Key takeaways:
First-line treatments for obstructive sleep apnea (OSA) include breathing machines and mouth devices. But they can be hard to stick with and don’t always work.
Surgery can be an option for some people with moderate or severe OSA, especially when other treatments haven’t worked. It can open, widen, or strengthen the airway so it doesn’t collapse during sleep.
There are many options when it comes to surgery for OSA. It isn’t the best approach for everyone, but a specialist can help you understand your options.
Obstructive sleep apnea (OSA) is a common sleep disorder. People with OSA have abnormal breathing patterns during sleep. Specifically, breathing stops for short periods of time (apnea). This happens when the airway in your head and neck collapses, temporarily blocking airflow, before breathing starts again.
Apnea episodes can happen many times during the night, making it hard to get quality sleep. OSA can also cause snoring, daytime sleepiness, morning headaches, and problems with concentration.
Does sleep apnea always need to be treated?
Yes. If you get a diagnosis of OSA, you need to treat it for a number of reasons:
Daytime symptoms can be problematic and even dangerous, like if you fall asleep while driving or on the job.
Untreated OSA can have serious, long-term consequences on your health. This includes heart, metabolic, mental, and physical health effects.
According to research, treating OSA can greatly improve your quality of life.
The most common treatment recommendation is using a continuous positive airway pressure (CPAP) machine. This forces high-pressure air through your nose and mouth while you sleep, preventing your airway from collapsing. Weight loss — with or without medication like tirzepatide (Zepbound) — is often effective, as well.
But some people have a hard time using CPAP machines, and treatment doesn’t always work for everyone. This is where surgical options may come in.
What is sleep apnea surgery?
Sleep apnea surgery can open, widen, or strengthen your airway so it doesn’t collapse during sleep. OSA is often caused by a mix of factors, including your weight, the shape and size of your airway, and the shape and size of structures around your airway.
Experts say sleep apnea surgery can be considered for people who:
Can’t sleep while using CPAP
Have pressure-related side effects of CPAP
Have structural abnormalities in your airways that might benefit from surgery
Are healthy enough to undergo surgery and anesthesia
There isn’t one type of surgery for sleep apnea. There’s a whole menu of surgery options that can widen your upper airway or strengthen it so that it doesn’t collapse during sleep. The “best” surgery depends on the specific problem and where it’s located. It’s also possible to have more than one blocked (obstructed) area, so a combination of procedures (not just one) could be helpful.
Get better sleep while living with sleep apnea. Aside from surgery, there are other steps you can take to maximize your sleep.
What to know about CPAP (continuous positive airway pressure) machines: See how CPAP machines work, how much they cost, and why they can make a big difference.
Does sleep apnea cause brain fog? Yes, it’s one of the many health conditions that can cause brain fog. Here’s what to know and what you can do about it.
Nasal surgery
Surgery to your nose can help when a blockage in the nose is contributing to OSA. Depending on what 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 your nose.
Endoscopic procedure: A healthcare professional inserts a thin, flexible camera into your nose to correct enlarged turbinates or remove polyps.
Nasal valve surgery: This can treat problematic nasal valves.
Septoplasty and/or rhinoplasty: These procedures correct deformities of the nasal structure or septum (the separation between your nostrils).
Nasal surgeries are not stand-alone cures. But they can improve success when combined with CPAP, mouth devices, or other surgeries.
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Upper-throat surgery
When the blockage that causes OSA is at the level of the upper part of your throat (pharynx), surgery can help to relieve or remove it. There are a few different types of upper-throat surgery.
Uvulopalatopharyngoplasty (UPPP) for sleep apnea
Uvulopalatopharyngoplasty (UPPP) is a type of upper-throat (upper-pharyngeal) surgery. In previous years, it was the most common type of surgical procedure for OSA. That’s because problems in this area are the most common cause of OSA. UPPP is often combined with a tonsillectomy, nasal surgery, or lower-throat surgery.
UPPP involves fixing the structures in your upper throat so they’re less likely to collapse during sleep.
Research suggests UPPP can improve symptoms of OSA and quality of life. But its effect on sleep-study results is mixed, and side effects can be bothersome. UPPP surgery alone is unlikely to completely cure OSA.
Pharyngoplasty
Newer, less-invasive procedures help to correct the upper airway. These methods reposition tissue and muscle without cutting into your palate (roof of the mouth). According to studies, these procedures are just as effective as (if not more than) UPPP. And they have fewer complications.
Tonsillectomy and adenoidectomy for sleep apnea
The tonsils and adenoids are lumps of lymphoid tissue at the back of your mouth (tonsils) and nose (adenoids). They’re part of your immune system. They’re usually large in childhood and get smaller with age. But in some people, they can be bigger than normal and cause problems like snoring and OSA. Removing them with surgery can help improve OSA symptoms.
If you have enlarged tonsils causing mild to moderate OSA, and no other contributing anatomical issues, then a tonsillectomy alone may cure your OSA. For children with OSA, tonsillectomy with adenoidectomy may offer a cure. And when combined with other procedures, tonsillectomy can improve outcomes and increase the success of nonsurgical treatments like CPAP and mouth devices.
Tongue and lower-throat surgeries
The base of your tongue and epiglottis (the tissue that covers and protects your windpipe) can also contribute to OSA. Lower-throat procedures can address these tissues and are sometimes combined with upper-throat surgery.
Here are some examples of lower-throat surgeries used to treat OSA:
Tongue reduction surgery: This reduces the size of your tongue to reduce blockage. Surgeons can sometimes perform these procedures robotically. TransOral Robotic Surgery (TORS) helps them see the lower throat and the base of the tongue.
