7 Good Reasons to Consider Surgery for Sleep Apnea

In my last post, I listed 7 Reasons Not to Undergo Sleep Apnea Surgery. For this post, I will give you 7 good reasons why you should consider sleep apnea surgery. There is a heated debate about sleep apnea surgery within the sleep medicine community. Some sleep physicians are adamant that you should never do surgery, whereas some surgeons downplay CPAP or dental appliances entirely. My belief is that you should do everything possible before considering surgery. However, there’s no “one size fits all” surgery for everyone (except for a tracheotomy), and any kind of surgery must be custom-tailored for every individual, since everyone is different.
1. I hate CPAP
This is the most common reason for wanting to consider surgery. In general, what I find is that most patients give up too soon with CPAP, without proper troubleshooting with the sleep doctors and equipment company. For the vast majority of issues that come up with CPAP, there are simple solutions. On the other hand, some of you have tried religiously for 9 months, going through 4 different masks and 3 different machines. Some find that CPAP makes things much worse, no matter what you try. At a certain point, you have to say enough is enough and consider trying another option. Einstein once said that the definition of insanity is doing something over and over again and expecting different results. Check out the CPAP pro and con posts. I will talk about CPAP in much more detail in later posts. 
2. Oral appliance is not helping
In general you want to try every mainstream non-surgical option before considering surgery. Practically speaking, insurance companies also want documentation about what’s been tried in the past. Sometimes, pushing the jaw forward won’t move the tongue forward very much. This can be seen with endoscopy in the office. Some people won’t have enough teeth, or may have TMJ issues. 
3. You have a stuffy nose
For both CPAP And oral appliances, you need to make sure that you’re able to breathe well through your nose. One recent study found that “non-compliant” CPAP users went from 30 minutes to over 5 hours after nasal surgery alone. Similar results have been found for oral appliances as well. This is why I have a very low threshold to offer nasal surgery. Once thing to note is that in general, nasal surgery doesn’t cure sleep apnea. 
4. You have large tonsils or adenoids
In children, removing tonsils and adenoids is the first-line recommended way of treating obstructive sleep apnea. But even with adults, removing huge tonsils or adenoids can make a big difference. One staging criteria called the Friedman classification found the if you have huge tonsils and a low positioned tongue, and your BMI is less than 40, then you chances of surgical success from UPPP alone is 80%.
5. Previous surgery didn’t work
Just because your previous surgery didn’t work, doesn’t mean that you’re not a candidate anymore. In most cases surgical failure happens because you didn’t address other areas of obstruction. The other possibility is that the areas that you addressed surgically wasn’t aggressive enough to make a difference. 
6. If you can’t breathe out through your nose
Notice that I said breathe out through your nose. I’ve described a phenomenon where the soft palate and uvula flops back into the nose, causing you to keep waking up due to your nose becoming clogged with each exhale.
7. You’ve tried everything
Some of you have tried literally everything. CPAP, APAP, oral appliances, nasal strips, tongue exercises, acupuncture, nasal surgery, and even playing a didgeridoo. Still no relief. 
If you think that you fit the bill for sleep apnea surgery, please read my past post on why you shouldn’t consider surgery for sleep apnea. If you don’t meet any of the criteria from this post, talk to your surgeon about what he or she recommends. Please share your experiences with sleep apnea surgery on Facebook, Twitter, or Linkedin below.

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