Sleep Apnea - Part 2

I went to see the ENT a few days after I got the referral. I found out that I have a deviated septum and that I had a polyp in the left side of my nose. I was born with a cleft palate or hole in the roof of my mouth, which I had corrected with plastic surgery when I was two years old. The ENT advised against having the deviated septum repaired, as it could re-puncture the roof of my mouth and I would have food come thru my nose etc. She referred me to a plastic surgeon for a second opinion. She referred me to get a CAT scan to see where the polyp was coming from and it there were more polyps. The ENT also said that I should lose 50 pounds in the next six months. She discussed a gastric bypass briefly, but that is not something I am interested in. I will lose my weight the old fashioned way.

The ENT also referred me to a dentist to see about getting a snore guard made. The snore guard helps to stop snoring, but also pushes your jaw forward so that your tongue can lie flat and does not obstruct the airway while you sleep. I went to see the dentist a few days later and she explained the snore guard or Thornton Adjustable Positioner (TAP) appliance to me. I would have to have impressions made of my teeth, which would then be sent to a lab to make the appliance. The appliance looks like a retainer of sorts with a few differences. The top plate has a hook on it as well as a knob to adjust the device initially. The bottom piece has a wire in the center to for the top piece to hook into. The idea is to push the bottom jaw forward and the knob is to get the bottom jaw in the right position. The device holds your mouth open slightly.

Before I could get the TAP made, I needed to have my teeth cleaned. I have gum disease and it had been a couple of years since my teeth had been cleaned, so I would need to have deep cleaning done on my teeth first. So I set up my first cleaning appointment a few days later, along with my CAT scan later that same day. I had forgotten how long the cleanings are, and I should not have scheduled both in the same day.

The CAT scan was interesting as I had never had one before. The CAT scan machine looked like the MRI machines that you see on TV medical shows, but shorter. Since the CAT scan was only for my sinuses, I was put in only far enough to get a picture of my sinuses. Being inside the machine was like being inside of a dryer with the door open. The machine turned very fast while it took pictures of my sinuses. The procedure took 10 -15 minutes at most.

I saw the plastic surgeon about a month after I had seen the ENT. I had to miss one of my classes, but it was important to get the surgeon's opinion. The plastic surgeon did not recommend correcting the deviated septum. He said that operating on someone with a repaired cleft palate is not wise, and he was surprised that my tonsils had been removed. He examined the polyp in my nose and gave me a steroid to take for 7 days to see if the polyp would diminish in size. I asked him about the CAT scan results, but he said that I would have to see the ENT after the medication was finished, and she would give me the results then.

I saw the ENT a little over a week later. The steroids reduced the polyp and the CAT scan had showed no other polyps. She was pleased that I had begun to lose weight and we had a nice conversation about exercise and weight loss. She gave me a prescription for Nasonex to make sure that the polyp didn't return.

By August, all of my cleanings were completed. The impressions for my snore guard were made. The device takes 2-3 weeks to make. I had an appointment after labor day to pick up my snore guard. When I arrived at my appointment in September, I was told that the impressions had broken on the way to the lab and I would have to have impressions made again. I have a very small mouth, so impressions are not fun. I was annoyed that they had not called me in sooner to re-do the impressions.

I returned to pick up the device. The dentist had me try it on and see if it felt tight in any area. It was tight in a few place, so she made some adjustments and sent me home with the device. She said she would call in about a week to see how I was doing. Last week, after having had the device for about a month, I went in to have the knob removed from the device. It had been a while since my last cleaning, so I was due for another one. I have to premedicate with antibiotics due to a heart murmur, so I had to wait an hour before my cleaning could be done. After my cleaning I asked my dentist about a referral to a periodontist as I need to have gum surgery. She referred me and I went to see him two days later.

Sleep Apnea - Part 1

I was diagnosed with Sleep Apnea earlier this year. The Greek word "Apnea" means "without breath". Millions of Americans have sleep apnea, which means that they stop breathing several times during the night. There are several treatment options for sleep apnea, which I will talk about later. For more information about sleep apnea please visit this list of resource links posted by the American Sleep Apnea Association.

I first suspected that I had sleep apnea after a trip to Las Vegas with my daughter, Beth. We shared a hotel room, and she told me that I not only snore but I stop breathing during the night. So upon our return from Vegas I went to the doctor. My diagnostic and treatment adventure began about a week later.

The first step in the process was to have a sleep study. I went to a sleep diagnostic center in Century City. You are given a list of instructions, which includes things such as don't take a nap the day of the study, don't drink any caffeine the day of the study, things to make you insure that you will not have a difficult time falling asleep the night of the study. My appointment was scheduled from 10:30 p.m. and went until 6 a.m. The sleep testing center at first looks like a doctor's office. The testing room itself is like a hotel room. My room contained a bed, dresser, TV with VCR, and a couple of chairs. First you are instructed to get ready for bed and told that the technician will be with you shortly. A word of advice, wear comfortable pajamas - on my second sleep study I wore some tight exercise pants, and this made it difficult to put the wires on my legs.

When the technician comes in, the first step is to hook you up to about 20 wires to monitor you while you sleep. There are wires on your head (put on with a stiff lotion), your arms, your legs, your stomach and it is all hooked up to a machine named "Alice 5". The first half hour to an hour of the study you are monitored as you sleep. After that, you are awoken and the technician hooks you up to a machine called a Continuous Positive Airway Pressure (CPAP). You are then monitored with this device for the remainder of the night. The CPAP machine delivers air thru your nasal passage thru a mask. The first mask was difficult for me, because I breathe primarily through my mouth. I was then switched to a mask that covered both my nose and my mouth. The technician adjusted the air flow several times during the night.

The only difference between the testing room and a hotel room is that the bathroom is down the hall. Every time you want to go to the restroom you need to unplug the monitor and bring "Alice" with you. There is no shower at the facility.

About a week later I received a note from my doctor's office that I needed to schedule a second sleep study. It had been determined that I had severe sleep apnea, but the first mask did not work for me, so they wanted to try a different type, Bi level Positive Airway Pressure (Bi PAP). Same drill as before, but the new mask was put on at the beginning of the night. After this sleep study, I received another note that I needed to see a doctor at the sleep diagnostic center. I called to schedule an appointment, and was told that I needed a referral from my doctor. HMOs - gotta love all that red tape! So I called and left a message for my doctor. My doctor was on vacation, so I was told that they would leave a note for another doctor to write up the referral. The next day, when I had heard back I called again. They took the message again and when I called later that day, they had referred me to an Ear, Nose, and Throat (ENT) doctor.