palate that is still causing the snoring. My husband says that he no longer hears me stop breathing. That's a good sign. I have an appt with the pulmonologist 2/22 then need to schedule a sleep study.

Aside from the jaw and ear pain that I described above I have not missed a night of wearing the TAP. I'm sleeping better and so is my husband.

Your best monitor will be your wife. My husband told me that he noticed a dramatic difference immediately about my snoring and breathing (as long as I slept on my side and even when I do snore on my back he says that the level of noise is reduced about 90%).

Sehay

---

Hi Sehay,

I have a little TMJ on the left side, but that never really gave me any problems. It was almost like a locked jaw I had - very painful right around the muscles that connect the jaws together. Too much advancement too quickly, I found out the hard way, will totally mess up these muscles.

The teeth were a little sore in the mornings for the first couple weeks, but that went away by itself. The ears (on the inside bottom) hurt a little the first few days, but that subsided as well.

During the titration PSG, I started off at ten turns (I have the original TAP). The Tech still noticed hypopneas at 10 turns, so she came in two more times and at the 12th turn the hypopneas went away. But because my dentist also wanted the snoring to go away, she wound up coming in another 3 times. At 15 turns, both the hypopneas and snoring went away. I spent more than 3 hours on my back, and not a single SDB event, or even snoring.

Please keep us posted on both the TAP titration and the implants. Also, if your pre-implant TAP titration still shows apnea, and you decide to get the implants - be sure to do another titration study on the TAP after your implant PSG, if need be.

It may very well work out, as it did for me, that you will have no apneas on the TAP *after* you get the implants.

-PaulY