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Surgery for adult sleep apnea

May 2005

Can anyone recommend a physician for adult laser surgery for obstructive sleep apnea. Also, was the surgery sucessful, and what was the process like? jessica


I had this surgery last August. It was performed by Dr. Andrew Moyce of Summit ENT. I liked him. Still do. Felt no pain during surgery. Had tonsils, uvula and soft palate tissue removed. (My apnea was severe and CPAP machine caused allergic reactions)

Recovery was tough for a while. Horrible sore throat for days. Very hard to eat anything but crushed ice, popsicles, jello for days.

A week in, I sprung a leak (artery blew in throat) and had to go to Summit emergency room at 3 am. Dr. Moyce came and sealed me up. Scary as hell, but I made it thru. I understand leaks are not uncommon with the surgery.

No other complications.

I've had to adjust for some time. Voice box resonates differently. Have issues with mucus drainage from nasal passages which is annoying.

OTOH. Apnea is gone! I get good nights sleep. My wife says I no longer snore...it used to be real bad. It was unpleasnat, but worth it. I'm far more rested (and so is my wife) and have adjusted fine to the issues I mentioned above.

I also have a good friend who had the surgery too, but he got it done at the VA hospital in SF since he is in the Coast Guard. Ray


Getting help for husband's sleep apnea

Sept 2003

My husband was diagnosed with sleep apnea in 1999. At the time we were living in Oregon and had excellent medical care. He was seen by specialists, had sleep evaluations done and was given a CPAP machine. About 9 months later we moved here to the Bay Area, meaning we had to change doctors. I was overseas when my husband was diagnosed and did not get to ask many questions about his care. When we left, we were given the machine to keep (not rent) and sent on our way.

Our doctor here, who has been in practice for quite a while, admitted to never having had a patient with sleep apnea before. In the last three years, we have never had a follow up appointment or even a phone call regarding how his treatment is going. It seems to me that since this is a lifelong condition that is potential fatal ( should he stop breathing and not start again) that we should be receiving some kind of follow up care on a regular basis.

At one point his CPAP machine broke and it took a month just to get a replacement machine. The respiratory therapy company we worked with, Apria, promptly lost our machine and then tried to charge for a years(!) rent while they made very little effort to find it. It took us over a year to get the machine that we owned replaced with a compareable machine. The doctor's office was of very little help and didn't even seem to comprehend the urgency of needing a CPAP to ensure that my husband didn't stop breathing at night. And in 3 years we have been unsuccessful at getting any replacement allergen air filters for the machine.

My question is for those who are being treated for apnea. Do you see your doctor or a specialist on a regular basis? I have a nagging feeling that we are not getting the proper medical for this condition. Our machine even has a smart card for usage tracking, but no one seems interested in it. We have Cigna insurance, but really no idea about whom in the Bay Area we should be seeing. We appreciate any advice or helpful information!


I have heard this dentist speak on sleep apnea (his specialty) at conferences. He is fabulous and had some interesting info on his site: http://www.brianpalmerdds.com/Default.htm Jen
I don't know if this was the type of information you were looking for, but I would consider checking to see if my neurologist, Joanna Cooper, accepts your medical insurance. I know she works with patients with sleep apnea. I myself see her for other reasons, so I can't speak specifically to that, but she is wonderful with me, and I would pay out of my own pocket to see her rather than change because of my insurance. Karen
I was diagnosed at the Stanford Sleep Disorders Clinic with a condition related to sleep apnea. I am a Kaiser patient and I paid for the initial evaluation out of pocket as Kaiser's rudimentary diagnosis technique did not show a problem, but I thought that one might exist.

Stanford's report from the evaluation- exam and history, cost about $300- confirmed my suspicions and forced Kaiser's hand- they then paid for a full sleep study at Stanford which confirmed the preliminary diagnosis. I was put on CPAP which has helped a lot- I am now rested by sleep instead of waking up still tired. Apria provided me with the CPAP machine and initial instructions, but I have not found them very helpful for ongoing assistance. But since the CPAP continues to work, I have not been particularly concerned.

