I am 28, 6'1, 250.  I have been tired all the time for a while.  I went to ENT with concern of sleep apnea, (girlfriend says i stop breathing multiple times at night, very scary to her), did sleep study, average of 23 arousals an hour, lowest oxygen level to 88%, longest stopped breathing was 80 seconds.  Not sure of AHI?? He said I have 2 options.  He said I have abnormally large tonsils that he could remove, but not 100% sure it will cure apnea.  Or start using CPAP.  I really dont want to use the machine. I am a very light sleeper as it is, have to be extremeley comfortable for me to sleep.  I know the surgery will be very painful, but will go through with it if it will help.  Any recommendations??

It was good that the ENT said there are no guarantees tonsil-removal will cure the sleep apnea.
So if you do have the tonsils removed, be prepared for it not to work AND do have more sleep study evaluations after the surgery.
I caution you against any other sorts of surgeries for sleep apnea and you might want to search this forum for discussions on surgeries.  
And it is always good to know as much as you can about your condition going in to any surgeries.  Find out  your AHI (it may be similar in number as the 23, but find out).  There may also be an RDI number.  Also find out how bad your condition was during your sleep study during your REM and non-REM stages and in your sleep positions (supine, meaning on back, verses on your sides).  It's always good to know this information, and you might want to ask for a copy of the sleep study report.  It's good to have in order to understand your condition, and good to have to compare with a post-operative sleep study, to see how you've improved with tonsil surgery if you elect to have it.


Linda

Ever try to hold your breath for 80 seconds? You should try it while you are awake, after all you are doing it all the time in your sleep! Once you try to hold your breath that long a couple of times you will see what your brain and heart are having to face each and every night. Month after month, year after untreated year, you are doing tremendous damage to your arteries. That is why untreated sleep apnea has an eleven fold increase of heart attack and stroke, and also why 91% of the heart attacks hospitals see in the late hours of the night and early morning are from people with untreated sleep apnea.

Have you considered that the reason you might be a light sleeper is that you keep getting woken up by apneas you are having every 2 to 3 minutes the whole time you are sleeping?? You are not getting any rest at all. Often sleep apnea sufferers feel weak, so they snack and drink sodas to try to get some energy. That could explain the weight gain.

The CPAP has near 100% success, if you use it, without a very painful hospital procedure. The tonsil thing success is very low, I don't know the exact number, but its LOW. I can't imagine your tonsils closing your airway, they would have to be INCREDIBLE tonsils! lol

I would get onto the CPAP, your future is too important to be sleepy, get into car accidents, forgetting things all the time, etc, etc. It has been a milestone in my getting better. Honestly, that's saying something for me, my health has been REALLY bad for the last few years until now.

Please let us know how you are doing!

Neil

The younger you are the better for tonsil removal.  It's not really that serious an operation anyway.   The swallowing pain is rough the first few days but the pain med takes care of most of it   If your tonsils are really that big it may help.  I would get a second (and third) opinion though.  Make sure to check all the other possible anatomical causes (jaw, tongue, nose).

When I was a kid I used to be able to hold my breath for an insanely long time, and I easily won any breath holding contest.  I had no idea that I was practicing my breath holding in my sleep.

texags02,

Statistically, your chances of cure are relatively small. It may help, but I agree with the other posters that it won't take care of your problem completely. In the ENT world, there's a staging system to predict if you'll respond to a UPPP. If you have very large tonsils (kissing or almost kissing) and you have a relatively small tongue (where you can see all or almost all of the height of your tonsils, then you'll have an 80% chance of surgical success (>50 drop in AHI and final # < 20). If you don't meet this criteria, then your chances are no better than 40%. In my experience, the success is probably more from removing very large obstructing tonsils, rather than stiffening the palate.

In your case, there's a wide variation in the definition of "abnormally large tonsils," but if you have "kissing" tonsils, then it's probably worthwhile to undergo the procedure. Ask if the ENT can do a Coblation subtotal tonsillectomy (where 95% of the tonsil is vaporized) that's much less painful. Imagine having two soft golf-balls sitting in your throat that falls back every time you go into deep sleep.

One of the reasons why people have persistently enlarged tonsils is due to the presence of sleep apnea (OSA). OSA causes stomach juices to be sucked up into the throat, which causes the tonsils (sometimes adenoids and lingual tonsils) to become inflamed and enlarged, since they are lymphoid tissue. The other issue is that in general, it's not that your tonsils are too big, but that your jaw is too small, so the side-walls of your throat between the back of your jaw is too narrow, which makes your tonsils appear larger or closer together. This also causes your tongue to sit higher up in your mouth, which makes the tongue look big and the soft palate elongated (when in fact it's not).

