CPAP: Back-up power and battery systems for travel

I'd probably use something like Anderson power poles if it were me.

http://www.andersonpower.com/us/en/products/powerpole/index....

There are third party battery solutions available, but they are all rather larger than the CPAP units themselves, and come with laptop-sized powerbricks.

I have the ResMed AirMini... and I like it quite a lot. I've had phones that were bigger. (i mean, they were Nokia Communicators... but still) - I use it whenever I sleep in a bed that is not my own. (ResMed says you shouldn't use it as your primary unit. I dunno if that is just "buy more stuff from us" or if there is a real reason, but it's reporting is way worse than the AirSense 10, and sometimes I like the humidifier, and frankly, I'm willing to pay money for a backup) I would like a battery, but between the size and the fact that I haven't slept away from a power outlet for a while, I haven't bothered to buy one.

Is this typical? I don't know. I know a fair number of people who use CPAPs (seriously, if you are overweight, you should probably get it checked out. It's one of the problems modern medical science can actually solve pretty reliably. Makes a big difference.) I'm the only one I know who has a portable cpap. Everyone else I know just carries an extra bag when traveling.

Btw, how is airmini humidifier working for you?

I guess I should get a Cigarette Lighter adapter so that in a pinch I could use this 75KWH portable battery I have called a Tesla. :-)

I know several people who are in this boat... but without exception, all the people I personally know who did not tolerate cpap treatment just used one mask, and when that didn't work, they stopped. I think I went through like ten masks from three brands before I really dialed in one that was comfortable for me, and I think that's key to tolerating sleeping with a face-hugger.

>the efficacy of surgery is up in the air. The surgeon in the Bay Area that does jaw reconstructive surgery to open up more space for the airways charges six figures for the procedure, and it is not covered by insurance.

I know two people who got the less invasive version of the surgery where they hack out parts of the soft pallet or something, which is dramatically cheaper (and usually covered) - and they both rave about it, a way better ratio than the CPAP, but when I asked my doctor about it, he pointed out that it tended to work well at first, but the fleshy bits that are cut away tended to grow back. I didn't really research too much further... I mean, really, going under the knife every five years doesn't sound that unreasonable, but I dunno if that's how it works.

After reviewing the literature, it quickly became clear that soft tissue surgery was a poor option - surgical success rates are often less than 50%, and surgical cures are almost non-existent. At best you'd trade a lot of pain for a temporary, modest reduction in AHI.

MMA, however, looked very different - in the hands of a skilled surgeon, surgical success rates are >90% and reduction of AHI to <5 is possible, though not guaranteed. A relevant paragraph:

"Staged surgery protocols have been developed to address multilevel airway abnormalities that contribute to OSA. Generally, procedures that carry less severe risks and potential complications are performed initially. The Stanford group protocol reports a staged surgical success rate of 75 % in patients with mild-to-moderate OSA and 40 % in patients with severe OSA in phase I (palatal surgery alone or in combination with GA) to 95 % in phase II or facial skeletal surgery [53]. In some cases when soft tissue abnormalities are not considered to play a significant role, maxillomandibular advancement can be considered as the initial therapeutic option [45]."

(source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480570/)

Among leading surgeons the view these days is that MMA is the gold standard and there is no reason to do soft tissue surgery first unless your physiology specifically warrants it. MMA does, however, require a skilled surgeon - in the hands of an inexperienced one you'll see much lower success rates and more complications. I did a ton of research before picking the surgeon I've been working with.

Dr. Kasey Li is probably the surgeon you're thinking of. I'm Canadian but paid to have a consult with him to make sure I was on the right path. My understanding is that many insurers will cover the surgery now, although in my case I'm having it done in Toronto by an excellent surgeon. Between the two surgeries and orthodontics it will come out to about $20k over two years. In Canada the hospital stay and most of the surgeries are covered by provincial insurance, so about 3/4 of that cost is actually for braces + expansion device for SARPE.

It's a long and sometimes difficult process, but my own personal calculus lead me to believe it was the best available option given the circumstances. If all goes well I should come out the other end with minimal or no sleep apnea, and as a bonus straighter teeth too :-D

There is some really interesting work being done on implantable hypoglossal nerve stimulation devices (https://www.inspiresleep.com/) but in my estimation the jury is still out on the long-term prospects of that modality.