None of the masks that Apria offered me were comfortable (it's a challenge to sleep with that device anyway), and I found another resource for other choices and replacement parts as I've needed them. I pay out of pocket, but maybe you have different insurance that would cover it. Jeanie Blair, a respiratory therapist, has a business called CPAP Company in Sunnyvale, phone 408-746-9764. she is a nice person and has been very helpful.

One word of caution about Stanford. I feel that they are too ready to recommend surgery, some of it experimental. I wasn't convinced that I needed it and it was very expensive (Kaiser would not pay for this as it was experimental), and I sought opinions from 3 doctors unaffiliated with the Sleep Clinic. None of them felt that the surgery was warranted, and one said it might even be harmful. anon


Does snoring mean Sleep Apnea?

Aug 1999

Does anyone have experience with their children's sleep apnea? My son (2 yrs old) snores terribly and seems to have trouble getting the breathing technique down at night. He can't seem to breath through his nose and sometimes will wake himself up trying to get air through. Obviously he breathes through his mouth, but when he's not in a deep sleep, he struggles with how to do it. It's painful for me to watch, not to mention the loud snoring and flopping around on the bed when he wakes up. We sleep together, so I get to participate in these events. I did see an ear/nose/throat doctor who said he did have big tonsils and probably big adenoids, but would need an x-ray to know for sure. We didn't really get into the subject of surgery, but it may come to that. However, the doc said he may outgrow it too. I really don't want to face surgery, but of course I don't want my son to lose sleep either. Thanks.


We had the same problem with our daughter, now 3 years old. For a long time she would wake up at night crying, and most times we (and her pediatrician) thought it was a new ear infection, because she always had some fluid behind her ears. It wasn't until she could say the word "nose" when she woke up that we realized there was something wrong with her breathing. She had been breathing mainly through her mouth too. She had huge tonsils and when they did the sleep test they found several episodes of apnea. We tried a nose spray for several months to diminish the inflammation in her throat and nose, but it wasn't very helpful. Finally, after hesitating for a long time, she had surgery, and tonsils and adenoids were removed. We still cannot beleive the difference. She sleeps trouth the night with no problem, her snoring is completely gone, she breaths much more easily, she is not cranky for being tired as she was before. And best fo all, her frequent ear infections have disappeared, at least for the last 4 months. The operation is really simple, and although the post-op is quite painful, now I believe it was really worth the trouble. It was done at Kaiser Oakland, by Dr. Byl. Good luck!
Sleep apnea that results in the person awakening gasping for air, with or with out, but usually with, loud snoring or other airway noises, in any age group, is not okay, not normal, and should be the occasion to run, not walk to a competent doctor who will perform a sleep study. The common reason for awakening is that the oxygen saturation level in the blood gets so low that the person jerks into consciousness to get more air: they are suffocating, in a sense. Not getting enough oxygen is not good for your body! that is why you wake up, to open the half-closed airway! in adults, this condition increases risk for heart attacks & sudden death. The person may need to use a CPAP machine: a mask fits over the face while (usually) he sleeps, thru which pressurized air is blow n into the airway to force open the air passages so that the person person gets enough oxygen while sleeping. Some people have their throats/airway remodeling surgically for this condition. Merrill Nissam in Marin is one surgeon who does the procedure. If it were happeneing to my kid I would not hang out & wait for him/her to outgrow it, I would get right on it, do a lit search, go to Children's Hosptial, UCSF or Stanford & not to a small pediatric office. Kaiser has classes on sleep apnea, and a doctor whose speciality it is to deal with it. How come I pontificate on this? I am an ER nurse & diagnosed my partner's sleep apnea (he was awakening gasping gasping from low O2 many times per night & felt tired all the time & was a monster loud snorer) & hauled him in for help. He now sleeps with a CPAP, feels much better. This is a common, oft-undiagnosed condition that is a serious health hazard for some people! It should be part of routine screening, especially in adult men, but it is not! Oh well. Now you know! Save your family members!

Is daughter's lack of growth due to sleep apnea?

