The video presents a detailed case study of a 58‑year‑old male (referred to as Al) suffering from severe obstructive sleep apnea (OSA) for 15 years. Al describes terrifying nocturnal apneic episodes, chronic sleep deprivation, and associated health anxieties. He previously tried standard therapies—CPAP, an oral appliance (deemed unsuitable), and a uvulopalatopharyngoplasty (UPPP)—all of which failed or were intolerable. A caregiver (an experienced RN) recounts observing Al’s breathing pauses and the cardiac stress caused by repeated arousals. Dr. Bill Hang explains OSA as a structural airway problem, using diagrams to illustrate how retruded maxilla and mandible, a high‑arched palate, and a posteriorly positioned tongue narrow the airway, leading to collapse during sleep. He provides alarming epidemiological statistics (e.g., 95% of U.S. OSA patients undiagnosed, 20% reduction in life expectancy when untreated). Al’s sleep study revealed 40‑50 apneic events per hour, some lasting up to 90 seconds, with oxygen saturation dropping to 70%. Imaging showed a tongue‑to‑pharynx distance of only 3‑4 mm (normal ≈11‑12 mm) and a “very narrow smile” indicating severe dental malocclusion. The treatment plan combined comprehensive orthodontic alignment of both arches followed by orthognathic surgery to advance the maxilla and mandible, thereby widening the airway. Post‑operative imaging demonstrated a restored airway space (≈11‑12 mm), normalized bite, and broader dental arches. Follow‑up sleep studies confirmed the resolution of OSA. Al reports dramatic improvements in energy, stamina, and overall quality of life, describing the surgery as life‑changing while emphasizing that surgery should be a last resort after lifestyle and non‑invasive options are exhausted. The video interleaves clinical explanations, statistical context, visual evidence, and personal testimonies to illustrate a successful, permanent solution to severe OSA.
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When I was going through the episodes of apnea at night, I would find myself waking up and choking or trying to get my breath going again. And it was scary in that sense because I was even afraid that if I went back to sleep, I may not wake up again. It was like a terror sort of thing. I'd get up and walk around, and my concern was saying, hey, I know people die from sleep apnea, and if in fact If I didn't start breathing again, if my heart didn't react properly, I could— it could stop, and that could be the end. And that really, frankly, scared me a lot.
Hi, I'm Dr. Bill Hang. Thank you for joining me. This case study is based on a 58-year-old male whose reason for seeking treatment was a severe case of obstructive sleep apnea. Throughout this presentation, you will see the letters OSA on your screen That is the acronym for obstructive sleep apnea. This patient suffered with obstructive sleep apnea for 15 years before seeking treatment in our office. We were 100% successful in alleviating his sleep apnea symptoms. In addition, as you can see from the before and after pictures on your screen, his facial balance was improved as well. Before coming to us, he had been told that his sleep apnea was too severe to be helped by wearing an oral appliance. In mild to moderate cases, oral appliances are commonly used to posture the lower jaw forward in the hope that the airway will open enough to eliminate sleep apnea. He also tried using a CPAP machine. CPAP is an acronym for continuous positive air pressure. It is a machine with a mask that blows air into the nose or mouth to assist breathing at night. CPAP masks can be cumbersome and uncomfortable. Like a majority of patients, he was unable to tolerate CPAP therapy. He also underwent a UPPP procedure, or uvulopalatopharyngioplasty. It shortens the soft palate in an attempt to open the airway and usually includes a very uncomfortable recovery. The procedure does not enjoy a high success rate and was not successful in helping this patient. The patient had grandchildren that he wished to see grow up, and he was aware of the fact that untreated obstructive sleep apnea statistically results in a 20% reduction in life expectancy. After a failed UPPP procedure, without the option of an oral appliance available to him, and unable to tolerate CPAP therapy, he was seeking a permanent solution for his sleep apnea problem.
