piller surgery

[soccergirl]

Does anybody have any experience with this.. I can't sleep with my cpap.. gave it two years..

[rested gal]

LINKS to surgery, turbinates, Pillar, TAP experiences

[Guest]

think its over in the snake-oil section

[Sleepy Stoboy]

Hey Guest, that's really funny. You need to go on the road with that.

Soccergirl- the links above will give you all the information you need.

Here are some quick hits though to point you in the right direction:

1. Pillar is rarely ever a "one and done" cure for sleep apnea. I believe in the clinical study by Restore, less than 9% were completely treated to an AHI below 5. And this study was limited only to people with less than a 30 AHI to start with. The higher your AHI the more likely you will need to combine pillar with another treatment.

2. Pillar only treats the palate and takes that obstruction out of the equation. For many of us, we also have a more significant problem with the tongue obstruction.

3. So, bottom line for most of us is that you would need a combination treatment of the pillar implants and a dental device. Several of us on the dental forum are reporting success after sleep studies have confirmed that we have reduced our apnea to 0 using the combination of pillar and dental.

4. Pillar does lack significant long term clinical study, but has been used for a few years now to treat snoring before it was approved a year ago to treat apnea. At this point, the extrusion rate of implants is about 1%, with most of that occurring shortly after the implants, not long term. You will need an ENT who has conducted several of these implants to profile whether your palate is long and soft enough to benefit from the implants.

5. Dental devices are considered a safe effective treatment, but you would want to review the list of specialized sleep dentists who can review your dental condition before fitting you for a device.

6. Finances may be a factor. Many insurance companies do not reimburse for pillar, and the rates generally run from $700 to $1500. My PPO did pay, but that isn't the norm. Dental devices are generally paid for, but expect to be asked to provide a wealth of information to your insurance company before they pick up the tab. Most stories I've read indicate that people eventually get paid, but the process can take up to 6 months. Try and work with a dentist who will give you time to go through this process.

I find this combination to be very comfortable, very portable, and gives me greater freedom with different sleep positions than CPAP. But it was a longer road to treatment (it takes a few weeks to properly adjust the dental device) and more costly up front.

Best of luck to you. There is a tremendous amount of support and counsel on this board if you want to work out the issues you are having with CPAP. There is also a strong amount of support on the dental forum if you decide to discuss or review alternatives.

[Guest]

I understand soccergirl. It has been a long two years for me also...and i can't do it any more. I need an alternative to this machine.

[soccergirl]

Thanks for the info. I don't have all the data on my sleep study but was told my apnea is mild. My oxygen level was not too compromised. I just know that my symptoms are enough to keep me from sleeping. I'll try to pursue insurance reimbursement but am desperate for sleep. They stated that they had not had any insurance payout on this surgery yet at quoted $1875 for a cash payment upfront. My professional work is suffering greatly and its hard to continue to play soccer on so little rest. I also am cursed with some insomnia and sick of unwrapping the cpap from around my neck all night long. Cheers to everyone who has found relief.

[RickRed]

Soccergirl,

[Less Sleepy]

Having the palatal pillar proceedure and coupling it with a dental device with a follow-up sleep study to confirm adequate treatment is not snake oil - it is a scientifically based treatment, just as CPAP is a scientifically based treatment.

UPPP with no follow-up sleep study, now that's snake oil, and the insurance will pay for that, but not palatal pillar with dental device confirmed by sleep study. Go figure!!!

By the way, I am a happy Bi-level PAPer.

[RickRed]

Less Sleepy,
What a great observation!

[soccergirl]

Thanks again for all the support and information. Having a sleep disorder is a daunting challenge, trying to maintain a professional demeanor but slowly loosing many skills such as language and cognitive functioning from sleep deprivation. I am fortunate to be able to pay for procedures that are not covered by insurance and will have to be my own advocate when pursuing alternative treaments to suit my personal apnea experience.