Dec 1999

My daughter is 3.8 years old, but she is shorter than the average 2 year old. I was concerned about her growth, so her pediatrician gave her some blood tests (what, I don't know) These came back normal. His explanation for her lack of growth is one I've heard before: Her tonsils are enormous (they squeeze up against each other). This causes sleep apnea which interferes with deep sleep needed for growth. (Evidently there is research to support this idea.) He believes that after we remove her tonsils, all will be fine.

She does act like a child whose sleep is being disrupted: She is relatively lethargic, inattentive, and constantly stares off into space. I would love to think that many of these problems could be fixed with a tonsillectomy. However, I am not convinced.

One, I haven't really witnessed this sleep apnea. She does snore when she's sick, and her breathing is always audible, but only a few times (when she was very congested) did I hear her stop breathing for a few seconds. She sleeps in the same room with me and I listen a lot. Is sleep apnea so subtle that I miss it? Have other parents had their children's tonsils removed just because they were large or the child seemed sleepy?

Which brings me to two: If she is so sleepy then why does she sleep far less than average for her age? In each of her 4 child cares, she was the ONE child who refused to sleep, and actually stopped napping regularly at 26 months. Are sleep apnea children sometimes non nappers? Have people seen their children go to sleep more easily after their tonsils were removed? Do they become less fidgety at bedtime?

Question three: Could a child have the growth and grogginess symptoms of sleep apnea, but have the problem really be some sort of childhood insomnia? I sometimes wonder about our family bed situation. (especially when I lie awake in bed at 3 am after being woken up by someone, for the hundredth night in a row). This girl takes so long to fall asleep and sometimes announces: " I'm not going to sleep tonight." Has anyone every heard of chronic insomnia for a child so young? Thanks


You have a really good pediatrician. Sleep apnea often goes unrecognized. Your description of her symptoms is exactly that of an affected child. If you want a 2nd opinion, I'd suggest calling Rafael Pelayo MD at the sleep disorders clinic at Stanford. You'll get state of the art advice and probably some good articles or references.
How about renting an apnea monitor? A sleep study at home? At least that way you could rule out apnea if that's not the culprit. Maybe your insurance would cover it, it's certainly worth testing before having a tonsillectomy. Good luck.
My son had his tonsils removed when he was almost five. He was also diagnosed as having sleep apnea. In his case, I could see it happening many times during the night and it wasn't something that was hardly noticeable. He snored very loudly when sleeping, and sometimes, would just stop breathing for a few seconds (maybe 6 or 7 sec) and then, he would start again very loudly, as if he was drowning before. He was always tired, specially in the morning, even though he slept long hours at night. He also didn't have much appetite and was very skinny, to the point that really started worrying me. I had talked to his pediatrician many times about how he snored and was tired and the pediatrician would always tell me that he would grow out of it. Just after changing pediatricians, for other reasons, I found out that he actually had sleep apnea. I was very reluctant about having the surgery and did a lot of research about it, but finally decided about doing it. Today, I can tell you that the only thing that upsets me is not having done it before. My son is another child. He doesn't snore anymore, wakes up every day in a good mood, grew up and gained weight, and his teachers at school keep telling me that he really flourished after the surgery. This is my experience, I hope the information helps you a little bit in deciding what is the best in your case.
I would suggest you talk to an ear, nose and throat specialist about this problem (didn't your doctor refer you?). My two-yr old had huge tonsils. and adenoids (3x larger than normal) which were detected by an x-ray. Dr. Wesman at Children's Hospital was his doctor, and although he recommended surgery, he never pressured us and let us decide when or if we wanted to have the tonsils and adenoids out. My son did not sleep well--he would snore loudly and at times, stop breathing for up to 15 seconds. I could see his chest heaving, but no air was going in. Then all of a sudden he would snort and gasp and breath through his mouth. All of this noise usually woke him up as well, so there was much flopping around on the bed. We sleep together and of course I was getting no sleep either as I waited for each breath. We finally decided it was time and had the surgery. The results were dramatic. Not only did he sleep and quietly at that, he began to eat better, too. I don't know why, but it was always a struggle to feed my son since he was 1 year old. He has always been in the lower percentile of weight and height. However, he gained two pounds in the month after his surgery and he continues to eat like a "normal" picky eater. As for sleep habits, my son still wakes up 2-3 times per night and doesn''t seem to need more than 10 hours at night (two hour nap at midday though). He has plenty of energy throughout the day. From what you describe, it doesn't sound like your daughter has sleep apnea as I know it. But perhaps it comes in different forms. Follow your gut feelings--- do get more information on insomnia. Sounds like you're on the right track... Good luck.
My older son, Benjamin, went through this when he was a toddler. He had a terrible snore and suffered from noticeable sleep apnea, which resulted in his being kind of spaced-out during the day. The obviousness of the sleep apnea developed over time--I'm sure he was experiencing interruptions underneath the snoring before the interruptions became prolonged enough to be distinguished from snoring. His growth flattened out entirely for a long period. The problem was identified when he was about 20 months old, but the doctors wanted to wait until he was 2 before operating (I never did ask for details about the need for the wait). Anyway, his tonsils and adenoids were removed shortly after his 2nd birthday and the change (after he recovered, of course!) was remarkable: quiet, restful sleep; increased alertness during the day; increased appetite; growth spurt; learning spurt.

