There aren't many of us around the world who are truly interested in Sleep Surgery, it's a bit of a nerdy topic at the moment. I hope you get sorted soon!
Mr Veer, it was a pleasure to see you the other day. The work you are doing is not only helpful for professionals in your field but really empowering for laymen like me.
Mr Vik Veer, thank you very much for this teaching video. You’re sharing your expertise to other professionals for free! Thank you for caring for all the patients in the world with this prevalent problem. God bless you more abundantly! 🙏🏼😇
Huge thanks for this video ! First time as a patient, I was able to see the whole picture and understand all aspects that can contribute to sleep apnoea
Great, i hope this classification will get around to doctors in germany. That would give me the confidence in the doctors again. Today the therapy is called CPAP. If you can't deal with it, you can deal with dubious operations that don't even help you, because the doctors don't know the cause or they don't want to know. Respect keep it up.
Hi Vik Great video although as a dentist I may have to refresh some of my anatomy . I can see the use of the classification in targeting effective treatment. Which classification is best treated by MADs ?Do many ENTs and drs use the classification in helping prescription of effective therapies ? Thanks Jack
Hahaha I bullied a registrar to do it for me years ago. I had to attack him then as I knew he would probably end up as my boss soon. Hope you are well, I will credit you one day (but not today..)
Thank you for such caring and insightful video. I am doing my own investigation into my sleep apnea, and tracking down a private consultant in my local area (Leicestershire) to help me. I will certainly ask if they know about this.
Great work Dr. Veer. Can you please provide the link for the publication you showed in the beginning of the video? Is that about this new classification? Thanks a lot. Best regards, Mayur Bakshi
It seems like jaw surgery (bimax/MMA) would do wonders for patients who suffer from soft tissue collapse. If you can move the skeleton into a more optimal position, all of those soft tissues should be better supported.
When a patient can sleep on their right side and in turn have a significantly lower AHI - does this tend to point towards a tongue based issue or one of the other conditions you reviewed? Assuming tongue based since side sleeping reduces the chance of it falling back.
Neither, I would see a sleep team. I think all of the specialists should be involved or you will be passed from clinic to clinic getting no where. Just my humble opinion.
Dr. Veer, first off, I want to thank you so much for your clear, pithy, and informative videos explaining many aspects of sleep apnea for the general public. I am a professional singer and a voice teacher who has developed complicated sleep apnea post heart surgery, but after having improved my heart health, may have only OSA at this point. I am going to be following your 5 excercise protocol for strengthening the tongue and pharyngeal muscles to help get them back in shape, with the hopes that this, in concert with CPAP and other non-invasive approaches, I can bring my AHI to 5 or under. Do you have a list of physicians in the United States who are following your PTLTbE classification when doing a DISE? I would like to avoid surgery at all costs, given that my livelihood depends on my voice being a well-oiled machine. Thank you so much for your service to humanity! Ken Jaffe, Los Angeles
Dr. Veer, I just had DISE procedure using the VOTE classification. My results V=1AP, O=0, T=0, E=1AP, also have nasal valve collapse and turbinates that tend to block up like a one way valve. I think the Epiglottis partial collapse is the reason I can no longer use CPAP after 4 years of compliance. Lost 45 lbs the last 3 years as well. My ENT is fairly new and has recommended no surgery as my AHI is now 8.4, down from 25.5, but I now have 20 RERA with associated flow limitations on last PSG. I have severely fragmented sleep, awakening up to 6X per night with nocturia. I am at a top notch facility with a Stanford trained ENT surgeon, but feel I am having to sell him on this problem, since he is convinced since my AHI is so low, no surgical intervention could improve my outcome. I really wish I could come see you and sort this out for once and for all. Lost my job as a Commercial Pilot because of OSA six years ago. Would like to get my life back. Any suggestions on how to proceed?
Steve: Just got endoscopy today and it looks like my epiglottis is not entirely and possibly blocking my airway. I've been using CPAP with not much improvement and my doctor thinks it might be epiglottis. Can't be confirmed fully until I get DISE. I'm looking at having surgery to either trim or pull back the epiglottis.
