[bobthepanda]

At least in the US my understanding is insurers don't generally support BiPAP because it's more expensive. Surgery costs more, has extended recovery time, is more risky, and is less effective at the broader population level; if it works, it may not work forever. For a lot of people, CPAP is good enough, and so it's currently the standard.

[elric]

BiPAP is only more expensive for artificial reasons. It's the same hardware just with a different algorithm. CPAP machines are around €/$500, BiPAP can be more than twice as much. But if you take into account that they last 5-10 years, and that my local hospital charges my insurance €90/month for leasing a CPAP device, it quickly becomes apparent how much of a cash grab that is.

Patient care should be at the top of the list, especially for something as important as sleep. But saving a few bucks in the short term seems to be more important. But people with improperly treated sleep apnea still suffer many of the same effects of people who aren't treated at all.

[bobthepanda]

For BiPAP i could buy that.

For surgery, it turns out there are higher rates of it being the improper treatment and partial or full failure, and you still might need CPAP anyways. And that’s on top of the fairly standard and obvious preference for non invasive treatments in general.

I will say a fairly non invasive surgery that is much easier to consider is fixing a deviated septum; it probably won’t fix your apnea, but it being deviated is probably not helping.

[elric]

I share your concerns about surgery. The way I understand it, the difficulty lies in choosing the right surgery (or surgeries) for the right patient. The supposed gold-standard diagnostic approach is a drug induced sleep endoscopy, where an ENT looks at your airway while you sleep. The problem is that being sedated is not the same as being asleep. It's possible to do this "right", but that is much more time consuming than just shooting people up with propofol and scoping them while they're knocked out.

One thing to keep in mind is that surgery might still be useful even if it doesn't get you off CPAP: being able to use lower CPAP pressures could increase comfort and adherence.

I've been putting off my own septoplasty because it all sounds extremely unpleasant, so yeah.

[bobthepanda]

IME septoplasty was bad for like a week (constantly nosebleeding more than I’ve ever done in my life) but in the grand scheme of surgery its a fairly low pain, fast recovery, at least compared to other ones I’ve done like ACL construction.

The ones they generally don’t recommend in the US are those that involve airway or jaw modification; they have fairly low success rates, you’ll have trouble eating for months, and they can come with a whole host of nasty side effects like permanent uncontrolled nasal drip. Plus, in general US medicine tries not to recommend major surgeries if alternatives are good enough or better, not only to reduce cost and recovery, complications etc, but also because general anesthesia itself is risky.