As a patient who has undergone this procedure, it's fascinating to get this extra insight. It's also disappointing to hear the adoption of this technique has been so slow throughout the NHS. Indeed, when battling through the various elements of the NHS on my way to your patient list, no other clinicians in other sleep departments had even heard of this. As an engineer, it makes perfect sense to me to divine the actual problem before attempting a fix. It's crazy that other sleep medicine departments in the NHS don't regard that as rule No.1, instead of just comitting a lifetime of CPAP resources to a patient, with all the cost and inconveince that entails for both the NHS and the patient.

@VikVeerENTSurgeon

3 жыл бұрын

It took us many years of negotiation with our CCG and ongoing communication to provide this service. Obviously most people consider this to be 'cosmetic', and so comments like this help me keep the department running.

@MountainAirOrganicBeds

3 жыл бұрын

@@VikVeerENTSurgeon I can't believe anyone could consider this cosmetic. How long can one go without a breath? This is a life or death issue. I have severe sleep apnea, so bad my chest is raised as if I was dying and it was my last breath. The US needs to get up to speed to save many lives that are at stake here.

As someone who suffers from apnea, I really appreciate you and all the others who are actually trying to innovate. I am a Dentist and am also trying to innovate. I spent 9 months on CPAP and it didn't help at all. Then I got DISE and started innovating on myself and have made considerable progress. One last comment I think DISE needs to check the larynx as well because some people might suffer from laryngomalacia or subglottic stenosis. I talked to a pediatric ENT who says he has found laryngomalacia in teenagers (the consensus is that it is mostly a disease for babies and then people "grow out of it")

Respect for that jumper Vik. 👊🏻

Such an interesting video - oh, how I would like the DISE you describe.

Great work!! Wish could have you as my Doctor treating my condition. You sound like very detailed and concinences. Live in the US, so gotta to find someone here. I am sure in the US tprobably they have a MacDonald version of the procedure .😲

Great video, as always. I love the genuineness of your presentation. Question: are you aware of any effect of pillows (number, type) on snoring?

Thanks

I wish you were in Sydney Australia. I think you would assist me in FINDING THE ROOT CAUSE FOR my Severe OSA

Thank you so much! Do you know if anyone is doing this in Dubai? I love your videos, very informative and also fun!

Danke!

@VikVeerENTSurgeon

2 жыл бұрын

Thank you ever so much, so nice of you. glad you found the video useful.

Great information.

@VikVeerENTSurgeon

3 жыл бұрын

Glad you think so!

@MountainAirOrganicBeds

3 жыл бұрын

I noticed you mentioned you were helping Covid-19 patients breathe better. Would a mattress made for tummy sleepers be better for them over a flat mattress? Here is a link to the Evolve bed we can make with air for hospitals and still work with adjustable medical meds. evolvebeds.com/collections/mattresses/products/prone-mattress. I would be interested to know what you think? evolvebeds.com/collections/mattresses/products/prone-mattress

Another thought: many microphone stands could be slightly modified to hold the scope in place. Seems like an easy fix.

Have you tried working with a clinical hypnotist to induce sleep? You may be able to bypass the anesthesia altogether. And I think you’re brilliant and wish I could go to you, I’m tired of being tired!

This sounds great! I have gone from CPAP to BIPAP to ASV, and now back to CPAP to try to solve my own apnea issues, and your videos have been quite helpful! Listening to your criticism of your technique, could you not also test a number of your patients electrodes to see if true sleep is occurring?

@preetimittal2123

5 ай бұрын

You have obstructive sleep apnea???

Thank you Mr Veer that was really interesting and informative, particularly as I have undergone two DISE’ in the last 2-3 years at the RN&T in Kings Cross. I was operated on last by yourself in February, probably due to Covid, I have not had a follow up appointment. When are things likely to get back to normal? Many thanks. PS, I do like the jumper!