I think your Doctor is phoning it in. There is no harm in fixing your septum if it is significantly deviated. There is no harm in a turbinate tissue reduction via ablation, local anaesthetic, 10 minutes. No harm in saline rinsing. No harm in using a drug like Mometasone nasal spray daily. Try the tongue retainer at night, in conjunction with blowing up balloons and singing during the day. There is even electrical stimulation of the tongue, like a muscle trainer. I find it almost impossible to understand how CPAP could not be working at this point. You should get your blood tested for everything, lose weight if you have a BMI over 25 and really just try everything you can. You have nothing to lose if you are that unwell.
Hello Vic. My ENT surgeon found collapsing of the epiglotis during sleep endoscopy. Is hyoid bone suspension (Airlift) appropriate procedure to treat my sleep apnea. If not, which treatment option would be best treat epiglotis based obstruction
I try and tether the epiglottis to the tongue base with adhesions first, if that fails I stitch it together, if that fails I consider a wedge resection. There are loads of non-surgical options out there as well - speak to your surgeon about these.
of course it will, it's positive pressure to keep the airway open. There's a reason it's the Gold Standard. The issue is usually how much pressure you might need. Some people can get used to it and others can't.
I'm afraid I honestly have no idea. I don't get involved with the money at all, my secretary will always organise a quote for you. at the moment however there is no operating going on because of the coronavirus pandemic. Also, I'm sure we can find someone closer to your home. sleep surgery is a tiny speciality, but I might know someone in your country that can help you.
@@VikVeerENTSurgeon Thank you Dr for responding that is very nice of you. I am living in US and they do have DISE test here but I am uninsured and since they are hiding price of testing from me I don’t want to let them rob me. I was trying to find country in Europe to go to. I know now that your country is also closed like EU countries but Turkey is not and I can travel over there. Just found clinic who said that they have DISE in Istanbul, it is Medipol Mega University Hospital. Will go there. Thank you and have a great rest of the week
i highly appreciate the videos you are putting out, but its very surprising that scienctists with all their physics and biotech etc have not found a way to solve a crucial problem of oxygen not properly reachin brain and heart during sleep when they need it most to repair the body in 2024. i suspect a lack of profit. i hope good people like you went one step further and came up with devices and processes to help sleep apnea patients. i am at my wits end in india....looking towards going under anesthesia where a weakened person like me could die doing dise. it looks like the untreated sleep apnea may cause the very procedure to assess it to kill me...wish sleep apnea patients had better help.....would seem like in the year 2024, we would have develope technology to keep airway open for 8 hours in night. seems like a very simple physics problem to be honest....thats not being done coz theres no profit for pharma in it.
i know its a very crude question...but cant we insert something in "there" to forcibly keep the airway open. some severe patients may prefer irritation over a cutoff of oxygen to brain. im guessing gag reflex and others come into play. very crude idea i know ..but maybe a starting place to work in. is physically keeping those areas open technologically that hard?
This is gold! Wish other doctors were aware of this practice and treat accordingly
There aren't many of us around the world who are truly interested in Sleep Surgery, it's a bit of a nerdy topic at the moment. I hope you get sorted soon!
Mr Veer, it was a pleasure to see you the other day. The work you are doing is not only helpful for professionals in your field but really empowering for laymen like me.
Great to meet you too, especially the point where we had to compare beards. I have to up my game!
Mr Vik Veer, thank you very much for this teaching video. You’re sharing your expertise to other professionals for free! Thank you for caring for all the patients in the world with this prevalent problem. God bless you more abundantly! 🙏🏼😇
My pleasure, Thank you for your comments.
Huge thanks for this video ! First time as a patient, I was able to see the whole picture and understand all aspects that can contribute to sleep apnoea
That's made my day, Thank you!
Nice video with helpful classification...we are waiting more videos on sleep
Very soon! Putting together some videos reviewing devices for snoring, and a video on the relationship between OSA and being overweight.
