To many patients with obstructive sleep apnea, surgery is an appealing option: It's a one-time procedure versus night after night of wearing a clunky continuous positive air pressure (CPAP) contraption to bed.
"But you have to remember, CPAP always works," says David Rapoport, MD, medical director of the New York University Sleep Disorders Center. "You may not like it, but it always works."
Surgery, on the other hand, has about a 25% to 30% success rate, and patients with the most severe cases of sleep apnea traditionally are the least likely to eliminate their symptoms.
"We ask our patients, 'Which is better? Are you willing to settle for a small chance of success?'" says Rapoport. "Some of them are; it's like people who buy lottery tickets all the time. The important thing is that they need to be making an informed decision."
It's true that better surgeons probably have better success rates or may be able to pick out people who are likely to have good results. And for some lucky patients, one operation will cure their sleep apnea. But the bottom line is, a doctor should never promise you permanent results from a surgery.
When Jim Latza was diagnosed with sleep apnea in his early 30s, his ear, nose, and throat doctor suggested an operation. "He told me I had a classic case in which my soft palate was too large, and was sagging down to cover my airways," says the 55-year-old salesman from Lakewood, Ohio. "He explained that surgery wouldn't cure it completely but would make it so I'd live a normal life, to a ripe old age."
So Latza got the works: soft palate cut back, tonsils and uvula removed, and a deviated septum repaired. The surgery was intense, with a long recovery: "When they take your uvula, they warn you that you're going to choke for a while because the throat has to learn to close on its own," he remembers. "There were several timesand it still happens even to this daywhen I eat something with a lot of crumbs, like shredded wheat cereal, and a little piece gets loose in the back of my throat where Im not expecting it. Then it's a 20-minute coughing spell until I get that little piece out of there."
The deep sleep lasted a few months, but soon enough Latza was snoring againa quieter whistling this time. Now it was his large tongue, his doctors told him, that blocked his throat while he slept. "It seems like no matter what we do, the apnea always manages to work its way around and pop back up," he says.
Latza knows now that no surgery can cure his apnea (aside from a tracheostomy, which is out of the question for him). But thanks to his earlier operation, his apnea is mild enough that he can keep it under control with lifestyle habits such as weight loss and sleeping on his side.
David Yu, 49, director of technology for a New York City publishing company, struggled with a CPAP machine for a year and a half, unable to wear a mask comfortably through the night. When his blood pressure spiked to unhealthy levels, he decided to take the next step and have surgery to correct his sleep apnea.
An ear, nose, and throat surgeon tightened Yu's upper palate and removed scar tissue left behind from a childhood tonsillectomy. The operation left him barely able to swallow for two full weeks. "It was so painful to drink that I was rinsing with Lanacane just to try and get water down," he says. "I couldn't even swallow my own spit. It was the most painful 14 days I've ever been through."
Yu lost a significant amount of weight in those two weeks, something he thought would improve his sleep apnea even more.
But just five months later, his wife noticed his snoring again. "Slowly, the signs of apnea started coming back," he says. "Waking up in the middle of the night, going more frequently to the bathroom, not feeling rested, blackness under the eyesall signs of not getting enough sleep."
Yu's not sure what his next treatment option will be; he may have to use the CPAP machine again, or try a similar device, like an APAP or BiPAP. His doctor may suggest other surgery options, but now he's skeptical.
"I'm going back to the doctor hesitantly, because I want to strangle him," he says. "If I could do it over, I would have opted out of that procedure." He mentions a couple of coworkers who are also considering sleep apnea surgery: "I tell them, unless there's another reason to have their palate excised, don't do it."