Can You Get Surgery to Treat Sleep Apnea?

Obstructive sleep apnea (OSA) is a common sleep disorder. People with OSA have abnormal breathing patterns during sleep. 

In OSA, breathing stops for short periods of time (apnea). This happens when the airway in the head and neck collapses, temporarily blocking airflow before breathing starts again. This can happen again and again through the night, making it hard to get quality sleep. 

OSA can also cause snoring, daytime sleepiness, morning headaches, and problems with concentration.    

But some people have a hard time tolerating first-choice OSA treatments. And these treatments don’t work for everyone. This is where surgical options may come in. 

OSA can be caused by many different things acting together, including your weight, the shape and size of your airway, and the shape and size of structures around your airway. So, in some cases, surgery can open, widen, or strengthen the airway to prevent it from collapsing during sleep. 

Does sleep apnea need to be treated?

Yes. If you get a diagnosis of OSA, you need to treat it. This is because daytime symptoms can be problematic and even dangerous, like if you fall asleep while driving or on the job. 

Plus, untreated OSA can have serious, long-term consequences on your heart as well as your metabolic, mental, and physical health. 

First-choice treatments for OSA

Typically, treatment starts with lifestyle changes and positive airway pressure (PAP) over night. This is a type of breathing machine that forces highly pressured air through your nose and mouth while you sleep. It prevents your airway from collapsing. 

Some people prefer to try an oral (mouth) positioning device instead. This advances the jaw or pulls the tongue into a forward position during sleep. 

Beyond that, the next step might be surgery. Surgery may be instead of or in addition to other treatments. Here’s how that works.   

Types of surgeries that help with sleep apnea

There isn’t one type of surgery for sleep apnea. There’s a whole menu of surgery options that can widen the upper airway or strengthen it so that it doesn’t collapse during sleep. The “best” surgery depends on the specific problem and where it is. 

Nasal surgeries 

Surgery to the nose can be helpful when there is an obstruction (blockage) in the nose that’s contributing to OSA. 

Here are some types of nasal surgeries that help to treat OSA caused by an obstruction in the nose. Depending on the problem that needs to be fixed, you may have one or more of these procedures done at the same time:

• Turbinate reduction surgery: This typically uses radiofrequency ablation (a heated instrument) to shrink the enlarged tissues in the nose. 

• Endoscopic procedures: A provider inserts a thin, flexible camera into the nose to correct enlarged turbinates or remove polyps.

• Nasal valve surgery: This can treat problematic nasal valves.  

• Septoplasty: This is to correct deformities of the nasal septum (the separation between the nostrils).

• Rhinoplasty: This is to correct deformities in the nose structure. 

Nasal surgeries are not stand-alone cures. But they can improve success when combined with CPAP, mouth devices, or other surgeries.  

Upper-throat surgeries

When the obstruction causing OSA is at the level of the upper pharynx (the upper part of the throat), surgery can help to relieve or remove it.  

Upper-throat procedures are some of the most common surgeries for OSA and include: 

• UPPP (uvulopalatopharyngoplasty)

• Tonsillectomy (often combined with UPPP in adults)

• Adenoidectomy (rare in adults, but often combined with tonsillectomy in children)

We’ll go over these in a little more detail below. 

Upper-airway (or hypoglossal-nerve) stimulation

This surgery is one of the most recent developments in the surgical treatment of OSA. It involves an implantable nerve-stimulating device. It’s a promising treatment option for certain people. 

Tongue and lower-throat surgeries    

If there is also obstruction further down in the throat, then it’s likely you’ll need additional procedures or treatment. 

Typically, lower-throat procedures are combined with upper-throat surgery in the treatment of OSA. In other words, it’s unlikely that you would need just lower-throat surgery.  

Here are some examples of lower-throat surgeries in the treatment of OSA:

• Tongue reduction surgery: This is to reduce tongue volume and obstruction. It can be done through radiofrequency ablation, endoscopy, or with robotic surgery (more on this below).   

• Tongue advancement or stabilization procedures: These procedures include genioglossus advancement, hyoid suspension, tongue suspension, and mandibular advancement. These procedures work to move the tongue forward and stop it from blocking the lower throat during sleep.  

• Epiglottis procedures: These shorten or stabilize the epiglottis to prevent it from collapsing into the airway. The epiglottis is the flap at the base of the tongue that covers the windpipe during swallowing so food, drink, and saliva do not go into the lungs. In some people it can flap into the airway during sleep and cause or contribute to OSA.  

Maxillomandibular advancement (MMA) 

In rare cases, more extreme surgery is required. Maxillomandibular advancement (MMA) is surgery that moves the entire lower half of the face and soft tissues forward. It can greatly improve symptoms and sleep-study results in people with severe OSA and other complicating factors. But it’s a major facial and oral surgery.

What is uvulopalatopharyngoplasty (UPPP)?

Uvulopalatopharyngoplasty (UPPP) is a type of upper-throat (upper-pharyngeal) surgery. It’s the most common type of surgical procedure for OSA. That’s because problems in this area are the most common cause of OSA. 

UPPP involves trimming, tightening, and fixing the various structures in the upper throat that cause it to collapse during sleep. These structures are the uvula, the soft palate, and the structures of the pharynx. Put these words together and you get the “uvulo-palato-pharyngo” part of the word. “Plasty” just means reconstruction.  

Sometimes, UPPP is combined with a tonsillectomy, nasal surgery, or lower-throat surgery. 

How successful is UPPP in treating OSA?

UPPP surgery has good success rates in the right people. Quality evidence shows that UPPP can improve symptoms of OSA and quality of life. But the effect on sleep-study results is mixed. UPPP surgery alone is unlikely to completely cure OSA. 

