Sleep Apnea Surgery
If you have obstructive sleep apnea (OSA), parts of your airways close up while you sleep. That makes it hard to get a good night’s rest. Your treatment options include using a continuous positive airway pressure (CPAP) machine, wearing a mouthpiece, or losing weight.
If none of those help, your doctor might suggest surgery to widen your airways and lessen obstructions. The best operation for you will depend in part on what’s causing your sleep apnea.
Types of Operations for Sleep Apnea
Surgery for sleep apnea can focus on a few different body parts, any of which could keep you from breathing well in your sleep:
- Nose
- Tongue
- Palate, the tissue in the back of your mouth and throat
- The bones of your face, neck, and jaw
To figure out what’s blocking your airway and what surgery might be best for you, your doctor will use a thin tube called a nasopharyngoscope. It goes in through your nose and down the back of your throat.
If this sounds uncomfortable, don’t worry: Your doctor will either numb the area or give you medicine to make you sleep.
Nasal Surgery
This type of operation removes or shrinks whatever is blocking your nasal passage. This may include growths called polyps and curved bones along the wall of your nose, known as turbinates. Nasal surgery can make it easier for you to use CPAP therapies.
The options include:
Nasal valve surgery. This helps strengthen weak or damaged nasal valves, the narrow areas right behind your nostrils. Your doctor might do this using cartilage from elsewhere in your body, with an implant, or by using radiofrequency waves to reshape the tissue.
Septoplasty. Your septum is the column of bone and cartilage that separates your nostrils. If you have a deviated septum (one that’s crooked or off-center), septoplasty can make it straight.
Turbinate reduction surgery. This procedure shrinks tissues around the turbinates using cauterization or heat.
You’ll likely have general anesthesia for nasal surgery. You’ll probably go home the same day, though it may take a few weeks to fully recover.
Palate Surgery
Your surgeon reshapes the tissue in the roof of your mouth (palate) and around the sides of your throat. It can be done in several ways, but they all widen your airways:
Uvulopalatopharyngoplasty (UPPP). This is one of the most common surgeries for OSA in adults. Your doctor removes part of your soft palate — the muscular tissue at the back of the roof of your mouth — along with your tonsils and uvula, the dangly tissue above the back of your tongue. You’ll get UPPP at the hospital, and you won’t be awake for the procedure. Healing might take six to eight weeks. Rarely, you could have voice changes or long-term problems with swallowing. But these side effects are less likely to happen with new techniques.
Adenoid or tonsil removal. These are lymph nodes behind your nose or on the sides of your throat. One or both can swell up and block your airways. If you only get your tonsils removed, that’s called a tonsillectomy. Kids with OSA often need an adenotonsillectomy, when doctors remove both their tonsils and adenoids.
Laser or cautery-assisted uvulopalatoplasty (LAUP). You might get this if your symptoms are mild. Your doctor can use a laser or electric current to zap off parts of your soft tissue. They’ll give you a shot to numb your throat for this in-office procedure. You can go home right after, but your throat might be sore for a few days.
Palate implants. If you have mild OSA, your doctor might put a few small rods in your throat. They can do this procedure in their office after they numb your throat. Scar tissue will form around the implants two to three months later. That helps stiffen up your soft palate. A sleep apnea surgery implant is usually made of plastic or polyester.
Palatal advancement. In this operation, the doctor removes part of the hard palate and moves the soft palate forward.
Tongue Surgery
These procedures may make your tongue smaller or stop it from flopping into your airway. Some types are:
Lingual tonsillectomy. Your doctor might remove tissue from the tonsils at the base of your tongue.
Genioglossus advancement. A surgeon can also pull your tongue muscle forward and attach it to your chin bone.
Epiglottis surgery. This procedure reshapes your epiglottis, moves it, or removes a portion of it.
Hyoid suspension. Your doctor attaches the hyoid bone in your neck to your jawbone or thyroid.
Midline glossectomy. In this surgery, your doctor removes part of your tongue to make it smaller.
You’ll get general anesthesia for most tongue surgeries, and you may need to stay in the hospital overnight. You’ll need to follow a soft-food diet for a few weeks afterward.
Nerve Stimulation
Hypoglossal nerve stimulation (HNS) uses electricity to help you breathe easier. It’s not surgery, but your doctor will do a procedure in their office to implant a small device in your chest under your skin. The device is kind of like a pacemaker but is wired to a nerve that controls your tongue muscle. While you sleep, an electric signal can trigger this nerve to push your tongue forward when you breathe
Your doctor is more likely to suggest HNS if:
- You can’t use a CPAP.
