For adults with obstructive sleep apnea, the standard treatment is positive airway pressure therapy (such as CPAP, BPAP, or APAP).  Surgery is reserved for patients who are unable to tolerate or benefit from positive airway pressure therapy.  For children, adenoidectomy and/or tonsillectomy for sleep apnea is the standard treatment.  Positive airway pressure therapy is not an ideal treatment for most children.  This is due to concerns over effects on facial growth and difficulty that children may have with tolerating it through the night.  It is reassuring that surgical outcomes in children–while by no means perfect–are relatively good, especially when the tonsils or adenoids are enlarged and when the child is not considered substantially overweight.

What about tonsillectomy for sleep apnea as first-line treatment in adults?

Just like in children, adults with enlarged tonsils also do better after sleep apnea surgery that includes tonsillectomy.  One reason seems to be that the physical removal of the enlarged tonsils immediately opens up space for breathing and improves the sleep apnea.  Many have wondered whether adults with sleep apnea and markedly enlarged tonsils should be treated with surgery that includes tonsillectomy.

The December 2016 issue of the medical journal The Laryngoscope included an interesting study examining this question.  Twenty-nine adults with markedly enlarged tonsils (size 3+ or 4+ on the Friedman scale), obstructive sleep apnea, and no substantial obesity (body mass index below 32 kg/meters squared) underwent tonsillectomy alone.  One patient was lost to follow up, but the rest of the patients had sleep studies before and then 6 months after surgery.  Impressively, the average apnea-hypopnea index decreased from 40 to 7 events per hour after undergoing tonsillectomy for sleep apnea, with only 2 patients having anything worse than mild sleep apnea.  There were also substantial improvement in the score on the Epworth Sleepiness Scale score that measures daytime sleepiness (mean score decreased from 11 to 6).

tonsillectomy for sleep apnea

View of the mouth, showing the tonsils

Are there other studies of tonsillectomy for sleep apnea?

This study followed previous smaller studies showing substantial improvement or resolution in sleep apnea after tonsillectomy alone and that tonsil size and body mass index were associated with outcomes after tonsillectomy alone and that tonsillectomy could reduce the required CPAP pressure in those who did not have resolution of their sleep apnea.  This was supported by a larger study of 202 adults published in 2015.  This study showed a 95% chance of surgical success after tonsillectomy for sleep apnea, with a decrease in the average apnea-hypopnea index from 18 to 3 events per hour.

So why isn’t tonsillectomy for sleep apnea a first-line treatment in adults?

There are likely many reasons.  First, not all patients have tonsils that are markedly enlarged.  I would estimate that this about 5-10% of all adults with sleep apnea would be ideal candidates for tonsillectomy as a first-line treatment.  This figure seems relatively small, but it still is quite a few patients who could have their tonsils removed because sleep apnea is so common.  Second, most of these studies are relatively small.  It would be important to repeat the studies in larger groups, just to confirm the findings.  Third, the studies are not what are called randomized trials.  Randomized trials could include patients with sleep apnea and markedly enlarged tonsils, either performing tonsillectomy or observing them without treatment for a period of time (6 months, for example).  Unfortunately, it turns out that making people wait for surgery just to be part of a research study is incredibly difficult.  Patients will prefer not to be involved in these studies if they are interested in having surgery (or any treatment).  Finally, there are perceptions about surgery for sleep apnea that we have to overcome.  I have written before that most surgeons, other physicians, and the public think that there is only one surgery for sleep apnea.  That is just not the case.

What would I recommend?

We are in the midst of a major change in rethinking sleep apnea surgery–for all parties involved.  The goal is developing a tailored approach to sleep apnea treatment with an approach that is often called personalized medicine.  I see many young adults with markedly enlarged tonsils who are struggling with positive airway pressure therapy, including many with mild sleep apnea who are not overweight.  For these patients, I think it is very reasonable to think about surgery as a first-line option instead of being on positive airway pressure for the rest of their life.  These patients have a greater than 90% chance of clearing up their sleep apnea with tonsillectomy alone.  Not every one of them will want to have surgery, but this should be part of the discussion because the results will be so good, based on everything we know about sleep apnea surgery outcomes.

