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Sleep apnea is a common breathing disorder in which your breathing temporarily stops, becomes shallow, or pauses at some point during sleep.
If you experience sleep apnea, there are several treatment options available, depending on which symptoms you have, how long the symptoms have occured, and any other health problems you may be experiencing. After conducting a few tests, a sleep specialist can determine which treatment is best. At times, more than one treatment option may be appropriate.
We cover how sleep apnea is usually diagnosed and the variety of treatment options available.
Diagnosing Sleep Apnea
Sleep apnea is usually diagnosed after your doctor checks your family history, reviews your personal medical history, conducts a physical exam, and then performs a sleep study. Your doctor will likely ask questions about your current symptoms to see if you meet the criteria for having sleep apnea.
Some symptoms that people with sleep apnea often experience include:
- Snoring, gasping for air, or choking
- Morning headaches
- Feeling sleepy during the daytime
- Difficulty falling asleep or staying asleep
After discussing your symptoms, a physical exam is usually performed. The goal of the physical exam is to check for physical attributes that can contribute to sleep apnea.
Types of Sleep Apnea
There are two different types of sleep apnea, obstructive sleep apnea (OSA) and central sleep apnea (CSA). Obstructive sleep apnea is more common than central sleep apnea. The recommended treatment depends on the type of sleep apnea.
CPAP and Other Sleep Apnea Machines
The most common treatment for obstructive sleep apnea is positive airway pressure (PAP) treatment. Because sleep apnea is marked by reduction or pauses in breathing, PAP treatment is designed to increase airflow without interruption. The aim of this kind of treatment is to improve your sleep at night, increase oxygen levels, and help you feel less sleepy during the day. The two main types of PAP devices are continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP or BPAP), though there are other types of sleep apnea machines available.
CPAP treatment involves sending a constant stream of air into a sleeper’s airway to keep it from collapsing. CPAP is considered the gold standard treatment for people with OSA because it’s simple and well-studied. While it works best for people who have moderate or severe OSA, it can also be helpful for mild cases. For efficacy, it’s recommended that you use your CPAP device for at least four hours each night for a minimum of five nights each week.
When using a CPAP machine, you wear a mask that fits over your nose and/or mouth and is secured with a strap. A hose connects the mask to the CPAP machine. The machine collects, filters, and pressurizes air from the room before sending it through the hose and into your airway.
CPAP works by setting and then maintaining a fixed, constant pressure that is needed to keep the airway open when you breathe. Your doctor will determine the pressure that works best for you and set your machine at that level.
CPAP therapy is effective and works well for most people, but it’s not the best option for everyone. The main reasons someone might not stick with CPAP treatment include feeling claustrophobic, not seeing the benefits of CPAP, or the machine interrupting a bed partner’s sleep.
BiPAP differs from CPAP in that a different pressure is set for when you breathe in and when you breathe out. BiPAP therapy is more complex than CPAP therapy, and it’s usually not the first treatment option recommended by doctors.
Because air pressure with a BiPAP device is lower during exhale, it might be helpful for people who struggle breathing out against the amount of pressure from a CPAP device.
Whether BiPAP therapy is right for you usually depends on what treatments you have tried before and whether or not they worked for you. If you meet the following criteria, you may be a good fit for BiPAP treatment.
- Breathing on your own is difficult for you
- You are currently taking narcotics or other medications that can affect your nervous system
- You tend to have issues with shallow breathing
- You can’t tolerate the fixed, constant pressure of CPAP
Experts do not recommend BiPAP therapy for people who have central sleep apnea (CSA) associated with heart failure, or those who need emergency treatment for CSA.
Auto-adjusting technology can be added to either CPAP or BiPAP to allow for different pressure levels throughout the night. This technology automatically adapts to your breathing patterns and sets a pressure that is most suitable.
Auto-adjusting positive airway pressure (APAP or auto-CPAP) is more flexible when it comes to adapting to lifestyle changes. For example, if your sleep apnea gets worse because of changes to weight, sleeping position, or alcohol consumption at night, the pressure settings of an APAP machine adjust automatically to help you sleep better. However, a potential downside of APAP is that because the pressure may change a few times while you sleep, it can wake you up.