At night, you know, sometimes I would— if I couldn't get to sleep, I'd start counting how many seconds it was, you know, when he wasn't breathing. And then every time he started again, it was a huge Startle reflex, and he would go like that and start up again. Then I'd think, okay, and then all of a sudden, wham, he's gone again. I mean, he was out more than he was ever in. I was an RN almost 40 years ago, but I had all that training, and I just was worried about the stress on his heart because every time you start breathing again, it jolts your heart. And I knew he doesn't— he didn't have any of the classic symptoms. He wasn't overweight, he didn't have high blood pressure, and so I figured all of that was for the positive. But it was just the fact that I knew that the stress on his heart every time he started breathing again was not good.
John Remmers, the Harvard-trained physician who coined the term obstructive sleep apnea, or OSA, states that obstructive sleep apnea will become the most common chronic disease in all industrialized countries. He further states that this is a structural phenomenon. What I'm going to explain to you next is what Dr. Remmers means when he talks about OSA being a structural phenomenon. On your screen is a cross-section diagram of the human head. The white section is the airway. The beige section is the palate. The red section is the tongue. The upper and lower jaws in this diagram are placed forward in the face, which allows for a healthy, open airway. Watch as the black dot, which represents the air we breathe, goes through the nose, past the soft palate and tongue, and down into the lungs. That, in simplified terms, is how a healthy airway works. Now I'm going to show what the structural problems associated with OSA look like and how they affect the airway. Watch closely as the upper and lower jaws begin to recede back into the face. As the jaws move back, the soft tissues attached to them, specifically the soft palate and the tongue, move back as well. The airway is narrowed dramatically as this occurs. Watch the black dot again. When the muscle tone is diminished during sleep, the soft palate and/or the tongue can fall back and completely close the airway for extended periods of time. Nothing good happens when breathing stops. By definition, sleep apnea occurs when a patient stops breathing for periods in excess of 10 seconds while sleeping. These breathing stoppages are a result of the airway becoming completely closed. Either the soft palate or tongue falls back during sleep and seals off the airway. Anything more than 10 seconds without breathing is called an apneic event. This is measured and documented during a sleep test supervised by a physician. We do not treat patients for OSA until a conclusive sleep study is done.
Oh, well, I think it was really interesting. Al was having a lot of physical problems back in the late '80s. And so I went to his— with him to his physical, and I told the doctor, I said, you know, he stops breathing in the middle of the night, and I've been counting it. You know, sometimes it's 30 seconds or more. And he thought, well, you're crazy. I've never heard of such a thing. And I said, well, I really think he's doing it. And so the doctor said, well, there is a— we do have a sleep doctor in the area, so I'll send him to the sleep doctor. And he did, and they— this was one of the early times of sleep studies. In fact, the doctor we went to, the internist, was supposedly quite one of the better ones, and he'd never heard of sleep apnea. And so when we went to the sleep doctor and they did the study, they said, well, Al's more sleep deprived than an intern. He said, I'm surprised he can even function. doesn't get any sleep at all. And so that's when we started, started exploring alternatives.
The narrower the airway is, the more likely the tongue and/or soft palate are to fall back and seal off the airway, resulting in an apneic event. Here are some statistics about obstructive sleep apnea. 60 to 80% of snorers will test positive for obstructive sleep apnea when they have a sleep study done. 40% of adults over age 40 in the United States snore. 95% of all obstructive sleep apnea patients in the United States are undiagnosed. 65 to 80% of all stroke patients suffer from sleep apnea. 1/3 of all people with coronary artery disease have sleep apnea. Sleep apnea patients are 6 times more likely to grind their teeth at night than a normal population. 90% of obstructive sleep apnea patients suffer from hypertension. All of the previous statistics are alarming in themselves. However, the final statistic that I'm sharing with you is the one that makes us at FaceFocus so passionate about helping OSA patients. Untreated sleep apnea results in a 20% reduction in life expectancy.
You're in a situation where you don't, you don't feel good. It used to actually make me so my stomach hurt. My whole body ached and was pained because I was sleep deprived and probably oxygen deprived. And it really actually was very, very uncomfortable. So he sent me off to have the sleep study done, and it was, and as they said, I performed like a star. It was amazing. I was stopping breathing anywhere between 40 to 50 times an hour and having episodes as long as 90 seconds. And in fact, my oxygen saturation level got down to almost 0.7, which is very dangerous, so they actually woke me up and stopped the study.
