Posted by: Jan | August 4, 2010

Is CPAP Really THAT Bad???

Almost every day I see a post from a newbie complaining that they will never get used to CPAP and inquiring about surgery instead.  I think this is part of those stages of acceptance–denial and bargaining are two stages that occur before final acceptance.  Everyone, including me, goes through that stage of denying that CPAP is that necessary and bargaining that if they just have the surgery the apnea will go away.

But some people get stuck on the idea of surgery and don’t put the effort into CPAP.

There are various types of surgeries.  Some surgeries “ream out” the nose or straighten deviated septums to give air more room for passage.  Other surgeries remodel the back of the throat–trimming or removing the uvula and remodeling the soft palate, often combined with removing tonsils and adenoids.  Some people undergo mandibular advancement–where they break the jaw, prop it forward, and wire it shut until everything heals.

I have no personal experience, but everyone whom I’ve seen go through surgeries like this (except on the websites for surgeons and dentists who do this kind of surgery)  say the recovery is prolonged and painful.  And that doesn’t even begin to cover the lifelong issues that a person can have with swallowing and sinus problems.  Some people can no longer swallow as easily after these surgeries.

There’s a reason that we have uvulas and soft palates–the uvula has a role in sealing off the nasal cavity during swallow and in production of certain speech sounds.  People with impaired or missing uvulas seem to have swallow coordination issues, putting their airways at risk.

Meanwhile, the statistics are scary.  I think I’ve seen that only about 50% of people who have these surgeries have success, and “success” is defined as a 50% reduction (NOT elimination) of apnic events.  Zikes!!!!  And even if you are able to get off CPAP after one of these surgeries, chances are that even a small weight gain will put you right back on it.

Adjustment to CPAP can be brutal.  The difference between that and the pain and discomfort of surgery is primarily that once the surgery is done you can’t escape it.  You have to get through the recovery process, whether you want to or not.  If you are having a tough time with CPAP, you can stop, health risks be damned.  (But don’t stop!)

On a scale of 1 to 10 for pain and discomfort, these surgeries have to be about 1 million.  CPAP, on the other hand, can be really crappy, but on that same scale, I’d put it at about a 7.

You lose some sleep, your nose or face hurts, your mouth and throat feel dry, the air blowing in your face is annoying, it’s hard to get used to the noise or the pressure from the straps, you feel claustrophobic.  Yes, these all are true, but a good attitude and some dedicated problem solving can eliminate all of them.  None of these–not even all of them together–come close to the pain, discomfort, down time, and risks of surgery.  And CPAP, once properly titrated and tolerated is 100% effective.

Do the math!

Attitude is key.  If you keep looking for an out like surgery, you may not ever give yourself a chance to adjust to CPAP.  And if the surgery does not “cure” you, you could be right back where you started–needing to get used to CPAP.

Try CPAP first, with a good, positive attitude to succeed.  You CAN do it.  And once you do, if you still want surgery–really want surgery–go for it.  At least then you’ll know if it doesn’t work out, you will still have CPAP to fall back on.

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Responses

  1. Aw, I’d put the surgery at about a 20, not all the way up to a million!
    But then, I had sinus surgery (to enlarge the passages and reduce infections), not the throat surgery, so that may be different. My sinus surgery worked, but may need to be done again at some point. I hope far, far into the future.

    But yes, CPAP therapy works. From what I read and my experience, it’s not only at the top of the list, it’s the only thing on the list.

  2. I agree one hundred percent. Attitude is everything. I was exhausted before CPAP, too exhausted to do much of anything after work, being late for work because I would sleep through my alarm and slowly putting on more weight without motivation to do anything about it. Unlike someone who was ‘sent’ to a sleep clinic by a spouse that was not getting sleep due to snoring or apnea spells, I went because I was determined to feel better. I wanted to have more energy and didn’t want to think that all there would be to my life was work and sleep at the age of 50. So I was determined….determined even when the first 3 masks didn’t fit right and were blowing air in my eyes, determined when the whistling of one mask woke me up regularly, determined when I would twist around in the hose and pull the whole unit off of the table and spill water all over me, determined when water dripped onto my nose from the hose. I have worn every night since I got it in March…except one night when I had a tremendous cold and knew it wouldn’t help. A few nights I have taken it off in my sleep but for the most part I have worn it an average of 7.5 hours a night. At first I was just as tired, if not more due to all the issues. Slowly I noticed that I didn’t wake up with a headache in the morning anymore, that I heard my alarm when it went off instead of sleeping through an hour or more, that I have energy at the end of the day to make dinner, go out for a brief time. There is still a ways to go and some nights are still not great but I remind myself that all nights were not great before. One day, and only one so far but it gave me great hope, I woke up before my alarm, felt like getting up right away, was energetic, chipper and happy all day at work and all evening. I am looking forward to more days like that. I am thankful for having CPAP and could not imagine going for surgery before giving this a worthwhile try (6 months to a year) and not seeing any benefit…surgery always has risks!


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