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Sleep Apnea: Should I Have Surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Sleep Apnea: Should I Have Surgery?

Get the facts

Your options

  • Have surgery for sleep apnea.
  • Do not have surgery.

Key points to remember

  • It's important to treat obstructive sleep apnea, because sleep apnea makes you more likely to have high blood pressure, depression, irregular heart rhythms, heart failure, coronary artery disease, and stroke.
  • Your doctor will probably have you try lifestyle changes and CPAP (continuous positive airway pressure) first. Surgery is a first choice only if the sleep apnea is caused by a blockage that surgery can easily fix.
  • There is no good evidence on how well the surgery called UPPP (which removes excess tissue in your throat) works for sleep apnea.1 There is a little evidence that shows that it helps 40 to 60 out of every 100 people who try it.2 You may still need CPAP after this surgery.
  • The surgery called tracheostomy (which puts a permanent opening in your neck to your windpipe) almost always cures sleep apnea that is caused by blockage of the upper airway. But other treatments work almost as well in most people. And the surgery can cause many complications.
  • Other types of surgery that may be used to treat sleep apnea include:
    • Maxillo-mandibular advancement, which moves the upper and lower jaw forward to increase the size of the airway.
    • Radiofrequency ablation, which reduces the size of the tongue or other tissue that may be blocking airflow to the lungs.
    • Palatal implants, which are small plastic rods that are implanted in the soft palate. They make the soft palate stiffer to keep the tissue from blocking the airway.
    • Laser-assisted uvulopalatoplasty (LAUP), which reshapes the tissue of the palate so it does not block the airway.
  • If you are very overweight, bariatric surgery may help you lose weight. Losing weight may improve your sleep apnea or end it completely.3
FAQs

What is obstructive sleep apnea?

Sleep apnea occurs when you often stop breathing for 10 seconds or longer during sleep. This may happen 5 to 50 times an hour. The more often it happens, the more serious the apnea is.

What causes obstructive sleep apnea?

Sleep apnea occurs when:

  • Your throat muscles and tongue relax during sleep and partially or completely block the airways in your nose, mouth, or throat.
  • Bone deformities or enlarged tissues block your airways. For example, you may have enlarged tonsils. During the day when you are awake and standing up, this may not cause problems. But when you lie down at night, the tonsils can press down on your airway, narrowing it and causing sleep apnea.

Other things that make sleep apnea more likely include:

  • Taking certain medicines or drinking alcohol before bed.
  • Sleeping on your back.
  • Being obese, or very overweight.

Why might your doctor recommend surgery?

UPPP: Your doctor may suggest UPPP (to remove excess tissue in your throat) if:

  • Your condition is easy to fix, such as very large tonsils.
  • You choose not to use—or cannot use—CPAP (continuous positive airway pressure) to treat your sleep apnea.
  • You have tried CPAP, but it hasn't helped.

Maxillo-mandibular advancement, radiofrequency ablation, palatal implants, or laser-assisted uvulopalatoplasty: Your doctor may recommend one of these other surgical treatments if:

  • You choose not to use—or cannot use—CPAP to treat your sleep apnea.
  • Oral breathing devices or other types of devices that you wear while you sleep have not worked for you.
  • Other forms of surgery are not right for you.

Tracheostomy: Your doctor may recommend tracheostomy (to put a permanent opening in your neck to your windpipe) if:

