A doctor I spoke to last night argued that severe sleep apnea should be treated more often with a tracheostomy. A tracheostomy is a surgical procedure to create an opening through the neck into the trachea (windpipe). A tube is usually placed through this opening to provide an airway into the upper trachea. This tube is called a tracheostomy tube or trach tube. This airway bypasses the entire upper airway and therefore is 100% successful in curing sleep apnea.
For those who get a tracheostomy for sleep apnea, the tube is capped during the day and breathing and speaking continues as normal. Before going to sleep, one removes the plug, and air is inhaled through the tube in the neck, not through the mouth or nose.
Obviously, this is a drastic procedure that would give anyone pause. That said, so are surgical procedures like maxillomandibular advancement. Furthermore, a tracheostomy is 100% effective in treating sleep apnea -- the AHI will zero out. It is a sleep apnea cure. Maxillomandibular advancement has a significantly lower success rate, and is often considered a success even if it does not "cure" sleep apnea (i.e., if it just reduces the AHI substantially).
Again, I'll stick to CPAP because I'm finding it effective and because turtle necks aren't a good look for me. But for those who have tried and failed with CPAP and everything else, and who have severe sleep apnea, you might want to consider a tracheostomy. Right now, it's not even presented to patients as an option. It should be.