As a sleep surgeon, I see many patients who want surgery because they simply do not like positive airway pressure therapy, even though they are doing well with it.  In fact, I actually discourage many of these patients from surgery.  My approach is always the same: if you are doing well with positive airway pressure therapy, keep using it.  The one caveat are those patients who have a very high chance of resolution of their sleep apnea with a straightforward procedure like tonsillectomy.

 

 

65 Responses to “Tonsillectomy for Sleep Apnea as First-Line Treatment in Adults”

  1. Joseph Tidwell

    If a study was to come up for volunteers for a tonsillectomy i’d do it in a heartbeat.. I”m stuck on a cpap at 18 for my pressure. I have issues with mask leaks and my quality of sleep is frequently hampered by it.. I’ve used aloe vera to help seal the mask which helps alotta times, but i’m glued to this machine when I sleep.. I cannot even go backpacking over night any more… So, yes if theres a study needing volunteers, sign me up!

    Reply
    • Dr. Kezirian

      Unfortunately, most research studies do not cover costs of surgery. If you have markedly enlarged tonsils, there is a reasonable chance that removing those tonsils can clear up your sleep apnea. Since you are struggling with CPAP, you may want to see a sleep surgeon for an evaluation.

      Reply
    • Mark

      Hi Joseph

      I can’t help you with an extensive sleep study. But I can let you know how my personal experience goes in the next couple of weeks.

      I have been in sleep clinic for two overnight stays, first was to determine severity and second was for titration for the APAP machine. I have had corrective surgery for septum, sinuses cleaned and had turbanites shaved to make room. 6 months later I am now having the tonsillectomy – my tonsils are massive, enlarged is putting it mildly.

      I hate the machine, 6 months later using it and I’m still reliant on sleeping pills to put me under – quality of sleep is terrific while asleep but like you; dependency and mask leaks are incredibly annoying. Also pretty sure I’m getting face wrinkles prematurely (not the main concern but definitely additive).

      Next week Friday 23rd Feb 2018 – the buggers are coming out! I will let you know if I noticed a remarkable improvement and if it’s potentially worth it – especially if you can have a checkup to see if you do indeed have enlarged tonsils.

      Worst case scenario, I am hoping if the tonsillectomy doesn’t cure my sleep apnea, it at least provides enough room for improvement for me to move away from the machine and use one of those MAD (mandibular advancement devices). The proper ones you get made by a dental surgeon! Not your pharmacy variety.

      But fingers crossed that surgery cures it first!

      Reply
      • Kim Snyder

        Did you get the surgery done and did it help? My husband has the same problem. Would love to hear your results.

        Reply
  2. Jules

    Yes-please let us know. My husband has huge tonsils. We r thinking of getting them removed or shaved down.

    Reply
    • Ruth H

      Hi Mark – I would love to know how it is going also. I’m scheduled to have surgery in early June. Was told I have severe apnea so I’m hoping this helps. I heard it is painful the first few days, but well worth it. Would love to hear your story.

      Reply
        • Dr. Kezirian

          If you are not doing well with CPAP, you should at least consider surgery. The next step would be an evaluation to determine whether surgery – and what kind of surgery – might be best for you. Please feel free to contact me directly to discuss the specifics of your situation.

          Reply
          • Kathleen Jacobson

            I’m very interested in surgery for Sleep Apnea. I cannot sleep with the machine.

            Kathleen

          • Dr. Kezirian

            Kathleen, If you would like to schedule an appointment with me, you can contact our Patient Access Center at 323-442-5790. Please feel free to e-mail me directly with any questions or concerns. Eric

          • Jackie

            It wont cure your sleep apnea. Got a tonsilectomy, turbinectomy and septomplasty. Still have it and my levels are actually higher now. Was a llevel 8 before surgery, went up to a 11 after the healing process for surgery

          • Dr. Kezirian

            Thank you for sharing your experience. I am sorry you have not had a good result. These studies show that those with markedly enlarged tonsils generally do very well after this kind of procedure. I am not sure how big your tonsils were, but you still do have mild obstructive sleep apnea. I hope you are now feeling more refreshed after a night of sleep, as this is actually more important than your apnea-hypopnea index number from a sleep study for mild obstructive sleep apnea. The reality is that sleep apnea surgery is not 100% effective. This is why I have focused my entire career in this field, with an emphasis on how we choose procedures and can try to predict results.

