How We Work
Consultation:
The doctor conducts a full length interview. (This may be partially conducted with a medical assistant, either a fully qualified Registered Nurse or Registered Respitatory Therapist). An examination of the nose and throat follows, including passing a fibreoptic telescope (endoscopy) comfortably into the throat for a video view of the area. This provides information as to where the airway may be narrow or collapsing, and thus where and what treatment is most appropriate for that person. Most importantly, it allows predictions to be made as to the effectiveness of the different forms of treatment.The findings will be explained and their significance discussed with you in detail.
Testing:
Besides other medical tests that may be advised by the sleep physician, there are 3 main types of sleep tests sometimes recommended on our patients.
A) Overnight oximetry at home. A small oxygen sensor rests on the finger while you sleep. Drops in blood oxygen may indicate pauses in breathing (apneas). This test is simple and safe, and done routinely.
B) Level 3 home sleep testing. This is a more elaborate overnight study at home. Besides the oxygen sensor on the finger, a nasal airflow meter and chest band give information about breathing, which may be very helpful . The test is not yet covered by the Medical Plan in BC, but is often covered by extended insurance policies.
C) Level 1 polysomnography. This is an overnight study in a hospital or other sleep facility with EEG leads on the scalp, ECG leads on the chest, other leads on the face and leg, as well as the chest, finger and nose sensors mentioned above. It is fully supervised throughout the night by a Polysomnogram Technician. Detailed information about sleep patterns, behaviour and physiology are obtained. If your sleep doctor deems it necessary, it is covered by the Medical Services plan in BC.
Treatment:
Snoring and mild sleep apnea are usually treated in the office under local anesthesia, by one of the following methods:
a) Removal of the uvula and some of the adjacent palate by laser (Laser Assisted Uvulopalatoplasty or LAUP). This is done once only and takes about thirty minutes. Some recovery time may be needed, and analgesia is usually required for about a week.
b) Implanting rods of woven polyester in the soft palate (Pillar Implant Proceedure or PIP) stiffens the palate and prevents it from vibrating in snoring and sleep apnea. Fibrous tissue surrounds the implants over a period of 3 months or so, creating further stiffness. 3 to 5 implants are required, each inserted with its own sterile handpiece. This is done under local anaesthetic in the office in about 20 to 30 minutes. Most patients resume normal diet and activity the same day. The implants can be removed if unsatisfactory to the patient, though this is rare. 15 month follow up studies show very little relapse.
c) Thinning and stiffening the palate with a probe (Somnoplasty / Radio Frequency Ablation / Radio Frequency Palatal Myoplasty or RPM). This takes only a few minutes, and immediate return to normal activities is possible afterwards. It must be done several times, usually three, four to six weeks apart. There is no significant pain during or after the treatment. Relapse does occur in some patients, so that it may need to be repeated in a year or two: for this reason it is done less commonly than it was.
More severe sleep apnea may require much more extensive surgery, often in more than one place in the upper airway, such as these proceedures:
d)Uvulopharyngopalatoplasty (or UPPP) under general anesthesia in a hospital or clinic setting. Genioglossal Advancement (GGA) may be done with this proceedure in selected patients.
e) Tongue Base Radiofrequency (TB Rf) removes some of the excessive tissue at the back of the tongue, and is done under local anaesthesia in the office. This involves a series of treatments at monthly intervals, usually for about 6 months. Pain is mild and return to work immediate.
f) Nasal and Jaw surgery according to individual requirements.
g) Non-Surgical Management. It is an axiom of the the Sleep Surgery Centre that treatment can and should be tailored precisely to the individual. For some patients non- surgical treatment will be more appropriate, at least on a trial basis. Referral for CPAP therapy, dental appliance fitting, positional devices, help with weight loss, or other forms of treatment are readily and frequently made from our facility. Because there is only one optimal form of treatment for each patient, to be arrived at only after full endoscopic exam of the upper airway and interview with the individual, we believe a multidisciplinary approach is essential: we therefore work closely with CanSleep Services Inc. who provide, though their staff and consultants, all the non-surgical services, as well as much of the diagnostic testing, required by our patients. In some cases, moreover, it is important to have non-surgical treatment as an adjunct to surgical, for instance CPAP as a pre and post operative intervention to increase surgical safety. Integrated management is central to to our philosophy of care.
Follow-up:
This will be scheduled for you after surgery, so that full assessment and counseling are provided. There will also be round the clock availability of medical advice by phone following your surgery.
Contact us today to find out how we can help you or someone you care about.
Updated 3rd Oct. 2011