One way or another you do need to address the apnea - it can kill you
in a lot of incidious ways besides asthma.

They sometimes can do the CPAP through a mask that fits over the nose
which you might find more tolerable. It is not uncommon to have to work
a respiratory therapist to find the right mask.

It would be impossible for anyone here to tell if you should have your
tonsil out. I would say that there are also dental appliances and other
things that might help. Of course, there is the ever popular advise to
lose weight.

What I would do is to see a "sleep specialist" - usually an ENT or
pulmonologist. I'm sure if your doc or insurer can't give you a name or
two the sleep lab that did your study can.

The doctor who sent me also mentioned my tonsils might be the

How old are you? I did have my tonsils out and I am over 50, so it is not
recommended.  The ENT didn't think it would help much, but I am happy to
report I have much less trouble with my ears, with swallowing, guttate
psoriasis, stridor and low grade fevers.  I would do it again, even as bad
as the recovery was because it did clear up many of my problems. You should
be warned this is not fun surgery for an adult.

Joy

I'm one of those respiratory therapist that spent the better part of 10 years
setting up CPAP's. My Dad has bad sleep apnea. I've seen LOTS of people with
sleep apnea.

Surgery on tonsils alone might be helpful but would have an extremely low
probability of doing anything besides a trivial improvement. The surgery done
for it is called palatophyrngealoplasty (PPP). It makes tonsil removal look
trivial. Success rate is improving (mostly by better candidate selection) but
still can be 50% or less. Side effects can be significant. Surgeons who tell you
otherwise want your money.

Weight loss if you have untreated OSA (obstructive sleep apnea) is basically
impossible. It's damn near impossible if you DON'T have OSA. Treat the OSA and
you have a small measure of possibility. For "some" women this can make a big
difference. For men it helps but generally will NOT cure.

CPAP is still generally the easiest, lowest cost, and most effective treatment.
At least you don't have chunks of you removed that you can't put back. Getting
used to it can take some time. You'll do better at home with your own equipment
but expect a learning curve. Getting someone to make sure you get a good mask
fit and lets you know what to expect will help a lot. Often units can be rented
for a month before purchase.

You should get checked for reflux. Index of suspicion with nocturnal asthma is
very high.

Check out this site for a simple self test for OSA
http://www.sleepnet.com/sleepapnea.html

For possible equipment options check here
http://www.cpapman.com/influent.html
(there are LOTS of sites available)

Fritz
Respiratory Therapy

If you can nose breathe sleeping on your side (but not on your back)
the resistance is lower and the propensity to apneas and snoring is
less.
See Eur Respir J. 2005 Mar;25(3):521-7.
   Effect of treating severe nasal obstruction on the severity of
obstructive sleep apnoea.
   McLean HA et al.    "An association between mouth breathing during
sleep and increased propensity for upper airway collapse is well
documented, .." and
Eur Respir J. 2003 Nov;22(5):827-32.    Effect of nasal or oral
breathing route on upper airway resistance during sleep.    Fitzpatrick
MF, et al.
"Healthy subjects with normal nasal resistance breathe almost
exclusively through the nose during sleep. ...Upper airway resistance
during sleep and the propensity to obstructive sleep apnoea are
significantly lower while breathing nasally rather than orally. "

This would provide an argument  in favor of training for nose breathing
in sleep to prevent apneas.  This would be a smarter tactic than
breathing through the mouth with the tendency for the pharynx to be
occluded by suction.  The actual reason for nose breathing resistance
being lower seems irrelevant.  Regards, Richard Friedel

and