SLEEP Surgeries

Sleep is important. For a very long time, the impact of sleep apnea on patient’s life was not understood, and then trivialized. Even today, in India snoring is often a matter of jokes, but ignoring it can affect your health, productivity and life.

I SNORE, DO I HAVE SLEEP APNEA?
All snoring is not sleep apnea, but all sleep apnea(OSA) patients will have snoring. However non apneic snoring can be extremely intrusive to your partner too. Moreover, the severity of sleep apnea does NOT correlate with the loudness of snoring.
 
HOW DO I KNOW FOR SURE?

One of the easiest ways to know is to have someone video you asleep. OSA usually includes bouts of snoring with pauses in breathing in between. We can review the video together to further confirm it.

SO how come some snoring is dangerous WHile some ISN'T?
Great question! See the reason for snoring is different. In OSA, you’re basically trying to breathe in all the air you need across an airway 1/3 its normal size. There’s something called Bernoulli’s principle which states that with decreasing size of the airway, the air speed increases leading to vibration of the tissues. As it gets narrower, the snoring increases until it completely collapses, leading to stoppage of breathing.
In non apneic snoring, the natural frequency of your palate (natural frequency law states that every system in the universe has a specific frequency at which it will tend to vibrate) coincides with the airflow across your mouth. That’s why this type of snoring is regular, the same pitch, and often described as musical (usually by people who dont have to sleep in the same room)
What exactly can happen if i have OSA?

With OSA, your airway is repeatedly collapsing on itself while you are asleep. This is the same as someone choking you thousands of times every night while you are sleeping. You may be sleeping, but your body does NOT know the difference, so it reacts with the evolutionary fight or flight response, flooding your body with adrenaline, increasing your blood pressure, heart rate and producing glucose resistance. Now multiply this by a few million times (every night over months to years) and you will start to see why chances of high Blood Pressure, Diabetes, Cardiac events or Heart Attacks are all greatly increased

SO, Basically surgery?
NOT at all. In fact this is a situation where surgeries are only adjunctive. While surgery can be very effective in children, adults with OSA have a far more complicated anatomy. The obstruction can happen at multiple levels and multiple planes. This means that you will be best served by non surgical measures including lifestyle changes.
Surgery is reserved for key indications like
1. One single source of obstruction that is clearly identified
2. CPAP pressures too high leading to dryness and inability to use it comfortably.
Please be advised, except for very selected cases, it is extremely unlikely that surgery alone will cure OSA. With us, you can always be assured of clear stepwise treatment with frank communication at every step, so you are always in control.
SO WHY DO I NEED A SLEEP STUDY IF OSA IS OBVIOUS?
Sleep studies or PSG tells us a lot more than “Yes, this is sleep apnea”.
It qualifies the specific type, and MOST importantly, gives us important clues as to the severity of sleep apnea.
This is a good spot to let you know not to waste your money on the home Sleep studies. They only monitor limited parameters which yield incomplete and inadequate information. The American Sleep Society discourages these tests, and so do we.

SNORING

Additional Information

If you read the section above, you know now why you snore. So the easiest way to fix the snoring is to change the natural frequency of your soft palate. Fortunately this can be done as an in-clinic procedure with zero downtime.
The treatment is usually done in stages titrated till you get complete relief. 70% patients get significant relief after 1 session, which rises to 85% or more at 3 sessions.
Please be aware these treatments may need to be repeated after 3-5 years.
TIPS & HINTS
  • DO have someone video you if you are coming to see us for this, if possible
  • Please understand that snoring may be multifactorial so we will need to scope the nose prior to any procedures.
  • Bring a list of any other medications you may be on currently
 

SLEEP APNEA SURGERY

Additional Information

Surgeries for sleep apnea are a dime-a dozen, but that does not mean ALL of them work. These surgeries should be applied to carefully selected patients for best results.
The surgeries usually involve addressing some form of local obstruction observed during a Drug Induced Sleep Endoscopy (DISE), either in the nasal cavity, oropharynx or hypopharynx.
Isolated unidirectional sleep apnea can sometimes be amenable to nerve stimulation.
Regardless, heroic surgery really offers long lasting results in metanalyses, so should probably be reserved for very strong clinical indications.
As always, you can be assured of frank & open communication; and clear outlining of all your options so you can make an informed decision.
TIPS & HINTS
  • DO have someone video you if you are coming to see us for this, if possible
  • DO NOT DRIVE alone if you are coming to see us for OSA, as daytime sleepiness can increase risks of driving related accidents
  • Bring a list of any other medications you may be on currently
 

OTHER SLEEP DISORDERS

Additional Information

There are many other forms of Sleep disordered Breathing (SDB Syndromes) that have been identified in the last few decades, and is reflected in the DSM IV and ICD 10 coding guidelines. Many of these are managed by sleep physicians in accordance with current paradigms. A team approach is always beneficial to ensure you are getting the absolute best advice. At our center we work closely with sleep physicians to optimize outcomes.
TIPS & HINTS
  • DO have someone video you if you are coming to see us for this, if possible
  • DO NOT DRIVE alone if you are coming to see us for OSA, as daytime sleepiness can increase risks of driving related accidents
  • Bring a list of any other medications you may be on currently
 

DR. BHATTACHARYYA'S SPECIAL SAUCE

All good surgeons can give adequate outcomes 85% of the times, however the unending passion and joy of surgery is striving for the last 15%. That means doing all surgeries under magnification to give you the finest scars possible, using surgical adjuncts to promote healing, reducing your downtime.
 
Dr. Bhattacharyya has trained at many of the premier institutes in India and abroad, including the famed Vanderbilt University, Nashville, TN. Extensive use of endoscopes, tissue glues, stem cell rich substrates to promote healing, usage of nerve monitoring whenever required are all steps we take to ensure we give you the absolute best chance at great outcomes. Do discuss with us in detail about your surgery, and if you would like a complimentary surgical video, where possible.
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