Should I have surgery?

[Pal2720]

I have been diagnosed with sleep apnea with 65 episodes an hour and I am on a cpap now, I was referred to a ear, nose and throat specialist and he recommended that I have surgery. He wants to remove my tonsils, shrink my uvula, and stretch my soft pallet. He said that it may not cure the apnea but that I would snore less and sleep better. Should I have this surgery? Have any of you had this done? What should I expect from it and what's recovery like if you've had it? Couldn't find too much on the internet so I was hoping to get help here. Thank you!

[Julie]

If your OSA is properly treated (by tried and true methods such as Cpap) surgery should not be necessary exept for possible nasal problems that respond to e.g. turbinate reduction, though don't treat apnea on their own, but do help breathing problems that can affect using Cpap. As far as the procedures you mention, they're well known to not work well for OSA and most inevitably revert after a few months to needing Cpap, though having had the surgery and anatomical changes, Cpap may be harder to use, leaving the patients with less treatment than they would have had otherwise.

[49er]

I have been diagnosed with sleep apnea with 65 episodes an hour and I am on a cpap now, I was referred to a ear, nose and throat specialist and he recommended that I have surgery. He wants to remove my tonsils, shrink my uvula, and stretch my soft pallet. He said that it may not cure the apnea but that I would snore less and sleep better. Should I have this surgery? Have any of you had this done? What should I expect from it and what's recovery like if you've had it? Couldn't find too much on the internet so I was hoping to get help here. Thank you!

Pal2720,

I agree with Julie as the only surgery worth considering is a septplasty/turbinate reduction to improve pap therapy tolerance. This is for people with suboptimal nasal breathing who have not responded to conservative methods for improvement.

Removal tonsils might not be a bad idea either.

Otherwise, apnea surgery should only be considered as a last resort option unless you are so opposed to using cpap (which I don't sense in your post) or a dental device that you won't get any treatment. And in that case, a complete examination of the airway should be done to pinpoint the trouble areas which didn't sound like it occurred regarding your situation.

49er

[Guest]

Thank you for your replies, I have been having trouble using the cpap, I take it off a couple hours after I fall asleep even after switching masks several times and having my air pressure set to a constant 12, yeah I had read that it isn't that effective, was just wondering because the doctor said my uvula was bigger than it should be, I don't want to do something that could just make it harder for me in the future, I will bring up what you've suggested and see if maybe that's a better option. I am a mouth breather when I sleep and I snore pretty loud so I will see what they think is best. I will continue with cpap and hope for the best. Thank you again!

[Greg Riddle]

Imo. If ent doesn't say try to make cpap work first then you should see another ent. He didn't have your interests in mind, just his wallet. I went yesterday ent made me aware of the surgery but said if you can make cpap work I don't want to do the surgery

[Drowsy Dancer]

Thank you for your replies, I have been having trouble using the cpap, I take it off a couple hours after I fall asleep even after switching masks several times and having my air pressure set to a constant 12, yeah I had read that it isn't that effective, was just wondering because the doctor said my uvula was bigger than it should be, I don't want to do something that could just make it harder for me in the future, I will bring up what you've suggested and see if maybe that's a better option. I am a mouth breather when I sleep and I snore pretty loud so I will see what they think is best. I will continue with cpap and hope for the best. Thank you again!

Please, please understand that I am in no way intending to rebuke you for "not trying hard enough." What I am saying is that there are a number of things to try before turning to surgery that you may not know about.

What kind of support have you had from your care providers about actually making CPAP work? Many posters here have had difficulties with removing masks in their sleep. There are a variety of techniques to break that habit.

Mask comfort is a really, really big deal (and can contribute to the mask-removal problem). It can be hard to find a mask that is comfortable. You say that you have switched masks several times. What specific masks have you tried? What type of masks? Many people find nasal pillows comfortable. Some people like the Wisp or the new Airfit model (I can never remember its name)? Mouth breathers often are recommended full face masks, which many find uncomfortable, but there are other techniques to reduce mouth breathing (chin straps and the controversial taping).