        • Bob J

          My ENT said my tonsils are enlarged and blocking passage…my sleep study Dr said I do not need the CPAP or surger for tonsils. My ENT wants to take my tonsils out…I think it said 4 on the sleep index, which they said was minimal sleep apnea but factoring in the blood oxygen levels it raised it to about moderate sleep apnea…my question is should I have my tonsils removed? I’m 37 …pretty sure I just need to lose 20 lbs….anyways thanks for any feedback, appreciate it!

          Reply
          • Dr. Kezirian

            It is hard to make medical evaluations purely on the basis of limited information here. It is good that you are speaking to both a sleep medicine physician and otolaryngologist/ENT.

  3. Joe

    I would like to know your outcome too. I cannot fall asleep with the CPAP, so it is no help to me. A friend said the tonsillectomy was a miracle for her daughter. How has it been for you?

    Reply
    • Melwyn

      Hi Joe, how old was your friend’s daughter? If she’s a child, then the success rate is very high.

      Reply
  4. Lauren

    Waiting to hear on this too. My husband can’t get very much sleep with the mask and is having many correlated health problems. We are at hospital now being told tonsils are inflamed/ enlarged. He literally hasn’t slept a wink in 3 days and is catatonic. Wonder if they would do tonsillectomy on an emergency basis.

    Reply
  5. Kathe

    Im waiting to see how Mark is doing as well. I have the dental appliance after years of frustration with the CPAP I now suffer from claustrophobia or more a fear of suffocating from the machine leaking, and causing what I can only describe as vapor lock seaming to pop my ears if my mouth opened at all, so no more chin strap, no more cpap, Im a month into the MAD dental appliance and turning it every 4 days to see if adjusting it (until I resemble a pug dog) will help. I have insomnia now too unless I take all my nightime meds.

    Mark hope all went well.

    Reply
    • Dr. Kezirian

      It would be great to hear how Mark is doing, but the nice thing about these studies is that they include scientific evaluation of groups of patients. I hope you have a great result with your MAD. Surgery like tonsillectomy can have substantial pain during the recovery period, but the good thing about surgery is that there is nothing to wear or tolerate like there is with CPAP or a MAD. This makes it easier for patients with insomnia to experience resolution of their sleep apnea after surgery if they are really good surgical candidates like patients with markedly enlarged tonsils. Studies show that women, especially, with sleep apnea will often seek medical care for insomnia that turns out to be mainly related to sleep apnea. However, people with insomnia and sleep apnea should not expect that their insomnia will clear up with treatment of their sleep apnea alone.

      Reply
  6. ricky woodruff

    Hi.. my name is rick and i had a sleep apnoae test.. i stopped breathing 55 times a hour. My lack of sleep is making my life intolerable.. i fall asleep on couch when i lay down after work andcwithin a minute or 2 wake up and are gasping for air.. at times i am afraid to go too sleep fearing i will have a stroke or something.. this has gone on for many years and i cant remember the last time i had a good sleep.. i feel totally weary in the mornings but late at nights feel wide awake so it makes it harder to go to sleep..i did not want a machine as i know of others who have had them who cant stand to use them and gives them a feeling if intrusion with there partners.. i am due over the next 2 months to have my tonsils removed and cartlidge in the middle of my nose straightened.. i am hoping for success and i know it will be pain but hoping fir plenty of gain. I am 56 years old and my tonsils are very big.. i would like to let you know my experience from start to finish over the next 4 mknths or so and will give you the thumbs up or down as to how it works for me..thank you

    Reply
    • Dr. Kezirian

      Thank you, but this is not a good place to document your entire experience. Please do feel free to share with others, whether on Facebook or some other platform. It will be much easier for others to follow everything about your surgery and recovery there.

      Reply
  7. Craig Smiles

    Hi all, I had my tonsils out on the 10th of July, although not because of the severe sleep apnea I suffer from but for persistent infection. However I have and so has my wife noticed a massive difference regarding sleeping and its only been 12 days. As soon as everything is healed properly i’ll be going back to my doctor to get retested and hopefully get rid of my cpap machine.

    Reply
    • Dr. Kezirian

      Craig, thank you for sharing your experience. I am so glad to hear that you have done well.

