5 Stuff you MUST Find out about Sleep Apnea Surgery

December 22nd, 2010

Sleep apnea surgery is likely one of the most controversial subjects in sleep medicine. There are heated debates throughout the sleep community in addition as in online forums and support groups. Sleep apnea surgery is well not for everyone, for some, it’s a life-changing experience.

Here are 5 important issues it’s good to comprehend before considering any kind of sleep apnea surgery:

1. Does sleep apnea surgery work?

Yes, but only when done properly. Much like with CPAP or dental devices, while you don’t use it properly or use it at all, it won’t work.

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

We now know that in case you address the total upper airway together (nose, soft palate, tongue), then your success rates are a lot better, approaching 80%. Why only 80%? There’s only so much which you could do with the soft tissues inside the small space within smaller jaws (that is the key anatomic explanation for sleep apnea). The more aggressive you might be, the higher the success rate, but the more chance of pain and complications.

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

To put things into perspective, in the event you bypassed everything with a tracheotomy (placing a breathing tube below your voice box), then you definately’ll have a 100% ” cure” , but obviously, this is often not a extremely practical option.

One question you’ll want to ask then, is, what’s the meaning of success? In surgery, one common definition is that the general AHI (apnea hypopnea index) on a formal sleep study drops greater than 50% of the original and the overall number needs to be not up to 20. One of many main criticisms of sleep apnea surgery is that despite the fact that ” successful” , one can 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 difficulty is that by definition, they’ll all work to a definite degree. As an example, procedures for a stuffy nose were shown to ” cure” sleep apnea in 10% of patients. But one of the most part, none of these options by themselves have first-class success rates.

The secret is to check the upper airway for each individual and determine where the obstruction is and shelter it simultaneously. Plenty of people have multiple area of obstruction. Surgeons at Stanford have about a 75 to 80% success rate with soft palate and tongue base procedures. This is often called multi-level surgery for sleep apnea. You need to inspect the airway from the end of the nose all of the option to the voice box.

3. There’s No Cure for Sleep Apnea

Unless we all undergo tracheotomies, there’s no strategy to prevent breathing pauses at night. Modern humans’ upper airway anatomy is known to be predisposed to breathing problems at night, which only gets worse as we age. I discuss why this problem has gotten much worse lately in my book, Sleep, Interrupted. All people 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, however won’t bring it down completely. This is the reason it’s important to incorporate a healthy diet and lifestyle and exercise regimen into any sleep apnea treatment regimen.

For nearly all people, lowering the numbers significantly will make you’re feeling significantly better. But sometimes, the numbers will go down dramatically, but you are able to not feel any better. This just goes to indicate that there could be other issues besides sleep apnea that must be addressed. You’ve had sleep apnea for years or decades. Just by fixing your sleep apnea won’t immediately fix problems that may arise from sleep apnea, comparable to 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 a lot folks that rush to surgery prematurely, but there are also many others that aren’t even offered surgery as a result of misconceptions by physicians. There are also many patients which are turned off by the whole conflicting information that’s available on the net.

Before you even consider surgery, make sure to’ve tried or considered all of the other options thoroughly. Plenty of people who fail CPAP accomplish that attributable to poor counseling, support and followup by the medical system. Much like everything else with life, your probabilities of success is dependent upon which doctors you notice. The follow-up and support offered by  your CPAP equipment vendor also can play a vital role in whether or not you’ll take advantage of CPAP. A similar issues also apply with dental devices for sleep apnea.

This is why it’s important to coach yourself about the complete healing procedures, and not to present up too easily. Too many folk stop at this point, and don’t consider any longer treatments. Surround yourself with a set of trusted doctors and professionals that forms a team. Use their expertise and guidance to search out how 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. The right way to Find the best Surgeon

Finding the correct surgeon in your sleep apnea condition could be challenging. Everyone claims to concentrate on snoring and sleep apnea surgery. Who are you to believe?

First of all, find someone who’s comfortable performing quite a lot of procedures in all of the three areas of the upper airway (nose, soft palate and tongue). Are they accustomed to the minimally invasive procedures in addition as the common-or-garden options? No everyone might be a professional at the complete procedures, but it’s important to grasp about the entire other options in addition in addition as to make appropriate referrals when necessary.

There are a number of ” minimally invasive” procedures obtainable, especially for the soft palate, but these procedures must be offered very selectively. Even supposing successful initially, is your surgeon prepared for relapsed which might be 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 ” simply to see,” without addressing the total upper airway from the nose to the tongue, go for a second opinion. When you do decide to undergo a palatal procedure (with or without tonsillectomy), be prepared for a 60% failure rate, this means that the tongue needed to be addressed in addition. Sometimes, more should be done to the soft palate or the nose needs to be addressed. People are different, and the treatment recommendations need to be tailored to the individual.