For milder cases of sleep apnea, your doctor may recommend only lifestyle changes, such as losing weight or reducing alcohol consumption. If you have nasal allergies or problems breathing through your nose, your doctor might recommend treatment for your allergies or treatments to improve nasal flow. If these don't improve your signs and symptoms or if your apnea is moderate to severe, there are other treatments available. Some people try several options before they find the one or a combination of treatments that works best for them.
Positive Airway Pressure
If you have moderate to severe sleep apnea, you might benefit from using a machine that delivers air pressure through a mask while you sleep. This helps to keep your upper airway passages open and can prevent obstructive sleep apnea and snoring.
There are many PAP machines from different manufacturers. There are also many different ways to deliver pressure that use a variety of “masks” that are used directly into nostrils (nasal pillows) to ones that are placed over the nose, over the mouth, or over both the nose and mouth (full face masks). Different masks also have different attachments (head gear and hoses)—some that point upwards and others, sideways.
It is hard to predict which type of mask might be most comfortable for any given patient. You might need to try more than one type of mask to find one that's comfortable and works best for you. Don't stop using the PAP machine if you have problems. It takes persistence and practice to adjust to the mask, the headgear and straps, and the air pressure itself. Check with your doctor or sleep technician to see what adjustments can be made to increase your comfort.
(Continuous Positive Airway Pressure) is the most common method of treating obstructive sleep apnea that involves using a machine that provides constant air pressure through the nose and mouth to keep your breathing airways open.
(Automatically-adjusting Positive Airway Pressure) automatically adjusts the pressure required to keep the airway open based on the sensors that detects breathing flow patterns during sleep.
is a type of positive airway pressure device that has two pressure settings: the prescribed pressure for inhalation (ipap), and a lower pressure for exhalation (epap). The lower pressures during expiration may improve the comfort of using the device in some patients who need higher pressure and have trouble adjusting to this. In some patients with underlying lung disease, the use of different pressures inspiratory and expiratory may help with breathing.
Oral appliances, or mandibular advancement devices, are something like a mouth guard or dental device. They work by increasing the space in the back of the throat by moving the jaw forward changing the position of the tongue. While CPAP is usually more effective than oral appliances, oral appliances might be easier to use, and therefore in some patients, they may be used for more total hours per night—providing good control of apneas.
The most effective of these devices are those that are customized for each individual by a qualified dentist. If this therapy is a good option for you, a sleep doctor will need to refer you to a qualified dentist. Some devices require ongoing adjustment to determine the right settings. Regular follow-up is recommended to ensure that your sleep apnea is well controlled and that fit remains good. More details on the side-effects and indications for oral appliances can be found below.
There are several types of nasal devices to address snoring and sleep apnea. Some such nasal devices are designed to actually treat Sleep Apnea and these require a prescription. Others are designed to simply open the nostrils, to make breathing easier, and reducing the narrowing that may occur during inspiration. It is important to note that off-the-shelf treatments to open the nose can help reduce snoring, but as sole treatments, are not usually effective for sleep apnea.
For children with obstructive sleep apnea, surgery (often tonsillectomy and/or adenoidectomy) is a first-line treatment option. Results of surgery are generally good, although a sleep study after surgery is often recommended for children who continue to have signs or symptoms of obstructive sleep apnea after surgery.
In adults, surgery is an option for those patients who are unable to tolerate or benefit from positive airway pressure therapy. Over the past 3 decades, the range of surgical evaluations and procedures has expanded substantially, moving beyond the use of a single procedure for all patients. Sleep surgeons focus on identifying the specific causes of sleep apnea in an individual patient and then selecting procedures to address these causes in a tailored, effective manner.
The blockage of breathing in obstructive sleep apnea is commonly related to the soft palate and tonsils, sides of the throat, tongue, epiglottis, or a combination of these structures. Surgical procedures have been developed to address these throat structures, whether by removing or repositioning tissue in order to keep open the space for breathing.
MORE ON SURGERY FOR ADULTS SURGERY FOR OBSTRUCTIVE SLEEP APNEA By Eric J. Kezirian, MD, MPH, Professor of Otolaryngology – Head and Neck Surgery, Keck School of Medicine of USC
Surgery for obstructive sleep apnea now includes a wide range of procedures developed to treat the diversity of patients with this condition. Sleep apnea surgery has moved beyond the one-size-fits-all approach that existed when there was just a single procedure to treat all patients. In fact, the evaluation of patients before surgery has become even more important because it is designed to identify the cause of sleep apnea and the right procedures to treat a specific patient.
Evaluation of patients considering sleep apnea surgery includes a detailed office examination (often including the use of a flexible telescope to look inside the nose and throat). The challenge is that this and many other tests can be limited by the fact that a patient is awake, while sleep apnea occurs while patients are sleeping. To address this, drug-induced sleep endoscopy involves performing the flexible telescope exam during sedation, so that the surgeon can evaluate the cause of sleep apnea in a state closer to sleep. Drug-induced sleep endoscopy can be helpful for some patients considering surgery and is actually required before patients can be candidates for hypoglossal nerve stimulation surgery.
Surgical procedures can address the potential causes of blockage of breathing in obstructive sleep apnea: the soft palate and tonsils, sides of the throat, tongue, epiglottis, or a combination of these. All procedures are designed to open or keep open the space for breathing in the throat. Soft palate procedures generally start with removal of the tonsils if they have not been removed already. In addition, surgery on the soft palate itself can include the traditional approach that removes tissue (often called uvulopalatopharyngoplasty) or can depend more on repositioning of tissue (techniques include expansion sphincter pharyngoplasty or lateral pharyngoplasty).
There are many other procedures to remove or reposition other tissues of the throat, whether focusing on the tongue or other structures. These include tongue radiofrequency, genioglossus advancement, tongue stabilization, lingual tonsillectomy, partial glossectomy, hyoid suspension, and partial epiglottis removal.
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References1-4 1. Cahali MB. Lateral pharyngoplasty: a new treatment for obstructive sleep apnea hypopnea syndrome. Laryngoscope 2003;113:1961-8. 2. Green KK, Kent DT, D'Agostino MA, et al. Drug-Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study. Laryngoscope 2018. 3. Kezirian EJ, Hohenhorst W, de Vries N. Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 2011;268:1233-6. 4. Pang KP, Woodson BT. Expansion sphincter pharyngoplasty: a new technique for the treatment of obstructive sleep apnea. Otolaryngol Head Neck Surg 2007;137:110-4.
Snoring and sleep apnea become worse when a Sleep Apnea Patient sleeps on their back. This may happen because of gravity pulling the lower jaw and the tongue backward, causing the back of the throat to become narrower, thus obstructing the flow of air. For people who have sleep apnea and sleep mainly on their back, positional therapy may be an option.