      Reply
      • Craig Smiles

        Have an update, I got retested for my sleep apnea about a month ago and it would appear the tonsilectomy worked as I have gone from severe obstructive sleep disorder (rated level 15) to having no trace sleep apnea whatsoever.
        Message to all, there is hope and cures out there you just have to keep pushing the right people to get what you want.

        Reply
      • Craig Smiles

        One other piece of advice, if anybody out there does have their tonsils out whatever you do not eat tomatoes until you are fully healed. I did and I can say is I have never experienced pain like it. Stay well clear.

        Reply
  8. C P

    Going in tomorrow for tonsil removal tomorrow. Sleep ENT wanted to do a UPPP but insurance denied it because no blockage was documented. Need an endoscopy to determine blockage… seems a bit counterintuitive.
    I have moderate apnea and often wake with a headache.
    I am very hopeful that I’ll be able to sleep and have a bit more energy.

    Reply
  9. Mathew

    Hey im 18, not overweight, exercise everyday, and i have mild sleep apnea.
    My tonsils are enlarged and i do have a adneotonsillectomy next week. Do you think it will work?

    Reply
    • Dr. Kezirian

      If they are markedly enlarged, that is certainly going to make it more likely that you would get a successful result. However, it is not possible for me to make blanket statements or give medical advice without examining you myself.

      Reply
  10. Elsie

    I am 20 years old, I have had sleep apnea due to enlarged tonsils for over a year now. I have extreme anxiety and have been postponing the surgery and have finally decided to get it done next month. I am worried sick because I am scared that this is going to kill me while i’m aleeoing and that i should go in for emergency surgery. I snore excessively and wake up by myself sometimes due to not being able to breathe. I would like to know if i’m going to be ok to wait till next month. I know I have waited far too long but now i’m scared that it’s too late. Thank you

    Reply
    • Dr. Kezirian

      It is normal to be scared before surgery. You should obviously be comfortable with the plan for surgery or any other treatment and should have all the opportunities you need to have your questions answered and be on the same page with everyone treating you.

      Reply
  11. Angela Tonkin

    My two year old had her tonsils and adenoids removed 8 days ago. She’s still waking up a lot. How long before her sleep improves?

    Reply
    • Dr. Kezirian

      I do not treat children anymore. This would definitely be a good question to ask her surgeon. I wish your daughter all the best.

      Reply
  12. Kenneth leong

    Hi, i had enlarged tonsils n sleep apnea with very severe ahi of 93.
    Can enquire if having a tonsils removak improves my sleep apnea condition?

    God bless

    Kenneth leong

    Reply
    • Dr. Kezirian

      I am not sure of your question. Having very enlarged tonsils can be a reason for obstructive sleep apnea, including very severe disease. Removing them should help, but only your doctors can tell if this will be the right approach or if anything else should also be done.

      Reply
  13. Jack

    Wow. This is so exciting. My dentist said I had massive tonsils. I have extremely severe sleep apnea, making me sleep all day too (like chronic fatigue syndrome).

    Now I can’t wait to get my tonsils out!! 😀

    Later tonsils! I know life is gonna be better!

    Hope its not too painful or expensive but whatever. Sounds so worth it. I really hope the surgery doesn’t kill me. I just wish they would have cut them out when they cut out my gall bladder…

    Reply
    • Dr. Kezirian

      It will be painful, but the pain typically lasts for about 10 days. However, you will be trading that pain for a good chance (depending on other aspects of your physical exam) or improving substantially or even eliminating your sleep apnea.

      Reply
  14. Barbara Schmidt

    I have extremely severe OSA. I am 60 and overweight. However, I cannot wear my CPAP due to a panic disorder. I’m having my tonsils removed and also having a dental device made. (My surgeon recommends both). I’m not looking forward to surgery, but I am looking forward to some better sleep.

