I have been diagnosed with severe obstructed sleep apnea and told that I need UPPP surgery. Can you tell me about it and how long and painful the recovery is? Thank you.

Jennifer

Obstructive sleep apnea is a condition in which your airway becomes physically blocked during sleep. You struggle to take a breath, and usually you have to wake up to overcome the obstruction. Patients with severe obstructive sleep apnea may repeat this process every minute of their sleep -- sometimes waking 100 or more times each hour!

CPAP (continuous positive airway pressure) is the undisputed treatment of choice for obstructive sleep apnea (OSA). CPAP is a device that blows air up your nose while you sleep. This "air cushion" holds your airway open so that it cannot collapse. CPAP is 100 percent effective: As long as you use the device, you will not have OSA. Only hitch: Can you tolerate the device? Roughly half of the people who use CPAP ultimately give it up because they simply can't stand it.

Nevertheless, it is important to emphasize that CPAP should ALWAYS be tried before resorting to surgery. Unlike CPAP, the surgical "fixes" for OSA do NOT have a 100 percent success rate and are NOT risk-free. (In the best published studies on UPPP, the success rates are around 85 percent.)

What type of operation do you really need? It all depends on what structure (or structures) are obstructing your airway during sleep. If it's your soft palate (the roof of the mouth) and uvula (that little punching bag in the back of the mouth) that are "falling backwards," blocking your airway, then UPPP (uvulopalatopharyngoplasty) is worth considering. If you still have your tonsils, we usually remove them at the same time we perform the UPPP. Tonsils can be obstructive. By removing the tonsils, the surgeon (1) gets rid of one obstruction and (2) has the opportunity to "tighten up" the throat when he/she sutures the wounds created by the tonsillectomy. This can greatly improve the caliber of the airway.

The tongue can also "fall backwards" during sleep, causing an obstructed airway. There are a variety of "tongue advancement" operations. Some individuals have obstruction from the tongue AND soft palate/uvula; if only one problem is dealt with, the results of surgery will usually be very disappointing.

To determine what type of operation(s) you need, your doctor must first evaluate your airway to see where you are obstructing. This usually includes an endoscopic examination of the patient's airway while the patient is supine (lying down). During this examination, your doctor might ask you to "imitate a snore" or perhaps "try to take a breath with your nose pinched and your mouth tightly closed." These maneuvers will sometimes reveal the primary source of airway obstruction. In addition to endoscopy, some doctors obtain special skull and neck X-rays to evaluate the airway more objectively.

Needless to say, if CPAP has not been offered to you, or if your airway has not been appropriately evaluated ("just say AH" is NOT a good enough examination), then the decision to undergo UPPP is premature.

But let's assume you've tried CPAP, hated it and are now interested in surgical options. Further, let's assume your ENT has thoroughly examined your airway and has decided that UPPP is the right procedure for you. NOW I'll answer your question.

In a UPPP, the surgeon will trim off the lower part of the soft palate, including the uvula. If you still have tonsils, the surgeon will remove them at this time. He/she will then place sutures to bring the raw tissue edges together. You will have an upside-down "U" of stitches in the back of your throat. Depending on whether you needed a tonsillectomy, the operation may take about an hour, more or less.

I usually keep my patients overnight in the intensive care unit after this operation. After all, such patients have poor nocturnal airways to begin with, and the post-operative swelling that inevitably occurs could worsen their airway problems. The results are potentially catastrophic. If the patient does well that first night, is eating and drinking well and does not require an excessive amount of pain medication, then he or she can usually be sent home the following day. Pain and poor liquid intake are two common reasons that I would keep someone in the hospital a bit longer.

How painful is it, and how long is the recovery? This is a tough thing to predict. I am constantly surprised by my patients' reactions to this operation. On one occasion I may remove just a thin strip of soft palate along with the uvula, and the patient will need strong pain medications for two or three weeks; on another occasion, I may have to remove the tonsils along with a very fat strip of soft palate (including the uvula), and the patient will refuse pain medications after three days! When I am asked this question, I usually err on the side of making the procedure sound worse than it is. "You are going to have a VERY sore throat, the worst sore throat of your life, for at least 10 days to two weeks. It will probably be one month before you feel close to normal."

You can figure on taking two weeks off from work, and you will probably want to take it easy for the first month. That means no rigorous exercise or athletics, get plenty of sleep, avoid foods that have hard edges and are hot or spicy, and limit sexual activity wisely.