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Question 1 - Problems with CPAP should I consider surgery?

From: Johnny C.

I am a 42 year old man with sleep apnea. I had two sleep studies about 4 years ago. The first one showed that I have sleep apnea and the second one showed that the CPAP machine helped my sleep apnea. I have tried to use the machine on and off for the past few years, but never been able to use it for more than 3 hours each night. I find that my sleep is actually worse when I use the machine and my nose is always blocked afterwards. My sleep has gotten much worse since my diagnosis. I wake up many times at night and never feel rested. About two months ago, I started waking up with a jolt with my heart racing and feel that I can’t get any air. I am considering surgery and would like some advice.


Answer Provided by Dr. Kasey Li
May 23, 2007

CPAP is the first line of treatment and is an excellent treatment option. However, only approximately 60% of the patients can tolerate this treatment modality (to varying degrees of success). Surgery is certainly an option as well. Just like the different types of CPAP machines and masks may be best suited for different patients, the different types of surgery are best suited for different individuals.

The objectives of sleep apnea surgery can be different for each patient. If a patient has significant nasal obstruction (such as deviated septum and/or enlarged turbinates) that is causing difficulty in using CPAP, I would simply offer nasal surgery to improve the nasal passageway in an attempt to improve the CPAP tolerability. However, surgery is usually done to try to improve sleep apnea so patients do not need to use CPAP.

Sleep apnea surgery can be very successful if the surgeon selects the right operation for the right patient. In another word, patient selection is the key to success. In general, as the severity of sleep apnea increases, so would the invasiveness of the surgery to improve it. For example, I would recommend tonsillectomy with modified pharyngoplasty (uvula preservation) if a patient has moderate sleep apnea and has very large tonsils and fair amount of pharyngeal tissues. However, the same operation would not be offered if a patient has severe sleep apnea and has no soft tissue excess, but has a very small jaw. I would recommend MMA for this patient, or no surgery at all since the success rate of anything other than MMA would be poor.

The first step is to speak with your sleep physician. He/she may work with a qualified surgeon that may be able to help you.

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