Who am I?
When I went off to college, I thought that the smart kids studied engineering. And that turned out to be true. What I didn't know was the clever kids studied finance.
Armed with an engineering degree, I began my professional adventures working for start-up and emerging companies in the Silicon Valley. Shortly after I started my first job, I realized that the world would be a safer place if I didn't practice engineering. I transitioned into a sales role and have spent the better part of my career as a serial entrepreneur working at start-up companies. I specialize in selling new technology products to emerging markets - mainly software and electronics. While there may be easier ways to make a living, I wouldn't trade what I do. Often, I joke that if I won the lottery, I would be late in claiming my prize because I wouldn't cancel my sales call the morning following the drawing.
My career has brought me around the world. The travel started the day I returned from my honeymoon in 1989, and hasn't let up since. When people describe how many miles they travelled, there are usually two descriptions: the total frequent flyer miles including bonuses and the AOS miles. It's the AOS miles that count. I've accumulated more than 1,500,000 AOS miles. For those of you that haven't figured it out, AOS=Ass On Seat.
At first, I thought that being tired all the time was the result of many flights, long days, and jet lag - not the case. It's the sleep disordered breathing that made me feel so tired.
In case your wondering about the URL name "pedal-MMA", it doesn't refer to being a peddler, but rather a pedal-er. I enjoy riding my bike. One of the benefits of not sleeping well is that I get to ride my bike early in the morning and return by 6:30 a.m. before everyone in the house wakes up.
Many people sleep late on their weekends. I ride my bike. During a good week, I'll train over 150 miles. 50+ on Sunday, 50-75 during the week, and 25 on Saturday. It's been quite a while since I've had a "good" week of training. As part of my planned MMA recovery, I'm hoping to ride the November Solvang century. Setting the goal for the 100 miles should be excellent motivation.
Thursday, April 30, 2009
Reservations
Will this work?
In a nutshell, that's my major concern. Most people get some benefit with either CPAP or the oral appliance. I didn't. We have not yet found any way to releive the symptoms. Just knowing that one of the other therapies had worked would give me a bit more confidence in this procedure working.
In a nutshell, that's my major concern. Most people get some benefit with either CPAP or the oral appliance. I didn't. We have not yet found any way to releive the symptoms. Just knowing that one of the other therapies had worked would give me a bit more confidence in this procedure working.
Wednesday, April 29, 2009
Making the MMA Decision
I just want to wake up rested
You know when it's time for surgery. Why? Because you've tried everything else.
The last time I woke up rested was in December 1991, the day after my brother's wedding. It's such a vivid memory since I had the flu the weekend of the wedding, and had to drive 200 miles after the wedding in a heavy rain storm at night. I woke up the next morning after the big day thinking "what a great night's sleep."
It's that rested feeling that I'm after. Whatever it takes, I'm going to wake up rested again.
Many have asked me why is it so important to wake up rested, and why can't I just get by being tired. The answer is simple: I deserve a better quality of life. Imagine how you would feel if you only slept a few hours each night, and the hours you got, weren't that great. Basically, you wake up with a dull headache, have little energy, become grumpy and irritable, and can't wait to get to sleep that night. Some days have all these challenges and other days have only a few. But you know it could be better. Throw in the reality that you need to put all your energy into a successful work day. I put every bit of energy into work. Being too tired to work was never an option.
When you come home to your family after work, if you've got nothing left and you're snappy with the wife, short tempered with the kids, and just want to lay down on the sofa - you miss out on all the best parts of having a family. The family deserves to see you at your best, not your worst. Being tired all the time just isn't fair to the family.
The first time I seriously thought about sleep surgery was in 2007 after seeing the most distinguished sleep doc. Since he's the guy who wrote the book on sleep apnea, and if he thinks surgery is going to help me, I had to believe that he's probably right. However, in 2007, I wasn't ready to have any surgery. I knew that surgery might be part of the journey to getting a better nights sleep.
The internet became the best resource to learn about sleep surgeries. The discussion boards, blogs, and medical studies provided more details than I could consume. Reading about other people's success and failures with sleep surgery made me think that perhaps surgery could help me.