Before undergoing a tonsillectomy, you need to examine your ENTIRE upper airway from the tip of your nose (nostrils) to your voice-box. Opening up one area while leaving tow other areas won't help. Having said this, it's probably a good idea to at least try CPAP. People with mild sleep apnea tend to have very sensitive nervous systems, so anything on their faces or inside their mouths causes more discomfort and arousals, whereas people with severe OSA have diminished nervous systems, and can tolerate CPAP a lot better (with many exceptions to this observation). Sometimes, people surprise me, and end up loving CPAP, despite their reservations. Only after you try CPAP (with the help of people in this forum) and fail, should you look into surgery. There's a lot of confusion and misconceptions about surgery (either for or against), so do your research.

Note that in children, tonsillectomy (and adenoidectomy) has a much higher success rate than in adults, and the results are pretty dramatic, in most cases. But a significant number of children have mildly or significantly persistent OSA, and these are the situations that are frustrating to ENTs like myself. These children probably have smaller than narrow jaws than normal, which is supported by a recent study from Stanford that showed that a combination of adenotonsillectomy and rapid palatal expansion helped significantly in the vast majority of children, in terms of behavioral, cognitive and parental scores.

I can go into the fascinating details of why there's so much more dental crowding and jaw narrowing if you're interested, but modern humans, but definition, have relatively smaller jaws than our ancestors even hundreds of years ago. Humans 500 years ago in general did not get impacted molars. Something to think about...

Hi sypark,

Thanks very much for that incredible post! Are there thoughts on why the human jaw has evolved so quickly???

Neil

I am in my third week of recovery from this surgery. I am 48 yrs. old, male and have used the Cpap for seven years. My Cpap was set at number 7 pressure setting. After one year of thought after 2nd and 3rd opions, I had the surgery. My uvula, tonsiles and adinoids were removed. I noticed a breathing improvement as soon as I woke in recovery. As for my Apnea, I no longer need my Cpap. The Dr. told me it was 50% chance for success. Those odds were not that great but I knew that at 48 yrs. of age, I needed to try it. Time will tell if the operation was a true success. Now, as for the pain after the operation. If anyone tells you that it's a bad sore throat, don't believe them. It's worse ! The first week was the worst, not to mention the pain when the scabs feel off. Pain!? You'll loose weight. I was 225 lbs, 3 weeks later I'm 110 lbs. That's the silver linning. The Rx that are given you just take the edge off, the pain is always present. So, so far I'm on the good side of the 50%.  
ps: I'm 6'2" tall, so I'm not obese. Though, 225 lbs was to heavy.

It's not evolution. It's the environment. There's a classic book in the dental and nutrition fields by a dentist named Weston Price, who traveled the world in the 1930s looking at indigenous cultures eating completely off the land, mountains or sea. What he found was that everyone was very healthy with wide jaws and straight teeth. Once they slowly started to adopt Western diets, their children's teeth began to grow in crooked, with narrow jaws and faces, and they were more sick. The same phenomenon occurred in areas of South America, Africa, Alaska, as well a in the remote mountains of Switzerland and an island off the coast of Scotland. Some of these cultures only ate two food groups—for example the Swiss ate only rye bread and milk/cheese products, with a rare serving of meat. The Scottish islanders ate only oats and seafood. Not very much vegetable or fruits at all. Here's a great summary of this concept if you're interested: http://www.westonaprice.org/healthissues/facial-development.html

Another theory as to why there's so much more dental crowding than in previous centuries was proposed by another dentist, Brian Palmer. He thinks that with the advent of bottle-feeding, due abnormal suck and swallow mechanics, the hard palate elevates and the jaw narrows, with malocclusion and dental crowding. This makes sense, since having an artificial nipple causes poor tongue positioning, as well as an increased sucking action which can produce a vacuum effect, which can narrow the infant's very soft jaws. His website is http://www.brianpalmerdds.com/

It's no wonder that there's so much more dental crowding these days compared with hundreds of years ago. It's a given these days that you'll have your wisdom teeth taken out. The smaller the jaws, the less room for the normal-sized tongue to sit in, which crowds the airway, and with deep sleep , especially on your back, you can obstruct and have an apnea. And the apnea is just the tip of the iceberg...there are many variations of obstructions and subconscious arousals that don't ever get counted as an apnea...this can lead to a host of other medical and mental health issues...

Okay, got copy of my report
AHI - 22.1
RDI - 22.7

texags02 wrote:

Okay, got copy of my report
AHI - 22.1
RDI - 22.7

My stats are somewhat similar, around 22-24 events per hour, my oxygen blood level stuff was 88 percent, luckily with the titration study the cpap brought the levels over 90 percent.

I was also thinking about the Surgery and my ENT said she thought I was a good candidate even though my tonsils weren;t HUge or anything. I talked to a Doctor friend of mine and he did say the UPPP surgery that i was thinking about was a very controversial surgery and wasnt sure I should do it. I use my cpap every night or almost every night, but am still tired all day. I wanted to explore surgery to help and maybe make me less tired, but not sure now if the surgery would help.

