Sleep Apnea Treatments
The ultimate goal of sleep apnea treatments is to relieve symptoms and prevent future problems or complications. There are a number of sleep apnea treatments; the correct treatment depends on the type and severity of the disorder, physical structure of the airway and other aspects of the patient’s medical history. Obstructive sleep apnea is much easier to treat than central sleep apnea. In most central sleep apnea cases, doctors attempt to treat the associated medical problem before tackling the sleep apnea issue. Medication is rarely ever prescribed to treat sleep apnea because of common side effects. If medication is prescribed, it is never the only treatment being pursued. In the case of mild obstructive sleep apneas, doctors usually recommend that the patient make lifestyle changes:
- Lose weight
- Follow a strict sleep schedule
- Avoid supine sleep position – gravity can cause the tongue or muscles to fall into the airway. Positional therapy techniques may help one sleep on their side or stomach. Sewing a tennis ball onto the back of pajamas, elevating upper torso with a foam wedge or using a positioning alarm may help individuals sleep on their side. The FDA has also approved a neck-positioning pillow that reduces snoring and sleep apnea.
- Avoid alcohol and medications right before bed – can cause further muscle relaxation and weak respiratory drive.
- Raise top of bed four to six inches – do not prop head up with pillows, it causes the chin to tilt toward the chest and closes off the airway.
- Promptly treat colds and allergies
- *Quit smoking
Some patients may require additional sleep apnea treatments. Oral or dental appliances are effective in 40 to 50 percent of mild obstructive sleep apnea cases. These appliances are fitted by a dentist with sleep apnea experience. Mandibular advancement devices (MADs) work by pushing the lower jaw forward. Tongue-retaining devices prevent the tongue from falling back into the airway. Both of these oral appliances require some getting used to; patients should visit their dentist at least once a year to discuss issues and have devices refitted.
Sleep Apnea Masks
More severe cases require the use of a sleep apnea mask. The most common sleep apnea mask is a continuous positive airway pressure (CPAP) mask. This sleep apnea treatment was first introduced in 1981; following a sleeker redesign, CPAP became increasingly popular by 1989. This device delivers a gentle stream of pressurized air into the throat to keep it open, preventing snoring and sleep apnea. The degree of air pressure is personalized and may need periodic adjustments. A typical CPAP machine has an air pump stored in a sound-absorbing case. A hose carries the pressurized air to the sleep apnea mask, which encloses the oral and/or nasal airways. There are a number of different CPAP sleep apnea masks available: full face mask, nasal pillows, headgear, chin strap or nasal mask. CPAP masks can be cumbersome; at first, many patients find it difficult to sleep while wearing this device. Nightly use will assimilate the sleep apnea sufferer to the sometimes awkward device.
Another type of sleep apnea mask gaining popularity is the bi-level positive airway pressure (bi-level PAP) mask. As with the CPAP, this device delivers a stream of air, but at two different pressure levels. When the patient is inhaling the pressure level is high, as they breathe out the pressure level decreases. The bi-level PAP sleep apnea mask boosts weak breathing patterns. It can also be set to administer a breath if it senses an apnea episode.
The third sleep apnea mask is called an adaptive servo-ventilation (ASV) device. It learns the normal breathing pattern of a patient and stores the information in a built-in computer. Using pressurized air, the ASV sleep apnea mask maintains a normal breathing pattern.
Sleep Apnea Surgery
Sleep apnea surgery is a last-ditch effort for the most severe cases or those that have not responded to other treatment efforts. There are several ways in which a surgeon can perform a sleep apnea surgery. Most surgeries require the removal of excess tissue from the nose or throat that may be blocking the airway. Other surgeries involve the insertion of tubes or rods in an attempt to open the airway. Still other sleep apnea surgeries try to correct structural deformities of the nose, throat and mouth.
Uvulopalatopharyngoplasty (UPPP) – remove excess tissue from the rear of the mouth and top of the throat. The tonsils and adenoids are usually removed as well. UPPP is performed in a hospital under general anesthesia. This sleep apnea surgery is less successful than other methods because the delinquent tissue may be located further down the throat.
Maxillomandibular advancement – upper and lower parts of the jaw are advanced from the remainder of the facial bones. This sleep apnea surgery enlarges the space behind the tongue and soft palate, making airway obstructions less likely. The surgery may require a specialized oral surgeon and/or orthodontist.
Tracheostomy – a hole is cut in the throat and a metal or plastic tube is inserted to hold it open. The hole is covered during the day and kept open while the patient sleeps. Because the hole bypasses any tissue blockages in the upper throat, tracheostomies are always successful sleep apnea treatments; yet, numerous side effects and complications make the surgery a rare procedure.
Tonsillectomy – complete removal of the tonsils.
Adenoidectomy – complete removal of the adenoids.
Nasal surgery – remove polyps or correct a deviated nasal septum.
Rod insertion – harden soft palate by inserting three small, plastic rods.