Do you have a data-capable machine so that you can assess how effective your current treatment is? If you are still snoring pretty loudly when you are using your CPAP your pressure might not be effective. Do you use any kind of pressure relief with your constant 12 (like EPR or Flex+?). Ramp?

It's not my place to tell you whether or not to have surgery. Something no one else has noted for your consideration yet I think is that the recovery from some of the procedures you are considering is frequently reported as being extremely painful, so you might want to weigh that in your cost-benefit analysis.

[chunkyfrog]

Any doctor that goes too quickly to the "alternates" just might be trying to pay off that country house in the Caymans.

[OkyDoky]

Interesting that he was covering all bases with "it may not cure the apnea" without giving you specifics on his patient success rate. How does he define success? How many of his patients no longer need CPAP?

[BVdog]

Ok my first post. I have severe apnea 67 per hour . Tried a couple mask and struggled but was getting better, 8-12 per hour . I than spent some time with a great tech and really got fitted with a new mask Fisher & Paykel Simplus. Last two nights 5 per hour. It took me 2 weeks of watching TV and using the machine before I could sleep a full night. The mask I am using now I can't wear my glasses but I am over that stage. My setting is 15 and I use Resmed's EPR to back off exhale at 3....
My advice is fully commit to Cpap , before thinking about surgery. Get a good support team for machine and mask. Also ask your sleep study tech how good they cleared up your apnea during your study. Good luck Bill

[Uncle Flapp]

As someone that had the surgery I say don't do it. Horrible recovery and success is short-lived. I still regret having mine and should have stuck with CPAP from the get go. Odds are you will eventually still need CPAP and it will be even harder.

- Flappy

[kteague]

Of the three people I know personally who have had surgeries for sleep apnea because they didn't want to wear a mask, none were cured. One went on to add a mouthpiece. Haven't talked to the other two in a few years, so I'm not sure what they chose to do. They all said the recovery was worse than expected. One now snorts what he drink up his nose. They had their surgeries back when they were routinely removing uvulas. That's the surgery I'd never recommend. As to any of the other surgeries, it depends on if there's an obvious need. Are you plagued with chronic infections and swollen tonsils that obstruct the airway? Do you chronic sinus issues? Some people on here report some procedures have helped them use CPAP with greater ease. I'm guessing only if the areas of the suggested surgeries are the cause for your CPAP issues will you achieve easier CPAP use. With an AHI such as yours, the chances of your sleep apnea being sufficiently reduced to not need CPAP probably aren't very good. How long have you been struggling with using the CPAP? Is there anything we can do to help you be sure you've left no stone unturned?

[chunkyfrog]

My dentist had the surgery. It had no effect on his apnea,
and now he gets food and drink up his nose --when he eats or drinks too quickly.

[archangle]

!!!!DO!!!!
!!!!NOT!!!!
!!!!HAVE!!!!
!!!!SURGERY!!!!

Spoken as an anonymous guy on the internet who doesn't have a medical degree or access to your medical history.

Tonsil surgery may be OK if you need it anyway. It MIGHT help your apnea.

Google "UPPP problems" for horror stories of others with apnea surgery.

Stick around here and maybe we can help you figure out your CPAP problems. Sign up for an ID, tell us what equipment you have in your profile and describe your problems in more detail.

If you really can't make CPAP work, you can always have the surgery later, but do a LOT of research and try everything else. If surgery goes wrong, you're fecked up for the rest of your life. With CPAP, you just stop using it and you're back where you were in a few weeks.

There are also a number of other types of apnea surgery, and new ones being developed, but I think they're all risky and not very effective.

[Nozzelnut]

I had a similar surgery. It slightly reduced my average highs; ; 2cm/h2o lower now. I think the biggest improvement was getting the chronically infected/inflamed tonsils out to help reduce swelling/full feeling in my throat. It opened my airway some too. Removed my elongated uvula and that helped reduce inflammation from snoring.

I wasn't expecting it to cure my OSA and it didn't, but it did help me.

[chunkyfrog]

Google "empty nose syndrome".
(Sorry, folks, somebody had to mention it.)