Surgery for Sleep Apnea Is Less Attractive Than It May Sound

We’d all prefer a one-time fix, but don’t count on it.

Surgery 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 machine.

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You also won’t have banished pressure to change other habits that are contributing to your problem. If your sleep apnea is caused by fatty tissue and weight loss could cure you, listen to the wake-up call. Can you summon up 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? 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. Congestion can be caused by allergies, polyps, a deviated septum, or enlarged adenoids or turbinates. If you have allergies, have you tried allergy shots, allergy meds, diligently irrigating your nose with saline at bedtime, nasal sprays, and simple plastic devices that keep the nostrils open? Then there are pets. No one wants to give up a pet; it’s heartbreaking. But you can start by keeping pets out of the bedroom or boarding your pet elsewhere temporarily to see if your symptoms change. The right surgery 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 the nose.

But the most common surgery for sleep apnea is an “uvulopalatopharyngoplasty” (UPPP), in which your surgeon removes tissue in the throat — possibly including part of the roof of the mouth; the uvula, the soft finger-shaped tissue that hangs down from it; and tonsils and adenoids — to make the airway wider. If you have an enlarged tongue, part of it may be removed.

This is surgery that 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 UPPP include swelling, bleeding, and infection; swallowing problems; a nasal quality in your voice; speech problems; and changes in how food tastes. About 1.5 percent of patients have serious complications, such as heart attacks 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.

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