Base of Tongue Apnea - Best Options - New Options?

[Bogmonster]

What are the best options for apnea where the doctor has indicated that the base of the tongue is the major (if not only) obstruction? Are there any new options available? I am considering repeating a somnoplasty procedure to the tongue base or trying another oral appliance. The first somnoplasty procedure did help somewhat. I am trying to figure out the best option first, as I have spent considerable amounts just trying out relatively random solutions to see what happens... any thoughts are most appreciated.

[Billinseattle]

Well...

The options for significant tongue base obstructions are (in order of preference , risk, and sacrifice) :

1) Improve use of CPAP/BIPAP by adjusting settings and mask fittings.

2) A dental device. Which may help immensely, however, in some it is also not tolerated well.

3) Additional directed somnoplasties. Which will help incrementally...but only temporarily in most cases.

4) An MMA/GA (advancement of the upper and lower jaws/ and advancement of the tongue base). Why not just a GA (tongue base advancement) ? For some reason the literature doesn't support this as a stand alone procedure that will cure your apnea. In most cases, the advancement of rigid structure (jaw) even further advances the tongue...and secures the operative result.

Actually, although this is a major procedure, it is perhaps the best ultimate cure for severe tongue base obstruction.

It is what I ended up with. I ultimately selected it because of the 95% cure rate in the medical literature.

5) A tracheotomy (trach...hole in the windpipe below your Adam's Apple). This bypasses the tongue base (and any other ) obstruction. This is an extreme, though in most people the most definitive and most time-tested fix. It is a lst resort, unless you are extremely ill !

*** Please note....nowhere have I mentioned the UPPP, LAUP, Pillar procedures. These do not in any way address obstructions of the base of the tongue ! They should NOT even be discussed if you already know that your primary obstruction occurs here !

Good luck.

Bill

[seand]

Hi,

I am having trouble using cpap.

I have mild to moderate sleep apnea but dont know where the obstruction is

How do I find out?

I did order a somnoguard (boil and fit at home) to see if I can tolerate it and if there may be some improvement.
I didnt realize I should find out where the obstruction is before trying any alternative treatments to cpap.

[Less Sleepy]

A boil and fit snore guard is not an effective treatment for sleep apnea. If you would like to try a dental device, you need to see a dentist who specializes in sleep medicine.

Sometimes it is very difficult to determine exactly where the obstruction is occuring. Before seriously considering a surgical solution, you need to be seen at a major, university medical school-based sleep center, such as the one at Stanford. Click on the profile button at the bottom of Bill In Seattle's post, and from there you can read more of his posts. He has had his sleep apnea cured surgically, but it was not an easy fix.

Exactly what kind of problems are you having with CPAP? Is your mask comfortable and leak-free (yes, it can and should be)? Do you have a heated humidifier? Having a comfortable mask is 90% of the battle of adjusting to CPAP. Unfortunately, most DME suppliers do not fit masks, but merely assign them. You can learn more about mask fitting by clicking here:
www.talkaboutsleep.com/message-boards/viewtopic.php?p=130180#130180

[seand]

I've been using cpap for about three weeks alternating between a nasal and a mouth mask.
I get between 2 and 6 hrs.

The other night i got 4 hrs woke with hose gurggling, then 3 hrs with no mask. I was so tired I had to come home from work. I then got 4 hrs with mask and woke up exhausted with a headache.
It was a truly awful experience and it made me not want to continue.

Now I've been just lying awake with the mask on but cant sleep.

I have never experienced something so frustrating in my life.
They send you home with a machine tell you to get a mask and come back in one month with no instructions or advice ...i don't get it

i have heated humidification.

I am sure I should try a FF mask but they are outrageously expensive and I don't know how much in the hole I need to get to make this work . I will be paying off my sleep study bill for a couple years.

I have heard several people say a dental device worked for them...some in conjunction with pillar.
It also seems that a boil and fit snore guard does the same thing that the TAP device does and that seems to have helped several at TAS.