MMA Experiences

Tuesday, January 29, 2013

Post MMA Sleep Study

After almost 4 years, I had my post MMA sleep study performed at Stanford.   The numbers are similar to before the sleep study.   AHI 8.6, snoring, mouth breathing, all hypopneas, and 50% of my breathing had "flow limitations".  Over the course of the 7 hour sleep study (sleep latency less than 1 minute and I don't recall waking up during the night) I spent less than a minute in Stage N3 sleep.    

 I definitely feel better than before the MMA and can't help but wonder how I would feel if I could get rid of the flow limitations.    

Dare to dream....(19% of the night spent in REM  :-) )

Tuesday, June 29, 2010

Final Update

It’s been fourteen months since the MMA and it’s now time to bring closure to my sleep apnea story and blog.

Let’s start with the answer to the BIG question: how do I sleep? Somewhat better. Of course, there is still tremendous room for improvement, but I do sleep better than before. I have yet to master the art of sleeping more than 4.5-6 hours a night, but I’ll gladly take what I can get. While I still wake up tired, I no longer have a headache in the morning. In addition, it’s much easier to make it through the afternoon without wanting to take a nap. There are no plans to have another sleep study.

Since the last blog update, I worked with a sleep specialist who encouraged me to meditate. I spent a few months practicing Mindfulness Meditation. Meditating was definitely relaxing, but it didn’t improve my sleep. I haven’t incorporated meditation into my daily routine, but I do enjoy the experience.

At this point, I don’t expect my physical recovery to progress any further. Here’s the quick summary of the physical symptoms that will likely remain with me:

  1. Numb lower lip, upper gums and the roof of my mouth
  2. Most top teeth have the wooden tooth feeling and don’t have complete sensation
  3. Upper gums still feel spongy when chewing
  4. Difficult to chew very hard and crunchy foods
  5. Weight returned to pre-surgery (bummer)

Looking back on the entire experience, I made the right decision to have the MMA – there were no other options left. While I haven’t had a breakthrough moment, I have benefitted from the surgery. I had the best surgeon do his best work and I feel somewhat better. Would I do it over again? I think so.

Saturday, January 30, 2010


Thought it would be interesting to compare before and after photos...

Tuesday, December 22, 2009

The Check's In Mail

...or so they told me many, many times. I haven't written about the insurance company experience until now. It was almost as painful as the surgery. Just in a different way.

It's taken seven months to resolve all the appeals with my insurance company. The net result is the insurance company did the right thing - they reimbursed the procedure based on the actual amount billed by the surgeon, as opposed to the “customary” amount typically set by medicare. The surgeon was not a preferred provider under my plan. In fact, there were NO preferred providers under my plan in my area who do MMA surgeries. When everything was finally settled, the insurance company agreed that they had no preferred providers in my area who do the procedure.

I had done as much as possible to work with the insurance company in advance of the surgery. The insurance company had approved the procedure as being medically necessary, but would not commit to the amount they would reimburse until the actual procedure was performed. They gave me the names of several surgeons in my area who they claimed performed the procedure– none of these physicians performed the MMA. Upon notifying the insurance company that they had no providers who perform the procedure, they said my only option was to have the procedure with a physician of my choice and take my chances on an appeal.

I went into the surgery expecting to get very little reimbursement from my insurance company. So it was no surprise when they sent me the first reimbursement and it was less than 10% of the surgery bill. My surgeon gave me some great advice - he said be very persistent and don't give up. He was right.

I wrote multiple appeal letters. The basis for the appeal was there were no preferred providers in my area that perform the procedure. Based on the insurance company's responses, it was clear that they did not read any of the letters I sent. Each response said I should have used a network provider and told me my only recourse was to appeal to my state’s insurance board. After receiving each denial, I wrote another appeal letter. The final denial included a list of preferred physicians they claimed preformed the MMA. I called each physician – each one referred me to the surgeon who actually performed the procedure. My final letter simply stated that their preferred providers referred me to the physician who performed the procedure. They agreed.

I woke up this morning and felt OK - coincidence? Perhaps.

