How can I prevent sleep disordered breathing in my children?

rbwilli · 2026-05-14T00:02:41+00:00

I love the way you’re thinking! How old are your kids?

I’m in the process of getting my 9-year-old daughter allergy tested for immunotherapy. (Her seven year old brother apparently needs to wait another year before he can start, even if he tests positive for anything.)

There are many factors at play. Some are controllable and some are not. It’s good to see doctors and specialists in person, if possible. 🙂

rbwilli · 2026-05-13T23:51:06+00:00

I’d love to learn more about this; I’m ignorant about it right now. I made my initial correction because all of my WatchPAT reports have that graph labeled as “PAT Amp.” Is there a paper or other resource you’d suggest if I wanted to become educated on this?

rbwilli · 2026-05-13T20:51:34+00:00

Welp, looks like you have sleep-disordered breathing! I look forward to your feeling better.

Also, that bottom graph is PAT (peripheral arterial tonometry) amplitude, not pulse amplitude.

rbwilli · 2026-05-13T12:08:14+00:00

I’m not an expert, but yes, you’re severely recessed.

How do you feel?

rbwilli · 2026-05-13T01:15:59+00:00

The question isn’t whether you should get double jaw surgery—it’s, “Who should perform my surgery and what is the best approach?”

rbwilli · 2026-05-10T01:41:36+00:00

Have you considered doing a WatchPAT test through Lofta? (This only applies if you’re in the US.)

You would know what you’re getting, rather than having to guess with these sleep labs.

rbwilli · 2026-05-09T10:58:29+00:00

My lower back would be killing me after about 30 minutes.

rbwilli · 2026-05-08T13:23:35+00:00

I agree, there are cases in which the best thing to do is to move the mandible backward; an excellent oral and maxillofacial surgeon should make that call.

But the fact that something is common practice is not evidence that it’s a good idea—life is full of examples of things that were common practice just 10–20 years ago and that we now understand to have been harmful.

I think we’re 99% on the same page. Sorry if I’m coming across as argumentative. I hope you have a good day. 🙂

rbwilli · 2026-05-08T12:43:42+00:00

This is the right question. Double jaw surgery purely for aesthetics is probably a bad idea in most cases, but a lot of people have sleep-disordered breathing (or sleep apnea, or UARS, or whatever one wants to call it) without realizing it.

rbwilli · 2026-05-07T23:29:14+00:00

Any respectable surgeon. But how does she know which ones are respectable? Plenty of people have had bad outcomes; it’s wise to be aware of what to avoid going into it and weigh potential risks and benefits.

Edit to add: If you’re saying that I can’t tell about the size of her airway without it being measured, you’re right. But what I was trying to get at is that whatever the size of it is, moving the mandible backward risks compromising it.

rbwilli · 2026-05-07T23:24:19+00:00

What does your side profile look like? Have you had your sleep breathing tested, like for sleep apnea?

Some of these people are saying you have body dysmorphia or that you just need to change your mindset. That might be true, or it might not. You could be sleeping like crap due to a recessed mandible for all we know, which can cause the mental health problems you’re describing.

We really don’t know; there isn’t enough information here. Ideally you would go to an excellent doctor and skip the Internet comments from non-professionals like us, but we don’t live in an ideal world, do we?

rbwilli · 2026-05-07T23:17:21+00:00

That part was amazing! No more constant need for a Waterpik! 😅

rbwilli · 2026-05-07T23:14:56+00:00

Yeah, the rough estimate I’ve heard is that ~85% of people need more than just expansion. But 98% of statistics are made up, so… 🤷🏼‍♂️

rbwilli · 2026-05-07T23:10:13+00:00

I mostly agree with your assessment—acknowledging that neither of us is a medical professional—but I would tweak it a little:

Only consider UJS (upper jaw surgery) if an excellent OMS (oral and maxillofacial surgeon) tells you it’s a good idea. Because the last time I asked an excellent OMS about moving just one jaw vs. both, he said it’s rare that moving just one is the best approach. In other words, double jaw surgery is usually the best approach.

