Treating Sleep Apnea

Weight Loss

When patients are overweight, there is a greater amount of tissue that can lead to collapse in the throat.  Weight gain is directly related to sleep apnea and guidance for weight loss will be provided if it is appropriate for you.  When patients are too heavy (as measured by body-mass-index, or BMI), treatments are often less effective, so this is a very important factor.

Positive Airway Pressure

The mainstay of sleep apnea treatment is the use of masks that keep positive pressure in the airway, thus eliminating (or significantly reducing) sleep apnea.  CPAP and BiPAP are some of the technologies used currently and are administered through nasal or full face masks.  This treatment is very effective if it is tolerated by patients.  Unfortunately, up to 50% of patient are intolerant to CPAP.

Medical Treatment of Nasal Obstruction

Some inflammatory conditions of the nose can simply be treated with topical or oral medications to improve nasal breathing.  This improved breathing can help reduce and sometimes eliminate sleep apnea.  Elimination of the problem is typically only for those with mild sleep apnea with nasal treatments alone are utilized.  Improving nasal breathing can also help patients who have trouble with CPAP.

Surgical Treatment of Nasal Obstruction 

While some nasal conditions can be treated medically and medications are often trialed to see what benefits they can derive, anatomic obstruction of the nose is unlikely to be corrected with medication.  If your nasal breathing is poor despite appropriate medication trials, minor procedures such as turbinoplasty or septoplasty can lead to dramatic improvements in breathing during the day and at night.  Similar to medical treatments for nasal obstruction, this often helps sleep apnea, but elimination of the problem is typically only for those with mild sleep apnea when nasal treatments alone are utilized. Improving nasal breathing can also help patients who have trouble with CPAP.

Oral Appliance Therapy

Oral appliances are devices worn in the mouth to advance the lower jaw bone, which advanced the tissues in the throat.  These devices can be very effective for some patients with mild or moderate sleep apnea.

OR-Based Procedures

Sleep surgery for sleep apnea typically requires operating room based procedures to improve the sites of collapse.  These procedures are typically guided by sleep endoscopy (see the evaluation section).  Some of the options for surgery based on anatomic site include:

  • Upper Throat Problems (Soft palate and tonsils):  Very large tonsils obstruct the airway and can be removed with tonsillectomy.  Collapse of the soft palate can be improved by a variety of techniques aimed at shortening the palate and bringing it forward, including uvulopalatopharyngoplasty (UPPP), expansion pharyngoplasty, lateral pharyngoplasty, uvulopalatal flap, z-palatoplasty, and transpalatal pharyngoplasty.  It is essential that you work with a surgeon familiar with all of these techniques, as they are catered specifically to your anatomy.
  • Lower Throat Problems (Base of tongue and epiglottis):  Collapse at the base of tongue and epiglottis lead to obstruction of the lower throat.  Procedures to improve obstruction at these levels include lingual tonsillectomy, midline glossectomy, hyoidopexy, hyoid and tongue base advancement, genioglossus advancement, and mandibular advancement.

Other Surgical Options

  • Upper Airway Stimulation: This implantable device by Inspire is for patients with moderate or severe sleep apnea and is only offered at a few centers in the Midwest, including our center.  See the next section to learn more. 
  • Tracheotomy:  Although a tracheostomy tube is not favored by many.  Some patients have severe enough disease, other medical problems, or are too heavy for the above treatments to be successful.  Tracheotomy is the one surgery that is an absolute cure for sleep apnea, but is rarely performed.

Dr. Parker performing an Inspire implant
Dr. Parker performing an Inspire implant