  • You have severe sleep apnea.
  • Other treatments have failed.
  • Other forms of surgery are not right for you.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have surgery for sleep apnea Have surgery for sleep apnea
  • You will probably be asleep during surgery.
  • You will probably stay in the hospital for at least a day or two.
  • UPPP: There is no good evidence on how well it works. But there is a very small amount of evidence showing that it works for about 40 to 60 out of every 100 people who have it done.2
  • Tracheostomy: A tracheostomy nearly always cures sleep apnea.4
  • A review of surgical procedures for treatment of sleep apnea concluded that maxillo-mandibular advancement (MMA) was effective in reducing problems caused by sleep apnea.5
  • Another review of surgery for sleep apnea stated that radiofrequency ablation (RFA) did not improve sleep apnea or its effects such as daytime sleepiness.6
  • Studies have shown that the use of palatal implants can reduce the severity of sleep apnea.5, 1
  • The results of LAUP have been mixed. Some studies show that it has a slight benefit, while others show that it makes sleep apnea worse.5, 6
  • There are risks with all kinds of surgery, including infection, bleeding, and a bad reaction to anesthesia.
  • UPPP has the following risks:
    • The surgery may stop your snoring, but you may still have apnea.
    • You may still need CPAP after surgery.
    • Other problems may include pain, infection, speech problems, and a narrowing of the airway in the nose and throat.
  • The main side effect of tracheostomy is that you have a hole in your throat where the breathing tube sits. Other risks may include:
    • Scar tissue forming at the opening of the hole in your throat.
    • Trouble speaking.
    • An increased risk of lung infections.
    • Emotional problems, such as depression or a change in self-image.
  • The risks of MMA and LAUP are:
    • Changes in appearance and in how the teeth meet.
    • Jaw numbness and problems swallowing.
    • Infection.
  • RFA for sleep apnea can cause:
    • Damage to tissue near the area being treated.
    • Infection.
    • Bleeding from the treated area.
  • The use of palatal implants can result in:
    • Changes in how the teeth meet.
    • Being able to feel the implants, which may be uncomfortable.
    • Loss of an implant, which would have to be reimplanted.
Do not have surgery for sleep apnea Do not have surgery for sleep apnea
  • You can try nonsurgical treatments, including lifestyle changes and CPAP.
  • You'll avoid the risks of having surgery.
  • For most people, lifestyle changes and/or CPAP work to control sleep apnea symptoms.
  • Lifestyle changes and CPAP may not be enough if your sleep apnea is very bad.
  • CPAP side effects may include nosebleeds, a sore throat, and headaches.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about treatment for obstructive sleep apnea

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I have been using continuous positive airway pressure (CPAP) to treat my sleep apnea for over a year. Since I travel a lot, CPAP isn't very convenient for me. Taking my CPAP machine on business trips is too much trouble for me. I talked with my doctor, and we agreed that surgery might be a good option to treat my sleep apnea.

Jorge, age 54

CPAP is doing wonders for my sleep apnea. It really isn't that much of a bother for me to use. I also read that surgery may only help about half of the time. I am not willing to risk the complications from surgery, so I am going to continue with CPAP.

Dara, age 42

I have been using CPAP. I am tired of being attached to a machine at night while I sleep. My nose is always dry, and I have been having terrible nightmares. My sleep is not improving. I am willing to have surgery to treat my sleep apnea if it can help.

Cal, age 45

Since I have been using CPAP, my sleep apnea symptoms have disappeared. My wife can't believe the change in my attitude during the day. We talked about my having surgery to treat my sleep apnea so I wouldn't have to use CPAP anymore. My doctor said that even if I have the surgery, I still might have to use CPAP. The risks and cost of the surgery and the possibility that I might still have to be on CPAP are not worth it.

Gordon, age 50

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for sleep apnea

Reasons not to have surgery

I'm willing to try surgery to get better.

I want to avoid surgery at all costs.

More important
Equally important
More important

I want to try surgery even though I know I may have to go back to using CPAP afterward.

I don't want to go through surgery if there's a chance I'll have to go back to using CPAP anyway.

More important
Equally important
More important

My appearance after a tracheostomy—having a hole in my throat—won't bother me.

I don't like the idea of living with a hole in my throat.

More important
Equally important
More important

I don't like the side effects of using CPAP, so I rarely use it.

The side effects of CPAP aren't bad enough to keep me from using it.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

Trying other treatments

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Do you need treatment even if your sleep apnea doesn't bother you too much?

  • YesYes, you're right. It's important to treat sleep apnea, because it makes you more likely to have high blood pressure, depression, irregular heart rhythms, heart failure, coronary artery disease, and stroke.
  • NoNo, that's wrong. It's important to treat sleep apnea, because it makes you more likely to have high blood pressure, depression, irregular heart rhythms, heart failure, coronary artery disease, and stroke.
  • I'm not sureIt may help to go back and read "Get the Facts." It's important to treat sleep apnea, because it makes you more likely to have other serious problems.
2.