Before surgery, I had to exhaust every possible option at least one more time -CPAP , oral appliance, medication , and outstanding sleep hygiene. Having tried all these therapies multiple times, surgery became the only remaining option.
You know when it's time for surgery. Why? Because you've tried everything else.
The last time I woke up rested was in December 1991, the day after my brother's wedding. It's such a vivid memory since I had the flu the weekend of the wedding, and had to drive 200 miles after the wedding in a heavy rain storm at night. I woke up the next morning after the big day thinking "what a great night's sleep."
It's that rested feeling that I'm after. Whatever it takes, I'm going to wake up rested again.
Many have asked me why is it so important to wake up rested, and why can't I just get by being tired. The answer is simple: I deserve a better quality of life. Imagine how you would feel if you only slept a few hours each night, and the hours you got, weren't that great. Basically, you wake up with a dull headache, have little energy, become grumpy and irritable, and can't wait to get to sleep that night. Some days have all these challenges and other days have only a few. But you know it could be better. Throw in the reality that you need to put all your energy into a successful work day. I put every bit of energy into work. Being too tired to work was never an option.
When you come home to your family after work, if you've got nothing left and you're snappy with the wife, short tempered with the kids, and just want to lay down on the sofa - you miss out on all the best parts of having a family. The family deserves to see you at your best, not your worst. Being tired all the time just isn't fair to the family.
The first time I seriously thought about sleep surgery was in 2007 after seeing the most distinguished sleep doc. Since he's the guy who wrote the book on sleep apnea, and if he thinks surgery is going to help me, I had to believe that he's probably right. However, in 2007, I wasn't ready to have any surgery. I knew that surgery might be part of the journey to getting a better nights sleep.
The internet became the best resource to learn about sleep surgeries. The discussion boards, blogs, and medical studies provided more details than I could consume. Reading about other people's success and failures with sleep surgery made me think that perhaps surgery could help me.
Before surgery, I had to exhaust every possible option at least one more time -CPAP , oral appliance, medication , and outstanding sleep hygiene. Having tried all these therapies multiple times, surgery became the only remaining option.
Tuesday, April 28, 2009
Monday, April 27, 2009
Where Were We?
More on the journey...
Before, during, and after the second CPAP/APAP trial, the doctor prescribed all the sleep narcotics. We started with clonazapan, moved to Norco, Halcion, Ambien, Lunesta, Rozerim, Remeron, Xyrem, and a few others. Since none of these sleep aids helped, I paid my first visit to the Stanford Sleep Clinic. I met with a sleep doc who suggested that I have a titration study. The doc also handed me a brochure for sleep surgery and suggested that I may consider seeing the local sleep surgeons who established the MMA. My impression from the Stanford doc was that the treatment plan was CPAP, surgery, next patient...
In 2004, I would not consider sleep surgery. I returned to my regular sleep doc, had the titration study (APAP @7-8), failed to get benefit, and abandoned CPAP for the second time. My sleep doc offered to write me a note to my employer prescribing daily naps - needless to say, I declined the nap pass. The doc said that I seemed highly functional and perhaps I could just keep going on as is. With no relief from my "wake up tired" syndrome, I decided to just "deal with it" and get through the days.
For the next three years, my sleep quality and quantity declined to the point where I slept four to six hours a night, woke up tired, and became even grumpier. As a last effort, I sought the advice the top doc at Stanford. It took only two days to get an appointment with the amazing physician. To make a long story short, the doc walks in the room, looks at my face, and tells me that my facial structures are all wrong, and they are going to need to break my jaw. WOW! He went on to explain that prior to surgery, there is a very specific protocol they follow - CPAP, phase I surgery, and ultimately phase II (MMA). He said the process would take several years. (He was right).
The doc ordered a titration study, and told me that he would see me the morning after the study. (Not only did he order the titration study, he walked me over to the scheduler and had my study scheduled the next week.) In addition to the sleep study, the doc also made an appointment for me to visit the the weekly surgery clinic after the sleep study.
When dealing with Stanford, prior to seeing the attending physicians on staff, you meet with a sleep fellow. The fellows are all post resident physicians, some directly from residency, others from private practice seeking advanced training in sleep medicine.