David25, UPPP alone is not sufficient to treat sleep apnea with your anatomy, especially if you have small tonsils. Try a dental device first to find out if your tongue is involved. You can try one of the simple low-cost boil-and-bite models (somnoguard or puresleep) to screen to see if you can tolerate a dental device and to see if you sleep better. If it works, you can either stick with this device or invest in a more sophisticated mandibular advancement device. If this works, then this means that your tongue falls back and must be addressed one way or another Have your ENT examine the space behind the tongue with you lying flat on your back. Then push your lower jaw forward to see if that space opens up at all.

You may feel better temporarily after UPPP, but there's a high chance that it won't help in the long run. Either consider surgically addressing your tongue along with the UPPP, expand your jaws, try a dental device or go back to CPAP. Ultimately, it doesn't matter what the numbers are, as long as you address the proper anatomy. If you have any nasal congestion, then deal with that as well (septum, turbinates, floppy nostrils).

When I counsel patients about OSA surgery, I make sure every other option has been tried or addressed. In most cases, people give up too soon with CPAP, mainly due to poor support and counseling. Sometimes optimizing nasal breathing helps in using CPAP, as well as in using dental devices (you need to breathe well through your nose for these devices to work). Once you get to the point of considering surgery, undergoing a UPPP "just to see" with only a 40% chance of success is not in your best interests. As long as we continue to equate palatal surgery alone with sleep apnea surgery, we'll continue to have dismal results and many unnecessary (and painful) procedures.

One caveat is that since your AHI/RDI is mild, it's difficult to apply surgical success criteria (greater than 50% drop in the AHI and the final number < 20). What's more important is how you feel and whether or not your main reasons for treating your condition was properly addressed. In my practice, a UPPP is used as an adjunctive procedure to other areas of obstruction (nose and tongue). Sometimes, especially in young, thin people, the tongue is the only area that needs to be addressed. In children, palatal expansion is another option in addition to tonsillectomy, with much better results. Ultimately, it's your smaller than normal jaw that's crowding your normal sized tongue.

If you do end up undergoing a UPPP, find out if your surgeon can use a Coblation device exclusively (the same device for tonsils) to shave and trim the palate, rather than using electrocautery (Bovie). I've been doing this for the past 5 years and patient do much better with pain.

Hi sypark,

I was going through Brian Palmer's website, and was reading up on how bottle feeding can cause/aggravate apnea. I have some doubts about this, here is my personal experience.

I come from an under developed third world country where bottle feeding was relatively unknown until some 30 years back. Pacifiers were unheard of. Most of us in my family as well as in my husband's family have OSA ,including myself, both my parents, my husband, my father-in-law, my husband's uncles, also my 8 year old nephew. (of course, my husband and I are not blood related) In this list, my nephew was the only one to be bottle fed.

Was Dr.Palmer's study confined only to Caucasians ? May be for Caucasians, bottle feeding might be a cause for apnea. Could the apnea among Asians and South Asians be due to some other reasons?

Thanks!

PS: of course, i am not questioning the advantages of breast feeding.

sk wrote:

Hi sypark,

I was going through Brian Palmer's website, and was reading up on how bottle feeding can cause/aggravate apnea. I have some doubts about this, here is my personal experience.

I come from an under developed third world country where bottle feeding was relatively unknown until some 30 years back. Pacifiers were unheard of. Most of us in my family as well as in my husband's family have OSA ,including myself, both my parents, my husband, my father-in-law, my husband's uncles, also my 8 year old nephew. (of course, my husband and I are not blood related) In this list, my nephew was the only one to be bottle fed.

Was Dr.Palmer's study confined only to Caucasians ? May be for Caucasians, bottle feeding might be a cause for apnea. Could the apnea among Asians and South Asians be due to some other reasons?

Thanks!

PS: of course, i am not questioning the advantages of breast feeding.

sk,

Dr. Palmer is not saying that all babies that bottle-feed will develop obstructive sleep apnea. He's saying that your chances are higher. I do agree this topic does create some degree of controversy, but I think you'll have to agree (along with most dentists) that dental crowding is more rampant now than 100 years ago. I'm not sure about which populations he studies; you can ask him yourself.

One thing I do know is that Asians are far more susceptible to obstructive sleep apnea, due to our smaller jaws. This is why even mild degrees of obesity makes Asians more likely to develop obstructive sleep apnea or even diabetes. I wouldn't say that people either have or don't have sleep apnea, rather, there's a continuum that all humans are on.  All humans are susceptible to a certain degree due to our unique upper airway anatomy.

Coincidentally, I just interviewed Dr. Brian Palmer 2 days ago about his views, which I recorded for my monthly teleseminar series.

To listen in your browser:

http://www.audioacrobat.com/play/WFVxK9ts


To download MP3 file:

http://sypark.audioacrobat.com/download/2200add3-69bc-bb42-fc5b-1766efc358f5.mp3

Hope you find it interesting...

If your doctor is sure the surgery will help than I would try that first. One time surgery or a life time of wearing a mask at night? Go for the surgery.