The vast majority of patients with sleep apnea have the obstructive variety called
Obstructive Sleep Apnea (OSA). There are a variety of treatments
available for OSA.
A few patients may try oral or dental appliances. These devices have the same success
rate as surgical intervention. They work best in patients with only mild to moderate OSA.
A nasal air pressure mask called CPAP (continuous positive airway pressure) is
the standard treatment for Obstructive Sleep Apnea, with a success rate of 95-98%.
Approximately 2-5% of patients who try this therapy experience claustrophobia or do not
wish to use CPAP long term. For these individuals, as well as patients who snore but do
not have OSA, an oral appliance or surgery may be options. In selected cases, it may be
suggested that a patient who is considering treatment with a CPAP mask be evaluated by an
ENT (ear, nose, and throat) physician to assure that his or her nose anatomy is adequate.
Surgical correction of nasal obstruction may enhance the use of CPAP or improve OSA.
There are several types of surgery for snoring and sleep apnea, with varying success
The most common types include Tonsillectomy and Adenoidectomy (which are the
removal of the tonsils and adenoids).
An excess of soft tissue or enlarged tonsil at the back of the throat may contribute
significantly to obstruction of the airway.
Uvulopalatopharyngoplasty (or UPPP for short). The tonsils and adenoids are
removed, in addition to carving out some of the hard and soft palate (the back and top of
the mouth), removing the uvula (the "little tongue" that hangs down the back of
the throat), and removing any other tissues or organs which may be enlarged, blocking the
airway. This procedure can also be performed with laser assistance (as opposed the
traditional scalpel method). This is called a LAUP. While the UPPP is done in one visit,
the LAUP is performed over several visits, usually 3-6 times.
Nasal Septoplasty is used to correct blockages in the nasal passages caused by
deformed cartilage from old injuries, polyps, or inflamed tissues. Some patients may have
a deviated septum (the cartilage that separates the two nostrils blocks airflow to one
side of the nose) which needs correction.
The most intrusive type of surgery is called Mandibular Osteotomy with Geniohyoid
and Bimaxillary Advancement. In this case, the lower jaw is broken and advanced,
enlarging the airway. Muscles in the chin may be permanently pulled forward to further
enlarge the airway. If necessary, surgery may be performed to reduce the size of the base
of the tongue.
The most recent advance in surgical techniques is called Somnoplasty. This
method uses microwaves (bursts of radio frequencies) to reduce obstruction at the base of
the tongue. Somnoplasty may need to be repeated to guarantee results.
Tracheostomy. This is surgical procedure creates a permanent hole in the neck to
bypass the obstruction in the upper airway. This is generally performed as a last resort
for patients with severe OSA, not responsive to other treatments.