Tuesday, December 15, 2009

Old Friend Returns

In 1998, I gave up caffeine - what was I thinking???

Over the past few month's I've introduced caffeine into my diet. My delivery vehicle of choice - diet Pepsi/Coke. There's nothing quite like that early morning burn on the back of the throat to get the day going. It seems to help, particularly with the post lunch yawnies.

No real changes in my sleeping patterns. I'm still getting the usual 5-6 hours a night and that seems to be good enough. Now that it's winter time (if you can call it winter here in N. California), it's harder to get out of bed because of the cold than it is due to being too tired.

As far as the physical recovery goes, there has been some minor progress over the past month:

  1. The spongy teeth feeling when I bite down is starting to diminish
  2. Upper teeth and gums starting to feel less wooden
  3. Upper gums and roof of mouth still numb, but some feeling starting to return
  4. While I can chew most things, softer foods are easier to eat and still preferred
  5. Weight returned to pre-surgery numbers (major bummer)
  6. Lower lip and chin still numb.
  7. Consistent "pussy" drainage in right sinus (this has been ongoing since the surgery) and does not go away with antibiotics

Wednesday, November 4, 2009

November Already?

Six months have passed since the surgery and what a journey!!!

The most significant question still remains to be resolved - did the surgery work? At this point, I don't know. Perhaps I'm in denial, or perhaps I need more time. While I still wake up tired, sleeping 5-6 hours a night, I do feel that I have more energy and can make it through most days without too much trouble. Yet, I still feel there is tremendous room for improvement.

During the past month, I've reintroduced both Bi-PAP and the "Silencer" oral appliance. While I could not tolerate the PAP treatment due to aerophagia, I was able to tolerate the oral appliance with minimum advancement . I worked closely with my surgeon to monitor progress. Perhaps there was some benefit, but the surgeon and I agreed that the improvement, (based solely on how I feel, not measured in the lab) was not enough to continue using either one. My surgeon has suggested focusing the next few months on the psychological recovery (relaxation, stress relief, etc.). He does not plan to do a repeat sleep study at this point since I'm not yet sleeping well enough where we will get significant data from the study. He expects a sleep study would tell us that I'm not sleeping better than before the MMA and therefore is not justified at this point in time.

I'm going to make a final attempt (at least for now) to improve my sleep by trying a device called the Aveo TSD. You can do a Google search to learn more about the product. It's basically a device used to prevent the tongue from collapsing on the airway. It looks like a big binky. We'll see how it goes...

As far as the physical recovery, here's the "latest"

  1. Eating most foods, with the exception of very hard foods or foods that require significant chewing or grinding to eat
  2. Upper gums still numb and limited sensation in upper teeth, but slowly improving
  3. Lower lip and chin still numb. Hard to say if this has improved in the past month
  4. Lower teeth and gums feel "normal"
Prior to the surgery, I had set a goal to complete a hundred mile bike ride in November. I felt having a training objective would force me to focus on the positive aspects of physical fitness and health. Along with my brothers and friend, we easily completed a 106 mile bike ride in October at 5 months post MMA.

In the above picture, we are riding in a paceline on the 106 mile ride. I'm wearing the red vest. We rode the first 23 miles in just over an hour at a pace of 19.7 m.p.h. Drafting on a bike can be quite a thrill. (Riding on a flat road helped keep the average speed high as well.) It turns out that the October century was my second 100 mile ride since the surgery. As I've posted earlier, I rode my first century 8 weeks post-MMA. Cycling is truly a great way to recover.

Wednesday, September 30, 2009

Could It Be?

In addition to the actual "sleep," I'm working on changing my expectations from sleep - silly things like is it reasonable to wake with the refreshed and wanting conquer the world feeling? While it would be nice to feel that way, perhaps it's just not realistic. If I ultimately get there, great, if not, it's OK too.

Last Friday, I returned to see the surgeon. He always has two questions: 1) how am I sleeping and 2) am I in pain. I reported my sleep had not improved and I was not in pain. While we knew my surgery was not a guaranteed success, we had hoped there would be some improvement. Most people at 5 months have realized some benefit. He suggested that I give CPAP a month trial, and if I wanted, I could also give the oral appliance another try. I left his office quite discouraged, knowing that both the CPAP and appliance failed pre-MMA.