    Reply
  15. Joanne Beckett

    Hi, what about adenoids? I’ve been having some night-time apnoea-type episodes, which are terrifying. I don’t have a diagnosis and I’m being passed round the departments. It isn’t reflux (had all the tests), and respiratory say I should get my throat checked. I inhaled some food in March and I think that might have been when this started. I’m not overweight and I feel there is something quite high up in the back of my throat that obstructs the airway at night. Could this be adenoids even though I am 50? I get a sore throat and lose my voice regularly every Christmas, and I’ve often had inflamed tonsils over the years. I’m also hypothyroid, although it’s managed with medication. I’ll be seeing ENT soon I hope…

    Reply
    • Dr. Kezirian

      Your plan of seeing an ENT/otolaryngologist for an evaluation is a good next step. Adenoid enlargement is not so common in adults, but it definitely is possible. I have performed adenoidectomy in some adults to treat blockage of breathing through the nose as part of treating obstructive sleep apnea.

      Reply
  16. Kirsten

    I had my tonsils and adenoids removed September 20 2018. I am finally on the mend. I had bleeding issues so my surgeon went back in to re cauterize my throat. It made my healing phase longer but after a month I can say it was totally worth it. I have had severe sleep apnea, enlarged tonsils and tonsillitis since I was a teenager. I’m 36 now. It was painful but worth it. I don’t have sleep apnea anymore and I don’t even snore anymore. The only thing is everyone says my voice sounds really different.

    Reply
    • Dr. Kezirian

      I am so glad you are now doing well. Having a noticeable change in your voice is not common at all, as I have not had a patient ever experience this before, aside from going from what many people would call “nasal” speech (because the nose is so blocked) to more-normal and clearer speech. I expect this was related to the need to return to the operating room for bleeding, although even then I would say it is unusual.

      Reply
  17. Michelle

    I am having the worst time sleeping with my mask. I feel like I am suffocating with it on. I may get 2, maybe 3 hours a night. Should I bring up to my Doctor the tonsillectomy?

    Reply
  18. Aron

    Hello to all,

    I’ve had a cpap device for a little close to 3 years now. My level is at a 9. Since using my cpap, i sleep well over 6-8 hours and I still feel restless. Although it’s easy for me to fall asleep, my body can’t seem to wake up on it’s own. I’m constantly having to snooze my alarm because i feel i need more rest. I feel my mask is on right without having to make any adjustments of improper air flow. Without my mask, i snore like no other and catch myself waking up due to it. I still feel restless. I’m 38 years old and I just want to know what it feels like to be rested. I feel there’s no way that i can sleep for those periods of time and yet still feel tired. Now, I want to see if removing my tonsils would make be the next step. Although, I’m no Dr., I do feel they seem enlarge and are very close to my uvula. Looking for some advice on here and want to see if people are having the same issues as i am. Thank you and Happy New Year.

    Reply
    • Dr. Kezirian

      There are definitely patients who wear CPAP but do not do well with it because they are not truly comfortable with it. They can end up waking up often during the night and obviously aware of not being comfortable with the CPAP mask on, but sometimes it is not quite as obvious. As you point out, the first step in considering surgery is determining what kind of surgery would be best for you and whether you would have a relatively high chance of clearing up your sleep apnea with surgery. Because everyone is different, I would recommend seeing someone who focuses in sleep surgery for an evaluation and discussion of your options. Please let me know if you would like to come see me.

      Reply
    • Ashley

      Hi Aron,
      Do you mean to say that your CPAP is not making you feel refreshed?
      I have only recently been using a device since November 2018 A Resmed APAP (I’m based in Australia) and found it amazing. Recurring tonsilitis was the main reason why I decided to have a tonsillectomy and I am recovering now.
      I cannot say that I have big tonsils, but without them already (day 10 post op) it feels like my breathing is clearer and less restricted at all times. I suggest the pain and discomfort was well worth my simple surgery.

      Reply
    • Dr. Kezirian

      Removal is still a surgery that requires recovery, but the recovery should be easier than the implantation procedure.

      Reply
  19. Yasmin Magliocco

    My partner has been on CPAP for a year and a half and on surgery waiting list 2 years. He has obstructive sleep apnea and the largest tonsils his surgeons have seen. Finally got a date for surgery, this Friday, I can’t wait to see if it helps. Before CPAP he had 78 apnea per hour and with CPAP he is down to 5 but the machine depresses him and he hates using it as it leaks and he is still tired every day.