Is surgery usually a doctor's first choice in treating sleep apnea?

  • YesSorry, that's wrong. Your doctor will probably have you try lifestyle changes and CPAP first. Surgery is a first choice only if the sleep apnea is caused by a blockage that is easily fixed.
  • NoYou're right. Your doctor will probably have you try lifestyle changes and CPAP first. Surgery is a first choice only if the sleep apnea is caused by a blockage that is easily fixed.
  • I'm not sureIt may help to go back and read "Get the Facts." Surgery is a first choice only if the sleep apnea is caused by a blockage that is easily fixed.
3.

Does research show that UPPP works well for sleep apnea?

  • YesNo, that's wrong. There is no good evidence on how well UPPP works for sleep apnea.
  • NoYou're right. There is no good evidence on how well UPPP works for sleep apnea.
  • I'm not sureIt may help to go back and read "Get the Facts." There is no good evidence on how well UPPP works for sleep apnea.
4.

Does tracheostomy almost always cure sleep apnea?

  • YesThat's right. A tracheostomy nearly always cures sleep apnea. But it leaves a hole in your throat where the breathing tube sits.
  • NoSorry, you're wrong. A tracheostomy nearly always cures sleep apnea. But it leaves a hole in your throat where the breathing tube sits.
  • I'm not sureIt may help to go back and read "Compare Your Options." A tracheostomy nearly always cures sleep apnea. But it leaves a hole in your throat where the breathing tube sits.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits and References

Credits
Author Healthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Mark A. Rasmus, MD - Pulmonology, Critical Care Medicine, Sleep Medicine

References
Citations
  1. Sundaram S, et al. (2005). Surgery for obstructive sleep apnoea in adults. Cochrane Database of Systematic Reviews (4).
  2. Guilleminault C, Abad VC (2004). Obstructive sleep apnea syndromes. Medical Clinics of North America, 88(3): 611–630.
  3. Buchwald H, et al. (2004). Bariatric surgery: A systematic review and meta-analysis. JAMA, 292(14): 1724–1737.
  4. Aurora RN, et al. (2010). Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep, 33(10): 1408–1413.
  5. Caples SM, et al. (2010). Surgical modifications of the upper airway for obstructive sleep apnea in adults: A systematic review and meta-analysis. Sleep, 33(10): 1396–1407.
  6. Franklin KA, et al. (2009). Effects and side-effects of surgery for snoring and obstructive sleep apnea: A systematic review. Sleep, 32(1): 27–36.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Sleep Apnea: Should I Have Surgery?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Have surgery for sleep apnea.
  • Do not have surgery.

Key points to remember

  • It's important to treat obstructive sleep apnea, because sleep apnea makes you more likely to have high blood pressure, depression, irregular heart rhythms, heart failure, coronary artery disease, and stroke.
  • Your doctor will probably have you try lifestyle changes and CPAP (continuous positive airway pressure) first. Surgery is a first choice only if the sleep apnea is caused by a blockage that surgery can easily fix.
  • There is no good evidence on how well the surgery called UPPP (which removes excess tissue in your throat) works for sleep apnea.1 There is a little evidence that shows that it helps 40 to 60 out of every 100 people who try it.2 You may still need CPAP after this surgery.
  • The surgery called tracheostomy (which puts a permanent opening in your neck to your windpipe) almost always cures sleep apnea that is caused by blockage of the upper airway. But other treatments work almost as well in most people. And the surgery can cause many complications.
  • Other types of surgery that may be used to treat sleep apnea include:
    • Maxillo-mandibular advancement, which moves the upper and lower jaw forward to increase the size of the airway.
    • Radiofrequency ablation, which reduces the size of the tongue or other tissue that may be blocking airflow to the lungs.
    • Palatal implants, which are small plastic rods that are implanted in the soft palate . They make the soft palate stiffer to keep the tissue from blocking the airway.
    • Laser-assisted uvulopalatoplasty (LAUP), which reshapes the tissue of the palate so it does not block the airway.
  • If you are very overweight, bariatric surgery may help you lose weight. Losing weight may improve your sleep apnea or end it completely.3
FAQs

What is obstructive sleep apnea?

