So I’ve been a horrible snorer for many years now, and it’s clear that I also have sleep apnea (I can remember a good handful of incidents where I woke up in the middle of the night gasping for air from blocked nasal passages, and can assume there are many more that I don’t remember). I’ve been tested and diagnosed and everything. And the doctor seems confident that the operation will likely help with both problems. But much of what I’ve read seems to indicate mixed results, and I have a friend who’s had a similar operation advising me against it.
So I just wanted to see if I can get some questions answered from anyone knowledgeable here. But first thing’s first, namely the actual name of the operation(s). In German it’s called: „Septumplastik“ and „untere Muschelkaustik“
The first seems to translate to Septoplasty. From the wikipedia page:
So, the first part seems like it would be directly related to sleep apnea, but why does it not include it by name? And why would this also not be indicated for snoring? Or is that also somehow implied?
A permanent decrease in the sense of smell?
The 2nd operation brings me to the German wikipedia page for Conchotomie which has a subheading for Muschelkaustik but the former has no corresponding page in English and the latter has no addition page at all. So, can anyone translate the exact name of the operation for me into English?.
So is this full procedure likely to have a successful result? Is it worth it? My friend said she was out of it for nearly a month afterwards, but my doctor says I’ll feel sore for 3 days. Admittedly the Germans suck when it comes to pain meds. (I’ll be surprised if I get more than Ibuprofen 600s. Seriously Germans, not everyone who takes an opiate will become a heroine addict in 3 days.).
That page describes different ways of reducing the nasal muscles. Muschelkaustik is cauterising them and that bit translates as:
“Other methods rely on introducing electrodes into the mucosa of the nasal muscles, through which a high frequency current is passed, which leades to burning in the deep layers of the mucosa. In the days and weeks afterwards, scars are formed, and the scars pull together to reduce the nasal muscles.”
But you need to press your doctor to explain the downside risks a bit more.
The second procedure is a Turbinectomy in English: Turbinectomy - Wikipedia. Will it work? That depends on the contributing factors to your sleep apnea. If nasal obstruction is really the issue, then yes, it will help. If it is because you are morbidly obese, which is why you have the nasal obstruction, and the problem would correct itself with weight loss (either natural of through medical weight loss), that is the better path to take. You also don’t mention if you are using a Continuous Positive Airway Pressure (CPAP) device, which is the preferred treatment here in the United States. My wife is a respiratory therapist by training and runs the Kaiser Permanente sleep apnea clinic here in San Diego, so I’ve certainly learned a lot about the condition over the years. I can tell you that she is not a fan of surgery since we says it is just a temporary fix in most cases and if the underlying cause is not corrected, it always returns.
One popular treatment here in the US is Radiofrequency Ablation (RFA), which is discussed as part of the main wiki page for obstructive sleep apnea: Obstructive sleep apnea - Wikipedia
We have a friend who had this done, which temporarily changed his voice and gave him a slight lisp, but he had no loss in taste or other side effects. After about a year, his sleep apnea returned, and he went back to his CPAP. In his case, he is great shape and it is more of a structural facial issue that is causing the problem. Either way, a CPAP is a better starting point if you are not already on one. Some patients have trouble sleeping with the constant air pressure of a CPAP, so while I don’t know how German healthcare works, you may be able to get an Automatic Positive Airway Pressure (APAP), which have a high and low setting (because exhaling against the pressure is easier with the low setting). And if you are able to get it, the Bilevel Positive Airway Pressure (BiPAP) is the most adjustable and the easiest to adapt to. That said, modern CPAP machines have a ramp up feature that makes it easier to fall asleep before the higher pressures kick in, so hopefully you won’t need any of this more expensive equipment, especially if you healthcare provider doesn’t offer it (or offers it with a large co-pay you may not want to provide out of pocket.)
I want the surgery specifically because I don’t want a CPAP!
