Is there anybody here having experience with Coblation of the Turbinate’s and the Soft Palette?

In Denmark this is only on experimental basis. Therefore I’m waiting for a Swedish specialist to do this Coblation on me.

My Soft Palette blocks for my expiratory. I can’t breathe out when lying on my back (Expiratory apneas).

If I set my AUTO CPAP to a minimum pressure of 8, this blocking disappears. But in that case my Turbinate’s swell up, and I have to increase the minimum pressure, and my Turbinate’s swell up more – and so and so..

I don’t expect that I will be cured for my OSA, but I hope that I can tolerate the necessary CPAP pressure, or even better, that I can be cured for my expiratory apneas.

Henning

Henning wrote:

Is there anybody here having experience with Coblation of the Turbinate’s and the Soft Palette?

In Denmark this is only on experimental basis. Therefore I’m waiting for a Swedish specialist to do this Coblation on me.

My Soft Palette blocks for my expiratory. I can’t breathe out when lying on my back (Expiratory apneas).

If I set my AUTO CPAP to a minimum pressure of 8, this blocking disappears. But in that case my Turbinate’s swell up, and I have to increase the minimum pressure, and my Turbinate’s swell up more – and so and so..

I don’t expect that I will be cured for my OSA, but I hope that I can tolerate the necessary CPAP pressure, or even better, that I can be cured for my expiratory apneas.

Henning

Coblation is a trade name for RFA (Radio frequency Ablation) of the soft tissue. A different type of instrument is used which apparantly allows for faster recovery.

RFA of the soft tissue has proven to be ineffective in treating OSA and there are no peer reviewed studies available for the newer method.

RFA is not recommended by NICE (National Institute for Healthy & Clinical Excellence) in the UK, as a treatment for OSA.

Daniel.


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

(Anon)

Henning, are you using a heatead humidifier w/your xPAP? Sufficient humidity will often take care of and eliminate those swollen membranes.


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Hello Daniel !

I know that Coblation is not recommended as a treatment for OSA in most Countries. But if you look at a lot of articles, you will see that Coblation has a good success rate for CPAP Compliance (for Turbinate’s about 95%). The risk is very low, but properly the treatment has to be done again after about 3 ears. The long term effect is not described very well.

I have planned (together with my sleep doctor) this Coblation done in 2 steps:

1. The Turbinate’s.
This should shrink my Turbinate’s (without damaging the mucus), and give me a lot of more airflow in my nose. Hereby I should tolerate a higher CPAP pressure. If I success with this, my sleep problems should be solved.

2. The Soft Palette
This is more complex, and the success rate is much lower. But the risk is still very low. Even if I success with the Turbinate’s, I want this Coblation done. That’s because these Expiratory Apneas sometimes also gives me problems in the daytime (mouth breather).

In Denmark this kind of Coblation only is to be done in a couple of Private Clinics. But in our neighbor countries Norway, Sweden and Germany they have a lot of experience.

Therefore my sleep doctor has made an appointment with one of the best specialist (maybe The Best) in Sweden.

I look forward to have this done.

Henning

CrohnieToo wrote:

Henning, are you using a heatead humidifier w/your xPAP? Sufficient humidity will often take care of and eliminate those swollen membranes.

Yes I am using a heated humidifier.

But I use it at a very low level, because a high level worsened the problem.

Henning

Quote:

1. The Turbinate’s.
This should shrink my Turbinate’s (without damaging the mucus), and give me a lot of more airflow in my nose. Hereby I should tolerate a higher CPAP pressure. If I success with this, my sleep problems should be solved.

Turbinate surgery (not necessarily RFA) has proven successful in helping with cpap compliance. I believe there have been some posts to that effect here.

Quote:

2. The Soft Palette
This is more complex, and the success rate is much lower. But the risk is still very low. Even if I success with the Turbinate’s, I want this Coblation done. That’s because these Expiratory Apneas sometimes also gives me problems in the daytime (mouth breather).

You have mentioned Expiratory Apnoeas on a number of occassins. I have been unable to locate any articles regarding them. I have read your other thread, but am still none he wiser.

How can you have daytime problems with Apnoeas ?

Quote:

In Denmark this kind of Coblation only is to be done in a couple of Private Clinics. But in our neighbor countries Norway, Sweden and Germany they have a lot of experience.

RFA has been around for quite some time. National/Public Health Health systems in Western Europe don't usually carry it out or recommend it (as a treatment for OSA) due to lack of peer reviewed studies, mainly any studies showing long term success.

Quote:

Therefore my sleep doctor has made an appointment with one of the best specialist (maybe The Best) in Sweden.

I wish you well, but this procedure is even less successful than the UPPP.

Daniel.


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

(Anon)

Quote:

You have mentioned Expiratory Apnoeas on a number of occassins. I have been unable to locate any articles regarding them. I have read your other thread, but am still none he wiser.