- You’re 22 or older.
- You have a BMI of 35 or less.
HNS isn’t recommended if you have a concentric collapse in your airway. That means the soft tissues in the roof of your mouth and your throat close in on all sides when you sleep. Your doctor can order some tests to find out if that happens to you.
Skeletal Surgery
Your doctor can move your upper and lower jaws forward to open up your throat. This is called maxillomandibular advancement (MMA). It’s not a common way to treat OSA, but your doctor might do it if you have structural problems with your face or head.
There’s some evidence that MMA works better than other sleep apnea surgeries, such as UPPP. But it’s riskier and requires a longer recovery. That’s because your doctor has to break your jaws to reset them. If you do get this surgery, expect to stay in the hospital for three to five days. Your jaws might be wired shut for a few days.
Other Surgeries for Sleep Apnea
Some other surgeries that can help with sleep apnea are:
Bariatric surgery. Your doctor might suggest weight loss surgery if you need to drop 100-125 pounds. Your airways can open up when you lose excess weight.
Permanent tracheostomy. Your doctor will make a small opening in your windpipe. You’d breathe out of a tube at night. That means you wouldn’t need to use your upper airways at all. You can cap the hole during the day. That way, you can breathe and talk normally. This may cure your OSA, but it’s usually considered a last resort.
Which Sleep Apnea Surgery Is Right for You?
Your doctor will refer you to a head and neck surgeon to figure that out. They’re called ear, nose, and throat (ENT) doctors, or otolaryngologists. During your exam, the ENT will likely put a small scope with a camera down your nose. They’ll check to see if there’s a problem with your nasal passages, throat, or tongue.
You might have more than one area that’s bulky, narrow, or closed off. If that’s the case, you may need a mix of surgeries. You can get some of them at the same time.
Does Surgery Cure Sleep Apnea?
A small number of people might get totally better after an operation, but there’s no guarantee. It’s more likely that your doctor will use surgery to lessen your symptoms and help other OSA treatments work better. Expect to keep using your CPAP after your procedure. But it might be more comfortable after surgery. That can make it easier to stick to your treatment.
Takeaways
If continuous positive airway pressure (CPAP) therapy, wearing a mouthpiece, or losing weight don’t work for your sleep apnea, you might be a candidate for surgery. Several types of operations can help widen your airways and clear obstructions, including nasal surgery, palate surgery, tongue surgery, and jaw surgery. The type you need will depend on what’s causing your sleep apnea. For some types of sleep apnea, a nonsurgical procedure called hypoglossal nerve stimulation (HNS) may be an option.
FAQs About Sleep Apnea
What is the best natural remedy for sleep apnea?
There’s no substitute for medical treatment. But these lifestyle changes may improve sleep apnea symptoms:
Is there a vitamin for sleep apnea?
A balanced diet can help promote good sleep. But unless you have a deficiency, there’s little scientific evidence that taking vitamins can help with sleep apnea. Some research has indicated that vitamins A, B, C, D, and E may play a role, so make sure your diet includes the recommended amounts. It’s best to check with your doctor before taking a new vitamin or supplement.
Can Ayurveda treat sleep apnea?
Ayurveda is a type of traditional Indian medicine that seeks to balance the mind, body, and spirit. There’s been little research into whether Ayurvedic medicine has benefits for sleep apnea or any other health condition. But some Ayurvedic practitioners treat snoring and sleep issues with massage, enemas, and herbal medications. Talk to your doctor before trying alternative treatments for sleep apnea.
What is the strongest herb for sleep?
While strength depends on dosage, valerian is one of the best-known herbs used to promote sleep. Studies on its effectiveness have had mixed results, though. The American Academy of Sleep Medicine says people shouldn’t use it for long-term insomnia. It’s thought to be safe for occasional use. But it can interact with some medications, so check with your doctor first. Avoid taking it with alcohol or sleep medications.
Does drinking a lot of water help with sleep apnea?
Avoiding dehydration may help with snoring. Proper hydration keeps the tissues in your nose and throat working as they should. And apnea may cause you to breathe through your mouth, which also dries out your breathing passages.
But avoid drinking too much water before bed. Waking up to pee interferes with sleep. Using a humidifier can also help you avoid dryness in your nose and throat.