The morning after the sleep study, the fellow doc came in at 7:45 a.m. with a prescription for a bi-pap @ 15/11 and Ambien CR. By noon that day, I had my bi-pap.
I used the bi-pap with almost 100% compliance for about a year with no improvement. We regularly increased the pressure to a maximum of 21/17 with no improvement. The Stanford Doc had said that I need such high pressures since we were trying to overcome structural bone issues, and not simply splint the soft tissue in the airway. During the third PAP trial, I was able to tolerate the machine for 5-6 hours a night, but swallowed significant amounts of air. We eventually switched from straight bi-pap to auto bi-pap. The auto bi-pap didn't prevent swallowing the air.
About nine months into the bi-pap trial, I got n mandibular advancement device aka an oral appliance (the "Silencer"). The Silencer failed to improve my sleep quality and I developed TMJ like symptoms. I tried both the oral appliance along with bi-pap without success.
Not willing to give up on the promise of a good night's sleep, I made an appointment with THE sleep apnea surgeon. The surgeon suggested that I consider a tonsillectomy as the next treatment. He did not want to perform an UPPP as he felt that most OSA issues need to be treated lower in the airway. He performed the tonsillectomy. With no improvement in my sleep quality, he suggested that I try PAP treatment again. Once again, the PAP failed yet again to improve my sleep. As a next step, he referred me to another distinguished sleep doctor who was involved in a trial for the Ventus valves - a device you put over each nostril to create a positive pressure in your throat when exhaling.
More Doom and Gloom
The Ventus device failed me or perhaps I failed with the device. For another 6 months, I was resigned to being tired. Finally, determined to wake up rested, I made an appointment to return the most distinguished sleep doctor at Stanford. He suggested one last trial with APAP along with a Prilosec to prevent swallowing air.
The APAP trial failed and I returned to see THE sleep surgeon - MMA Scheduled for next week.
Before, during, and after the second CPAP/APAP trial, the doctor prescribed all the sleep narcotics. We started with clonazapan, moved to Norco, Halcion, Ambien, Lunesta, Rozerim, Remeron, Xyrem, and a few others. Since none of these sleep aids helped, I paid my first visit to the Stanford Sleep Clinic. I met with a sleep doc who suggested that I have a titration study. The doc also handed me a brochure for sleep surgery and suggested that I may consider seeing the local sleep surgeons who established the MMA. My impression from the Stanford doc was that the treatment plan was CPAP, surgery, next patient...
In 2004, I would not consider sleep surgery. I returned to my regular sleep doc, had the titration study (APAP @7-8), failed to get benefit, and abandoned CPAP for the second time. My sleep doc offered to write me a note to my employer prescribing daily naps - needless to say, I declined the nap pass. The doc said that I seemed highly functional and perhaps I could just keep going on as is. With no relief from my "wake up tired" syndrome, I decided to just "deal with it" and get through the days.
For the next three years, my sleep quality and quantity declined to the point where I slept four to six hours a night, woke up tired, and became even grumpier. As a last effort, I sought the advice the top doc at Stanford. It took only two days to get an appointment with the amazing physician. To make a long story short, the doc walks in the room, looks at my face, and tells me that my facial structures are all wrong, and they are going to need to break my jaw. WOW! He went on to explain that prior to surgery, there is a very specific protocol they follow - CPAP, phase I surgery, and ultimately phase II (MMA). He said the process would take several years. (He was right).
The doc ordered a titration study, and told me that he would see me the morning after the study. (Not only did he order the titration study, he walked me over to the scheduler and had my study scheduled the next week.) In addition to the sleep study, the doc also made an appointment for me to visit the the weekly surgery clinic after the sleep study.
When dealing with Stanford, prior to seeing the attending physicians on staff, you meet with a sleep fellow. The fellows are all post resident physicians, some directly from residency, others from private practice seeking advanced training in sleep medicine.
The morning after the sleep study, the fellow doc came in at 7:45 a.m. with a prescription for a bi-pap @ 15/11 and Ambien CR. By noon that day, I had my bi-pap.
