If your sleep apnea is severe, and none of the previous solutions have provided relief, it might be time to talk to your doctor about surgery. Although surgery ranks behind breathing machines, dental appliances and weight loss in its effectiveness, if the surgeon is able to pinpoint the exact portion of the airway that is causing an obstruction (one of the major challenges of this surgery), there's a chance that you could find relief.
The most common type of surgery for sleep apnea -- and one that has roughly a 50 percent success rate -- is called uvulopalatopharyngoplasty, or UPPP. During this procedure, parts of the soft palate, throat tissue and the uvula (that dangly bit that you seen in cartoons when a character screams) are removed along with tonsils and adenoids, if present. If all goes well, the airway will be increased in size, the movement of the soft palate will be improved and some of the muscle action in the upper airway will be limited to help keep the breathing channel open. There's the potential for significant complications with this surgery, however. They include infection (which can affect up to 40 percent of all patients and requires another round of surgery), a hampered sense of smell, changes in the pitch of your voice, a lessened ability to keep fluids out of your airway and other swallowing problems.
A procedure that has been shown to be as effective as UPPP, but less invasive, is a pillar implant in which three short pieces of polyester string are inserted into the soft palate to reduce its vibration. This process is more successful in treating snoring than sleep apnea, but it is a possible avenue of relief.
Maxillomandibular advancement might also be considered if a mandibular advancement dental device is not appropriate for the patient. In this operation, the lower jaw is surgically moved forward, creating a greater space behind the tongue and soft palate.