Up until the early 1980’s, the medical community often considered most sleep disordered breathing (SDB) conditions to be neurological in nature (i.e., related to brain function and the nervous system.)  The introduction of modern diagnostic techniques showed that the vast majority of SDB cases were as a result of a physical problem, related directly to constriction of the airway.

In the past 30 years a variety of treatments have been developed to alleviate constrictions of the airway.   In general terms, the professional treatments fall into three main categories, namely:

• Surgical intervention (involving the removal or reduction of the soft tissue in the tongue, palate, uvula and/or pharynx) ;
• Airway pressurising systems (which inflate the airway to hold it open.  Airway pressurising systems such as CPAP or 'constant positive airway pressure', do not 'breathe' for the patient.  They merely act as an air splint to keep the pharyngeal walls apart) ;  and,
• Oral Appliance Therapy (involving specialised dental devices which sit inside the mouth to hold the jaw, tongue and connected soft tissues clear of the airway).

In all cases, behaviour modification (such as weight loss, reduction of alcohol consumption, changed sleeping posture and cessation of smoking) may be necessary in order to achieve the best possible results. 

Surgical procedures are sometimes an unavoidable necessity (for example, in cases where the patient suffers from a ‘crowded airway’, caused by enlarged adenoids or tonsils, or where there is chronic nasal obstruction.)  Apart from these and similar situations, surgical intervention should be considered a ‘last resort’, not only because of the risks, expense and pain often associated with surgical procedures but also because this is in line with current medical ethical standards. 

Most medical associations promote principles and ethical guidelines which emphasise, among other things, that no surgery must be performed unless it is necessary.  The American College of Surgeons and The Royal College of Physicians and Surgeons express the idea most strongly in their policy statements, which state:   “Unnecessary surgery is condemned”.     

Dr. George Lewkovitz of the Centre for Snoring and Sleep Disorders in Sydney, Australia, emphasises that surgery may sometimes be an unavoidable requirement, but goes on to say:

“Surgery should rarely be the 'first option' taken in choosing a form of treatment.  Surgery has a place in the treatment of both simple snoring and sleep apnoea (but) any treatment programme for a medical disorder should commence with non surgical treatments except in the uncommon disorders where a surgical intervention can offer the high probability of a cure of the disorder.  Examples of this are found in the younger patient who may have very large tonsils or nasal blockage.  In surch cases, surgical correction may be the first line of treatment."    (Note:  Dr Lewkovitz also points out that an oral appliance may be a necessary part of follow up treatment for a surgery patient:  "In some patients with a combination of large tonsils and an under-developed jaw, there may be a case for the use of a dental appliance in the follow-up care should any snoring remain."  )

Since unnecessary surgery is generally considered to be unethical, every attempt must be made to alleviate an ailment first with non-surgical treatments.  Only if the condition cannot be treated effectively with non-surgical treatments, or if the non-surgical treatments prove to be ineffective can the surgical options then be deemed ‘necessary’.

That said, the full range of (known) surgical procedures are described on this site so that SDB sufferers can be aware of the complete range of treatments available to them.

For information on how the non-surgical treatment provided at The Sleep Therapy Clinic can help, click here.

For information on the surgical procedures which are commonly used to treat sleep disordered breathing, click here.

For information on CPAP (constant positive airway pressure), click here.

For information on oral appliance therapy, click here.

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