Dear Dream Doctor,

I’ve done two sleep studies for sleep apnea. I did terrible on both. I’m doing worse with the CPAP machine. I weigh 550 + pounds. My doctor wants me to go see another doctor about gastric by-pass surgery. I’m wondering if anything else should be looked at first. My tonsils and adenoids are out. Your opinion is appreciated.

—Robert, Age 44, Houma, LA, USA

Hi Robert—

Considering that your weight is so high right now I think your doctor probably is correct in suggesting gastric by-pass surgery. You’ve got to bring your weight under control—it is too hard on your body to carry all that weight.

You also need to be using your Nasal CPAP device on a regular basis—or you may have to get a tracheotomy—where they cut a hole in your throat—in order to by-pass the location of the collapse of the airway so you can breath during sleep.

I suspect that the air pressure level prescribed for you on the CPAP machine is fairly high. If the air pressure level is so high that it is uncomfortable—then tell your doctor that you need a bi-level device. A bi-level device alternates a higher pressure when you breath in with a lower pressure when you breath out. Bi-level devices are easier to breath with than CPAP devices when you get into higher pressure levels.

Thanks for writing in to Ask the Dream Doctor and please write back if I can provide any more information.