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Obstructive Sleep Apnea

by , last modified on 4/14/21.

If you are already familiar with obstructive sleep apnea (OSA), skip down to treatment.


Obstructive Sleep Apnea (OSA) is a serious medical condition where one's own throat and nasal tissues collapse to the point where air movement is very nearly or completely obstructed (ie, your own body is choking you). OSA not only prevents you from having a good night's rest and ability to stay awake during the daytime, but it also increases the risk of heart attack, stroke, hypertension, and even death. OSA affects patients of all different ages from infants to adults. Read more OSA risks here.

OSA may be suspected in a person if you have one or more of the following symptoms (Watch Video):

  • Severe snoring (there are procedures to address this specifically)
  • Feeling tired during the daytime
  • Morning headaches
  • Restless sleep
  • Waking up repeatedly throughout the night
  • Loved ones note that you literally stop breathing repeatedly throughout the night
  • Sore throat in the mornings

In order to determine whether you have OSA or not, a sleep study is required (video of a sleep study shown below). If you snore, but do not have many of the other symptoms, but still have concerns, it may be worthwhile to get a device like the Go2Sleep Smart Ring, Wrist Pulse Ox, or Finger Pulse Ox that can continuously measure oxygen levels and heart rate while you sleep. These devices sync with a smartphone where the data is downloaded and analyzed (More info). Should consistent abnormalities be found over time, then it would be warranted to get a formal sleep study done.

Wellue Ring Pulse Ox Finger Pulse Ox Wrist Pulse Ox Go2Sleep Sleep Ring

Once a sleep study documents that you have OSA, treatment is mandated given the various serious medical conditions it can cause adversely affecting your overall health.

In children, the treatment for OSA is always removal of the tonsils & adenoids first (standard of care). That said, for mild OSA, it is not unreasonable to try a 2 month course of steroid nasal sprays and singulair [more info]. Keep in mind that although a sleep study is required to diagnose obstructive sleep apnea, for children older than 3 years old, a sleep study is not required if there is a good clinical history suggestive of sleep apnea. For those under 2 years old, a sleep study must document obstructive sleep apnea prior to surgical consideration.

In adults, the treatment protocol is a bit more complicated. Treatment for OSA in adults is geared towards keeping the airway open by:

  • Forcing air into you via face mask (ie, CPAP or BiPAP machines). This treatment is considered the gold-standard.
  • Making the airway larger preventing collapse via surgery (see the list of surgeries below)
  • Oral appliance obtained through your dentist (medical grade) or over-the-counter (which forces your tongue and jaw forward preventing collapse)
  • Losing weight is also very helpful as fat deposits occur in the throat and tongue which does narrow and increase the risk of collapse.
  • Making sure you are not hypothyroid

The key thing to remember regarding surgical options for OSA is that multiple surgical procedures may be required to thoroughly address obstruction at different levels of the airway (nose, oral cavity, and tongue/throat). Why? The best analogy to use is a pipe through which water flows. Imagine this pipe has 3 clogs in it. Improving water flow will not occur until ALL THREE clogs are removed. The three clogs in a human contributing to OSA include nasal factors, oral cavity factors, and tongue collapse against the back of the throat. Each individual may have one or all 3 contributing to the OSA and it is up to the ENT to determine where the clogs are and discuss the chances of improvement if not cure with various surgical procedures. In the properly selected patient, significant improvement if not OSA cure will occur (ie, not all patients are candidates for surgical treatment). Sometimes, sleep endoscopy will be recommended in order to determine the levels that require correction.

Airway Level
Surgery to Correct
Non-Surgical Products That May Help
Nasal Level
Oral Cavity Level
Tongue Level
ALL Levels  

Indeed, studies suggest that the most common airway obstruction (ignoring nasal level) was mixed involving the soft palate and tongue base (40-60%), followed by soft palate alone (34%), and tongue base alone (22.5%) [Link #1] [Link #2]. Of note, our office performs all the listed procedures EXCEPT for pharyngoplasties, GA, GHA, and MMA. Check out our online store on over-the-counter snore products here that may help.

For more information, Dr. Kasey Li in Palo Alto, CA has a good website going over various sleep apnea surgical options.

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Financial Considerations

ONLY in adults, in order for insurance to pay for any type of OSA surgical procedure(s) involving the oral cavity and tongue/throat level, a strict protocol must be followed. These steps have been set by some (but not all) health insurance plans. The steps to follow are as follows.

  • Sleep Study (required by all)
  • CPAP Use for at least 3 months (required by all)
  • Letter from pulmonologist documenting (required by some):
    • Failure of CPAP use and reasonable intervention to try and allow for CPAP tolerance
  • Use of an oral appliance/dental device tried and failed if applicable (required by some)
  • Letter from your primary care doctor documenting the following (required by some):
    • Documentation of height and weight over time.
    • Documentation to support that weight loss has been tried and failed if applicable.

IF everything above has been accomplished and AHI score is >10, only than are surgical options considered. Most insurances require at least the sleep study and 3 months of CPAP trial. An increasing number are now requiring the other steps to also be obtained.

The only surgical procedures that can be performed without going through these steps are surgeries to address nasal obstruction (nasal level).

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Commonwealth Sleep Center (Gainesville, VA), Nova Sleep Center (Warrenton, VA), 1st Class Sleep Center (Gainesville, VA), and Fauquier Health Sleep Center (Warrenton, VA) performs sleep studies in our area. The video below was done at the Commonwealth Sleep Center in Gainesville, VA. If you are unable to view video, click here.

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