[Guest]

found the following on SleepNet's forum doing a search over there for the Pillar:

"Posted by Sleepy Stoboy on February 28, 2005 at 04:41:19:
About 3 months ago, I posted that I had undergone the pillar implant procedure and reported that I was sleeping better. I thought I would post the pre and post sleep study results for your review.

Pre-Pillar (9/15/2004)
- RDI of 36
- Low oxygen point of 86.5%
- REM Sleep % = 11%
- Sleep Efficiency = 70%
- Supine Apnea RDI = 67
- REM RDI = 20

Post-Pillar (2/7/2005)
- RDI of 18
- Low oxygen point of 89%
- REM Sleep % = 22%
- Sleep Efficiency = 95%
- Supine Apnea RDI = 41
- REM RDI = 17

"

Mr. Stoboy: Please help me understand this as I am trying to decide between the Pillar procedure and a Dental device myself. My insurance is giving me a hard time but what is RDI? My study doesn't have RDI listed anywhere. How does it differ from AI or AHI? does RDI include any snore data?

And if I read the above results correctly, isn't your Supine Apnea of RDI=41 still considered to be severe OSA? I have also been told Sleep Efficiency doesn't really mean anything towards severity only a measure how tired you are. Is that true?

Please excuse me if the above is not your post from the other forum, but I have been searching all the forums for respectable data on this procedure in order to persuade my doctor and I'm having a difficult time finding any.

If I am to be left with severe apnea after having this Pillar surgery wouldn't my money not be better spent getting the dental device first?

I checked my insurance, they will pay for most of the Dental device but not the Pillar, so if I have that procedure it will be out of my own pocket and right now with Christmas coming up I just cannot afford them both. Thanks

Lisa

[Sleepy Stoboy]

Hi Lisa,

You've come to the right thread. Did you read my reply to SoccerGirl above? I think you'll find your answer there.

The bottom line is that for most people, pillar isn't a cure. Maybe 1 in 10 can "cure" their apnea with these implants. My sleep study used RDI (respiratory disturbance index) while many others use AHI (apnea hypopnea index). There are slight differences between the two benchmarks, but what you want to see is a reduction to less than 5 per hour to be considered "cured". Many on this board using CPAP with data tracking work to hit a level of 0 disturbances per hour.

If finances are a consideration, my advice would be to go ahead and get the dental device. Many people are able to treat their apnea solely with these devices. This is because their palate isn't playing such a major role in their obstruction. In my case, it looks like it was about 50/50. There are confirmed studies out there that show that dental devices can treat all severities of apnea, including severe apnea. (The percentages do drop as your severity level increases).

You can always have the implants done at a later time. Once more sizeable clinical studies come in, the insurance companies will be more likely to consider them a viable treatment option.

You'll want to see a dentist that specializes in treating sleep apnea using oral appliances. Make sure you get information from your insurance company up front as to what you'll need to provide for reimbursement. A few of us have had our share of wrangling with insurance companies over reimbursement.

Good luck in whatever treatment options you choose. If you are interested in this route, visit the dental forum on this site as there is an extensive amount of information regarding dental devices and pillar.

[soccerboy]

hi soccergal,
i'm a mild apnea sufferer who loves soccer, seeking alternatives to CPAP treatment. please keep us posted.

[notasuckerboy]

obviously more planted posts by stewboy to get his snake oil treatment back to the top of the list, stents must be backing up in the warehouse!

But please explain to us again why insurance doesn't pay for this procedure and most exclusively exclude it in their policies?

are they trying to tell us something your are not?[/b]

[Winston]

Sleepy Stoboy,
Thank you for all the information you post. If the pillar along with a dental device works for some than everyone needs to know about this option. As far as insurance not paying for this procedure, AT THIS TIME, is not unusual. Insurance will try to not pay for anything unless it is proven to save them money or they are forced to pay. I appreciate you keeping us informed even at the risk of personal attacks. Thanks again. I hope this procedure will help some who just cannot adjust to the pap.