OSA Treatment Options
The figure at the below shows the value of several treatment options. Darker means more valuable.
|Snoring||Mild Sleep Apnea||Moderate or Severe Sleep Apnea|
About 70 percent of people with obstructive sleep apnea are overweight or obese. Their health care professionals usually encourage them to lose weight.
Surprisingly, there have been few formal studies of how effectively weight loss leads to lesser, lighter snoring and diminished incidents of apnea and hypopnea during sleep. Despite this, anecdotally practitioners report striking improvements in both OSA and snoring among patients who lose weight.
In some situations a physician may wish to prescribe weight loss medications to an overweight or obese patient with OSA.1
Nasal decongestants are more likely to be effective in cases of snoring or mild sleep apnea. In some cases, surgery is an effective way to improve airflow through the nose.
Some people snore or have sleep apnea only when sleeping on their back. Such people can eliminate or reduce airway blockage simply by learning to sleep on their side.
The traditional technique to induce side-sleeping is dropping a tennis ball in a sock and then pinning the sock to the back of the pajama top. There are also a couple of companies that make a products designed to discourage supine sleeping. Visit the Online Directory of Products and Services for additional infomation.
Positional therapy generally works only in mild cases of OSA. In more severe cases, the airway collapses no matter what position the patient assumes.
Surgery is often effective in treating snoring. It is less effective in treating obstructive sleep apnea.
The challenge that confronts the surgeon is determining what part of the upper airway is causing the obstruction to airflow. There are many possible sites, and conventional sleep testing does not identify the area the surgeon should modify. If the surgeon does not treat that site in the airway, or if there are multiple sites of obstruction, it is unlikely that the sleep apnea will diminish to a degree that eliminates the need for other treatment.
Given the several sites where airway obstruction may exist, there are several types of operations currently used to treat sleep apnea. The most common is uvulopalatopharyngoplasty, or UPPP. The success rate of this operation is about 50 percent. Some surgeons have achieved very high success rates using multiple, staged operations.2 Nonetheless, most authorities recommend routine re-assessment for sleep apnea after surgery. See the caution below. There's more about surgery here.
Most children with snoring or sleep apnea have enlarged tonsils, or adenoids, or both. In 75 percent of those cases, surgical removal of these tissues cures sleep breathing problems.
The American Academy of Pediatrics has endorsed removal of the tonsils and adenoids as the initial treatment of choice for sleep breathing problems in children. There is more information children's sleep apnea and its treatment here.
Oral appliances look like the mouth guards worn by football players. The oral appliances for treating sleep apnea and snoring are specially designed for that purpose.
The appliance is worn in the mouth during sleep. Most appliances work by positioning the lower jaw slightly forward of its usual rest position. This small change is, in many people, enough to keep the airway open during sleep.
You can simulate the effect of an oral appliance with a simple experiment. If you make a snoring sound right now and, in the middle of it, thrust your jaw forward, you will see that the snoring sound stops.
The American Academy of Sleep Medicine has endorsed oral appliance therapy for selected patients with sleep apnea.
Many authorities recommend routine assessment for sleep apnea after oral appliance therapy has been applied. See the caution below. More information is available here.
Positive Airway Pressure Devices
Positive airway pressure machines, used with a variety of breathing masks, are the most widely used treatment for moderate and severe sleep apnea. They have been endorsed by the American Academy of Sleep Medicine.
The mask, worn snugly over the nose, or sometimes nose and mouth, during sleep, supplies pressurized air that flows continuously or intermittently into the sleeper's throat. The increased air pressure prevents the sleeper's airway from collapsing.
The pressurized air is supplied through a flexible tube from one of several types of machines: CPAP (continuous positive airway pressure), BiPAP (bilevel positive airway pressure), VPAP (variable positive airway pressure), and so on. Studies of the effect of PAP therapy show that OSA patients who consistently use their machines feel better and, as a result of the reduction of apnea and hypopnea episodes during sleep, encounter fewer complications of the disease. There's more information about PAP therapy here.
A variant on the PAP device is Provent. Operating on the same principal of keeping the lungs full and the upper airway open, this therapy does not require electricity to operate or the use of a humidifier.
Although PAP devices are not used to treat snoring alone, they do eliminate snoring in addition to treating obstructive sleep apnea.
Abstinence from alcohol before bedtime is an important part of treating sleep apnea.
In one study, several persons who received cardiac pacemakers were reported to have shown an improvement in their sleep apnea. No major organizations have endorsed this type of treatment, however. Further studies are underway.
Alternative healing methods are also in use. There is some evidence that playing the didgeridoo or other wind instruments may help in managing OSA. In Brazil, acupuncture researchers who are physicians report positive results in treating OSA with acupuncture.
Snoring, and certain details of snoring, can be a valuable early-warning alarm that sleep apnea is present. Treating snoring can remove this warning system. Just as seeing smoke is a warning that a fire may be burning, hearing snoring is a warning that sleep apnea may be present. And just as smokeless fires may be discovered late, with unfortunate consequences, so too may snore-free sleep apnea. Thus, when surgery or oral appliances are used to treat snoring, it is important to check for sleep apnea on a regular basis afterwards.
Anesthesia and Pain Medicine
The presence of sleep apnea presents special challenges to the administration of anesthesia and pain medications that may affect respiration or relax muscles. Since most people who have sleep apnea don't know it, the anesthesiologist or pain clinician is well advised to screen the patient for OSA before proceeding. Should it be determined there is a likelihood that OSA is present, the next move is to order a sleep study to make sure or, at a minimum, to take the precautionary steps that should be taken with a patient whose sleep apnea has been diagnosed. These procedures are laid out in greater detail here. See also this article from two Mayo Clinic physicians
This summary of obstructive sleep apnea treatments is adapted from an article written by John Sotos, M.D., a member of the American Sleep Apnea Association's board of directors, and appears here by permission. The original may be viewed at http://apneos.com/treatable.html. Obstructive sleep apnea and snoring respond to several types of treatment.
2 Riley, R.W., et al., “Surgical therapy for obstructive sleep apnea-hypopnea syndrome.” Chapter 77 in: Principles and Practice of Sleep Medicine. 3rd ed. Kryger, M.H., et al. (eds.) Philadelphia: WB Saunders, 2000.