Somnoplasty (Radio Freq. Tissue Reduction)

[sleepyweep]

I was wondering who out there had tried this procedure and how effective it was in treating your apnea/snoring? How does this differ from the laser treatment that I've heard is excruciatingly painful? My concerns are that my ability to speak could make me sound like Mike Tyson or having swallowing be affected. Any feedback would be greatly appreciated! Thanks.

[tutuu]

Thanks for the post and being more courageous. First you should understand that
most of the visitors here never dare to do anything. You will hardly find any answer or any word of encouragement. This whole talkaboutsleep or any other sleep chat site is visited by bunch of cowards trying to find easy way out of apnea. they talk and talk and talk about humidifiers/masks and not a single thing about diet change life style change or anything that makes sense. when there is a fear there is a seeking answer for remedy everyday/everynight and they are dipressed (most of them are) or retired and have nothing to do (some of them spend 24 hours on this site!). I would suggest you to go by a gut feeling. most of the successful surgeries were done by courageous people and they get cured and they never comeback and post here. they are busy with their own lives. no need to get cyber consolation from across the world for them.

[CJE_?]

[pappy]

did i miss something, or has tutuu finally landed his spaceship in "never never land"!!!!!!!!!!

[Less Sleepy]

Understand that the cure rate for OSA is quite poor for this type of surgery, and it is difficult to determine who would be a good candidate. Also, if you have the surgery, and still need CPAP, it will be harder to use. You would probably need a full face mask. Get multiple opinions, some from people who know from the start that they will not be the ones performing the surgery. A better option might be a palatal implant procedure which stiffens the soft palate with little pain, a very short recovery time (virtually no time lost from work), and is reversible should the side effects be intolerable. If you have a singing voice, you may not want to have the snoreplasty, since your voice almost certainly will be changed, and almost certainly not for the better.

If you want to go the whole surgical route to a cure, that could include, in addition to the UPPP (snoreplasty), surgery to advance your lower jaw, and bring your tongue forward. There is a poster to this board (BillinSeattle, I believe) who has successfully undergone this procedure. While he does not regret doing it, he said it was arduous, to put it mildly.

My ENT said I was not a candidate for surgery.

By the way, if you do a search under the word "retired," you will find that there are many people here who are not, including me although, I'll be glad to retire if someone wants to pay for my son's college tuition....didn't think there would be any takers. Ah well, I guess I won't be retired any time soon.

[billinseattle]

Cool,

There's more mud being slung here than at a local election.

There's a reason why more people on this board aren't risk takers...PAP is a better answer (if tolerated). Blind leaps into procedures are ill-advised.

Courage has nothing to do with it.

RF tissue reduction is usually not a cure for OSA. It can alleviate snoring. It is well tolerated and has only minor morbidities associated with it.

Many other procedures (the pillar, turbinate reduction, nasal septoplasty, UPPP, hyoid tucks) have varying degrees of short-term success and/or some symptom improvement. At least that is the data in the medical literature as of now.

Only a trach or the MMA/GA procedures have good enough long-term numbers to qualify as a "cure" for OSA. Both of these are big, bad, potentially morbid procedures (but they do work). Unfortunately, I know this first hand.

Once again, try to stick it out with PAP devices. They are your best bet. But, there are alternatives if they are trully undoable.

Bill

[billinseattle]

Redux.

I guess after paying for my successful surgery, I'll never get to retire either.

I've gained alot of insight here during my PAP phase.

Eventhough I've seemed to be rid of my OSA after MMA/GA surgery, I plan to post here to give reasonable feedback with regard to procedures I've either had or researched. Kind of my version of returning the favor to those who've been helpful to me.

No need to be inflammatory either way. Just the facts.

Bill

[rested gal]

Thank you, Bill. You, having been through so much, are helping a great many people with your well reasoned, sensible posts.

[sleepyweep]

Thanks all for the replies. I saw my ear/throat/nose doc today who also did my sleep endoscopy. He recommended the dental device for me and said that RFTR would have a 50-60% chance of being succesful with me and would require 5-6 treatments over the course of 4 months but would have minimal side effects. He said that because it wasn't a sure thing and results would not be immediate apparent for some time, the dental device would be a better option in the interim. I've visited 2 dentists and think I'll try the dentail device to start and if that doesn't work will try the RFTR. I'll post more as I go through the process so those who are thinking about doing one or the other can at least hear from someone firsthand.

[sleepyweep]

[rested gal]

sleepyweep, here are some interesting threads:

Topics containing posts by BillinSeattle - various surgeries he's been through for OSA:

Apr 18 2005 subject: Important week, I must decide between UPPP and MMA/GA

Feb 22 2005 subject: decision...surgery?