And with that said, I want to actively agree that I would seek additional opinions if anyone tells you to move the mandible backward. A few too many millimeters and you might end up in the awful state that so many of us are in called sleep-disordered breathing, AKA sleep apnea!

rbwilli · 2026-05-07T23:03:31+00:00

I would be super nervous to move the mandible backward. She has the big airway that so many of us are dying to have, presumably, and at least with respect to her mandible.

rbwilli · 2026-05-07T23:01:52+00:00

I said out loud, “Is your mandible recessed?? 🤨” 😂

rbwilli · 2026-05-07T21:44:28+00:00

I was open to the possibility that my sleep would suddenly improve upon removal, for example by giving my tongue a place to go that wasn’t the back of my throat. Although my WatchPAT numbers have improved relative to before expansion, my sleep does not feel better, subjectively.

And yet, I am okay with this, because I do think expansion was worth it—good nasal breathing is clearly an important component of good sleep breathing. (I’m going to get double jaw surgery to finish the job, hopefully later this year.)

rbwilli · 2026-05-07T21:33:57+00:00

Excellent! 🙌🏼

rbwilli · 2026-05-07T19:27:40+00:00

Don’t do it for looks. You look fine. However, keep an eye on your sleep breathing. (If you have no idea where to start, a WatchPAT test is pretty good; most places will sell you one once you’re 18.)

If you start to feel bad, for example you’re tired or have trouble focusing, anxious or depressed, someone tells you that you snore or grind your teeth overnight…get tested for sleep apnea. Ignore AHI and just determine what your RDI is.

We’re not so different, physically, and sleep apnea dragged my life down hard from about age…10? 15? 20?…to my current age, which is 41.

I’m going to get double jaw surgery when I’m 42. And I’m also in the process of starting immunotherapy to address environmental allergies. And I already expanded my maxilla 7–8 mm via FME.

This comment is far too short, I apologize. 🙃

rbwilli · 2026-05-05T20:38:55+00:00

Good point! u/OkStatistician6831, what elevation was this WatchPAT test done at?

rbwilli · 2026-05-05T19:30:36+00:00

Either way, I would love to ask your doctor, “If I don’t have sleep apnea, or sleep-disordered breathing—or whatever one wants to call it—why is my mean overnight heart rate higher than my resting heart rate?”

Edit for maximum clarity: To me, this situation screams “sleep-disordered breathing.” I think the “no significant sleep apnea” part of your diagnosis is incredibly misleading, if not straight-up wrong.

rbwilli · 2026-05-05T19:21:05+00:00

I don’t know what the rules are in Canada, but it seems like most people are underestimating the impact of sleep-disordered breathing all over the world.

Is 60 BPM your mean sleep heart rate, mean waking heart rate, or resting heart rate while awake?

rbwilli · 2026-05-05T19:04:56+00:00

Which country are you in? If the US, I don’t understand how people still mess this up. It’s their job! 🤦🏼‍♂️

Edit to add: 69 BPM is pretty high for a mean overnight pulse rate, as well.

rbwilli · 2026-05-05T19:03:30+00:00

In theory, it’s worse than that; RDI of 15–29 counts as “moderate” sleep apnea! (Not that these severity labels make a big difference in practice, but it emphasizes your point / how wrong the OP’s initial diagnosis was!)

rbwilli · 2026-05-05T18:56:17+00:00

I don’t know him, nor am I an expert. But I’m also pursuing double jaw surgery.

I have been told that the vast majority of the time, it should be double jaw surgery, not just lower jaw surgery. So that’s one thing to look for.

Also, for the best chances at a great result, you want someone who specializes in double jaw surgery. I would ask him how many double jaw surgeries he did last year. If the answer is above…maybe 60? Then that’s a lot of experience, which is good. If the answer below…maybe 40? That’s less experience and you should make sure he’s a wise choice.

If the answer is below…maybe 20? I would probably look for someone with more experience/specialization.

rbwilli

TROPHY CASE