Q: Is there a surgical fix for sleep apnea? I've tried CPAP and a couple of other treatments, and none of them work well for me.
A: Sleep apnea is a condition in which breathing stops intermittently, or becomes shallower, during sleep. Obstructive sleep apnea (OSA) is the most common form.
OSA occurs when muscles in the back of your throat relax as you sleep. This causes the airway -- the space in the back of your throat through which air passes when you breathe -- to periodically collapse.
If air can't get into your lungs, oxygen levels in your lungs drop, which then causes oxygen levels in your blood to drop. That's not good: Every cell in your body needs the oxygen that the blood brings them.
If air can't get out of your lungs, a waste product -- carbon dioxide gas -- can't get expelled from your body. This changes your blood chemistry in several ways, including making it more acid. That also is unhealthy.
Your sleeping brain is smart enough to recognize that the carbon dioxide level is too high and the oxygen level is too low. This causes a person with obstructive sleep apnea to suddenly awaken and gasp for air -- sometimes hundreds of times a night.
In addition to fatigue, untreated sleep apnea increases the risk of heart failure and stroke.
Treatment usually starts with lifestyle changes such as losing weight or sleeping on your side instead of your back.
But the gold standard (and most commonly used) treatment for OSA is continuous positive airway pressure (CPAP). CPAP uses an air-pressure device connected by a hose to a mask that you wear over your nose while sleeping.
The air pressure opens your airway, preventing it from collapsing when muscles relax during sleep. This allows you to breathe regularly, without interruption.
Newer treatment devices, which also rely on air pressure, are similar to CPAP, but less cumbersome. And dental devices exist that reposition the jaw and tongue to aid in breathing. Ask your doctor about these options if you haven't already tried them.
Surgical treatment options for OSA do exist, but they do not have good success rates. Surgical options include:
• UPPP (Uvulopalatopharyngoplasty) surgery removes tissue from the throat. Many patients who have this surgery need further upper airway surgery or need to use CPAP.
• Somnoplasty uses radio-frequency waves to shrink obstructive tissues.
• Corrective jaw surgery moves the upper or lower jaw forward to enlarge the upper airway. It changes facial appearance and tooth alignment and entails a long recovery period.
• Palatal implants stiffen the soft tissue at the back of the roof of the mouth so that it doesn't relax as much during sleep.
A new experimental procedure shows promise. The hypoglossal nerve activates the muscles in the back of the throat -- the muscles that relax too much and cause the airway to collapse.
A nerve stimulator (which is connected to a little battery placed inside the body) seems to help keep the airway open.
If you decide on surgery, find an experienced surgeon to improve your chances for success.
• Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.