I used the bi-pap with almost 100% compliance for about a year with no improvement. We regularly increased the pressure to a maximum of 21/17 with no improvement. The Stanford Doc had said that I need such high pressures since we were trying to overcome structural bone issues, and not simply splint the soft tissue in the airway. During the third PAP trial, I was able to tolerate the machine for 5-6 hours a night, but swallowed significant amounts of air. We eventually switched from straight bi-pap to auto bi-pap. The auto bi-pap didn't prevent swallowing the air.
About nine months into the bi-pap trial, I got n mandibular advancement device aka an oral appliance (the "Silencer"). The Silencer failed to improve my sleep quality and I developed TMJ like symptoms. I tried both the oral appliance along with bi-pap without success.
Not willing to give up on the promise of a good night's sleep, I made an appointment with THE sleep apnea surgeon. The surgeon suggested that I consider a tonsillectomy as the next treatment. He did not want to perform an UPPP as he felt that most OSA issues need to be treated lower in the airway. He performed the tonsillectomy. With no improvement in my sleep quality, he suggested that I try PAP treatment again. Once again, the PAP failed yet again to improve my sleep. As a next step, he referred me to another distinguished sleep doctor who was involved in a trial for the Ventus valves - a device you put over each nostril to create a positive pressure in your throat when exhaling.
More Doom and Gloom
The Ventus device failed me or perhaps I failed with the device. For another 6 months, I was resigned to being tired. Finally, determined to wake up rested, I made an appointment to return the most distinguished sleep doctor at Stanford. He suggested one last trial with APAP along with a Prilosec to prevent swallowing air.
The APAP trial failed and I returned to see THE sleep surgeon - MMA Scheduled for next week.
Sunday, April 26, 2009
First Post - MMA - Scheduled, Locked and Loaded
This is the beginning of my blog and MMA adventure. The date is set for early May, 2009. For those of you not so familiar with the MMA, it stands for maxillomandibular advancement surgery. In a nutshell, MMA treats obstructive sleep apnea by advancing both the upper and lower jaw to enlarge the airway. Many others have already published so much on the procedure. You can find out more with a simple Google of "MMA Surgery."
My blog has two objectives:
1. Detail the journey that led me to the MMA decision
2. Provide updates and ramblings on the recovery
Most of my entries will be short updates.
Bits of Background
A bit of my sleep history and background. After all, this blog is all about me. I've never slept well and have always been a "morning person." As early as high school, we scheduled all my academic classes in the morning. Classes after lunch might as well have been naps.
My blog has two objectives:
1. Detail the journey that led me to the MMA decision
2. Provide updates and ramblings on the recovery
Most of my entries will be short updates.
Bits of Background
A bit of my sleep history and background. After all, this blog is all about me. I've never slept well and have always been a "morning person." As early as high school, we scheduled all my academic classes in the morning. Classes after lunch might as well have been naps.
I don't recall having any major sleep issues in college, or the years following. My only sleep "problems" for most of my twenties was that I just didn't sleep that long, and would never sleep late, regardless of the time I went to bed.
Around 1995, I developed chronic sinus problems and ultimately had four functional endoscopic sinus surgeries. After the third surgery (and probably the first and second), I was always tired. I would describe the tiredness as being just as tired in the morning as when I went to bed at night. My doc sent me off for my first sleep study which indicated that I snored (which was news to my wife) and possible upper airway resistance syndrome. With the possible UARS diagnosis, I had a second sleep study with a esophageal pressure monitor (Pes). The second sleep study showed a negative pressure of -20. The sleep study report indicated "mild UARS." My doctor prescribed a CPAP trial with a pressure of 5 cm H20. Needless to say, the CPAP didn't work, and I abandoned the treatment and my pursuit of a good night's sleep.
After hearing more complaints about being tired, my ENT (who did my fourth surgery) sent me off for my third sleep study in 2002. The sleep study showed many, many unexplained arousals, possible UARS and an RDI of about 10. I followed up the sleep study with a sleep doctor. The doc tried many treatment options: sleep deprivation therapy, tennis balls to keep me from sleeping on my back, medication, medication, medication, medication, and other medication. On another blog, I'll comment on the drugs. Let's just say, if they made it, I tried it.
With no progress and many therapies, I had another sleep study with a daytime sleep test to rule out narcolepsy (which they did), and ultimately tried my second stint with CPAP/APAP.
I'm out of time, but will add to my story soon.
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