What is tonsillectomy and adenoidectomy?

The tonsils and adenoids are lumps of lymphoid tissue at the back of the mouth (tonsils) and nose (adenoids). They are part of the immune system and are typically large in childhood and get smaller with age. 

Tonsils and adenoids can temporarily get bigger in response to infection. Then they shrink back to normal size. But, in some people, they can be bigger than normal and cause problems, like snoring and OSA. 

For children with OSA, tonsillectomy with adenoidectomy are common treatments that can cure OSA. Adults may have tonsillectomy along with UPPP.  

How successful is tonsillectomy for OSA?

If you have enlarged tonsils causing mild to moderate OSA without other contributing anatomical issues, then a tonsillectomy alone may cure your OSA. 

But most people with enlarged tonsils also need other surgery to treat their OSA. When combined with other procedures, tonsillectomy can improve outcomes and the success of nonsurgical treatments, like PAP and mouth devices.  

What is upper-airway stimulation (Inspire implant)?

Upper-airway stimulation is a recent and evolving technique to treat OSA in certain people. It involves implanting a small device under the skin, beneath the collar bone. Only one device — the Inspire implant — is currently available in the U.S. But more will likely follow.

The Inspire implant is a remote-controlled device that senses your breathing patterns while you sleep. When it detects pauses in normal breathing (apnea), a wire stimulates the nerve to the tongue (the hypoglossal nerve). This activates the tongue, pushing it forward. As the tongue moves forward, the upper and lower throat open up, relieving the obstruction and the apnea. 

Currently, the Inspire implant is FDA approved for adults over 18 years old who meet certain criteria.  

How successful is the Inspire implant for treating OSA? 

Upper-airway stimulation works well in the right people. Quality evidence shows improvements in symptoms, quality of life, and sleep-study results.   

What about TransOral Robotic Surgery (TORS)?

You may have heard or read about TransOral Robotic Surgery (TORS) for the treatment of OSA. TORS isn’t a type of surgery. It’s a way of performing surgery. More specifically, it’s a way of performing surgery on the lower throat (hypopharynx) and larynx (voice box). 

The lower throat and the base of the tongue are difficult to operate on because the surgeon can’t easily view the area from the mouth opening. In TORS, robotics guide the surgical tools, allowing the surgeon to precisely control the surgery from a computer. 

TORS is a game changer when operating in the tiny, dark spaces at the back of the throat. It avoids open surgery (where the surgeon has to approach from a wide cut in the front of the neck), meaning the procedure is typically much safer and has a faster recovery.

TORS is also used to treat mouth, tongue, and throat cancers. 

Who should get sleep apnea surgery?

Experts agree that surgical procedures for OSA are not first-choice treatments in adults. Typically, surgery should be considered when first-choice treatments like PAP or a mouth device haven’t worked, despite best attempts. 

Most experts offer surgical treatment for OSA when: 

• There is a surgically correctable problem with the airway causing OSA.

• The person is willing to have surgery.

• The person is healthy enough for surgery and anesthesia.

The first step in exploring surgery for OSA is to meet with a doctor who specializes in OSA, such as a sleep specialist. They’ll confirm the diagnosis and get an up-to-date sleep study. Depending on what and where they think the problem is, they’ll recommend next steps. 

Which doctor should you see for OSA surgery?

Most people exploring OSA surgery will see an otolaryngologist, also called an ENT surgeon. These surgeons specialize in surgery to the ear, nose, and throat.

But, in some cases, it may be more appropriate to see an oral surgeon (oral maxillofacial surgeon). It really depends on what kind of surgery you are likely to need. 

What to expect when you see a doctor about surgery for OSA   

Expect your provider to ask you questions about your symptoms and which treatments you have tried. 

After that, you’ll probably need some (or all) of these tests: 

• A physical examination of the nose, mouth, and throat: This can happen right in the doctor’s office with a few tools. 

• A follow-up laryngoscopy (exam of the lower throat): In this test, a trained specialist, usually your ENT, inserts a small, flexible camera into your mouth and drops it down the back of your tongue to look at the structures in your throat and how they move. 

• Imaging of your face: Typically this is a CT scan. 

• Other tests during sedation or sleep: These are to confirm what happens when your nose, mouth, and throat relax during sleep.   

How much does sleep apnea surgery cost?

Sleep apnea surgeries can be costly. Insurance covers many procedures, but often only under certain circumstances. And you may still have significant out-of-pocket expenses for your share of the bills.

According to CareCredit, a medical credit card company, the average cost of all sleep apnea surgeries ranges from $6,400 to $10,000. More complicated procedures can cost even more:  

• Turbinate reduction surgery: This can cost between $1,000 and about $3,000 without insurance. If you need a septoplasty too, then that’s an additional $3,500 to $10,000 or more.

• UPPP: This surgery can cost upward of $10,000 if you don’t have insurance. Even if you have Medicare, UPPP is only covered under certain circumstances.

• Inspire implant: Most insurance plans cover this, and it’s also available at some Veterans Affairs and military hospitals. CareCredit reports the price of a hypoglossal-nerve stimulator like Inspire as $30,000 to $40,000 if you self-pay. If you have Medicare, this surgery is covered only if you meet an extensive list of eligibility requirements.

It’s important to note that the cost of these procedures depends on whether you have a bundled price or are charged for each service. This may include a separate charge for anesthesia. Your costs may also vary depending on whether you have the procedure at an outpatient surgery center — which is often less expensive — or at a hospital.

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Written by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

Reviewed by:

Cindy George, MPH

Cindy George is the senior personal finance editor at GoodRx. She is an endlessly curious health journalist and digital storyteller.

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