However, many patients find sleeping with a face mask less awkward or uncomfortable than using a CPAP machine. The technical term for these devices is mandibular advancement device, so named because it pushes the mandible forward, which in most people helps keep the airway open. There are many variations of these devices in drug stores, but a dentist can design a more effective personalized device and modify or customize it if necessary. The patients in the laryngoscope study were all re-examined after the initial adjustment, and most of the adjustments required over a period of two to four weeks.
"We recommend a custom device made by a dentist," said Dr. Benjamin. "And you should be retested to see how well it works. There are subjective and objective improvements that should be pursued."
However, there are people for whom neither CPAP nor dental devices work for either because they cannot use them consistently or correctly, or because the devices themselves do not solve the problem, even when used properly. Various effective surgical procedures exist for these patients.
The most common is soft tissue surgery, which involves modifying or removing tissue from the back of the mouth. Depending on the structures and muscles of the mouth, the surgeon may trim the soft palate and uvula, remove the tonsils, shrink tissue with a heated instrument, straighten a deflected septum, or change the position of the tongue muscles, all with the aim of improving the Airflow.
There are also bone surgeries that move the jaw forward to increase the total breathing space, a procedure that can involve a lengthy recovery period.
In 2014, the Food and Drug Administration approved a device called the Inspire Upper Airway Stimulation. This is a small device that is implanted under the skin like a pacemaker. Using two electrical wires, it detects the breathing pattern and stimulates the nerve that controls the tongue to move it out of the way and allow air to flow freely. The implantation is a daily operation that takes about two hours.
"It doesn't change the anatomy and recovery is easier than with other surgeries," said Dr. Maria V. Suurna, an associate professor of ear, nose and throat medicine at Weill Cornell Medicine who specializes in sleep apnea surgery. "It's effective. It has the lowest complication rate of any surgery.