Tongue advancement or stabilization procedures: These procedures include genioglossus advancement, hyoid suspension, and tongue suspension. These procedures work to move your tongue forward and stop it from blocking the lower throat during sleep.
Epiglottis procedures: These shorten or stabilize your epiglottis to prevent it from collapsing into your airway.
Jaw surgery
In some people, the position of the jaw can affect the opening of the airway. Maxillomandibular advancement (MMA) is a 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 a retracted jaw position. But it’s a major facial and oral surgery with a long recovery.
Hypoglossal nerve stimulation
Upper-airway stimulation is a more recent technique for certain people with OSA. A small device is implanted under the skin, beneath your collarbone. When it detects pauses in normal breathing (apnea), a wire stimulates the nerve to the tongue (the hypoglossal nerve). This causes your tongue to move forward. As your tongue moves forward, your upper and lower throat open up, relieving the obstruction and the apnea.
Upper-airway stimulation works well in the right people. Quality evidence shows improvements in symptoms, quality of life, and sleep-study results.
Weight-loss (bariatric) surgery
Weight loss can help improve OSA symptoms, but it can be difficult for most people. For those who live in a larger body and have medical conditions, bariatric (weight-loss) surgery might be an option.
While weight-loss surgery doesn’t fix airway structure issues, losing weight afterward can lead to fewer apnea episodes at night. About one-third of people still have OSA after bariatric surgery.
How to decide which surgery is right for you
The first step in exploring surgery for OSA is to meet with a sleep specialist, if you haven’t already. 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 a sleep apnea surgery?
Most people exploring OSA surgery will see an otolaryngologist, also called an ENT surgeon. These surgeons specialize in surgery of the ear, nose, and throat.
In some cases, it may be more appropriate to see an oral and maxillofacial surgeon. It really depends on what kind of surgery you’re likely to need. But your sleep specialist can help you determine who to see.
Diagnostic tests for sleep apnea
Your healthcare team will ask about your symptoms and which treatments you have tried. After that, you’ll probably need some (or all) of the following tests:
A physical examination of your nose, mouth, and throat: This can happen right in the doctor’s office with a few tools.
Endoscopy: A trained specialist, usually your ENT, inserts a small, flexible camera into your nose and down your throat. This gives them a close-up view of your nasal and throat structures.
Imaging of your face: Typically this is a CT scan, although not everyone needs this.
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 sleep apnea surgeries ranges from $6,400 to $10,000. But it depends on the actual procedure:
Turbinate reduction surgery: The average cost without insurance is roughly $5,000. If you also need septoplasty, expect to pay thousands more.
UPPP: This surgery can cost around $10,000 if you don’t have insurance. Even if you have Medicare, UPPP is only covered under certain circumstances.
Nerve stimulation implant: Most insurance plans cover this. CareCredit reports that the price of a hypoglossal nerve stimulator costs about $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 the surgery is done at an outpatient surgery center — which is often less expensive — or at a hospital.
Frequently asked questions
Studies report a wide range of success rates for different surgeries. Success often depends on each person’s anatomy (airway structures) and other medical conditions. And “success” may mean fewer apnea events each night, lower CPAP pressures, or better daytime symptoms. Because of these differences, it’s hard to give exact numbers.
Keep in mind that not everyone is a good candidate for surgery. And the “best” surgery for you depends on your anatomy.
This refers to scoring recommendations from the American Academy of Sleep Medicine. They define hypopnea as an event during sleep where oxygen saturation drops by 3% or more and airflow drops by 30% or more. Hypopnea events, like apnea events, are important when diagnosing OSA.
Recovery time depends on the surgery. For procedures involving soft tissues, like turbinate reduction or less invasive upper-throat procedures, you may be back to school or work in a couple of weeks. But when bones are involved, such as with MMA or rhinoplasty, recovery can take months. It should be noted that recovery from tonsillectomy is much longer for adults than for children.
Studies report a wide range of success rates for different surgeries. Success often depends on each person’s anatomy (airway structures) and other medical conditions. And “success” may mean fewer apnea events each night, lower CPAP pressures, or better daytime symptoms. Because of these differences, it’s hard to give exact numbers.
Keep in mind that not everyone is a good candidate for surgery. And the “best” surgery for you depends on your anatomy.
This refers to scoring recommendations from the American Academy of Sleep Medicine. They define hypopnea as an event during sleep where oxygen saturation drops by 3% or more and airflow drops by 30% or more. Hypopnea events, like apnea events, are important when diagnosing OSA.
Recovery time depends on the surgery. For procedures involving soft tissues, like turbinate reduction or less invasive upper-throat procedures, you may be back to school or work in a couple of weeks. But when bones are involved, such as with MMA or rhinoplasty, recovery can take months. It should be noted that recovery from tonsillectomy is much longer for adults than for children.
The bottom line
Surgery for OSA may be an option for certain people who haven’t had success with CPAP, mouth devices, or lifestyle changes. Surgery can usually improve symptoms in the long term and reduce the number of apnea episodes during sleep. In some cases, surgery doesn’t cure OSA altogether. But it can lower the CPAP pressures you need or make CPAP easier to use.
There isn’t a single “best” surgery to treat OSA. The right procedure depends on the person. First, you’ll need a thorough assessment from a sleep specialist and a surgeon. Then you’ll discuss options with your care team. Cost and insurance coverage will be a big consideration for most people.
Why trust our experts?
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