This picture shows the patient in profile looking at himself in a mirror. The red line shows how dramatically his head is tipped back. In a healthy individual, the forehead will be vertical in rest position. The patient tips back his forehead and keeps his chin forward in order to keep his airway open. If he were to move his forehead into a vertical position, his chin would fall back toward his neck and his airway would narrow, making it difficult for him to breathe. Watch the diagram again as the airway becomes occluded. That blockage is a result of a patient like this simply moving his or her head into a vertical position. This picture illustrates what we call a very narrow smile. His teeth are barely visible and his smile is not complete to the corners of the mouth. Although the patient did not seek treatment for aesthetic reasons, you can see in this picture that his upper teeth are poorly aligned. In his case, the visual improvements he achieved during treatment were an added benefit of finding a permanent solution to his OSA. This picture shows the lower teeth from above. Because the patient grinds his teeth at night, as most OSA patients do, his lower teeth are worn. They are also very poorly aligned. This picture shows his upper and lower teeth from the front. An ideal bite relationship would feature the upper incisor teeth overlapping the lower incisor teeth by approximately 1 to 2 millimeters. This patient's bite is so deep that you can hardly see the lower incisors at all. Such a deep bite severely limits the amount of space he has in his mouth for his tongue. As a result, his tongue moves to the back of his throat when he is sleeping and his airway becomes obstructed. The lateral head x-ray shows a dramatic narrowing of his airway near the angle of his lower jaw. The distance between the back of the tongue and the back of the throat is severely reduced to 3 to 4 millimeters. A more normal distance would be 11 to 12 millimeters. There is a dramatic increase in the resistance to airflow when the size of the airway is severely reduced, and if the tongue falls back even slightly during sleep, the airway can close.
That I was sleep deprived. At work in the afternoons in particular, if I wasn't actually moving or doing something, I'd have a tendency almost to fall asleep. I'd be in a hallway talking with people and actually standing up and literally fall asleep on my feet and have to fight to keep awake. So I knew I was sleep deprived and I needed to do something about it, but I'd never really heard of any way other than the CPAP machine that was going to be helpful.
The treatment for this patient involved orthodontic alignment of both the upper and lower arches to prepare him for an orthognathic surgical procedure. During surgery, his upper and lower jaws were moved forward in his face. This made a dramatic improvement in his airway. This post-surgical lateral head x-ray shows the distance between the back of the tongue and the back of the throat has improved from 3 to 4 millimeters to perhaps 11 to 12 millimeters. He no longer snores or suffers from OSA symptoms. In this side-by-side comparison of the patient's airway, You can see the dramatic change that occurred during his treatment. The picture on the right of your screen shows the improved alignment of his teeth and the reduced overlap of the upper teeth over the lower teeth. The pictures on the left of your screen show a dramatic broadening of both the upper and lower arches, which leaves plenty of room for his tongue.
Now I can hardly describe it as anything other than outstanding. I feel great. I feel like I'm a new kid again. I've got a lot of energy. I've got plenty of stamina. I feel like I can do about anything. I feel so much younger, and I can breathe, and I feel like I've got a whole new lease on life. Surgery should be a last resort to anything. If there's any other way of managing it, improving your lifestyle by other ways, you know, do it. Do that first. But, you know, when it comes down to the difference of being sure it's gone, because even if you do have a CPAP machine or you have an appliance or other things, there's still that chance that, you know, it may not be enough. And to me, it was so worthwhile just to know that when I did that and made that decision and that surgery was completed, that I'd have a clean bill of health. And I went back and had that sleep study done, and it was so reassuring to get that A sleep study doctor tell me, you know, you don't have sleep apnea anymore. We can't guarantee it won't come back, and we can't ever say that you'll never be bothered with it again, but clinically you're cured. And to me, that was like, wow. And I've never felt better about anything. And I would do it again, as I say, in a flash. And I would just pass on to other people, you know, the experience I've had and I would tell them, or say to them, here's a choice that you can make, and I'd go with it and just plain do it.
I'm Dr. Bill Hang. Thanks for taking the time to watch and listen to this case study.