@VikVeerENTSurgeon

3 жыл бұрын

Dear Mr Gilbert, I'm so sorry that you've been stuck in the middle of this. Our department was closed over COVID (I was redeployed away over the spring and summer to cover covid airway emergencies), and we have only started back a few weeks ago. We are currently running at 50% capacity until we move into our new facility, and the COVID thing settles a bit. Anyway, our waiting list is pretty massive right now, and so we are trying to call patients rather than making them wait so long. When I'm next in central London I'll check where you are on the waiting list and try and get back to you. Also we've just employed someone to help me, so that should take some of the list down a little. We'll get to you eventually, it's been a bit of a storm recently, so sorry!

I live in the "City of Medicine" in the Research Triangle Area of NC and nobody in the area does this yet, including Duke University Hospital. The only option is to travel.

Love this informative video. Question - I have dry mouth & sinuses as well with chronic sinus infection. Could dry mouth cause worsening sleep apnea.

@VikVeerENTSurgeon

3 жыл бұрын

There are articles about this - but we don't understand the processes behind it.

I asked my ENT about 5 years ago to give me a DISE. He looked at me like I was completely insane. Please can you record and your DISE technique. NZ is a couple of steps behind too.

Hi there, interesting video. I was formerly diagnosed with depression in 2011 which then changed to CFS in 2016 and then UARS in 2019 (probably the UARS all along). I have an RDI of 26.5 and been trying a cpap for nearly a year with no effect. I asked the sleep clinic for a DISE before they gave me the cpap but they said it’s too long winded and not cost effective lol. I can sleep for 9 odd hours then go down stairs and make a cuppa, then fall asleep on the couch for another 2 hours and still wake up yawning wanting more sleep.

@VikVeerENTSurgeon

3 жыл бұрын

UARS means you aren't losing oxygen at night, but you are fighting to breathe. The fact you are working hard all night just to breathe means you will be nackered in the morning. On saying that, you do sound more tired than one would expect with UARS. I wonder if you have had all the blood tests and a full PSG? A lot of people miss low iron / ferritin levels as that often causes restless leg syndrome. consider also hypothyroidism, cortisol, testosterone, vitamin d etc.. the list is endless come to think of it. your GP will be able to do most of it. perhaps I ought to do a video on that one day... good luck! also love the custom auto versions ;) subscribed.

@ODDAutos

3 жыл бұрын

@@VikVeerENTSurgeon thank you! I will keep pushing with this, hopefully get to the bottom of it one day.

Very informative Dr. Vik but what about the idea that apnea occurs in Stage II of the sleep cycle rather than Stage I? Does that sedation actually let you drop into Stage II?

@jeffreylylemason

Жыл бұрын

I was thinking the same thing while watching the video. I have heard that some people have worse apnea in REM and some in Deep Sleep. I think where we should be headed is actual sleep so we can see all the stages.

Couldn’t we do a MRI or CT instead of insert this tube?

How is it possible to know that the propofol worn off?

I am being 'treated' by Eastman ENT /Sleep Clinic without ever having had a face to face appt with a sleep clinic doctor in 12 months. No appt for future. Last 4 appts cancelled. PLEASE PLEASE can you tell me how I get to see a Sleep doctor? I will not survive another year of this exhaustion. Once I lose my job, I cant pay my rent and it all goes from there.

Hi Vik Do you do drug induce sleep endoscopy on the NHS also can I just ask my consultant to refer me?

Do you have any chance of practicing in Singapore?

@thomaspuang4201

2 жыл бұрын

I did at sgh last year from dr toh

Dear Dr. Veer, Thank you for the very interesting and educational video. I had a question around the normal sleep vs propofol induced sleep! Do you have any evidence on anatomical differences between these two methods? As the major pointfor DISE is to locate the obstructio. Do you think propofol can hinder locating the obstruction precisely? Thanks a lots. Best regards

@VikVeerENTSurgeon

3 жыл бұрын

On the whole, with a well conducted DISE using a target controlled propofol infusion, I believe the concordance between the two is pretty good. I do have a collection of recordings that show that propofol has a significant muscle relaxing effect in some people even at low levels. In these people I had to wait a long time for the the effect to wear off and the obstructive level change accordingly. I've seen quite a few patients who have been classified as having tongue base collapse (and went on to have RFA and robotic surgery), only to really have a different problem altogether which was only picked up by using the technique mentioned in this video. I have to say this is very rare, but it has kept me using this technique as my primary method. I found a massive difference however with midazolam even in low doses. There was a high rate of tongue base collapse which was not identified on propofol only DISE. I hope that answers your question?

