5 Things You MUST Know About Sleep Apnea Surgery

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Sleep apnea surgery is one of the most controversial subjects in sleep medicine. There are heated debates within the sleep community as well as in online forums and support groups. Sleep apnea surgery is definitely not for everyone, for some, it can be a life-changing experience. Here are 5 important issues that you must be aware of before considering any form of sleep apnea surgery:

1. Does sleep apnea surgery work?

Yes, but only when done properly. Just like with CPAP or dental devices, if you don't use it properly or use it at all, it won't work.

One of the most common misconceptions about sleep apnea surgery is the relatively low success rate of the uvulopalatopharyngoplasty (UPPP) procedure, which is often quoted at 40%. But performing this operation is like bypassing only one blocked heart vessel when you have 3 other vessels that are blocked. For some strange reason, ENTs are overly obsessed with the soft palate, since this is where snoring usually comes from and we have the most research and procedures for the soft palate.

We now know that if you address the entire upper airway together (nose, soft palate, tongue), then your success rates are much better, approaching 80%. Why only 80%? There's only so much you can do with the soft tissues within the small space within smaller jaws (which is the main anatomic reason for sleep apnea). The more aggressive you are, the higher the success rate, but the more chance of pain and complications.

If you go to the next level and enlarge your jaws (upper and lower), then success rates can reach 90 to 95%.

To put things into perspective, if you bypassed everything with a tracheotomy (placing a breathing tube below your voice box), then you'll have a 100% "cure", but obviously, this is not a very practical option.

One question you must ask then, is, what's the meaning of success? In surgery, one common definition is that the final AHI (apnea hypopnea index) on a formal sleep study drops greater than 50% of the original and the final number has to be less than 20. One of the main criticisms of sleep apnea surgery is that even if "successful", you may still have mild sleep apnea. Surgeons will argue that it's better than not using CPAP at all.

2. Not All Surgeries Are The Same

There are probably dozens of procedures for sleep apnea from various nasal, soft palate and tongue operations to skeletal framework procedures. These can range from minimally invasive to major surgery. The problem is that by definition, they'll all work to a certain degree. For example, procedures for a stuffy nose have been shown to "cure" sleep apnea in 10% of patients. But for the most part, none of these options by themselves have very good success rates.

The key is to examine the upper airway for each individual and figure out where the obstruction is and take care of it simultaneously. Most people have more than one area of obstruction. Surgeons at Stanford have about a 75 to 80% success rate with soft palate and tongue base procedures. This is called multi-level surgery for sleep apnea. You have to look at the airway from the tip of the nose all the way to the voice box.

3. There's No Cure for Sleep Apnea

Unless we all undergo tracheotomies, there's no way to prevent breathing pauses at night. Modern humans' upper airway anatomy is thought to be predisposed to breathing problems at night, which only gets worse as we age. I talk about why this problem has gotten much worse in recent years in my book, Sleep, Interrupted. All of us are on a continuum, where various factors (anatomy, age, weight, inflammation, etc.) contribute to forces that make our tongues and palates to collapse. The older we get, we'll either gain weight, which narrows our breathing passageways, or our throat tissues will sag and collapse easier.

Surgery will shift the line of this continuum downwards, but it won't bring it down completely. This is why it's important to incorporate a healthy diet and lifestyle and exercise regimen into any sleep apnea treatment regimen.

For most people, lowering the numbers significantly will make you feel much better. But sometimes, the numbers will go down dramatically, but you may not feel any better. This just goes to show that there may be other issues besides sleep apnea that have to be addressed. You've had sleep apnea for years or decades. Just by fixing your sleep apnea won't immediately fix problems that can arise from sleep apnea, such as hormonal problems, weight gain, or memory problems and brain fog.

4. Surgery is the Last Resort, But Don't Rule It Out

Admittedly, there are many people who rush to surgery prematurely, but there are also many others that aren't even offered surgery due to misconceptions by physicians. There are also many patients that are turned off by all the conflicting information that's available on the internet.

Before you even think about surgery, make sure you've tried or considered all the other options thoroughly. Most people who fail CPAP do so because of poor counseling, support and follow-up by the medical system. Just like everything else with life, your chances of success depends on which doctors you see. The follow-up and support offered by your CPAP equipment vendor can also play an important role in whether or not you'll benefit from CPAP. The same issues also apply with dental devices for sleep apnea.

