What surgical treatments can cure sleep apnea?
Surgery to increase the size of the airway can be a successful treatment for sleep apnea. Younger patients may benefit from the removal of tonsils or adenoids. Other surgeries focus on reducing the excess tissue at the back of the throat (the soft palate and uvula) or reconstructing the jaw.
The key to successful surgery for sleep apnea is to correctly identify ahead of time the tissue that is blocking the airway. The surgical techniques are very specific to the cause of obstruction. Performing the wrong surgery can make no difference or even worsen the sleep apnea. In addition, people respond differently to the same surgery. If unsuccessful, a surgical technique can impede the success of alternative future treatments.
The most common surgical techniques for remedying sleep apnea are:
Uvulopalatopharyngoplasty (UPPP), (only 30% effective) for severe Obstructive Sleep Apnea, removes soft tissues in the back of the throat and soft palate (uvula), and expands air passages. Sometimes the surgeon also removes the tonsils and other loose tissues. Uvulopalatopharyngoplasty does not remove obstructions at the base of the tongue. What they don't usually tell you is UPPP requires three to five separate treatments, each with general anesthesia and an overnight hospital stay. LAUP (below) is a similar, more modern procedure that removes tissues with a laser beam.
Thermal Ablation Palatoplasty (TAP) treats snoring and various types of Obstructive Sleep Apnea. The types of TAP include:
-Laser-Assisted Uvula Palatoplasty (LAUP) vaporizes the uvula and a portion of the palate with a laser in the doctor's office under local anesthesia. LAUP removes obstructions to the airway, which may be causing snoring or sleep apnea. Laser-Assisted Uvula Palatoplasty has a higher success rate than UPPP, but it requires a surgeon with expertise in laser procedures.
-Radiofrequency ablation (has an average of 17 percent and as much as a 35 percent reduction in tongue tissue volume), or somnoplasty, shrinks excess tissue in the upper airway with a needle electrode. For snoring, the soft palate and uvula are reduced. For Obstructive Sleep Apnea, the base of the tongue is reduced. For chronic nasal obstruction, nasal turbinates are reduced. Somnoplasty does not require general anesthesia.
-Tonsillectomy and adenoidectomy are recommended for anyone with serious snoring problems.
These procedures should have tonsils and adenoids removed:
-Genioglossusandhyod advancement prevents collapse of the lower throat tissues and pulls the tongue muscles forward to open the obstructed airway.
-Enlarge the airway by moving the jaw forward are maxillomandibular osteotomy or advancement (MMO or MMA) and the two-part inferior sagittal mandibular osteotomy and genioglossal advancement with hyoid myotomy and suspension (GAHM). BUT I am told you will be in EXTREME pain and wish you were dead. The proceedure is long and multiple involved surgeries (lasting several hours) with a significant recovery period and potential complications.
- Other surgical procedures include laser midline glossectomy and lingualplasty where part of the tongue is removed.
-Cautery assisted palatal stiffening operation (CAPSO)
-Palatal restoration with implants (The Pillar® Palatal Implant System)
The tongue suspension procedure (with the trade name Repose), it is intended to keep the tongue from falling back over the airway during sleep with a small screw inserted into the lower jaw bone and stitches below the tongue. Usually performed in conjunction with other procedures, this surgery is potentially reversible. No studies on the long-term success are available, and little clinical data to demonstrate the efficacy of the procedure have yet been published in a peer-reviewed journal.
"While each surgery is said to “cure” sleep apnea, that is only partly true. They may not access all of the pertinent tissue, and each procedure’s effectiveness varies. While studies report improvements with regard to snoring, impact on obstructive sleep apnea remains unclear. A standard saying of physicians in the field is that for the scalpel-based procedure, “50 percent of patients will get about 50 percent better.” For the laser and radiofrequency procedures, percentages are worse." – Eric J. Olson, M.D., Sleep Disorders Center, Mayo Clinic, Rochester, Minn.
What are the types of dental appliances, oral devices, or jaw adjustment devices for sleep apnea, and how do they work?
A wide range of dental appliances, oral devices, and lower jaw adjusters can reduce sleep apnea episodes. Oral devices work by bringing the lower jaw forward during sleep. Most of the products fit inside the mouth, but some products are worn around the head and chin to adjust the position of the lower jaw.
Most of the products that fit inside the mouth are acrylic and look similar to an athletic mouth guard or an orthodontic appliance. Two examples of dental appliances are:
Mandibular Repositioning Device (MRD): The Mandibular Repositioning Device works by bringing the lower jaw forward during sleep. If the lower jaw and tongue remain forward during sleep, the air passage of the throat opens up. This is the most commonly used device.
Tongue Retaining Device (TRD), or a splint, keeps the tongue in place while you sleep, so that it does not fall back and block the airway.
What are the advantages and benefits of dental appliances or oral devices for sleep apnea?
Oral appliances help certain patients who have Obstructive Sleep Apnea (OSA) or snoring. Specific benefits of dental appliances include:
-Reduction in the frequency and loudness of snoring
-Improved quality of sleep
-Reduced daytime sleepiness
-Improvement of airflow
-Reduction in sleep apnea episodes
-Smaller size and portability. Dental devices are generally smaller than Continuous Positive Airway Pressure. The small size of oral devices makes them more convenient than CPAP for traveling.
Easier to use. Oral devices are usually straightforward and easy to use. They generally fit inside the mouth and are left in for the entire night. Dental devices are an alternative to Continuous Positive Airway Pressure (CPAP), which can be cumbersome and difficult to maintain. Lack of proper use of CPAP prevents effective treatment of the problem.
Might be as effective as some surgeries, such as uvulopalatopharyngoplasty (UPPP), which tightens flabby tissues in the throat and palate and opens the airway.
What are the problems with dental appliances or oral devices for sleep apnea?
Common problems associated with the use of dental devices include:
Discomfort and soreness from the device
Saliva buildup during the night
Damage to teeth, mouth tissues, and jaw joints
Toothache and jaw joint pain
Permanent change in the position of the jaw or teeth
Lack of long-term effectiveness in treatment because of problems with using the device
In a limited number of cases, the use of an oral device has made sleep apnea worse.
To avoid problems with oral appliances:
Make sure you are a good candidate for a dental device
Monitor the effects closely after starting to use the device
Am I a good candidate for a dental appliance or oral appliance to treat my sleep apnea?
Dentists who specialize in treating snoring, sleep apnea, or jaw misalignment can help you evaluate the devices available and determine whether you might benefit from one of them. The following characteristics make you a good candidate for an oral appliance:
Lack of periodontal disease
No significant temporomandibular joint (TMJ) disease
Reasonable range of motion in the mandible (lower jaw)
Normal weight or only moderately overweight
Older than 18, but younger than 65
“Buck teeth” and a small chin
A jaw line parallel to the floor
The airway obstruction is in the middle of the airway, rather than very high or very low
You sleep on your back or stomach, rather than on your side
Diagnosed with snoring or mild to moderate Obstructive Sleep Apnea (not severe OSA)
You have moderate to severe OSA, but cannot tolerate or refuse CPAP treatment
You don’t respond well to weight loss or change in sleep position, or these therapies are not applicable to you
Failure to be effectively treated with throat surgery
You refuse tonsillectomy, adenoidectomy, craniofacial operations, or tracheostomy, or these procedures are inapplicable to you
See your dentist to discuss whether you are a good candidate for oral appliance therapy.