@darklight221

3 жыл бұрын

@@VikVeerENTSurgeon yes, that was really comprehensive answer. Thank you very much. I was just concerned over false positive obstructions due to Anaesthesia during DISE, as this directly affects the decision for the surgical intervention. Wish you all the success for the great work you are doing in the ENT world. Best regards.

Why do we snore?

My ENT surgeon performed sleep endoscopy while I was undergoing my nasal surgery. He recommends I get airlift (Hyoid bone suspension) along with UP3 surgery. I'm little skeptical about UP3. What's your opinion?

@VikVeerENTSurgeon

3 жыл бұрын

I'm not a fan of UPPP, but it is an operation which has a randomised controlled trial to prove it works, and it has data from over 850,000 patients over 20 years to show long term data. Every patient is different, but if you aren't sure to go ahead with an operation, don't do it. You have to be 100% sure before you go ahead with an operation, there are so many other options in the meantime.

@_Trakman

2 жыл бұрын

Don't. Gave me relief for a few months, then I relapsed

Hello Dr Veer, could you pls tell me how much would cost me as international patient to do DISE test in you hospital?

@VikVeerENTSurgeon

3 жыл бұрын

please see my reply to your other question, sorry I can't be any less vague.

You need some sort of brace, or tripod to hold your arms.

Just had this done yesterday at Duke in the US. I was surprised how quickly I awoke following it & that I remember everything before and after it even with the anesthesia. What is a typical cause of weak throat muscle? Is it equivalent to another muscle in your body weak and out of shape? And what part of the throat is lateral wall collapse? Is that behind the tonsils?

@VikVeerENTSurgeon

3 жыл бұрын

No one knows why certain muscles start collapsing. I would say the most popular theory is that snoring vibration damage causes neuronal injury to the muscles.

@VikVeerENTSurgeon

3 жыл бұрын

also yes, the lateral pharyngeal wall is the space behind the tonsils. I hope they found out what to do. good luck.

@Jason-ej8cg

3 жыл бұрын

@@VikVeerENTSurgeon thanks for the reply The surgery they want me to have is NPPP I understand that might be Neck Pain Pain Pain Lol during the recovery period Do you have a video on NPPP?

@Jason-ej8cg

3 жыл бұрын

Meant UPPP

@andrewrocha1167

3 жыл бұрын

Hello Jason, I am in the US and though I wish I could go to London to Dr. Veer right now it is a bit difficult. If you don’t mind me asking how much was the procedure at duke? My insurance will not cover the DISE and I am looking a reasonable price. Thank you

How much do you charge for one of these assessments?

@VikVeerENTSurgeon

2 жыл бұрын

It's free on the NHS

@yerrrboy100

2 жыл бұрын

@@VikVeerENTSurgeon hi vik, I’m currently waiting for tonsillectomy for my sleep apnea but watching your videos I wish to know what is causing the apnea. Should I ask for a DISE before hand or I’m interested in getting a nox t3 sleep study done, which would you advise ? Thanks for all your amazing content. I think I speak for everyone when I say your content really does help people like myself

@VikVeerENTSurgeon

2 жыл бұрын

sorry I missed this. if you have grade 3 or 4 tonsils I would get on and do that first. if they are small I would normally consider a DISE first. if they are infected or get infected often then tonsillectomy by itself first as well. I would get the NoxT3 afterwards just incase. often big tonsils go with big lingual tonsils and that would often show up as supine OSA or UARS. it's quite complex to give good advice on here. speak to your surgeon and talk it through properly. take care and thanks for the nice comments

@yerrrboy100

2 жыл бұрын

@@VikVeerENTSurgeon thanks vik this information is greatly appreciated. I will take all information you give onboard and talk it through with my surgeon on the next appointment. All the best

"Denial about Brexit..." Oh no, a doctor with sense of humor!! 🤣🤣🤣 Seriously Dr. Veer, I was so disappointed that the UK chose Brexit! 💔💔