If you have sleep apnea or know someone who does, chances are you’ve heard of the CPAP machine, which works to keep breathing airways open at night.
What you may not have heard is that a large number of people hate using their CPAP, or outright refuse to.
While continuous positive airway pressure (CPAP) therapy is usually the first treatment prescribed for moderate to severe sleep apnea, its high success rate only applies to those who actually use it.
Studies show that CPAP is commonly used only around 50% of the required time. Patients complain about issues wearing the mask at night and discomfort caused by the high air pressure blown into their noses.
For noncompliant patients, surgery may be the only alternative. There several possible approaches, depending on the causes and severity of your sleep apnea. Below are some of the more well-known surgical methods.
1. UPPP (Uvulopalatopharyngoplasty)
UPPP has been performed for the last 25 years. It was developed to help remove excess tissue from the pharynx, soft palate and tonsils.
After removing the membrane, the surgeon performs sutures to keep the area wide open and prevent collapsing. After surgery, patients are required to stay overnight at the hospital. Recovery can be painful, and generally takes up to a week.
Performing UPPP surgery alone may not cure severe sleep apnea; the surgeon may opt to combine this approach with operations targeting other upper airway sites.
The hyoid bone is a U-shaped bone situated in the neck to which the tongue and the epiglottis are attached. Through a minimally invasive procedure, the hyoid bone is anteriorly repositioned by putting a suture around it, while suspending it to the front jawbone.
Surgery takes less an hour, and only requires two tiny incisions in the neck. Pain is minimal and patients generally return home immediately after.
3. Maxillomandibular Advancement (MMA)
This surgical procedure is an option for the treatment of severe, obstructive sleep apnea. It involves moving the lower and upper jaw forward to enlarge the entire throat’s breathing space.
The jawbone is cut as a part of this surgery, making it a relatively painful and complex intervention. Recovery can take up to a month. The surgeon may wire the jaws shut for few days; as such, diet may be limited after surgery.
Palatoplasty is a well-known procedure used in the reconstruction or correction of the palate.
The aim is usually to shut an abnormal opening in between the mouth and nose. This helps in developing normal speech and also aids in breathing, swallowing, and the healthy development of mouth structures.
Usually, palatoplasty is performed on infants between the ages of six and twelve months. If the procedure is carried out on patients who are over three years old, it may alter speech development.
Somnoplasty is a surgical procedure used in the treatment of snoring and mild sleep apnea.
The surgeon modifies the soft palate and uvula tissues by use of heat energy. It’s a minimally invasive procedure that is performed using local anesthesia in a clinic — most patients say the process is surprisingly comfortable.
After the procedure, you may experience swelling at the back of your throat as well as a mild sore throat for a few days. You can minimize the swelling by slightly elevating your head above your heart and also take medication to sooth the throat.
Do not drink or eat anything until the anesthesia has completely worn off. Improvement are noticed after a week or two and continue for several months thereafter.
6. Transoral Robotic Surgery (TORS)
TORS is a surgical procedure which involves the use of sophisticated, computer-enhanced systems to guide the surgical tools swiftly. Using robotic methods to control the surgical instruments allows for more precise movement.
Patients who undergo this procedure tend to recover quickly and experience few mouth and throat complications, unlike other surgeries.
The Bottom Line
Numerous surgical options exist to treat sleep apnea in patients who can’t tolerate CPAP therapy. Since the seriousness of obstruction as well as airway patterns vary from one patient to another, the medical approach must be tailored to the specific individual.
Various rhinoplasty procedures may be also advised to address issues caused specifically by nasal obstruction or septal deviation. In most cases, a surgeon performs a combination of procedures to achieve the desired outcome.
A patient should be guided on the procedural steps when he/she seeks surgery. It’s therefore essential that a surgeon is well versed in the pathophysiology of sleep apnea as well as the upper respiratory anatomy to ensure success after the procedure. Follow-up after surgery is also strongly advised.