Surgery for Sleep Apnea Is Less Attractive Than It May Sound

You may prefer a one-time fix for your sleep apnea, but surgery might not be your best option. You should try other options first. Here's what you can do.

Surgery for sleep apnea may sound preferable to the nightly exercise of wearing a continuous positive air pressure (CPAP) contraption in bed. An ear, nose, and throat doctor can tell you if you’re a good candidate for surgery, depending on why you’re experiencing pauses in breathing while you sleep.

Just be clear: Even after you’ve undergone the pain, inconvenience, and risk of the surgery, if it is successful your sleep apnea will be reduced, but not banished. To avoid symptoms, you may even continue to need the CPAP machine.

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You also won’t have banished pressure to change other habits that are contributing to your problem. If fatty tissue is causing your sleep apnea and weight loss could cure you, listen to the wake-up call. Can you summon more motivation to diet now that you know your health is at stake? Doctors routinely tell sleep apnea patients to lose weight, but few do.

Smoking is also a risk factor. If you smoke, what would it take to finally quit?

Let’s say you tried a CPAP machine but gave up after a week or so. Did you use a humidifier and have the settings adjusted before you gave up? Could you try a different type of mask? Did your spouse give you the right kind of support?

Some people who try a CPAP breathing machine or oral appliance find that they still don’t sleep well because their noses are chronically blocked. allergies, Polyps, a deviated septum, or enlarged adenoids or turbinates can all cause congestion. 

If you have allergies, have you tried allergy shots, allergy medications, diligently irrigating your nose with saline at bedtime, nasal sprays, and simple plastic devices that keep your nostrils open?

Then there are pets. No one wants to give up a pet; it’s heartbreaking. But you can keep pets out of your bedroom or board your pet elsewhere temporarily to see if your symptoms change.

If you do need surgery, the right kind for you may involve your nose. For instance, an office procedure called radiofrequency turbinate reduction uses radio waves to shrink swollen tissues in each side of your nose.

But the most common surgery for sleep apnea is an uvulopalatopharyngoplasty (UPPP), in which your surgeon removes tissue in your throat, possibly including:

• Part of the roof of your mouth
• The uvula, the soft finger-shaped tissue that hangs down from the roof of your mouth
• Tonsils and adenoids, to make your airway wider

If you have an enlarged tongue, part of it may be removed. The soft palate, the roof of your mouth connecting to your throat, contributes to airway blockages in more than 90 percent of people with sleep apnea. UPPP surgery requires an operating room, not a doctor’s office, and general anesthesia. Many patients return to their ordinary activities after a week and can eat normally after two. You’ll likely have some pain swallowing and may need medication during that time.

More serious risks of the surgery include:

• Swelling
• Bleeding
• Infection
• Swallowing problems
• A nasal quality in your voice
• Speech problems
• Changes in how food tastes

About 1.5 percent of patients have serious complications, such as a heart attack or pneumonia, from a respiratory tube.

If your tongue collapses backward during your sleep, your surgeon can implant a kind of pacemaker for the tongue, called a hypoglossal nerve stimulator, that stimulates your tongue to move forward.

A procedure to move your upper or lower jaw forward, called a maxillomandibular advancement, may help some people, but the recovery is longer, and you risk a change in your appearance. 

In an anterior inferior mandibular osteotomy, your chin bone is divided, allowing your tongue to move forward to open your airway.

In a genioglossus advancement, your surgeon tightens the tendons in your tongue so it can’t roll back.

Another possibility, which can be part of the UPPP package, is a midline glossectomy and base of tongue reduction — removing part of your tongue.

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