Great, i hope this classification will get around to doctors in germany. That would give me the confidence in the doctors again. Today the therapy is called CPAP. If you can't deal with it, you can deal with dubious operations that don't even help you, because the doctors don't know the cause or they don't want to know. Respect keep it up.
Thank you!
Brilliant Doc very informative thank you albeit I am looking at it from a patient s perspective
I'm sorry it was a little clinical, I didn't expect anyone non-medical to watch it. Glad it wasn't too boring!
Amazing, so informative
Glad it was helpful!
Hi Vik
Great video although as a dentist I may have to refresh some of my anatomy . I can see the use of the classification in targeting effective treatment. Which classification is best treated by MADs ?Do many ENTs and drs use the classification in helping prescription of effective therapies ?
Thanks
Jack
Thank you for this Mr Veer, really helpful.
Most welcome!
I really like those drawings, really good... Great videos
Hahaha I bullied a registrar to do it for me years ago. I had to attack him then as I knew he would probably end up as my boss soon. Hope you are well, I will credit you one day (but not today..)
i wonder if the specific sound of the snore could help identify the classification?
Hello Doc I am hopeful 1 day you will be the one who will save us from this obstructive sleep apnea and will bring a cure for this.
That would be amazing! But there are people doing some terrific research on this, I guess I'm happy to tell the world about it.
Thank you for such caring and insightful video. I am doing my own investigation into my sleep apnea, and tracking down a private consultant in my local area (Leicestershire) to help me. I will certainly ask if they know about this.
Michael Oko? I think he lives around there?
Since nasal obstruction plays a role in sleep apnea, it would seem there would be a part of this for it.
Great work Dr. Veer.
Can you please provide the link for the publication you showed in the beginning of the video? Is that about this new classification?
Thanks a lot.
Best regards,
Mayur Bakshi
Please look In the description, the pubmed link is there.
how do you treat epiglottis collapse? my ent won't operate. I feel I have a hard time breathing when awake too - very small posterior airway here.
It seems like jaw surgery (bimax/MMA) would do wonders for patients who suffer from soft tissue collapse. If you can move the skeleton into a more optimal position, all of those soft tissues should be better supported.
When a patient can sleep on their right side and in turn have a significantly lower AHI - does this tend to point towards a tongue based issue or one of the other conditions you reviewed? Assuming tongue based since side sleeping reduces the chance of it falling back.
informative. Can you please tell whom to consult if we are suffering from OSA - Pulmonologist or an ENT Specialist. Thank you
Neither, I would see a sleep team. I think all of the specialists should be involved or you will be passed from clinic to clinic getting no where. Just my humble opinion.
This is so interesting and informative. What are this test called?
The examination is part of DISE.
Dr. Veer, first off, I want to thank you so much for your clear, pithy, and informative videos explaining many aspects of sleep apnea for the general public. I am a professional singer and a voice teacher who has developed complicated sleep apnea post heart surgery, but after having improved my heart health, may have only OSA at this point. I am going to be following your 5 excercise protocol for strengthening the tongue and pharyngeal muscles to help get them back in shape, with the hopes that this, in concert with CPAP and other non-invasive approaches, I can bring my AHI to 5 or under. Do you have a list of physicians in the United States who are following your PTLTbE classification when doing a DISE? I would like to avoid surgery at all costs, given that my livelihood depends on my voice being a well-oiled machine. Thank you so much for your service to humanity! Ken Jaffe, Los Angeles
Dr. Veer, I just had DISE procedure using the VOTE classification. My results V=1AP, O=0, T=0, E=1AP, also have nasal valve collapse and turbinates that tend to block up like a one way valve. I think the Epiglottis partial collapse is the reason I can no longer use CPAP after 4 years of compliance. Lost 45 lbs the last 3 years as well. My ENT is fairly new and has recommended no surgery as my AHI is now 8.4, down from 25.5, but I now have 20 RERA with associated flow limitations on last PSG. I have severely fragmented sleep, awakening up to 6X per night with nocturia. I am at a top notch facility with a Stanford trained ENT surgeon, but feel I am having to sell him on this problem, since he is convinced since my AHI is so low, no surgical intervention could improve my outcome. I really wish I could come see you and sort this out for once and for all. Lost my job as a Commercial Pilot because of OSA six years ago. Would like to get my life back. Any suggestions on how to proceed?
