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Sleep Apnea Surgery Failure in Many Cases
Throat collapse in sleep apnea is not a simple obstruction but instead, a vacuum collapse: much like "sucking on a balloon".
If you grasp a balloon at one point between your thumbs and fingers on two sides and pull it apart to try to keep it open at that point, and then suck on the balloon again, what happens? It sucks shut at another level. In fact, in some patients, the side walls of the throat were even found to suck inward and "slam together" in the midline--and one can't surgically remove the side walls of the throat!
In contrast, positive airway pressure (PAP) tends to be much more reliably effective at eliminating throat collapse, since it is a more logical and direct approach to the basic problem. PAP can usually blow the entire upper airway open, irrespective of the level at which it had been collapsing.
Many people suck the base of their tongue down into the airway like a cork being sucked into a vacuum bottle, even if their soft palate has been trimmed.
In sleep apnea, one is dealing not just with structure but with function of the airway.
Some patients with obstructive sleep apnea demonstrate reasonably normal appearing throats but appear unable to coordinate their throat muscles during sleep.
Also, people with sleep apnea have been found to have abnormal floppiness of the throat muscles that normally should pull their throat open as they breathe during sleep.
Intermittent swelling of the airway-especially the nasal passages-can contribute to sleep apnea.
Even if one makes a nose structurally normal by surgery, that nose still can swell shut, particularly if the person has allergies that he or she may not even recognize--particularly if the problem is present year-around rather than occurring just during certain times of the year.
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