Sleep apnea occurs when you often stop breathing for 10 seconds or longer during sleep. This may happen 5 to 50 times an hour. The more often it happens, the more serious the apnea is.

What causes obstructive sleep apnea?

Sleep apnea occurs when:

  • Your throat muscles and tongue relax during sleep and partially or completely block the airways in your nose, mouth, or throat.
  • Bone deformities or enlarged tissues block your airways. For example, you may have enlarged tonsils. During the day when you are awake and standing up, this may not cause problems. But when you lie down at night, the tonsils can press down on your airway, narrowing it and causing sleep apnea.

Other things that make sleep apnea more likely include:

  • Taking certain medicines or drinking alcohol before bed.
  • Sleeping on your back.
  • Being obese, or very overweight.

Why might your doctor recommend surgery?

UPPP: Your doctor may suggest UPPP (to remove excess tissue in your throat) if:

  • Your condition is easy to fix, such as very large tonsils.
  • You choose not to use—or cannot use—CPAP (continuous positive airway pressure) to treat your sleep apnea.
  • You have tried CPAP, but it hasn't helped.

Maxillo-mandibular advancement, radiofrequency ablation, palatal implants, or laser-assisted uvulopalatoplasty: Your doctor may recommend one of these other surgical treatments if:

  • You choose not to use—or cannot use—CPAP to treat your sleep apnea.
  • Oral breathing devices or other types of devices that you wear while you sleep have not worked for you.
  • Other forms of surgery are not right for you.

Tracheostomy: Your doctor may recommend tracheostomy (to put a permanent opening in your neck to your windpipe) if:

  • You have severe sleep apnea.
  • Other treatments have failed.
  • Other forms of surgery are not right for you.

2. Compare your options

  Have surgery for sleep apnea Do not have surgery for sleep apnea
What is usually involved?
  • You will probably be asleep during surgery.
  • You will probably stay in the hospital for at least a day or two.
  • You can try nonsurgical treatments, including lifestyle changes and CPAP .
What are the benefits?
  • UPPP: There is no good evidence on how well it works. But there is a very small amount of evidence showing that it works for about 40 to 60 out of every 100 people who have it done.2
  • Tracheostomy: A tracheostomy nearly always cures sleep apnea.4
  • A review of surgical procedures for treatment of sleep apnea concluded that maxillo-mandibular advancement (MMA) was effective in reducing problems caused by sleep apnea.5
  • Another review of surgery for sleep apnea stated that radiofrequency ablation (RFA) did not improve sleep apnea or its effects such as daytime sleepiness.6
  • Studies have shown that the use of palatal implants can reduce the severity of sleep apnea.5, 1
  • The results of LAUP have been mixed. Some studies show that it has a slight benefit, while others show that it makes sleep apnea worse.5, 6
  • You'll avoid the risks of having surgery.
  • For most people, lifestyle changes and/or CPAP work to control sleep apnea symptoms.
What are the risks and side effects?
  • There are risks with all kinds of surgery, including infection, bleeding, and a bad reaction to anesthesia.
  • UPPP has the following risks:
    • The surgery may stop your snoring, but you may still have apnea.
    • You may still need CPAP after surgery.
    • Other problems may include pain, infection, speech problems, and a narrowing of the airway in the nose and throat.
  • The main side effect of tracheostomy is that you have a hole in your throat where the breathing tube sits. Other risks may include:
    • Scar tissue forming at the opening of the hole in your throat.
    • Trouble speaking.
    • An increased risk of lung infections.
    • Emotional problems, such as depression or a change in self-image.
  • The risks of MMA and LAUP are:
    • Changes in appearance and in how the teeth meet.
    • Jaw numbness and problems swallowing.
    • Infection.
  • RFA for sleep apnea can cause:
    • Damage to tissue near the area being treated.
    • Infection.
    • Bleeding from the treated area.
  • The use of palatal implants can result in:
    • Changes in how the teeth meet.
    • Being able to feel the implants, which may be uncomfortable.
    • Loss of an implant, which would have to be reimplanted.
  • Lifestyle changes and CPAP may not be enough if your sleep apnea is very bad.
  • CPAP side effects may include nosebleeds, a sore throat, and headaches.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about treatment for obstructive sleep apnea

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I have been using continuous positive airway pressure (CPAP) to treat my sleep apnea for over a year. Since I travel a lot, CPAP isn't very convenient for me. Taking my CPAP machine on business trips is too much trouble for me. I talked with my doctor, and we agreed that surgery might be a good option to treat my sleep apnea."

