Obstructive sleep apnea is a sleep-related breathing disorder in which the back of the throat collapses, blocking the airway. This leads to multiple cessations of breathing throughout the day, that requires the body to wake up momentarily to begin breathing again. These pauses are known as apneic events, and one can experience several hundred of these a night.
The impact of this disease is poor sleep, chronic sleep deprivation, weight gain, metabolic syndrome, heart disease, and just an overall poor quality of life. The gold standard for treating sleep apnea is continuous positive airway pressure, or CPAP. This therapy is a machine that blows air into your lungs when you exhale to keep the tissues from relaxing.
The CPAP machine can be uncomfortable, requires a lot of maintenance to keep it clean and sanitized, and often can be a bit cumbersome. Therefore, there are alternatives to using a CPAP machine, like surgery. There are various surgeries to improve your sleep apnea, but the decision to have surgery comes with more risks that moderate treatment. Continue reading to learn more about surgery for sleep apnea, and what exactly that may entail. After reading this article, you may have more information for a clear conversation with your doctor about what the best move is for you.
Considering surgery for sleep apnea
Surgery is normally recommended if you cannot tolerate the CPAP, and therefore, never wear it. If you don't wear the CPAP, then it can't improve your symptoms, therefore leading to prolonging of the treatment, and worsening of your symptoms.
If you have tried a CPAP and continue struggling to breathe, or just don't like it, then surgery may be the next step. Surgery is the most effective option, but some may carry more risks than others. The goal of surgery is to treat the areas of the airway that continue to close as you sleep, and block your nighttime breathing.
Surgeries can stiffen, remove or reposition tissues in and around your throat. These surgeries tend to focus on the tissues in the back of the throat like:
- Soft palate and uvula
- Tonsils and adenoids
- Upper and lower jaw
Weight loss surgery is another option that can help sleep apnea patients who are extremely obese. Treating sleep apnea requires a large team of medical professionals, including your sleep doctor. The sleep doctor is responsible for diagnosing you with sleep apnea. This is normally done using a polysomnography, or a sleep study. The sleep study requires you to sleep at a sleep center, and be hooked up to various monitors and machines. These will monitor your vitals, number of apnea events, movement, and progression through sleep stages.
When you are done, the sleep physician will analyze your results and subsequently diagnose you with sleep apnea. Upon your diagnosis, surgery will most likely not be one of the first options. Lifestyle modifications, like weight loss, cessation in smoking, and various positioning, may be suggested in conjunction with a CPAP.
If all of those fail, then the next step would most likely be surgery. The sleep doctor will then refer you to either an otolaryngologist or oral surgeon to perform the surgery. Post-surgery, you will need to follow up with sleep doctor, and repeat a sleep study to see if your sleep issues have resolved.
Side effects of surgery include pain, bleeding/throat swelling, orthodontia and limited diet for several weeks, and an overnight hospital stay. Everyone is not a surgical candidate, so please consult with your physician to see if you are.
Types of surgery for sleep disorders
There are different types of surgery for sleep apnea and snoring. Surgery may even be a multi-step process that involves more than one procedure. At the conclusion of surgery, you may need to continue wearing your CPAP machine, and it's important to follow up with your sleep doctor regularly. Below are some surgical options
This procedure involves the back of your mouth where they will remove and reposition excess tissue in the throat to make the airway wider. Some surgeons will opt to trim down your soft palate and uvula, remove your tonsils, and reposition some of the muscles of the soft palate. UPPP and other soft palate procedures are the most common type of surgery for sleep apnea. However, this procedure is unlikely to cure moderate to severe sleep apnea on its own. It may be combined with other surgeries that target the upper airway.
Upper airway stimulation therapy
This is an outpatient procedure where a device is implanted that monitors your breathing while you sleep. The device stimulates the hypoglossal nerve, which controls your tongue's movements, pushing it out of the way to keep your airway open.
In order to qualify for this, patients must have moderate to severe sleep apnea that cannot tolerate CPAP or oral appliance. They must be at least 22 years of age, and not significantly overweight. They will have to meet with the surgeon to decide if they are a candidate for this. Patients can expect to have a sleep study before and after the procedure.
Radiofrequency volumetric tissue reduction
The surgeon uses a heated instrument in this procedure to shrink and tighten the tissues in and around the throat. This can be used on the soft palate, tonsils and tongue.
Septoplasty and turbinate reduction
These options open your nasal passage to improve airflow. Septoplasty, a "nose job", straightens a bent or deviated nasal septum, which is the divider of your two nostrils. Turbinate reduction reduces or removes the curved structures that stick out from the side of the nose. They can be enlarged due to allergies or a number of other reasons. Medications can also help to reduce the size of them. This surgery rarely treats OSA, but may allow more mask options and lower CPAP pressures.
The tongue blocking the back of your throat can be part of the cause of sleep apnea. Therefore, in this procedure, the surgeon move the major tongue attachment forward, opening up space for breathing behind the tongue. It is completed by making a cut in the lower jaw where the tongue attaches, and the piece of the bone is then moved forward.
This procedure involves enlarging the space for breathing in the lower part of the throat. The hyoid bone is a u-shaped bone in the neck. The tongue and other muscles are attached to it. The suspension of this bone pulls it forward, securing it in place.
Midline glossectomy and lingualplasty
These two surgeries remove part of the back of your tongue, which makes it smaller and can prevent air blockage. This is one of the more rare surgeries.
Maxillomandibular osteotomy and advancement
The surgery is for sleep apnea patients with a small lower jaw. It moves your upper and/or lower jaw forward to enlarge the space for breathing in the entire throat. In this procedure, the bone of your jaws is cut, which then heals over the course of months. You jaws may be wired shut, or banded close for a few days. You also will have a limited, liquid/soft food diet for several weeks after the procedure. You'll need an orthodontia to align the teeth to a new bite.
These may be affective in those with snoring or mild sleep apnea. Small, fiber rods are inserted into the soft palate to stiffen the tissue, and prevent blockage of the airway.
Weight less surgery
Bariatric surgery can promote weight loss and improve sleep apnea in those who are morbidly obese. It is normally recommended because of other health risks related to obesity, like heart strain, lung strain, diabetes, etc. There are various types of weight loss surgery, and discussion of if it's right for you, and which one is right, needs to happen between you and your physician.
This procedure is not normally recommended for sleep apnea. The surgeon makes cuts using a laser to scar and tighten the soft palate. The uvula is trimmed over a period of several visits, and is less painful, with few side effects than UPPP. However, it is not nearly as effective.
Lastly, this surgery is an effective treatment for sleep apnea. However, it's only used in emergency situations as all the other treatments are more preferable. Tracheostomy involves placing a hollow breathing tube directly into the neck and trachea. This tube can be plugged during the day so you can speak and breathe on your own. However, at night, it's open, allowing air passage freely through the hole. It's associated with many risks, and quite unsightly, so other management options are much more preferred.
If you are having trouble with sleep apnea, and either aren't tolerating the CPAP well, or would like other options, then please consult a sleep health professional at our center by clicking the orange button below and taking a free online sleep test.