That night, I dusted off the Silencer appliance, cleaned out its cob-webs and went to sleep. Over the past 5 nights, sleep seems better. I'm sleeping at least 7-7.5 hours and feel like I'm in a deeper sleep, not waking up at all. Not only have the nights been better but the days seem to be improving too! The post lunch circadian dip is lessening as well. While it's too soon to claim victory, I'm very encouraged! I'm going to continue with the appliance for a couple of days, and then give CPAP a try.

Sunday, September 13, 2009

Not All the Same

Since I've had the MMA, I have become very aware of other people's facial structures, particularly the jaw & chin. I look to see if they have a very strong jaw line or a weak jaw and chin. I also look to see if their upper jaw is setback like mine had been, or more dominant like others. I then wonder, based on my non-existent medical training, if these people have had an MMA or OSA. After careful observation of the jaw, I move on to check out their noses. Are their noses flat, proportioned to their face, too big, too small, etc. If their noses are flat, I then apply my lack of medical training to assess whether or not they have had an MMA.

Yesterday I met with twenty+ people who had the MMA. While I thought that we would all have strong jaws that would appear unique, I fully expected everyone would have the MMA nose - slightly flattened at the base and wide. Much to my surprise, I couldn't tell a thing about all these people based on their appearance other than they seemed very nice. We spent an afternoon together, relating to one an other's experiences, sharing our own stories, and providing support to those who joined the gathering in advance of their own MMA.

My major takeaways from the gathering were:

  1. Be patient, healing takes lots of time
  2. Don't overlook the psychological healing that goes with the physical healing
  3. Everyone was in agreement that they would do the MMA again. Almost everyone felt they had improved, a few of us felt they still had room for improvement (including me)
  4. Many of us have had at least one other medical procedure/surgery in addition to the MMA

As far as my own recovery goes, I've been focused on the behavioral aspects of sleep. Over the years of "bad" sleep, I've developed a number of behaviors that need to be relearned. The most significant behavior I need to learn is it will be OK for my day to start after getting a few more hours of sleep. I can't be in such a rush to get things going. In fact, I'm more likely to have a great day if I allow myself to get sufficient rest.

Friday, August 28, 2009

Probably Shouldn't Write This

I'm sure by posting this update, I'm going to curse any progress I've made. While I can't offer that "Great, and I feel rested" post, I can say that the past few nights have been "better." Although I'm only sleeping 5-6 hours a night, I have felt better during the day. The headache's gone, I'm not as tired, and I'm gaining some weight :-(

As for the rest of the healing process, here's where things stand today:
  1. Chin, lower lip, upper gums, and palette still numb, and improving
  2. Occasional jaw popping when yawning
  3. Eating many more foods, but nothing that requires serious chewing. Bread crusts still require a fair amount of effort, and usually are too hard form me.
  4. Sensation returning to the teeth, but they still have that wooden feeling
  5. Speech has pretty much returned to normal.
  6. Jaw mobility pretty good laterally and about 30 mm vertically (I didn't measure what it was pre-MMA)
  7. Strength - Slowly returning. I'm riding 2-4 times a week, and it's getting a bit easier. Prior to the surgery, I could do 7 pull-ups. Now, I'm down to 3. I'll need to start weight training.

Monday, August 10, 2009

Double Sleep

This experience was just too bizarre...

In a dream last night, I took a nap. I dreamt that I was traveling, and while on the bus I fell asleep. Not only did I fall asleep, but I overslept by two hours and missed my stop. It's enough of a challenge being tired when awake, but being tired while already sleeping is even worse!

So here I am sleeping, and in my sleep, I go to sleep. And, I got to wake up twice in the same sleep stage. First, I woke up from the nap in the dream, then, I woke up from the dream itself.

Could this double sleep be a way to to cut my sleep hours in half? Or, could it be a way to sleep the same amount and feel like I slept twice as much? Or like most dreams, mean nothing at all.