— Jorge, age 54

"CPAP is doing wonders for my sleep apnea. It really isn't that much of a bother for me to use. I also read that surgery may only help about half of the time. I am not willing to risk the complications from surgery, so I am going to continue with CPAP."

— Dara, age 42

"I have been using CPAP. I am tired of being attached to a machine at night while I sleep. My nose is always dry, and I have been having terrible nightmares. My sleep is not improving. I am willing to have surgery to treat my sleep apnea if it can help."

— Cal, age 45

"Since I have been using CPAP, my sleep apnea symptoms have disappeared. My wife can't believe the change in my attitude during the day. We talked about my having surgery to treat my sleep apnea so I wouldn't have to use CPAP anymore. My doctor said that even if I have the surgery, I still might have to use CPAP. The risks and cost of the surgery and the possibility that I might still have to be on CPAP are not worth it."

— Gordon, age 50

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for sleep apnea

Reasons not to have surgery

I'm willing to try surgery to get better.

I want to avoid surgery at all costs.

             
More important
Equally important
More important

I want to try surgery even though I know I may have to go back to using CPAP afterward.

I don't want to go through surgery if there's a chance I'll have to go back to using CPAP anyway.

             
More important
Equally important
More important

My appearance after a tracheostomy—having a hole in my throat—won't bother me.

I don't like the idea of living with a hole in my throat.

             
More important
Equally important
More important

I don't like the side effects of using CPAP, so I rarely use it.

The side effects of CPAP aren't bad enough to keep me from using it.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

Trying other treatments

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Do you need treatment even if your sleep apnea doesn't bother you too much?

  • Yes
  • No
  • I'm not sure
Yes, you're right. It's important to treat sleep apnea, because it makes you more likely to have high blood pressure, depression, irregular heart rhythms, heart failure, coronary artery disease, and stroke.

2. Is surgery usually a doctor's first choice in treating sleep apnea?

  • Yes
  • No
  • I'm not sure
You're right. Your doctor will probably have you try lifestyle changes and CPAP first. Surgery is a first choice only if the sleep apnea is caused by a blockage that is easily fixed.

3. Does research show that UPPP works well for sleep apnea?

  • Yes
  • No
  • I'm not sure
You're right. There is no good evidence on how well UPPP works for sleep apnea.

4. Does tracheostomy almost always cure sleep apnea?

  • Yes
  • No
  • I'm not sure
That's right. A tracheostomy nearly always cures sleep apnea. But it leaves a hole in your throat where the breathing tube sits.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

 
Credits
By Healthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Mark A. Rasmus, MD - Pulmonology, Critical Care Medicine, Sleep Medicine

References
Citations
  1. Sundaram S, et al. (2005). Surgery for obstructive sleep apnoea in adults. Cochrane Database of Systematic Reviews (4).
  2. Guilleminault C, Abad VC (2004). Obstructive sleep apnea syndromes. Medical Clinics of North America, 88(3): 611–630.
  3. Buchwald H, et al. (2004). Bariatric surgery: A systematic review and meta-analysis. JAMA, 292(14): 1724–1737.
  4. Aurora RN, et al. (2010). Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep, 33(10): 1408–1413.
  5. Caples SM, et al. (2010). Surgical modifications of the upper airway for obstructive sleep apnea in adults: A systematic review and meta-analysis. Sleep, 33(10): 1396–1407.
  6. Franklin KA, et al. (2009). Effects and side-effects of surgery for snoring and obstructive sleep apnea: A systematic review. Sleep, 32(1): 27–36.

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