Once a diagnosis is made, treatment options depend on what is found to be the cause of the blockage, as well as the severity of the sleep apnea. Lifestyle changes, such as losing weight and treating allergies, positional changes during sleep (trying to sleep on your side) are important considerations. Other treatment options include wearing a dental appliance and surgery. Most doctors use CPAP (continuous positive airway pressure) treatment before surgery. CPAP has a high rate of success when tolerated. The machine delivers a constant pressurized stream of air through a face mask worn while you sleep. The long-term results of CPAP include improved quality of sleep and fewer disruptions in breathing.
Sleep apnea may be treated with either surgical or non-surgical techniques, depending on the underlying cause of the problem and the preference of the patient. Some patients find relief with simple behavioral changes. Other patients may need to turn to surgical procedures to find restful sleep.
The process of finding an effective treatment for sleep apnea usually begins with the least invasive, non-surgical options. For some sufferers, simply changing the position in which they sleep can bring marked improvement. Because excess weight can be a risk factor for sleep apnea, patients who are overweight may be encouraged to lose weight to see if their condition improves as a result.
If conservative treatments are not effective, the next step is often the use of a positive airway pressure machine. Positive airway pressure (CPAP or BiPAP) therapy is usually the primary treatment in the management of sleep apnea. In PAP, pressurized air is delivered by a face mask which is worn during sleep. The pressure of the air is adjusted in order to maintain adequate pressure to overcome airway obstruction. In this way, most airway closure episodes are eliminated. Many patients find that while wearing this device, they experience a much improved sleep pattern with an overall better night’s sleep. Some patients find, however, that the CPAP device is cumbersome and difficult to use. For those who tolerate PAP, it is very effective. CPAP should be used every night. Self-titrating PAP (AutoPAP) adjusts the air pressure throughout the night to deliver just enough pressure to keep your airway open. Many people find this type of PAP the easiest to tolerate.
CPAP machines are very effective in producing healthier sleep patterns and decreasing the harmful consequences of sleep apnea. Unfortunately, some patients do not tolerate them well. They may find the machines uncomfortable or intrusive, and some people find it difficult to use the CPAP machines correctly. Even though the CPAP device is the most effective non-surgical solution for obstructive sleep apnea, it will not work if the patient cannot tolerate it and therefore does not use it. In this case, surgery may be the next recommended step.
Some patients opt for surgery very quickly when more conservative methods are not effective for them. Others may use a CPAP device for as long as a couple of years and then decide that they would prefer an alternative solution that surgery can offer. There are no standard time tables for the rate at which patients should move from one option to another as they seek an effective solution.
Mandibular Advancement Appliance
These devices are worn at night to improve your airway. Typically, they are composed of an upper and lower tooth guard that are connected to each other. Using the upper teeth as the focal point, the lower teeth and jaw are moved forward. This brings the tongue forward opening the airway. Most are adjustable so that they can be customized to your needs. You wear the appliance nightly. In some people this prolonged pressure on the teeth can result in movement of the teeth or cause discomfort of the jaw joint (TMJ). Most people without pre-existing problems with TMJ do well wearing the appliance.
Once surgery has been decided upon, there are several options. These include uvulopalatopharyngoplasty, expansion pharyngoplasty, tongue size reduction, and upper airway stimulation therapy. Another possibility is radiofrequency treatment of the palate or tongue. The purpose of all of these procedures is to open the airway and allow for unobstructed breathing during sleep. The specific surgery that is used for each patient will depend on the individual nature of the cause of that patient’s apnea.
The most common side effect of surgery is a sore throat, which can last for up to two weeks. Most patients who have surgery experience significant improvements in sleep and overall well-being.
Diagnosing and treating obstructive sleep apnea is vital if sufferers are to enjoy healthy, restful sleep. It does, however, often take time and patience to find the best solution for each person. With the options available today, patients can choose the level of treatment that is most effective while avoiding treatments that are too aggressive for their needs. From simple, non-surgical solutions to CPAP devices to dental appliances and surgery, there is a choice that will lead to relief from obstructive sleep apnea.