I am 55 years old and have been on CPAP for 5 years.  I have progressed to a full face mask since I open my mouth and nothing holds it closed.  My pressure has gone from 12 to 19 through the years and several sleep studies.  Recently, ENT has isolated the gap between the back of my tongue and throat (only 1/4" when in a sitting position) as the culprit with my OSA.  He has recommended the surgery that puts a screw in my jaw so that they can wire and pull my tongue forward.  I have had two laser surgeries cutting out the back of my mouth (this was no help.)  I am leery of the painful tongue surgery that may not eliminate my OSA.  I am not interested in reducing my OSA since I have a severe case.  I am not overweight (Male, 6'-3", 195 lbs.).  I am considering a tracheostomy because it is 100% effective.  I am considering surgery because at a pressure of 19 it is difficult to maintain a seal throughout the night and the noise is sometimes extreme.  Also I live in hurricane alley and when the power is gone - so is the CPAP.  I just don't feel comfortable relying on a machine.

I know that water sports are out with a tracheostomy, but I am not a big water person anyway.

Can anyone offer me feedback on either the tongue surgery or the tracheostomy?  Thank you in advance.

Your surgery options are pretty extreme.  The new Fisher & Paykel Flexifit 431 is a full face mask that works well at higher pressures and is very comfortable.  I use it and certainly recommend giving it a shot first.  Trachs have a a lot more issues than just keeping you out of the water.  They are very prone to nasty infections and require meticulous care.  I should know, my dad died from one.

There are ways to deal with power outages from alarms to wake you up when the power goes off (but full face masks have anti-asphyxiation values for those cases) to UPS lines and battery packs.  I disagee that a relying on a CPAP is more obtrusive than what you want as options.

Vicki

pensacola_hosehead wrote:

I am 55 years old and have been on CPAP for 5 years.  I have progressed to a full face mask since I open my mouth and nothing holds it closed.  My pressure has gone from 12 to 19 through the years and several sleep studies.  Recently, ENT has isolated the gap between the back of my tongue and throat (only 1/4" when in a sitting position) as the culprit with my OSA.  He has recommended the surgery that puts a screw in my jaw so that they can wire and pull my tongue forward.  I have had two laser surgeries cutting out the back of my mouth (this was no help.)  I am leery of the painful tongue surgery that may not eliminate my OSA.  I am not interested in reducing my OSA since I have a severe case.  I am not overweight (Male, 6'-3", 195 lbs.).  I am considering a tracheostomy because it is 100% effective.  I am considering surgery because at a pressure of 19 it is difficult to maintain a seal throughout the night and the noise is sometimes extreme.  Also I live in hurricane alley and when the power is gone - so is the CPAP.  I just don't feel comfortable relying on a machine.

I know that water sports are out with a tracheostomy, but I am not a big water person anyway.

Can anyone offer me feedback on either the tongue surgery or the tracheostomy?  Thank you in advance.

Hi,

You are looking at some fairly extreme surgical options. Below are details of most types of 'tongue' surgery.

Genioglossus Advancement
The Genioglossus muscle attaches from the back of the tongue to a spot on the back of the chin.  This surgery attempts to pull the back of the tongue forward in an effort to enlarge the air space behind the tongue.  The procedure pulls forward a rectangular or circular segment of chin bone (below the front four teeth) and holds it in place with a plate or screw.  A minimal change in the appearance of the chin results (millimetres).

Hyoid Advancement
The Hyoid bone is just above the Adam’s apple.  The Hyoid bone is moved forward and either attached to the Adam’s apple or jaw bone.  The purpose is to enlarge the air space behind the tongue.

Midline Glossectomy, Lingualplasty, and Lingual Tonsillectomy
Midline Glossectomy involves a reduction in the size of the tongue (if enlarged).  The back of the tongue is reduced in size by excising a V shaped portion of the centre part of the tongue.  Lingualplasty is a more aggressive resection with additional removal of side wedges.  Lingual Tonsillectomy involves the removal of
Tonsil like tissue on the back part of the tongue, it may also be removed with a laser.  A temporary tracheotomy is usually performed with these procedures to avoid breathing difficulty that might result from temporary swelling. The purpose is to reduce the size of the tongue thereby increasing the air space behind the tongue.


Tongue Suspension Suture (Repose)
The tongue is pulled forward by way of a permanent stitch attached to a screw which has been placed through the back of the tongue.  This is to prevent the tongue falling back during sleep and obstructing the airway.

As you can see, not too pleasant.

The tracheotomy, as you say, is almost 100% effective in dealing with OSA particularly for those of us using high pressure cpap. 10 cms is very high, my top pressure was 18, thankfully now reduced to 14. Has your sleep doctor suggested a Bi Level machine or even an auto adjusting type machine. It might make things a little easier. Is there any way the pressure can be reduced (weight loss, deviated septum etc).

Anyway, on to the tracheotomy. Personally I only ever met one person who had one. He had tried everything and had it more out of frustration. There are many problems, mainly, in the area of hygiene and routine.
Firstly, you need to do a lot of research first so that you are fully aware of what you are having done. The surgery itself is quite straight forward, after which you are left with a 'stoma' (opening). This stoma is then fitted with a 'canula', which is either a metal or plastic 'pipe' which can protrude slightly at the front (you might check out Montgomery Canula.....trade name). Cravats have a habit of coming back into fashion to cover this during the day, while it is blocked with a 'cork' for want of another word. At night you remove the cork and breath through you neck.

A high level of hygiene is required. Daily cleaning of the canula and stoma with peroxide to prevent fresh tissue growth there. Coughing etc during the night can be a little frightening as it all comes out through the hole in your neck. I seem to remember the words 'snot storms'. :lol:

Any more questions, don't hesitate.

Kind regards,

Daniel


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The untreated Sleep Apnoea sufferer died quietly in his sleep.......
Unlike his three passengers who died screaming !!!!!!

(Anon)

Vicki wrote:

The new Fisher & Paykel Flexifit 431 is a full face mask that works well at higher pressures and is very comfortable.

pensacola_hosehead ..

I agree with Vicki, the Flexifit 431 seems to be a comfortable mask.  I can’t really evaluate the mask in comparison to others in that the 431 is the only one I have ever used.  The area just above the nose between the eyes seems a little sore if I tighten the forehead strap to eliminate “eye leakâ€�.  However, I can bear with that after reading the discomfort problems others have reported with different masks.

I have one curious sensation in the middle of the night or upon wakening.  In comparison to feeling the air pressure and feeling my cheeks expand in the beginning of the night, it seems at the middle and end of the night there is no pressure at all inside the mask.  This could be an interesting characteristic of the 431 to you.  Removing the mask seems to return the full pressure until putting it on again.  I have the ResMed S8 with no variable pressure features except for ramping, thus the late feeling of no pressure is a mystery to me!


_________________
Success Nourishes Hope

Thank you very much for your replies: Anhelo Impedio, Daniel and Vicki.

You have given me much to think about.  I will try the Fisher & Paykel Flexifit 431.

Thanks again.