Steve: Just got endoscopy today and it looks like my epiglottis is not entirely and possibly blocking my airway. I've been using CPAP with not much improvement and my doctor thinks it might be epiglottis. Can't be confirmed fully until I get DISE. I'm looking at having surgery to either trim or pull back the epiglottis.
What have you tried besides cpap?
I think your Doctor is phoning it in. There is no harm in fixing your septum if it is significantly deviated. There is no harm in a turbinate tissue reduction via ablation, local anaesthetic, 10 minutes. No harm in saline rinsing. No harm in using a drug like Mometasone nasal spray daily. Try the tongue retainer at night, in conjunction with blowing up balloons and singing during the day. There is even electrical stimulation of the tongue, like a muscle trainer.
I find it almost impossible to understand how CPAP could not be working at this point.
You should get your blood tested for everything, lose weight if you have a BMI over 25 and really just try everything you can. You have nothing to lose if you are that unwell.
Hello Vic. My ENT surgeon found collapsing of the epiglotis during sleep endoscopy. Is hyoid bone suspension (Airlift) appropriate procedure to treat my sleep apnea. If not, which treatment option would be best treat epiglotis based obstruction
I try and tether the epiglottis to the tongue base with adhesions first, if that fails I stitch it together, if that fails I consider a wedge resection. There are loads of non-surgical options out there as well - speak to your surgeon about these.
@@VikVeerENTSurgeon can Hyoid bone suspension partially take of epiglottis blockage?
@@VikVeerENTSurgeon What are the non-surgical options?
Would epiglottis based apnea cause snoring? It seems like not?
in the video he said it can and it does.
If CPAP won't help an epiglottis based apnea, what will?
of course it will, it's positive pressure to keep the airway open. There's a reason it's the Gold Standard. The issue is usually how much pressure you might need. Some people can get used to it and others can't.
Hello Dr Veer, could you please tell me as international patient how much would I have to pay for DISE testing in your hospital?
Thank you
I'm afraid I honestly have no idea. I don't get involved with the money at all, my secretary will always organise a quote for you. at the moment however there is no operating going on because of the coronavirus pandemic.
Also, I'm sure we can find someone closer to your home. sleep surgery is a tiny speciality, but I might know someone in your country that can help you.
@@VikVeerENTSurgeon Thank you Dr for responding that is very nice of you.
I am living in US and they do have DISE test here but I am uninsured and since they are hiding price of testing from me I don’t want to let them rob me. I was trying to find country in Europe to go to. I know now that your country is also closed like EU countries but Turkey is not and I can travel over there. Just found clinic who said that they have DISE in Istanbul, it is Medipol Mega University Hospital. Will go there.
Thank you and have a great rest of the week
@@VikVeerENTSurgeon do you know of anyone who does DISE in CA?
i highly appreciate the videos you are putting out, but its very surprising that scienctists with all their physics and biotech etc have not found a way to solve a crucial problem of oxygen not properly reachin brain and heart during sleep when they need it most to repair the body in 2024. i suspect a lack of profit. i hope good people like you went one step further and came up with devices and processes to help sleep apnea patients. i am at my wits end in india....looking towards going under anesthesia where a weakened person like me could die doing dise. it looks like the untreated sleep apnea may cause the very procedure to assess it to kill me...wish sleep apnea patients had better help.....would seem like in the year 2024, we would have develope technology to keep airway open for 8 hours in night. seems like a very simple physics problem to be honest....thats not being done coz theres no profit for pharma in it.
i know its asking too much from you and other well meaning drs.
i know its a very crude question...but cant we insert something in "there" to forcibly keep the airway open. some severe patients may prefer irritation over a cutoff of oxygen to brain. im guessing gag reflex and others come into play. very crude idea i know ..but maybe a starting place to work in. is physically keeping those areas open technologically that hard?