Sounds like your wife isn't well read on the topic.

CPAP is life saving treatment for some. Sleep apnea surgeries have poor success rates https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480570/

"oral surgeon"

Doctors specialize for a reason.

"poster on HN"

If you ask a surgeon if your problem should be solved by a surgery in their specialty, you are more likely to get a "yes" than you should. There is definitely a confirmation bias there, tending to see patients for which surgery is necessary instead of a fair sample of those afflicted.

I've witnessed this first hand. After having a sleep study and finding that I have mild OSA my ENT suggested removing my tonsils, uvula, and part of my palate to open up my airway. I told him that sounded like the nuclear option and he seemed somewhat surprised by that conclusion.

He also suggested palate coblation, which seemed more reasonable. I chose to forgo both of those procedures and eventually ended up with a mandibular advancement device from a TMJ specialist, which has made a huge difference.

The problem is that breaking your jaw and moving it forward has its own risks--especially in patients 50+ years of age.

Nerve damage occurs in the vast majority of cases. The older you are, the worse the recovery from that seems to be.

CPAP machines may not work for everybody, but there is a significant set of people for whom they clearly do.

Surgery might work for obstructive sleep apnea, depending on the actual cause, but it will not work at all for people like me who suffer from central sleep apnea. With central sleep apnea the windpipe isn't obstructed, your autonomic-nervous-system just doesn't breathe sometimes.

https://en.wikipedia.org/wiki/Central_sleep_apnea

They are very much not bunk.

They don't work for everyone.

For people (like me) that they work for, the benefit is large, and immediately obvious.

I'm going through this now, luckily without the surgery. I was self-diagnosing on webmd and thought I had fibromyalgia! After much research, and a sleep study, I found myself in the situation your wife describes.

My narrow palate is due to sucking my thumb until I was 9 due to some mental trauma from home fires and moving a lot when I was a kid, changing schools etc. I had braces/headgear until I was 17 and was left with a jaw set too far back. 20 years of growth hormone from working out caused my jaw to grow back into my throat and narrow my airway.

After being dismissed this year by 2 orthodontists who also said I needed orthognathic (jaw) surgery, I began researching on my own and stumbled onto orthotropics and the A.L.F. appliance:

https://www.google.com/search?q=orthotropics&tbm=vid

https://www.google.com/search?q=alf+appliance&tbm=vid

Luckily I found a dentist locally who specializes in this. As an adult, it takes several times longer to move teeth and expand your upper jaw, but it is possible. I'm about 3 months into a 9-18 month treatment and have felt immediate relief. With breathe right strips, I'm back to feeling awake and happy again (I don't know if the strips are as safe as CPAP, especially over the long term though).

I'm also starting myofunctional and osteopathic therapy. It turns out that many problems in the body with posture and breathing start with the teeth/jaw/tongue. Computer geeks are at terribly high risk of these problems due to our sedentary lifestyle. I think Gen X finally reached middle age and is hitting long-predicted health issues like these.

Hope this helps someone.

You don't need surgery to move the jaw forward in order to treat obstructive sleep apnea.

Some dentists (like mine) offer a removable orthotic [0] that you wear during sleep which accomplishes the required jaw movement and improves sleep quality. It's an alternative to treatment with CPAP that doesn't require anything invasive like surgery.

I haven't undergone this particular treatment myself, but I know from wearing other styles of precisely designed orthotics (both removable and semi-permanent) that they can improve the quality of your breathing, and thus improve the quality of your sleep.

[0]: https://somnomed.com/en/

If all you have is a hammer... CPAP machines are the standard treatment, because they are cheap (compared to most other treatments for chronic diseases) and fully effective for most (but not all) patients.

There are few treatments with better cost/effect ratios.

My fiancee is a sleep specialist nurse practitioner and would say the opposite, that most people don't need surgery and a majority of sleep apnea can be resolved with a CPAP.

Also, the barber says you need a haircut.

Moving the jaw forward is highly invasive surgery that is hard to recover from. Another surgery, the "UPPP" is also very invasive and has a much lower success rate than CPAP.

CPAP is by far the best solution for most obstructive sleep apnea patients.

> My wife (oral surgeon) says the only real solution to sleep apnea is surgery. CPAP machines to her and bunk

And this is why she is an oral surgeon and not a sleep specialist.

Doesn't weight loss help many patients improve?

For those that are overweight yes, but not everyone that has sleep apnea is overweight (like me). The apneas are caused by different things in different people and I believe any surgical solution would likewise depend on the person.

It usually helps, but as with most obesity-linked conditions it's not suitable on its own as a first-line treatment. The effect is small compared to CPAP, and sufficient weight loss to see that effect takes months, whereas CPAP starts working literally overnight (DME/insurance shenanigans notwithstanding).

Also, chronic sleep disruption is associated with a cluster of symptoms (impaired insulin sensitivity, lethargy, increased hunger) that make it very difficult to lose weight in a normal/healthy way. Many patients find that they lose 10-20 pounds after starting CPAP with no conscious change in their lifestyle.

OSA can be caused by many factors. Weight is only one. I'm skinny and I'd be dead without CPAP.

Generally yes, because the throat is less constricted when you're not overweight.