Sleep Apnea Surgery
Are You UPPP For A Good Night’s Sleep?
Greg Shayer, 35, says his low energy levels and restless sleep had affected him and his family long before he was officially diagnosed with sleep apnea, a dangerous disorder that caused him to stop breathing periodically throughout the night. “I was always tired and run down no matter how much I slept,” says the Franklin resident and father of four.
He especially couldn’t keep up with his active kids, whose ages ranged from 2 to 5. “I couldn’t play with them for very long or help out with them,” he recalls.
Greg’s wife, Michelle, says his snoring was so bad that it would wake her up throughout the night and also wake their newborn daughter who slept in their room. “It was awful,” she bemoans. Simply getting him out of bed in the morning after he hadn’t slept well the night before was a huge task. “That’s frustrating,” she states, “especially when you’re trying to raise a family.”
Another scary side effect of his perpetual sleepiness was that he would fall asleep while driving.
The problem got so serious that Michelle had to call 911 one morning after not being able to wake Greg up. “It was so scary,” she says emphatically. “Our daughter was only four weeks old at the time.”
Michelle, whose own mother has sleep apnea, thought Greg had all of the tell-tale signs of the condition. A visit to his PCP and a sleep study confirmed her suspicions. Unfortunately, the standard therapy for sleep apnea, a machine used to assist airflow (CPAP), was unsuccessful for Greg. So, his PCP referred him to Dr. Mark Wallace, an otolaryngologist (ear, nose, and throat [ENT] surgeon) to investigate the possibility of undergoing surgery to correct the condition.
As an ENT surgeon, Dr. Wallace treats numerous conditions related to the head and neck, including sleep apnea. Some common surgeries he performs are ear surgery to improve hearing, sinus surgery for chronic sinus infections, thyroidectomy, tonsillectomy and facial plastic surgery. Dr. Wallace also performs uvulopalatopharyngoplasty (UPPP)—a procedure used to treat sleep apnea during which he removes excess tissue from the throat that would otherwise collapse and restrict the airway.
According to Dr. Wallace, sleep apnea is a condition that has consequences which can be far more serious than incessant snoring and lethargy. “It’s a medical concern because it can contribute to increasing the risk of heart disease and stroke,” he explains. “It decreases the oxygen saturation in one’s system and increases the blood pressure in the pulmonary arteries to create long-term problems.”
Dr. Wallace performs UPPP for patients who have tried using the CPAP machine and can’t tolerate it. This population is typically only one-third of those diagnosed with sleep apnea. “We want to make sure that when we’re performing surgery, we’re doing it for all of the right reasons and that there are no other options,” he emphasizes.
In some cases, patients undergoing UPPP also require other procedures to alleviate the sleep apnea. When the tonsils become so enlarged that they, too, block the airway, Dr. Wallace may perform a tonsillectomy. When the nose is congested, he may perform a septoplasty with inferior turbinate reduction during which he straightens the septum and shrinks the turbinates (the structures that project from the lateral wall of the nose into the nasal cavity) in the nose to improve airflow. These procedures may be performed during the same operative session to improve a patient’s outcomes. “We want to clear everything up at the same time in order to give the best results we can,” he explains.
When Dr. Wallace first met with Greg for an initial consultation, he performed a thorough evaluation as well as a flexible nasal laryngoscopy by inserting a small fiber optic camera through Greg’s nose to look at the back of his throat. “We can actually see where the collapse of the throat is occurring,” he notes. “This helps us guide the recommendations and surgical management of the case.”
This ability to detect the actual area of the collapse and other restrictions can greatly improve the odds that UPPP will effectively cure or significantly reduce sleep apnea. “The effectiveness really depends on identifying and diagnosing exactly where the constriction is in the throat,” he explains. “If you’re able to treat that area, there’s a higher success rate.”
During the flexible nasal laryngoscopy, Dr. Wallace could see that Greg’s tonsils were enlarged, increasing the likelihood that Greg would need a tonsillectomy in addition to the UPPP. As he does with all patients, he explained to Greg and Michelle what the procedure would entail and spent plenty of time answering their questions.
“Dr. Wallace was knowledgeable and personable,” Michelle recalls. “He didn’t talk around the subject. He told us what he thought Greg needed and what he thought Greg would benefit from.”
Dr. Wallace says he tries to paint as realistic a picture of the procedure and recovery period as he can. “The throat is a very sensitive area,” he points out, “and many people have pain that can last for up to two weeks in some cases. Patients need to look past the recovery and know that it’s going to be better once they’re recovered from it.”
Ultimately, Greg decided to pursue the surgery because he and Michelle knew it was the next logical step to prevent any future complications from sleep apnea. “The risks of surgery are not even close to the risks of having sleep apnea,” Michelle reasoned. “The procedure is minor compared to what was going on in his everyday life.”
Choosing Milford Regional for the surgery was easy. “I grew up in Franklin, and we’ve always had everything done at Milford,” Michelle states. “I also highly respect my primary care doctor. When he said to go see Dr. Wallace, I trusted him.”
Greg agrees, adding that he liked the idea of being local. “Who wants to travel all that way [to Boston] if you don’t have to?” he asks.
Dr. Wallace says he enjoys performing surgery at Milford because of the hospital’s emphasis on surgical excellence. “This procedure is well within the range of expertise of the hospital and the physicians and nursing staff,” he says with confidence. “Patients in this area don’t need to look further than Milford to have this kind of surgery.”
When Greg arrived at the hospital, nurses prepped him for surgery and gave him medication to relax. “Everybody was wonderful,” recalls Greg. “I did have a little anxiety before the procedure, but everybody made me feel as comfortable as possible.”
Dr. Wallace performed a UPPP on Greg with a tonsillectomy. He stayed at Milford Regional overnight so nurses could monitor his airway to ensure that it wouldn’t swell after the procedure.
Once home, Greg drank warm soup broth with noodles, ate popsicles and other liquid-based foods during the first week and a half following surgery. After that, he was back to eating pizza and pasta! “At the end of two weeks, he was a considerable amount better,” Michelle recollects. Greg returned to work after two-and-a-half weeks.
The good news is Greg’s snoring stopped immediately after he returned home, and his energy level skyrocketed shortly thereafter. “Since the surgery, he actually sleeps! It is amazing!” exclaims Michelle. “He’s a part of our family again. He’s participating in family activities. He does things with the kids now.”
Greg says he is happy he decided to have the surgery that ultimately gave him his life back. He encourages others with sleep apnea to consider the procedure. “I would highly recommend it without a doubt.”
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