This is why it's important to educate yourself about all the treatment options, and not to give up too easily. Too many people give up at this point, and don't consider any further treatments. Surround yourself with a group of trusted doctors and professionals that forms a team. Use their expertise and guidance to find a way to make things work. If nothing works for you, don't rule out surgery just for the sake of avoiding surgery. Learn and educate yourself about surgery before rejecting it.

5. How to Find the Right Surgeon

Finding the right surgeon for your sleep apnea condition can be challenging. Everyone claims to specialize in snoring and sleep apnea surgery. Who are you to believe?

First of all, find someone who's comfortable performing a wide range of procedures in all the three areas of the upper airway (nose, soft palate and tongue). Are they familiar with the minimally invasive procedures as well as the standard options? No everyone will be an expert at all the procedures, but it's important to know about all the other options as well as well as to make appropriate referrals when necessary.

There are a variety of "minimally invasive" procedures out there, especially for the soft palate, but these procedures have to be offered very selectively. Even if successful initially, is your surgeon prepared for relapsed that are likely years later? Is the goal of surgery only to cover up the snoring, or will it treat the underlying anatomic causes?

If your surgeon recommends palatal surgery "just to see," without addressing the entire upper airway from the nose to the tongue, go for a second opinion. If you do decide to undergo a palatal procedure (with or without tonsillectomy), be prepared for a 60% failure rate, which means that the tongue needed to be addressed as well. Sometimes, more needs to be done to the soft palate or the nose has to be addressed. Everyone is different, and the treatment recommendations have to be tailored to the individual.


For a more detailed free report on The Truth About Sleep Apnea Surgery, click here.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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4 thoughts on “5 Things You MUST Know About Sleep Apnea Surgery

  1. Dr. Park,
    I am an ENT in KC and have a focused interest in Sleep Medicine/ Surgery. I noticed that you are a member of AASM.  Are you board certified in sleep medicine ? As you are most likely aware the AASM has offered an alternative pathway for 5 years to ENT's to become certified without having to do a formal fellowship.  This expires in 2011. To date according to the AAOHNS 150 of us have taken the exam and have become certified and they feel at least twice that will be taking the exam in 2011 ( I among them).  I feel that perhaps this qualification  may be another criteria that you can suggest an your popular website/blog to people who are seeking ENT specialists who would likely have a wide breadth of experience in treating sleep disorder breathing problems.  Keep up the good work !! 

  2. It’s been nearly 2 years since I had my sleep apnea surgery. I had tonsils/adenoids removed, soft palate trimmed back, uvula removed and a bilateral septoplasty. I was 47 years old old and diagnosed with severe sleep apnea. All I can say is I wish I would have had this surgery YEARS ago..I’d been a very heavy snorer since early childhood and at the time of my surgery was sleeping in separate rooms from my wife. My wife says I still snore, but it is barely audible, I never wake her up any more. The recovery was extremely painful, as my surgeon clearly warned me it would be, but I stayed ahead of the pain with proper pain dosage to keep it manageable… I would recommend this surgery to anyone, but advise them to be very choosy when selecting a surgeon…. IMO the surgeon makes ALL the difference in a successful operation of this kind.

  3. I had sleep apnea appx 3 years ago. Healed wonderfully with a sore thoat lingering
    for about 1 year. Sensitive to tomato sause etc. Now my soft palate has been
    very sore for about 1 week. Nothing seems to help with the pain. Swallowing
    is quite painful. Is there something I can do?

    thanks so much for your time!!
    Michael

  4. I would encourage people to NEVER have the surgery done. Not only does it not work it damages your entire system. I get ailments such as colds and other respiratory ailments much more easily than I did prior to the surgery. Also, it causes something incredibly life threatening to you: the uvula is also removed in this process. As you may or may not know is that the uvula is your gag reflex. As a result if you eat anything shortly before bedtime there is a high probability that you will vomit during your sleep as a result of losing your uvula. Many a night I’ve slipped up because of late night hunger and woke to the sudden life threatening crisis of choking on my own vomit. If anyone has ever experienced this you’ll know of the sheer terror of this feeling. It is only a small amount of vomit involved but it goes in to your lungs and throat and it’s like trying to breathe through mud. You’ll awakened by your system (hopefully) to find yourself fighting for your life trying to clear your lungs and throat of the vomit and to catch your next breath. Do not have this surgery. Although the other methods may be hokey at best, they’re preferred to letting one of these high priced witch doctors hack you up and cash in on your suffering. Say “No” to sleep apnea surgery!