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GBerger

GBerger
Joined May 2017
GBerger
Joined May 2017

Well, it's been about a month since I originally posted this topic to the forums. Since that time, I had an appointment with my new ENT (who also happens to be the brother of my cardiologist). He examined me, looked over the recommendations from the ENT who performed my sleep endoscopy and suggested the following: he felt like (2) of the (4) procedures that were recommended (in his opinion) have the promise to provide me enough relief to be worthwhile getting done. They were the Palatopharyngoplasty or UPPP & the Septoplasty. The Palatopharyngoplasty or UPPP is the surgical removal of the uvula & additional adjacent tissue in the throat to widen the airway. It takes 30-60 minutes & is done with a general anesthesia. A short time is spent in the recovery room but patients typically spend the night at the hospital for observation. A Septoplasty is a procedure designed to improve a patient's nasal airway. Nasal obstruction is usually caused by bone or cartilage which blocks the nasal airway. This procedure also requires a general anesthesia & typically requires a short time in recovery following the procedure. I gave him the initial go ahead to secure approval from my insurance company & the insurance company has already responded with a request for additional information. The tentative date for the surgery is Tuesday, July 25th. I had my pre-op appointment with my family physician which he is faxing to the ENT. I've sent inquiries to both my cardiologist and my endocrinologist asking them for a recommendation on my medications.

Yesterday I had a sleep endoscopy performed to determine if I could qualify for the Upper Airway Stimulation (UAS) Therapy offered by Inspire Medical Systems, Inc. In addition to providing the qualification data, the procedure also provides information regarding whether the blockage of my breathing is primarily at the palate and/or tongue regions and to determine which specific structures seem to be playing a major role in my airway obstruction.

UAS Therapy represents a option for a subset of patients with moderate to severe Obstructive Sleep Apnea (OSA) who are unable to use CPAP. The UAS Therapy is a fully implanted system consisting of a small generator, a sensing lead & a stimulation lead. The single external component is a small handheld remote used to turn the system on before bed and off upon waking. Once activated, the system senses breathing patterns & delivers mild stimulation to key airway muscles, which keep the airway open during sleep. If successful, this therapy avoids the removal or permanent alteration of facial or airway anatomy.

One of the key qualifications to becoming a candidate for UAS Therapy involves a complete concentric collapse of the soft palate when the patient is in a sleep-like state. And that is what they were looking for during my sleep endoscopy yesterday. Unfortunately, during my procedure my surgeon observed a lateral wall collapse in addition to anteroposterior collapse of the soft palate, which disqualified me for UAS Therapy.

So, where does that leave me? Well, the next step is to consider additional surgical options which involve the alignment of the bones & tissue in the jaw, mouth & throat. The most common surgical options rearrange, reduce, or totally remove the tissue in the throat that is blocking your airway while you sleep. This tissue can be in the soft palate, which is at the back of the roof of your mouth; the uvula, your tonsils & adenoids, or your tongue. There are also surgeries that correct the alignment of the bones in the mouth, nose & face.

I'd like to hear from anyone who has had any of these types of surgeries & what their experience was like. Does anyone know what kind of success rates these types of surgeries usually yield? What are the risks involved when having these types of surgeries? I have an appointment with my ENT who performed my sleep endoscopy on May 24 and I'd love to have some data on hand when I speak to him about my options. Thanks in advance for any information anyone can provide me.

Hi George! And thanks for the input. I most definitely will be looking into all that Medicare has to offer. I'm excited about that since my wife & I have really struggled with securing private healthcare insurance that we can afford & that affords us the healthcare services we require. This is much more important for me than my wife at this point since she is much younger than me & is spared of all of the medical challenges that I have.

In so far as your advice regarding self-education, I can certainly appreciate that. However, I must say that I have had an excellent sleep doctor & the resources of an excellent sleep center to call upon for assistance thus far with my sleep apnea. I can also appreciate what you had to say about your DME. I also suffered from having a DME originally that was pretty worthless. However, that is another area where my sleep doctor was able to intervene & help out. My DME had another office located in the sleep center facility where my sleep doctor practices & where I had my in-lab study performed. Through his contacts, I was able to elevate my experience with my DME.

