Sleep Disorder Therapies
Treatment Options for Obstructive Sleep Apnea
There are different treatment options for obstructive sleep apnea (OSA).
Which option is right for you depends upon the severity of your sleep
apnea (which is determined from a sleep study), the physical structure
of your upper airway, and other aspects of your medical history. The various
options are listed below so that you can discuss them with your doctor.
Only your sleep specialist can tell you which treatment option is best for you.
Continuous Positive Airway Pressure (CPAP)
CPAP works by gently blowing pressurized room air through the airway at
a pressure high enough to keep the throat open. This pressurized air acts
as a "splint." The pressure is set according to the patient's
needs at a level that eliminates the apneas and hypopneas that cause awakenings
and sleep fragmentation. Pressure that is too low will not be as effective
in eliminating the apneas and hypopneas. CPAP is the most effective method
for treating obstructive sleep apnea. Sometimes it takes time to get used
to but any complaints about the comfort of the machine or mask can be
addressed easily. Talk to your sleep specialist about any discomfort you may have.
Sleep apnea can be weight-related. Additional fat around the neck may make
the airway narrower, making obstructions more likely to occur. For some
overweight people, especially those with mild cases, losing weight can
be an effective treatment. Or weight loss may reduce the severity of the
sleep apnea. However, it may be hard to lose weight when you have untreated
sleep apnea: you may be too tired to exercise and you may eat to stay
awake. Also, it may take some time before the weight loss is achieved,
so in light of the potential consequences of untreated OSA, using another
treatment option while working towards the weight loss goal may be an
option. Losing weight may also improve your health in other ways, but
it is always advisable to talk to your doctor before beginning a weight-loss
program. Remember that sleep apnea occurs in thin people as well; the
airway can close during sleep for a number of reasons, not just excess weight.
Oral appliances, sometimes called dental appliances, are intended to treat
apnea by keeping the airway open in one of three ways: by pushing the
lower jaw forward (a mandibular advancement device or MAD), by preventing
the tongue from falling back over the airway (a tongue-retaining device),
or by combining both mechanisms. Oral appliances are typically more effective
for people with mild sleep apnea and for non-obese people but can, for
some, be effective for moderate and severe sleep apnea. The most common
type of oral appliance, a MAD is often adjustable so that the dentist
can move the jaw further or reduce the advancement as necessary. The goal
is to find the most comfortable and effective position for the patient.
On occasion oral appliances may worsen the apnea. Not all dentists have
the necessary knowledge of sleep apnea, so if you wish to pursue this
therapy, ask your sleep doctor to refer you to a dentist who is familiar
with apnea and who works with oral appliances.
The intention of surgery is to create a more open airway so obstructions
are less likely to occur. There are several different surgical procedures
with different effectiveness rates, and surgery can also sometimes worsen
the apnea. In addition, there are also several non-surgical procedures
that can remove excess or obstructive tissue or harden the soft palate
by inserting three small polyester rods.
Appropriate behavioral treatment should be implemented for all patients,
even those requiring additional interventions. These measures include:
- Weight loss
- Reduction of alcohol consumption
- Sleeping laterally (on your side)
- Cessation of smoking
Patients treated with behavioral techniques should be re-evaluated periodically
after initiation of treatment. If they show improvement with these simple
techniques, then continued support and positive reinforcement is extremely
helpful. Other therapies are warranted for those patients who continue
to experience symptoms.
Avoiding Alcohol and Other CNS Depressants
Alcohol and medications that act as central nervous system (CNS) depressants-such
as pain killers, sedatives, and muscle relaxants-can worsen sleep apnea
by relaxing the airway muscles further and/or by reducing the respiratory
drive and causing more apneas to occur. Hence avoiding alcohol and CNS
depressants close to bedtime may be helpful. Ask your doctor or pharmacist
if medications you take prescription or over-the-counter or herbal, affect
your sleep apnea. The prescribed sleep apnea treatment may be adjusted
to take into consideration the use of medications that are CNS depressants.
Discuss with your doctor all of your options to find the one best for you.
Which treatment you use is not important; being treated properly is.