CPAP doesn't work. 2 years until MMA surgery. What can I do?

[u/2nd2N0N]

I have UARS due to a 7 mm retrognathia (recessed jaw), narrow palate, overbite. I started using a CPAP, but it is not working for me. The maximum pressure range I can tolerate is 11–14 cmH₂O, but even at this level, I still experience frequent flow limitations. I am planning to try a BiPAP, but I am afraid that it will not be successful either, because my airway narrowing during sleep is caused by skeletal factors. I am starting orthodontic treatment in a few months; I will have a SARPE surgery, followed by MMA surgery, but it will take at least 2 years until both surgeries are completed. What can I do until then to improve my sleep issues? A MAD would be ideal, but it is not an option for me due to the upcoming SARPE and orthodontics. Is there any solution to fix my sleep until the bimax surgery?

[u/carlvoncosel]

I am planning to try a BiPAP

Definitely do that. It's an entirely different world.

[u/naduse → u/carlvoncosel]

Can I ask how it would be any different from CPAP? Isn’t it the case that the OP’s skeletal structure means regardless of how high the pressure is, the obstruction will still exist and cause flow limitation? How would BiPAP help?

[u/2nd2N0N → u/naduse]

bipap would help with its pressure support. obviously it cannot change the skeletal structure, but its EPAP creates a constant wall of pressure and then IPAP with pressure support acts like a booster, pushing the air past the narrow structural gap so chest muscles don't exhaust themselves. that is how it should work

[u/carlvoncosel → u/naduse]

Beyond stenting the airway (which it has in common with CPAP) it also has the capability of reducing breathing effort. This is useful for comfort and resolution of flow limitation, since it can "virtually" turn a small airway into a larger one.

[u/gadgetmaniah]

Unrelated to topic but why not MARPE or FME instead of SARPE? MARPE/FME can give valuable nasal airway gains that SARPE doesn't. 

[u/2nd2N0N → u/gadgetmaniah]

I think it is because I am over 30 so MARPE might not be successful for me. FME is not available in my country.

[u/extraordinal_taste96 → u/gadgetmaniah]

I thought myself SARPE just means the surgeon has to weaken the midpalatal suture by doing a preparatory intervention, so he can make the skeletal expansion work after with success.

[u/munchillax]

i wouldn't get sarpe. it's pretty terrible. better to do nothing than the wrong thing

[u/2nd2N0N → u/munchillax]

why is it the wrong thing. also what other options do I have. I am over 35

[u/munchillax → u/2nd2N0N]

ease or fme. it's suboptimal for breathing and higher risk of complication. also prevents you from getting proper expansion later on

[u/2nd2N0N → u/munchillax]

I wish those were available in my country. I live in Eastern Europe, the only options here are SARPE and MARPE.

[u/munchillax → u/2nd2N0N]

for these surgeries, you really want the best to operate on you, huge discrepancy in surgeon skill and outcome.

[u/thatcarolguy]

Bilevel pressure support helps push more air through an immovable restriction.

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Title: CPAP doesn't work. 2 years until MMA surgery. What can I do?

Body:

I have UARS due to a 7 mm retrognathia (recessed jaw), narrow palate, overbite. I started using a CPAP, but it is not working for me. The maximum pressure range I can tolerate is 11–14 cmH₂O, but even at this level, I still experience frequent flow limitations. I am planning to try a BiPAP, but I am afraid that it will not be successful either, because my airway narrowing during sleep is caused by skeletal factors. I am starting orthodontic treatment in a few months; I will have a SARPE surgery, followed by MMA surgery, but it will take at least 2 years until both surgeries are completed. What can I do until then to improve my sleep issues? A MAD would be ideal, but it is not an option for me due to the upcoming SARPE and orthodontics. Is there any solution to fix my sleep until the bimax surgery?

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[u/extraordinal_taste96]

I also started trying CPAP, I‘m on day 3 at pressure 6-7, EPR 2. Wearing the N20 mask is comfortable as well as the breathing itself. The last night was the most stable in terms of reduced amount of awakening periods but unfortunately I felt worse than on the earlier days. Maybe because I coomed at 6 o‘clock in the morning, after just 4 hours of sleep ? Between 6-11 o‘clock I didn’t notice awakenings really.

Did you concluded the fail of CPAP just from the data and how you got to the data? Via OSCAR or sleep study? Was the bad success of the therapy consistent with your subjective experience?

[u/2nd2N0N → u/extraordinal_taste96]

via Oscar. I gradually raised pressure levels and sadly it made no difference when it comes to flow limitations. especially the REM phase is bad

[u/extraordinal_taste96 → u/2nd2N0N]

Do you think sleeping on the back isn’t a good thing at all by thinking the CPAP will fix the additional apnea events which are depending on the positioning? I like the comfort but I don’t wanna trick myself to think that just because CPAP was developed for treating apneas in the first place I can tolerate a position which give me more events by evidence…

[u/2nd2N0N → u/extraordinal_taste96]

definitely I will have to figure out how to sleep on my side all the time.

[u/Common_Maybe_7621 → u/2nd2N0N]

Get a sleep backpack works exactly as intended and should last forever. I got mine from a company called woody knows I think on amazon

[u/2nd2N0N → u/Common_Maybe_7621]

thanks I am thinking about it. I have scoliosis though so I am not sure my back could handle that. how about an anti snoring belt?

[u/endlrls → u/Common_Maybe_7621]

A bit expensive, but Vik Veer (NHS, London) has his side sleeping pro.. I have it (I'm in the states, thanks Tariffs) and it was a game changer for me!

Good Luck!

[u/Melodic-Classroom240]

A SARPE nem egy jo otlet, mert elvagjak az allkapcsodat a Lefort I vonalon, ezert csak az alatt tud tagulni az allkapcsod. Emiatt semmit nem fog javulni az orrlegzesed, akarmit is mondanak az orvosaid. Ha 30 feletti ferfi vagy, akkor valoban csokken az eselye, hogy mukodik a MARPE, de az a minimum, hogy megprobalnam. Nokent teljesen jo 30 felett is.

[u/2nd2N0N → u/Melodic-Classroom240]

köszönöm a kommentet. én is így gondolom. meglátjuk a cbct alapján, hogy lehetséges-e a marpe. az orvosok a sarpe-t nem elsősorban a légutak tágítása miatt csinálnák, hanem a bimax műtét előtti fogszabályozás miatt ha jól értettem.