Sleep Apnea co-morb, oral appliance treatment and surgery issues

[Erissel 12]

I've been lurking around the forum since June, but I figured it's time I introduce myself and post my story. So, here it goes.

I am currently 32 years old, 254 lbs (originally 290), married and mother to a 2.5 year old girl. Like most around here, I have struggled with my weight my entire life. A few years back I successfully managed to literally lose a whole person's worth of weight... I was 165 lbs for a brief time. I eventually got pregnant with my daughter and all the weight came back. By the time I delivered, I was 290 lbs.... three months after delivery, I weighed 264 lbs.

Late last year, I became extremely depressed and my weight ballooned to 290 lbs. I eventually got treated for my depression, and in June I realized I had to do something about my weight. And so I did. I joined one of the region's most prestigious bariatric programs and aced all the requirements, dietitian appointments, etc. I dropped 26 lbs by my last mandatory appointment in August, and I have dropped another 10 since then. My goal was to lose 40 lbs by the time I had my surgery, and I am quickly approaching that... 4 lbs to go.

However, one last hurdle remains to be cleared before I even get to submit for insurance approval. During the qualifying tests, I was diagnosed with mild sleep apnea and given the option to pursue treatment with a CPAP machine or an oral appliance. I chose the oral appliance because it seemed far less cumbersome than the CPAP, although much more expensive so most people did not go that route. My insurance covered most of the cost without issues, and last week I picked up my custom-made Herbst-style oral appliance. I have now been using it since then and I am glad I made this choice.

This is when the problems began. Apparently, my surgeon's office has no idea what to do about my sleep apnea treatment because it is very uncommon for people to be eligible and choose an oral appliance, so they are making it up as they go. They first requested a letter from the dental office where I had the appliance made stating that it had been delivered. Once I gave them that, now they say it may not be enough and we may need to continue treating it and perform follow-up studies to determine if the appliance is effective.

I am extremely frustrated about all this. I did everything right, and my progress with the surgery seems to have stalled. I was supposed to be meeting my surgeon this month and scheduling the surgery for Oct, and it doesn't seem like this is going to happen anymore. I barely even had apnea to begin with! Neither my husband nor I were aware because I never stop breathing... it's just a slight restriction on my airflow.

I spoke with my surgeon's office yesterday to confirm they received the letter from my dental office, and they said they would get back to me about next steps. Last time they said that, nobody got back to me for 3 weeks until I called them!

Feeling so discouraged right now. Has anyone dealt with this type of issue involving an oral appliance? If so, what was the outcome?

Any advice or feedback would be appreciated....

Edited September 20, 2016 by Erissel

[KristenLe 5,979]

Did you go to a sleep clinic? I would ask the sleep doctor to reach out to your surgeon to discuss. They'd be more apt to listen to a sleep specialist than a dentist (no offense to Dentists).

[Erissel 12]

Did you go to a sleep clinic? I would ask the sleep doctor to reach out to your surgeon to discuss. They'd be more apt to listen to a sleep specialist than a dentist (no offense to Dentists).

Yes. That's how the sleep apnea was diagnosed. Because it was very mild, I was given the option of treating it with CPAP or an oral appliance.

The sleep study place pretty much removed themselves from the equation after I told them I did not want a CPAP machine. They referred me to a dentist and told me to go get it done. So, I did.

And that's where I am

[KristenLe 5,979]

@@Erissel I sure hope they figure it out soon - to go through all that you did only to be stuck on something like this! UGH!

[Armygalbonnie 643]

Will your insurance buy you a CPAP machine so you can go that route for the time being?

[Erissel 12]

Will your insurance buy you a CPAP machine so you can go that route for the time being?

I thought of doing that.... however, because they've just covered the oral appliance, they are not willing to cover the CPAP machine. I don't blame them... they covered 80% of nearly 5k.

I don't have a couple thousand lying around to buy a CPAP machine out of pocket so I'm stuck waiting on them to figure out whether the oral appliance is "good enough". This really bugs me because they never told me before I got it that it would cause any problems. They just told me to follow whatever recommendations the sleep study place made for treatment, which I did.

Edited September 20, 2016 by Erissel

[Armygalbonnie 643]

You were dealt a bad hand. I sure hope everything works out quickly.

[trekker954 421]

Isn't the oral appliances e removable. You don't need a cap machine to qualify for surgery only the diagnosis from the dr thst u have sleep apnea. I also have diagnosed mild sleep apnea. And you will likely be cured once you lose weight. My daughter says I rarely snore anymore and I'm only 6 weeks out

Sent from my SM-N910T using the BariatricPal App

[KristenLe 5,979]

Isn't the oral appliances e removable. You don't need a cap machine to qualify for surgery only the diagnosis from the dr thst u have sleep apnea. I also have diagnosed mild sleep apnea. And you will likely be cured once you lose weight. My daughter says I rarely snore anymore and I'm only 6 weeks out

Sent from my SM-N910T using the BariatricPal App

I think the issue is they don't know how to handle this in the hospital. We're required to bring our CPAP machines with us and they are most likely stumped as to what to do about someone having the appliance instead.

[Erissel 12]

Yes, that's correct @@KristenLe

The bariatric center doesn't know whether the sleep apnea is adequately treated by the oral appliance. And to top it off, they just told me that I will be forced to use THEIR CPAP machine, whether I like it or not, for the actual surgery. Otherwise, they will not operate.

Nobody got back to me today, as expected. I guess I will call them on Friday if I haven't heard anything by then....