A variety of factors may determine if APAP treatment is right for you:
- Having moderate or severe OSA without any other respiratory problems
- Having mild OSA and not tolerating CPAP
- Highly variable breathing when you sleep in different positions or have allergies
Expiratory positive airway pressure (EPAP) treatment involves valves placed in the nostrils before sleep that use a person’s natural breathing to create air pressure that keeps the airway open. It’s a relatively new treatment option, but might be a good fit for people who haven’t had success with CPAP or who don’t want to try CPAP.
In clinical trials, EPAP has been shown to be very effective, and some studies show that it can work as well as CPAP. EPAP also has a fairly high adherence rate — meaning people stick with the treatment over time — while adherence is sometimes a challenge with CPAP. That said, because EPAP is relatively new, more research is needed to compare effectiveness between EPAP and other treatment options.
Adaptive servo-ventilation (ASV) is an advanced therapy that is generally intended for people with CSA or a combination of OSA and CSA. Rather than delivering air pressure at a constant level like CPAP, ASV provides air pressure levels that constantly adapt to a sleeper’s needs. It is often the next line of defense if CPAP doesn’t work, especially for those who have CSA.
If you meet the criteria for using ASV, experts recommend having an evaluation and trial done at a sleep laboratory. It’s worth noting that ASV is not recommended for people who have both CSA and more advanced heart failure.
Other Sleep Apnea Treatments
There are other types of sleep apnea treatments available if PAP therapy isn’t a good option for you. Options for treatment include surgery, devices to help stabilize your jaw and mouth, and using medication. How effective these treatment options may be depends on the severity of your sleep apnea.
Oral appliances are devices that resemble mouth guards, and they help stabilize airway structures like the jaw, mouth, and soft palate. They can be customized in a way that helps you to address specific symptoms, such as snoring or difficulty breathing. While PAP therapy tends to be more effective than an oral appliance, some find oral appliances more comfortable and people tend to use them longer and more often. That said, an oral appliance is only a good fit for those with mild to moderate sleep apnea.
Depending on how severe your sleep apnea symptoms are, surgery can also be an option. It is usually offered if PAP therapy and oral appliances don’t work after trying them for about three months or more. Surgery works best for people who have severe OSA that is caused by some type of airway structure that interferes with breathing. A common type of this surgery is the Inspire treatment. There are a couple of specific scenarios where surgery might be a good fit:
- Tonsils or adenoids are too large
- Atypical formation of the bones that make up the face and skull
Certain medications for sleep apnea are currently being studied. Medications might focus on increasing respiratory drive or keeping airways from collapsing, with the ultimate goal of increasing your ability to breathe on your own. As of now, experts can’t recommend any medication that could replace PAP therapy.
Lifestyle Approaches to Managing Sleep Apnea
There are a variety of lifestyle changes you might consider to reduce your sleep apnea symptoms, including exercise, changing sleep position, and avoiding certain substances. These steps can be helpful on top of PAP treatment, too.
- Exercise regularly: Your doctor may recommend exercise and weight loss. Losing excess weight can help improve blood pressure, make you less sleepy during the day, and reduce your risk of developing diabetes and heart disease.
- Sleep on your side: Studies have shown that sleeping on your back can make sleep apnea symptoms worse. Sleeping on your side is recommended to help improve symptoms.
- Avoid alcohol: Alcohol can exacerbate sleep apnea by potentially contributing to weight gain, making you sleepier than normal, and worsening airway obstruction.
- Quit smoking: Smoking can cause irritation and swelling of the airway, which can contribute to difficulty breathing.
- Avoid certain medications: Some medications can worsen sleep apnea, directly or indirectly. Benzodiazepines, for example, should generally be avoided if you have untreated sleep apnea. Make sure you check with your doctor first before starting or stopping any medications.
Risks of Untreated Sleep Apnea
Experts have reported that untreated sleep apnea may lead to some health complications over time.
- Accidents: People with OSA are up to three times more likely to be involved in motor vehicle accidents.
- Heart problems: In people with moderate or severe OSA, there is an increased risk for heart failure, stroke, and irregular heartbeats.
- Type 2 diabetes: In one study, people with severe OSA showed a 30% increased risk of developing type 2 diabetes.
Selecting the Right Treatment for You
After being diagnosed with sleep apnea, your doctor will help you determine the best treatment approach. Treatment will vary based on other medical concerns you may have, what you are able to tolerate, your lifestyle, and other factors.
The goal is to choose the right treatment based on what works best for you and what you will continue to use long enough to see your symptoms improve or completely resolve.
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