Even though it was hard to subject a 2-year-old to surgery (Benjamin's father was traumatized for life when the surgical resident took Benjamin in his arms and walked off down the hallway with him---Benjamin reached his little arms back over the resident's shoulders and said "Papa, Papa"), I am convinced that having those swollen glands removed was absolutely the right thing to do. Good luck with whatever you decide to do.


To the parents of the child with very large tonsils and possible sleep apnea. My "child" is my almost 40 year old husband who always had the exact same symptoms you all mentioned since he was a very small child. It became a bit of a family joke that when he shared a room with his older brother the brother would realize he wasn't snoring (therefore not breathing) and just as he would get out of bed my husband would snort and breath again. After about 10 years of marriage the snoring became so pronounced and the other symptoms so debilitating that I encouraged him to see a doctor about it. The doctor did a sleep study along with many other tests and referred him to a specialist. At that time he was found to be so seriously apneic that they did major surgery and removed his uvula, part of his soft palate, tonsils and adnoids. They said that if we had not caught it he would have died in his sleep. Once your blood oxygen drops to a certain level long enough it will stop your heart. Much like drowning. After his surgery a second sleep study found that because it had gone on so long his brain no longer knew when to tell him to breath when he was asleep. He uses something called a nasal cpap machine to help him breath at night by blowing air into his nose to stimulate his lungs to inflate.

I can understand your concern about having your child undergo any kind of surgery, but if your pediatrician does not refer you DO IT YOURSELF. Do not let this go on until he is an adult.

I will ask for my name not to be used in this but in an adult male another side effect is impotence which they tell me is the LAST thing to go!! We have since had 2 more children and my husband can't believe the difference in his life! He will graduate from graduate school in May after 7 years of school which he would never have had the energy to do before.


Apnea in adults and CPAP mask

July 2001

I have just been diagnosed with moderate sleep apnea, and have been told that I need a CPAP mask to wear while sleeping. I'm totally new to this, so any information you'd like to share I'd appreciate. Thanks.


I don't know much about apnea myself, but I came across a site on sleep disorders on the internet that may be helpful to you. They also have a sleep clinic in Oakland. There are sleep disorder centers at UCSF and Stanford as well. http://www.sleepsmart.com/ Good luck. avds
I was initially diagnosed with moderate sleep apnea. I tried the usual mask that fits over the nose and I found it difficult to fall asleep. I felt like I was suffocating, and it was very noisy. My respiratory therapist recommended I try nasal pillows that fit under the nose. Go to this site for a picture: http://www.mallinckrodt.com/respiratory/productcatalog/product.asp?id=233. I found the nasal pillows much less invasive and quieter. Also, I went to an ENT for an evaluation after the first sleep test, and it was discovered that I had nasal polyps. I had an operation to remove the polyps and fix a deviated septum. I had another sleep study and my sleep apnea improved to mild. And I continue to use the nasal pillows. There's a variety of masks, CPAP machines, etc. If something doesn't work for you, push to try something else. Good luck.
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