Thing is, I’m a single guy. I play in a band that’s going on tour next month. I occasionally party all weekend and sleep out. I occasionally go camping with a group. I can’t imagine living my life with a CPAP. How is that even still the solution of choice? I mean sure, as long as I’m sleeping at home and it’s part of my nightly routine, fine. But those spontaneous nights where I find myself elsewhere and am too embarrassed to even fall asleep lest I drive someone to insanity with my snoring… that’s the bigger problem. And I don’t think I’d get into the habit of having it with me at all times.
I’m really, really hoping the operation is a better solution, but I’m waiting to hear more in this thread.
Not sure how bad your sleep apnea is, nor what all was done to test it.
When I was first diagnosed I was having an event (waking without knowing it) almost once per minute). After 15 yrs on CPAP, I was still having over 30 per hour.
With CPAP I have less than 5 per night.
Not once have they ever suggested any surgery.
CPAP is very good and much easier (no recovery).
If sleep apnea is your only problem, I would definitely try that.
My wife had sinus surgery, and in doing so they fixed her deviated septum. She still snores and wished she had not had the surgery done. She came out of the anesthesia and wanted to punch the surgeon. She took a couple of weeks to recover.
Well, I guess the good news is, the problem is not morbid obesity. Thanks for the translated name. Running out now but looking forward to reading it when I get home.
(but getting very discouraged from the feedback. grrrrr… )
I have severe obstructed sleep apnea. About 15 years ago I went to an ENT and he diagnosed a slightly deviated septum, and I went through septoplasty surgery to correct it. It wasn’t pleasant, but after about a week I was back to normal - with no notable improvement in my sleep apnea or breathing. So, in my case, the septoplasty was unsuccessful and a waste of time.
Soon after I got a CPAP, and it was life-changing for both me and my spouse. I know it’s unattractive, and you think you’ll never get used to sleeping with it - but it’s amazing. I sleep better and more deeply, and fall asleep more quickly, with it. I strongly recommend trying it for at least a few weeks before resorting to surgery, which is not guaranteed to be effective and carries at least some risk of making things worse.
ETA: if you’re going to be sleeping in groups with friends, then I understand the resistance to a CPAP. It’s not attractive, and most of them have to have a power source (some can run on a car-type battery). I avoid camping with my son’s scout group because of it. So I don’t blame you for looking for a surgical options.
You may consider this irrelevant, but in the UK the NHS says pretty firmly that “Surgery is usually only considered as a last resort when all other treatment options have failed, and also if the condition is severely affecting your quality of life.”
They only speak of electrocautery as a means of dealing with severe nosebleeds, to seal a vein.
I had surgery for sleep apnea when I was in my late 20’s. I wasn’t overweight or out of shape. It was just a structural issue with the shape of my throat that had always been that way.
It was actually 4 surgeries in one: uvulaplasty, tonsils removed, adenoids removed, deviated septum corrected. That is a very serious and painful set of procedures to have done as my ENT told me in no uncertain terms. The recovery time can be a month or more (as in not able to eat properly and mostly bedridden for much of it) and there is the risk of sudden hemorrhaging that may require emergency surgery to save your life if it happens.
I was one of the lucky ones and I was able to eat small amounts of soup after a few days of lying in bed on strong painkillers and I was able to walk functionally after a week but not everyone recovers that quickly.
After all that, the surgery only corrected some of the problem and I still have to use a CPAP, just at a lower setting than I would otherwise. I believe only about half of people are helped enough by the surgery that they can forgo a CPAP entirely. I don’t regret having the surgery because it had other benefits like fewer throat infections and easier breathing in general but I would have been very disappointed if I expected it to fix the whole problem.
CPAP technology has advanced a lot in recent years. Models like my new one are small, very quiet and monitor your breathing to give just the pressure needed at any given time. I use nasal pillows that just slip right on and off in about a second. I actually like sleeping with it on and find it relaxing especially compared to the alternative. There are battery powered mini-CPAP’s available now as well that are designed for travel. Some of them are small enough to fit in the palm of your hand.