    Reply
  20. Rose

    After suffering with severe CPTSD I was so hyper-aware I could no longer sleep through my snores. Every time I’d start to dose off my snoring would wake me up. After being hospitalized for suicidal ideation because of the snoring issue I was finally put on a CPAP with a nose pillow mask that wraps around the back of my ears. I use that kind because I have horrible pain in my head if anything touches it, including bobby pins! (This from a head injury in 1984) However, it is very hard to sleep even with that mask as it hurts my head behind my ears. I’ve fashioned a fancy doughnut shaped pillow that helps sometimes. I’m very aware of how I snore because I’m so hyper aware of it. It seems that most of my snoring comes from the sides of my throat where my tonsils are. And now that I’ve lost a significant amount of weight I can sleep sitting in a recliner without worry of snoring. However, back when the issue first started in 2016 I saw an ENT who didn’t see that my tonsils were enlarged. I would like to get off of my CPAP so I’m trying a SomnaMed devise but still get awakened by snoring sometimes for reasons unknown (except whenI awake on my back). And I’m concerned with long-term use because I have an overbite and very short grinding teeth, and TMJ issues and I hear the devise can cause repositioning of your jaws. Because this is such an issue ( psychologically and physically) do you think I might qualify to get the surgery even if the tonsils are not enlarged? If you think I might do you have any suggestions on how to approach my doctors about it?

    Reply
    • Dr. Kezirian

      You absolutely could qualify for surgery, including the array of options that goes beyond tonsillectomy. You should discuss the potential benefits of surgery with your sleep medicine team and consider seeing a surgeon (usually would be an otolaryngologist or ENT).

      Reply
  21. Ashley Steward

    Hello,
    I am Ashley. I have had chronic tonsillitis (12 times in the last 2 years) and their enlargement had caused me severe sleep apnoea.
    I have just had a tonsillectomy on 20/2/19.
    There is a lot I would like to share if anyone has questions. One quick observation here that has surprised me was peoples thoughts of the APAP Machine. I love mine but I’m not allowed to use mine until the risk of bleeding goes down (normally after day 10) this was according to the surgeon anyways.
    So my question to the experts Does using an APAP increase the chance of a post tonsillectomy bleed?

    Reply
    • Dr. Kezirian

      I actually love it when my patients can wear APAP or something similar during recovery from sleep apnea surgery. It is usually not possible because patients are havnig surgery often because they are not doing well with APAP or other forms of positive airway pressure therapy. As far as risks of bleeding, I would not think it would raise the risk, but I guess it could theoretically lead to dryness and cracking of the healing area.

      Reply
    • Maegan

      Ashley,
      As I am going to be undergoing a tonsillectomy soon, I am very interested to hear about your experience. Could speak via email?

      Did you have a normal tonsillectomy or an intracapsular tonsillectomy?

      Reply
      • Ashley

        Hi Maegan, Sorry I have not been on this page. Happy to discuss anything you like. How do I contact you? Ashley

        Reply
  22. Maegan

    Hi there. I’ve recently been diagnosed with mild sleep apnea. I have had large tonsils for most of my life but they are finally causing me distress at night. I am scheduled to have them taken out in a couple of months and am very anxious about the surgery. I have heard this can be very painful for adults. My surgeon plans to complete an intracapsular tonsillectomy rather than the traditional tonsillectomy. Have you had luck with this procedure? I worry about infection in the tissue that will be left. Is it rare for the tissue to grow back in adults?

    Also, how do your patients normally rate post-operative pain? While I want to have the surgery as I feel this will help my sleep apnea tremendously, I worry that I am going to go through this pain for nothing.

    Reply
    • Dr. Kezirian

      I do not perform intracapsular tonsillectomy myself, as I remove the tonsils entirely because this seems to have a lower rate of growing back. Tonsillectomy in adults is extremely painful for about 10 days, but you have to weigh risks and benefits of any procedure, trading off this pain for the benefits of the procedure. Good luck.

      Reply
  23. Lotus

    I suffered from sleep apnea until my late thirties. Finally, by the time I was diagnosed, I have developed type 2 diabetes. I have a normal weight. I got on CPAP and it was affecting my ability to camping, travel etc.. I got my tonsils removed in Asia in a private high-end hospital for $2,000 (costs less than what I spent on my CPAPs) and all my sleep apnea is gone. I highly recommended for anyone with enlarged Tonsils. Your life changes with this surgery. I wished my stupid GP would have recommended my tonsils be removed as a kid (because of multiple reoccurring infections each year due to sleep apnea and mouth breathing) like that of my brothers’ GP. They both had their tonsils removed as a kid. I would have not developed diabetes due to sleep apnea if I had the same surgery as a kid.

