Sleep apnea is a potentially dangerous sleep disorder that causes people to stop breathing during their sleep.
“Apnea” is a medical term that refers to the cessation of breathing. Holding your breath causes an apnea but it’s under your control.
The apneas some people have during sleep are involuntary and, although respiration generally only pauses for a short time, people who have sleep apnea often have up 100 apneas per hour.
Surgery is just one of several options available to people suffering from sleep apnea. However, unless your doctor tells you otherwise, it’s probably best seen as a last resort.
What Will I Learn?
Sleep Apnea: Things to Know Before Contemplating Surgery
If you presently have a problem with snoring, believe it may be due to sleep apnea, and think surgery may be the right way to go, there are several things you need to know.
Before you can tame the beast, you need to understand the nature of the beast.
1. There are 3 Types of Sleep Apnea
Many people do not realize it, but there are three types of sleep apnea.
- Central Sleep Apnea (CSA): Happens when the brain fails to send the respiratory muscles the signal that tells them to breathe.
- Obstructive Sleep Apnea (OSA): The brain sends the signal but an obstruction in the airway prevents an adequate flow of air.
- Mixed Sleep Apnea: A combination of CSA and OSA.
OSA is the most common type of sleep apnea. It’s also the type that’s most likely to make you snore. Mixed sleep apnea can make you snore as well but the noise is due to the airway obstruction not the absence of a signal from the brain.
In this article, “sleep apnea” refers to OSA because all the forms of sleep apnea surgery share a common aim—helping to keep the airways clear.
2. Snoring and Sleep Apnea Do Not Always Go Hand-in-Hand
Snoring is an audible response to obstruction in the airway. Obviously, when the obstruction completely blocks the airway, there will be no airflow at all. However, when the obstruction is partial, as well as restricting breathing it causes turbulence at the back of the throat.
The turbulence causes soft tissues at the back of the throat to vibrate and emit that horrible rasping/grunting sound we call snoring.
As already explained. If you have CSA, you probably will not snore. If you do, it will be due to an obstruction (OSA), meaning you have mixed sleep apnea.
However many people who snore do not have sleep apnea. Although the airway obstruction is sufficient to cause snoring, it never becomes bad enough to cause breathing to stop. There is no apnea.
This is an important point, so let’s underline it and say it again—snoring is not always due to sleep apnea.
3. There are Several Types of Sleep Apnea Surgery
There are several surgical options that have the potential to prevent sleep apnea and snoring. If you are a good candidate for a surgical procedure, your doctor will discuss the various options and let you know which one(s) are likely to work best for you.
- The Pillar Procedure: Involves implanting small plastic rods into the upper palate. The rods stiffen up the flesh, helping it become more resilient to turbulence. The pillar procedure is only suitable for normal snoring and mild cases of sleep apnea.
- Uvulopalatopharyngoplasty (UPPP): A surgical procedure that opens up the airway by removing the uvula and other tissue from the back of the throat. The procedure is generally done by a surgical laser. It’s also possible to use radio frequency (RF). Cosmetic surgeons often use RF to tighten sagging skin.
- Maxillomandibular Advancement (MMA): A surgical procedure that opens up the airway by moving the upper and lower jaws forward.
- Genioglossus Advancement: A procedure that pulls the tongue forward by pulling on the flesh below it. Surgeons achieve this by cutting through the bone at the front of the jaw and moving a small section of bone forward.
- Hyoid Suspension: A sleep apnea surgery that requires surgeons to cut into the upper throat and move the hyoid bone forward.
- Midline Glossectomy and Lingualplasty: A procedure that reduces the size of the tongue. The surgeon achieves this by removing a section of flesh and then stitching the tongue together again. You could see it as a kind of nip-and-tuck for the tongue.
- Hypoglossal Nerve Stimulation: Surgeons implant a stimulatory device that keeps the airway open by sending electrical impulses to a nerve that moves the tongue.
- Septoplasty and Turbinate Reduction: Two surgical procedures that are performed together and make it easier to breathe through the nose.
Alternatives to Sleep Apnea Surgery
As you can see, there are several types of surgery that may help reduce snoring caused by sleep apnea. However, unless your doctor has already made a sleep apnea diagnosis, surgery is unlikely to be the option for you.
If you snore but do not have sleep apnea, there are several non-surgical alternatives that may be able to help. MADs and TSDs are two of the most popular anti-snoring devices but some people find chins straps, nasal dilators, or anti-snoring pillows work well too.
Sometimes the best way to stop snoring can be as simple as making a few lifestyle changes. For instance, some people, who snore due to obesity, find their snoring stops after they successfully lose weight.
It can also be beneficial to avoid things that can cause snoring and/or make it worse. Alcohol and smoking are two good examples. If either one is causing you to snore, removing it from your life or reducing usage frequency may help you get your snoring under control.
However, if have been diagnosed with sleep apnea, your doctor is more likely to recommend a CPAP machine instead of suggesting surgery.
If the condition is only mild, your doctor may suggest a MAD instead.
CPAP is an acronym. It stands for continuous positive airway pressure. It prevents sleep apnea and controls snoring by pressurizing your airway. The extra pressure within the airway helps keep it open and makes the windpipe less likely to collapse.
Modern CPAP machines are small and portable. This makes them easy to take on vacation or use while sleeping away from home on a business trip.
The machine contains a small electric air pump that draws in air from the room and sends it to a face mask via a small length of plastic tube.
The face mask is similar to the oxygen masks you see in hospitals.
When the machine is running, it provides a constant flow of air. It may take a little getting used to the sensation but the pressure is not particularly high. You will still be able to exhale.
However, when you exhale, your out-breath will have to provide greater pressure than the machine. So, regardless of whether you are breathing in or out, the pressure in the airway will be constant.
Like CPAP, MAD is an acronym. It stands for mandibular advancement device. The device works in a similar way to maxillomandibular advancement surgery.
However, unlike the surgical option, a MAD only advances the lower jaw and it’s a temporary advancement. The Jaw returns to its normal position when you remove the device. You only wear a MAD during sleep.
Sometimes called anti-snoring gum shields, MADs have upper and lower trays that mold to the teeth. During the initial set up, the lower tray is set to a position that forces the jaw forward. Generally around 3 millimeters.
When you advance the lower jaw in this way, it pulls the tongue forward. This opens the airway by creating extra space at the back of the throat.
The Bottom Line
Sleep apnea surgery can help you to stop snoring. The various surgical procedures work for some patients, but many people find surgery provides little or no benefits at all.
If you snore but do not do so due to sleep apnea, your doctor is unlikely to suggest surgery. Depending on your circumstances, your doctor may suggest simple lifestyle changes such as going on a low-energy diet and losing weight.
Your doctor may also suggest wearing a MAD during sleep or using an alternative anti-snoring device. Even if your doctor believes sleep apnea is making you snore, they will probably suggest CPAP over surgery.
That’s not to say surgery is not a viable option it’s just, for sleep apnea and snoring, it’s seldom the first port of call. As a means of controlling sleep apnea, CPAP works well for a lot of people. It can provide good results without presenting health risks or side effects.
Surgery, on the other hand, only offers a limited success rate. Depending on the form of surgery, it may take some time to recover and there is always a risk of infection and/or side effects.
If your snoring is not due to sleep apnea, you may be surprised at how well some non-surgical snoring solutions work. However, if you do have sleep apnea and your doctor does not recommend surgery, there will be a reason for this. There’s a lot of truth to that old saying, “Doctor knows best.”
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