GBerger

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.

Oh I almost forgot. After finding out about the issues with the ENT that did my sleep endoscopy (not being "in network"), I was talking to my cardiologist. He's a great cardiologist ... he treated my mother for her heart problems before she passed away, he runs the cardiology department at the top cardiology hospital in my area & he's so well known in the field that people come from great distances (including celebrities, who can afford the best care) to get his services. Any way ... I was talking to him at my appointment about my sleep apnea issues & he told me that his brother was a great ENT who specializes in sleep apnea. I called my insurance company & had them verify (in writing) that he is in my network (as well as the facility he works out of) and he is the ENT that I have my appointment with on Monday. So I'm pretty pumped about making the change & getting a new perspective on my condition & his recommendations on treatment (my second opinion).

First off I'd like to thank everyone who responded to my request for input. I have good news & bad news. The bad news is my insurance company denied my claim for sleep endoscopy that I had done on 5/18/2016. It turns out that even though the ENT told me that he was in my network & that he took my insurance, it turns out that they coded the request to my insurance company incorrectly & they are not "in network". Neither is the facility where the procedure was performed. I explained that I had been misled by the ENT & my insurance company rep. recommended that I file an appeal so I did that. However, the good news is since the ENT that performed my sleep endoscopy was out of my network, I had to find an "in network" ENT, which I have an appointment with this Monday. He is being provided all of my records and will be providing me with his opinion on the recommended procedures. If he convinces me that surgery is the best option, I will probably have him perform the procedures. I've been reading a lot of data on all of the procedures and based on the findings from my sleep endoscopy, the risk vs. benefit analysis, a careful consideration of any alternative options for treatment ... the decision to move forward looks like the right one. However, I want my new ENT to give me his opinion after carefully reviewing my records.

Well, I had my follow up visit with the ENT who performed my sleep endoscopy on 5/18. Based on his finding, he is suggesting that I have the following procedures performed:

• Nasal Turbinate Reduction
• Possible Septoplasty
• Palatopharyngoplasty
• Hyoid Suspension

I've given my doctor the okay to apply for approval by my insurance company (Anthem BC) but I am in the process of doing some research & asking a lot of questions before I make my final decision. My doctor has told me that the likelihood of achieving the goals of these procedures is "Good".

I would welcome any information that anyone can provided me on any of these procedures, especially if you've had had one performed on you in the past.

Sleep Dent, First off thank you for responding to my post. I have a few questions and please understand that I have not done much research on dental appliances for treating OSA. My first question is can dental appliances be an effective means of treating OSA, even if a person has already tried CPAP & BiPAP, only to find them not tolerable? My second question is you stated that the MyTAP device from Airway Management is a candidate for an effective, yet relatively inexpensive treatment for my OSA. I don't have any dental insurance. Is there any chance that my private medical insurance (Blue Cross/Blue Shield) might cover all or a portion of the cost? Thanks in advance for any additional information you can provide.

Wiredgeorge, I see the ENT that performed my sleep endoscopy in two days (on Thursday). I plan on listening to what he recommends very carefully. I haven't had much of an opportunity to talk to him, since my sleep doctor referred me to an other ENT who ended up not being in my network & I had to cancel my originally scheduled procedure & quickly find another ENT in my network that would perform the procedure. I had a short window before the pre-op data became invalid, forcing me to have a new pre-op workup. I was trying to avoid that additional cost. So I don't know if he is going to try to motivate me to continue looking for a surgical option. My hope is that he will see some value in simply treating my sinuses & if he can help me with the, perhaps we could revisit the BiPAP or even explore APAP. I'm not terribly excited at the surgical options beyond the Inspire Sleep Therapy; unless he can convince me that the data he obtained from last week's procedure uncovered a very specific course of action involving a surgical procedure. I appreciate your suggestion regarding getting a second opinion. I think that is a very good idea in almost every medical situation. I'm also keenly aware of how to value the information I read on these sleep apnea boards. The way I see it, they are just one of the many sources for data & require validation & additional research. Thanks a gain for the input.

SleepDent, I did try an oral sleep apnea appliance but i did not get fitted by a dentist. A friend of mine who had been struggling with snoring for years, finally gave in to his spouse's demands and ordered a device online that was marketed as an anti-snoring device. It did wonders for him so I decided to give it a try. I ordered it online & when it arrived there was instructions explaining how to heat it up in water before placing it in my mouth & biting down on it with my jaw in a specific position to create an impression in the device. I used it and got some pretty good results the first couple of times that I used it but then a strange thing happened; it started becoming less & less effective, until I was back to snoring as badly as i was before I began using it. Based on my earlier experience, do you think it would be worth my while to revisit it only, this time under the guidance of a practicing dentist? Of course my other consideration is the cost. I have private (ObamaCare) insurances that leaves a lot to be desired. I have no dental or eye care any more.

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.