    Reply
  24. Janet Greenlee

    I have been diagnosed with severe sleep apnea. With the cpap machine my AHI ranges from 20-47. Does this mean the machine is working or is not working. Sorry for this probably dumb question. I used sleeping pills for years to sleep. Now I don’t use sleeping pills but I have never gotten a good night’s sleep with the machine. I am ancient— 73. I wonder if I’m too old to have my tonsils etc out.

    Reply
    • Dr. Kezirian

      The first step is to follow up with your sleep medicine physician. Although the AHI measured by a CPAP machine is not the same as the AHI measured on a sleep study, an AHI of 20-47 from a CPAP machine is not normal. Someone should evaluate why your AHI measured by the CPAP machine is so high, potentially having you obtain an in-laboratory positive airway pressure (PAP) titration study. If it proves impossible to treat your obstructive sleep apnea with PAP, you may consider surgery. The age of 73 is not ancient, as you certainly still have your sense of humor.

      Reply
  25. Jeff

    I appreciate this forum and all the comments about personal surgical success. I have obstructive sleep apnea and considering surgery for a deviated septum and large tonsils. I’m 42, average weight, and the CPAP was not working for me. The comfort of wearing the mask was fine but I felt like it took too long for the small pump to get me a large enough volume of air when I needed a big breath and was suffocating and had to constantly take it off to breath, then put it back on. The technician (I think they work for the Manufacturer of the CPAP) was dismissive and insisted that it works fine. I gave up on it but having a lot issues (like high blood pressure now) and scared the sleep apnea is going to kill me. Need to get this done. I was told I’d be a good surgical candidate but want to be sure I go with someone well versed in this area of surgical options and the various specifics. Dr. Kezirian: You seem to be very knowledgeable but in L.A? I’m in the Midwest. Any experts/surgeons you’d recommend near IL or MI?

    Reply
    • Dr. Kezirian

      I have tremendous respect for sleep technicians and respiratory therapists, as they work for the centers and not for specific manufacturers. I understand your frustration, however, and the issue is that CPAP is not always a simple solution for every patient.

      Please e-mail me directly with your question.

      Reply
  26. Victoria

    I am a 55 year old woman of normal weight. I was diagnosed with moderate sleep apnoea and have since been using a new generation mandibular device. I have responded fairly well and a subsequent sleep test showed an AHI of 11 – mild sleep apnoea. However, I am not keen on the prospect of having to wear the oral device every night forever and certainly would prefer to avoid the CPAP machine. So, I went to see an ENT to investigate surgical options. It turns out I have a floppy soft palate and I have been booked in for a tonsillectomy and palatoplasty. My ENT dutifully went through the associated risks during our consultation and it all seemed reasonable at the time. However, since the consultation, I have received consent forms to sign and those same risks, written on paper, look more worrying! Furthermore, I (foolishly?) did some internet research and came across an abstract that mentioned significant morbidity/mortality rates in patients who underwent a palatoplasty ( the subset who suffered from OSA)! I have booked another consultation with my ENT prior to surgery to address my concerns however, I would love your opinion too. I am a part time jazz singer and my initial worry (based on the consent documentation) was that my voice could remain nasal beyond the healing period. Now I have a more significant concern – based on that pesky abstract – I could choke and die either during the surgery or afterwards! Perhaps I should just be happy with the improvement achieved with the device.
    I plan to ask my doctor for percentages regarding those 2 concerns. I am trying not to think about the pain!

    Reply
    • Dr. Kezirian

      The risks of any surgery do include death, but your surgeon can discuss the risks in more detail. I was fortunate to be involved in a large study looking at serious complications after sleep apnea surgery (it was mainly soft palate surgery at the time), and they were 1-2%, with a risk of death within 30 days after surgery of 0.2% (1 in 500). What is more important than these overall numbers is the fact that the risks were most clearly associated with significant medical problems prior to surgery, such that patients who were reasonably healthy and undergoing sleep apnea surgery had a fairly low risk of these serious complications.

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