I struggled big time with finding a mask that wouldn't leak, however, that is fairly inconsequential at this point since I no longer use my Bi-PAP. My sleep doctor was convinced that I was not going to be able to tolerate it's use & (as I mentioned in my forum post) we've moved on to considering surgical options; up to & including the new Inspire Sleep Therapy which I hope to qualify for in the coming days.

Thanks again for your very informative response to my post.

Hi! My name is Gary Berger. I'm 64 yrs old & a resident of Lebanon, Ohio. I was originally diagnosed with sleep apnea more than 20 yrs ago; shortly after suffering massive heart attack & having triple-bypass surgery. I was issued 1st a CPAP & later a Bi-PAP, made an effort to get comfortable with their use, found I couldn't tolerate them & gave up. A few years later I was diagnosed with type 2 diabetes & have been treated with medication ever since. Fast forward to 2015. I was having some problems sleeping & at my wife's urging I decided to talk to my family physician about my sleep apnea. She convinced me to do an in-home sleep study. The day following my completion of the in-home sleep study kit, I awoke with pain similar to what I experienced when I had my heart attack so I decided to have my wife drive me to the emergency room to be checked out. They decided to do an angiogram (a test that my cardiologist had requested several times over the past 10 yrs only to be denied by my insurance company). Fortunately for me, the cardiogram turned up 3 fairly severe blockages which they were able to clear via an angioplasty & install 3 stents; thus avoiding a 2nd heart attack. The day I was released from the hospital I returned the in-home sleep study kit to my doctor, she had the results analyzed & issued me a CPAP. I had lots of problems with mask leakage. This was sort of a known problem from the 1st time I tried CPAP/Bi-PAP. I started out with an air-pillow & they switched me to a full face mask but nothing worked well for me. I also couldn't seem to last any more than 3 hrs before I would awaken, gasping for air & ripping my mask off. After talking it over with my family physician, I convinced her that I needed more extensive testing so she referred me to a sleep center for an in-lab sleep study. The results from that study indicated that my sleep was being interrupted on an avg. of 63 times each hour & I needed to switch from the CPAP to Bi-PAP. I continued to have issues with mask leakage. After several months of trying to use the Bi-PAP again, my sleep doctor decided I couldn't tolerate it & referred me to an ENT. He felt my sinuses may be contributing to my sleep apnea problems & wanted the ENT to treat my sinuses, examine me to determine if a surgical solution might be a viable option & see if he could qualify me for the new Inspire Sleep Therapy. I’m scheduled to have a sleep endoscopy performed this Thursday 5/18/2017 to help my ENT to make some of these determinations. Now, I should probably mention that 1 of my biggest concerns is how I'm going to pay for all of this research & treatment for my sleep apnea. You see I’m self-employed & my wife does child care out of our home. So we don't have the option of employer-provided health insurance. We are forced to buy private insurance on the marketplace (Obamacare) & as such are experiencing all the same hardships that many others have been experiencing ... crazy high rising premiums & deductions, after we find an insurance plan that we can afford & 1 that meets our need ... trying to find doctors, specialists & facilities that will accept our plan & dealing the crushing limitations like worthless pharmaceutical coverage. The ENT performing my procedure this Thursday told me he will do everything he can to qualify me for the new Inspire Sleep Therapy. However, based on his experience, he’s relatively sure my insurance will initially deny our request due to the Inspire Therapy being so new. However, he believes that with my history, he should have no problem winning an appeal of that denial. The bad news is that process could take anywhere from 9 to 18 months to complete. So 1 question I have is what good is it to have this wonderful new technology to treat our sleep apnea if insurance companies deny or delay its use? I'd love to hear some comments from others who have situations similar to mine. I apologize for the long entry but I wanted paint an accurate picture of my situation.