Feb 02 2005 subject: 2 weeks out from MMA/GA...whew!

Jan 22 2005 subject: Brother considering MMA surgery

Jan 12 2004 subject: surgery option experiences wanted

[tutuu]

there are manay many UPPP successes but the thing is one needs to stop eating heavy diet and start gaining weight again. weight need to go downward than upward after UPPP.
70% UPPP failures are due to weight gain or keeping constant. I doens't work for obese.
Rest of 30% UPPP failures are due to incompetent surgeons(little experience/use of good instrument and techniques).

[billinseattle]

Wow !

I actually agree with what Tutuu said!

The UPPPs that may initially provide relief are prone to relapse overtime. Weight is a factor but so is muscle laxity with advancing age. That adds to their disappointment as a treatment...and hardly any surgeon will mention this.

People with large necks have a column of airspace that require adjustment. From top to vocal cords. That requires a series of unpleasant procedures (probably including both a UPPP and MMA/GA)...OR...SUCCESSFUL and COMPLIANT use of a PAP device.

Sleepweepy, Sorry I didn't mention the TAP dental appliance. I should've. It does a similar job as the GA (gennio-glossal advancement). Together with your RF ablation, if your main problem is macroglossia ( a Gene Simmons tongue), you may be in luck ! I personally know several people who have had far better luck and compliance with dental aplliances than with PAP devices or UPPP surgeries.

A caveat though, while ENTs can be optimistic based on their exam, when percentages are tossed around and quoted, they apply to an individual only. In general, for the rest of the viewers on the forum, no such numbers exist in the medical literature for this procedure-appliance combo. That could simply mean that nothing has yet been published. The pillar device, for example, is so new it'll take years for reliable studies to determine its efficacy and therefore for anyone to quote percentages on it.

Thank goodness for Rested Gal. I am cyber-challenged an am not able to conjure up old posts. Without reviewing them, I essentially think I've been consistent in describing the MMA/GA surgery throughout.

In a nutshell, it is an upper/lower jaw and tongue advancement that opens up 1 cm or more of your lower posterior airway. This combo has a 96% mid-term "cure" for OSA. It is all done through the mouth. It is quite an ordeal with an intense 2 month recovery...and a 6 month total recovery (I am at month 3). Along with it comes risks and potential morbidities...but very little pain. In fact, more people say that the UPPP was worse than the MMA. Because it is complex, not everyone performs it...and the surgeon and facility must be vetted carefully (it is trully the "mother" of all OSA procedures). Even the MMA can fail if there is excessive weight gain later post-op; or if not done in combination with the GA.

Hope your TAP device and ablation works out.

Bill

[Bill in Van]

Hello there.

I have a really bad case of macroglossia (though not of the Gene Simmons kind, as bis put it, but in thickness only, not length), and I'm undergoing the tongue RF ablation treatment right now. Just last week, I had my fifth and final installment of it.

In addition to the RF, I am also using a home crafted dental device I built myself and use entirely on my own accord, without any authorization from any medical or dental professional (though I don't recommend taking medical matters into your own hands unless you are either very desperate and all legitimate options have all been exhausted and failed, or really know what you are doing). It holds my jaws a whole 3 centimeters apart.

As for its effectiveness, the RF and oral device combo works better than anything else I've tried so far. I do feel more rested and alert, and less anonizingly tired, and my sleep hours are closer to regular, though I am still far from home free and cured. Prior to the RF, I've tried all kinds of medications, CPAP, UPPP and tubes in the throat, and the dental device by itself, and found the dental device to be the most effective. However, it too was not enough, so I've arranged to have a series of RF ablations to be done on the tongue in conjunction with its use, and have found notable improvement in my condition with each application, though never quite there yet. I still have another couple of weeks until the swelling on my tongue to heal until the full effect of my latest treatment can be realized.

Complicating matters, though, is the fact that I do not have official "apnea" (ie. sleep apnea that is detectable in the form of technically defined "apnea events" that can be backed by laboratory data). Only hints to it are disturbances, fragmentation and lack of depth of sleep, not to mention disrupted and irregular sleep times, and the visibly obvious severely enlarged tongue. Note that modern sleep studying techniques are far from perfect, and though they can detect the presence of apneas, they are no good at detecting their absence.

Since the apnea cannot be determined by lab studies, my doctor has agreed to do the procedure to officially treat the macroglossia, not the apnea per se.

[billinseattle]

B.I.V.

How are you ?

I was thinking the other day, I'd love to see your device.

Patent it...and we could pack it up and market it !

I still don't dig on the self-intubation theme though.

Bill