You can jump right in with the surgery if your doctor agrees to it but be aware that there is a good chance that it will not work and you will still need a CPAP even after all the hassle and expense of surgery.
No anti-snoring or anti-apnea surgery is foolproof or guaranteed effective. I should know as I’ve had pretty much all of them - septoplasty, turbinate reduction, antrostomy, and uvulo-palato pharyngoplasty, aka UPPP.
About twenty five years ago, the UPPP was being heralded as a miracle cure for snoring. The effect lasted not quite a year for me before tissues grew back and the snoring returned.
Recovery from a septoplasty is just plain miserable - I endured one or two weeks of mouth-breathing as my nose was jammed solid with sponges and splints. Again, no permanent effects other than slightly fewer sinus infections.
I had the antrostomy and turbinate reduction a year ago for the purpose of hoping to reduce the frequency and/or severity of sinus infections - I’d typically get three or four a year. Weird procedures to experience (cautery stinks and painless or not, the sound of bone and cartilage being crushed and moved is creepy) while awake, but not terrible. I haven’t had a sinus infection since then, so that part seems to be successful, but exactly zero effect on snoring or apnea.
I have a CPAP machine and I completely understand your not wanting to sleep around other people. There are dental appliances that work for some people. Like this.
Is there no positive personal testimonials for this surgery? I mean really, between this thread, other things I’ve read, my friend’s experience… I’m wondering why this surgery is even still being performed.
I’m very torn, because my doctor (he’s got a really nice office in the classy part of Berlin incidentally, so what more do I need to know? ) seemed very confident that the operation would help with the sleep apnea, AND that it would be unlikely to return in the next few years at least. But every other source of information is in sharp contrast with that.
Well, I have an appointment Thursday, so I’ll question him on a few things, and then I might even go the CPAP route at this point, which I absolutely HATE the idea of. I dunno. Gotta think about it.
Please, if someone has a positive (and factually accurate) experience with the surgery to share, convince me to do the operation!
Per UpToDate.com, a subscription website for medical professionals:
If your OSA’s cause can be definitely pinpointed as due to a correctable obstructing lesion, then surgery may indeed be the first best option for you. A decent otolaryngologist should be able to figure out whether this is indeed your case or not. And it sounds like that may be the case in your situation.
There is a device that is surgically implanted into your body- I think it’s called Inspire. Don’t know anyone who uses it, but it would avoid the issue of unexpectedly spending the night away from home
"In some cases, alcohol actually seems to cause sleep disorders. If snoring disrupts your sleep, the malady becomes worse when you drink. If you don’t snore, you may start after a drink or two. If you normally snore, drinking can augment the problem into sleep apnea.
One of the reasons that sleep apnea becomes worse after drinking is that when throat muscles relax and cause a cessation of breathing, you ordinarily gasp for breath and startle yourself awake. If you have been drinking, you are more relaxed, and may be unable to awaken and start breathing again. Alcoholics are at a higher risk of getting sleep apnea, other sleep disorders and sleep disruptions."
Thanks for that info. Now I just have to figure out how to ask (and discuss) this in my crappy German.
I will say, with all my reluctance, and short of the lesion case, I’m already getting resigned to the idea of the CPAP.
[short rant]But this sucks. Yes the quality of my sleep and life can be greatly improved. That’s great. No really… cool… good. BUT, if I’m being honest, the one thing that drove me to pick up the phone and make an appointment was the total fear of needing to crash at a friend’s or with a lovely lady and realizing that in the morning it is very likely that they will want to kill me. And the CPAP is really no solution for that. I can’t believe this is the best science has to offer at this point. That is all. [/short rant]
) seemed very confident that the operation would help with the sleep apnea, AND that it would be unlikely to return in the next few years at least. But every other source of information is in sharp contrast with that.