Tracheotomy: Highly effective, but at the expense of having a hole in your neck that you breath out of during the night. During the day you plug it.
Midline Glossectomy: The side of your tongue has the absolute hell shaved out of it. 5/12 patients had their RDI decrease from 60.6 to 14.5. 7/12 patients had their RDI decrease from 62.6 to
48.8. Since this doesn’t get to the root cause of sleep apnea, it’s not real effective and isn’t done anymore. Permanent taste changes can be expected.
Genioglossus/Hyoid Advancement: Genioglossus (muscle from your chin to the base of your tongue) is pulled forward. Your hyoid bone (near your Adam’s Apple) is pulled forward to pull the
airway open more. Narrow airway is the root of most sleep apnea.
Uvulopalatopharyngoplasty (UPPP): The Uvula and excess tissues (fat or stretched) of the soft palate are removed. Crazy painful. Also doesn’t get at the root of what causes sleep apnea…a crowded airway. 137/337, 40.7% success rate. Success is considered decreasing the AHI by 50%. That’s stupid. An AHI of 30 being cut in half is still in the range of receiving a sleep apnea diagnosis. Many of these “successes” are considered failures to me.
LAUP: Laser Assisted UPPP. You basically blast the hell out of your upper airway with a laser scarring it like a piece of crispy bacon. This is supposed to keep it firm so the airway doesn’t collapse. Ummmm….no….
Maxillomandibular Advancement: Jaw is broken and moved forward as is the area below the nose. This opens up the upper airway. This is one of the most effective surgical options available, but it basically does the same as an Oral Appliance with the same “success rates.” Why have surgery when you could just use an oral appliance. This will change your facial features by pulling the bottom half of your face forward.
Hypoglossal Nerve Stimulation (N XII): Hypoglossal nerve is the main nerve of the upper airway opening. Stimulating N XII flexes it and stiffens it, keeping the upper airway open. The nerve is stimulated when inhalation is sensed. An battery implant is placed in the chest and an electrode is run up and placed on the hypoglossal nerve. This system needs to be titrated just like CPAP. Too little stimulation and the airway isn’t opened enough. Too much and the patient is unable to sleep because they are getting shocks to their nerve that are keeping them awake.
A Host of other Crazy options: These include attaching a mini harpoon to the base of the tongue and reeling it from a place near the chin. The tongue is strong….the harpoons break….ouch! Another is where the base of the tongue is lassoed with a wire to keep it pulled forward. Tongue is still strong and the wire is sharp enough…ouch!! Another offered a solution that accidentally caused the airway to close even more. That company went out of business really quickly.
Surgery may be an option for you, but please be careful and know the facts. You may want to try something that is non-surgical and non-permanent first. CPAP is very effective though it does have some inherent problems for some users. (I can assist you in overcoming these.) Oral Appliance Therapy has a “success” rate similar to that of the most successful surgeries, but it is also not permanent.