Hello Daniel !

You are right; if you search for Expiratory Apneas you will find only a few articles. This term I have from my sleep Doctor. He is very well known with this phenomenon.

But I think there is no official term for this phenomenon yet.

I have found this definition of “Respiratory Pause” on Sleepdisordersguide.com, and on a couple of other sleep centers home page:

Respiratory Pause

“Respiratory pauses include obstructive apnea, central apnea, mixed apnea, obstructive expiratory apnea, post-sigh apnea, central hypoventilation, obstructive hypoventilation and periodic breathing.”

The last four definitions, I never had heart about.

I also have found a definition of expiratory apnea:

"Obstructive expiratory apnea has received little attention. It is defined as absence of polysomnographically recorded nasal and oral airflow in the presence of continued expiratory effort against an occluded upper airway. Almost all expiratory apneas are preceded by an augmented breath or sigh. Upper airway occlusion may occur at any level, from the oropharynx to the larynx. Significant heart rate deceleration occurs during the first third of the respiratory pause in a manner similar to that seen during the Valsalva maneuver. There is little change in the SaO2 in spite of the length of the apnea. This might be explained by a temporary increase in lung volume and positive expiratory pressure. "

But there are a lot of articles on the internet – but with other terms.

The phenomenon has been known for some ears.

The oldest article (1999) I have found use the term “Expiratory flow limitation during sleep”. Here is the URL:

http://erj.ersjournals.com/cgi/content/abstract/9/10/2116

They postulate that this is the first time that expiratory flow limitation during sleep has been reported.

Another article (from 2001) uses the term “expiratory abdominal muscle activity”. Here is the URL:

http://www.chestjournal.org/cgi/content/full/120/2/390

They also postulate that this is the first time this phenomenon is described.

Here is an article from Laryngoscope (only abstract) from 2003 where they concluded that airway obstruction during sleep is not limited to inspiration but may also occur with expiration.

http://www.laryngoscope.com/pt/re/laryngoscope/abstract.00005537-200309000-00004.htm;jsessionid=LWKVqHCVn7ZdQCj7yQDYjTWxJHm113HMkXGWW8yByQHr9GJjBCFJ!-1109333067!181195628!8091!-1

But you can find a lot of articles under other terms like:

Expiratory obstruction
Expiration obstruction
Valsalva apnea / obstruction    // Inspiratory = Müllers
And a lot of other terms.

Quote:

How can you have daytime problems with Apnoeas ?

The word Apnea is Greek and means "No Wind". You can have Apneas whitout sleeping. The most common is Adenoides.

But in my case I can't breathe out when laying on my back, or when I lay on a deck-chair. (Then I have to mouth breathe)

When I am sleeping this problems worsened, and then I can't lay on my right side too.

So for the moment I have to fixate my sleep position on my left side, because I can't tolerate the nessesary CPAP pressure to eliminate this apneas.

Henning

I have had a sleep study and I do not have OSA.  However, on a number of occasions, I have been unable to breathe out even though I can breathe in.  This happens at night and I have no idea if it happens in my sleep (but didn't during my sleep study).  On those occasions but one when I noticed it, I was awake but only just.  As to the singular exeption, I dreamed that it was happening and then woke up.  (Something like those occasions when you dream that you have to to the bathroom and soon wake up to find that you do indeed have to).

I saw an ENT specialist about it, but he could not find anything wrong.  I can eliminate the problem with a hard sniff, what you might do if you have a runny nose but can't blow or wipe it.  It's possible, I think, that it is sinus congestion.

I mention it only to have it on record that it is a real problem not in imaginary one.

Frances wrote:

I have had a sleep study and I do not have OSA.  However, on a number of occasions, I have been unable to breathe out even though I can breathe in.  This happens at night and I have no idea if it happens in my sleep (but didn't during my sleep study).  On those occasions but one when I noticed it, I was awake but only just.  As to the singular exeption, I dreamed that it was happening and then woke up.  (Something like those occasions when you dream that you have to to the bathroom and soon wake up to find that you do indeed have to).

I saw an ENT specialist about it, but he could not find anything wrong.  I can eliminate the problem with a hard sniff, what you might do if you have a runny nose but can't blow or wipe it.  It's possible, I think, that it is sinus congestion.

I mention it only to have it on record that it is a real problem not in imaginary one.

Hello Frances!

Everything about SA is average measuring.

In my opinion, this one night sleep study often isn’t enough to give the right results.

In my case I have servere SA – with at lot of Apnea - when I sleep on my back (I can’t breathe out through my nose). On my right side I have a lot of Hypopnea. On my left side I only have mild to moderate SA.

At my first sleep study (8 hour sleep) – I only slept on my back for a half an hour, and mostly on my left side. Therefore my first diagnose was mild to moderate SA.

I think it would be better to look at “worst case” and make the treatment from this point.

Henning