Sleep Apnea Treatment

September 30, 2011

An unmade bedSo, you have sleep apnea (or even sleep hypopnea). You have several options available to you for treating it. You also have the option to ignore it and hope it goes away. By the way, the last option doesn’t work. Don’t bother trying it.

There really isn’t a total cure for apnea at this point, but several treatments have been used successfully and your doctors can help you to look at which options might be best for you.

There are 2 goals in treatment: 1) eliminate apnea events and 2) remove sleep deprivation symptoms. Meeting the first goal is a big step towards meeting the second, but you still need to focus on getting quality sleep once your apnea is stopped.

5 Options for Sleep Apnea Treatment

There are 5 different categories of treatment for sleep apnea. Within each of these categories there are several different options. Let’s try to make some sense of them.

Medications

There are currently no drug treatments for sleep apnea although treatment for hypothyrodism or acromegaly will eliminate apnea if it is caused by those disorders.

Keep in mind that many medications (including sleeping pills, tranquilizers, antihistamines and muscle relaxants) can have a negative affect on apnea. Talk to your doctor about any medications that you take regularly.

CPAP

CPAP stands for Constant Positive Airway Pressure. This is the use of pressurized air in your airways to prevent the collapse associated with apnea. Note that this is not correcting the problem that causes the collapse (i.e. the failure of the muscles to control the airway during sleep) but it helps to keep the air moving in and out of your lungs.

This is the most common form of treatment for both obstructive and central forms of sleep apnea. It is also used in cases of hypopnea (heavy snoring to the point that breathing is restricted but not stopped).

There are actually 3 classes of machines that are lumped together in the CPAP family. When we talk about CPAP machines in general we also include the others.

CPAP

The traditional CPAP machine which is set at a constant pressure that is applied throughout the night (hence the name Constant) is the least expensive type of machine.

BiPAP

There is also a family of BiPAP machines (Bilevel Positive Airway Pressure) which have 2 levels of pressure: one for breathing in and the other for breathing out. These machines are better suited to those who require high pressure which makes exhaling difficult. The machine cycles through the 2 pressures as you breathe in and out.

APAP

Finally, there are APAP machines (Automatic Positive Air Pressure). These are either CPAP or BiPAP machines that automatically adjust the pressure level(s) based on how you are breathing. They will monitor your breathing with each breath during the night and if they detect apnea happening the level will increase. The nice thing about these machines is that they adjust to you. The minimum pressure that is required to prevent your apnea will fluctuate over time — even during the night. A CPAP or BiPAP machine is set to the worst case pressure and is often more than you really need.

Masks, etc.

All of these machines need a way to deliver the air pressure to you. Most people use a nasal mask which fits over the nose. The air is blown in through your nose during the night. While this works for most CPAP users, many people don’t breathe well through the nose. It is possible to get an oral mask (mouth only), full face mask (mouth and nose) or total face mask (covers from forehead to chin). There are also nasal prongs and nasal pillows which fit into your nostrils. Some people find these more comfortable than a mask.

Humidity

Many CPAP users find that having the extra air flowing through their system leads to dry mouth, sore throats and/or irritated sinuses. To deal with this, most CPAP machines are equipped with a humidifier system (either built in or as an accessory). This will provide heated, moist air to the mask and it will alleviate most of the symptoms. If you use a humidifier you will need to figure out what heat setting works best for you. The higher settings will provide more moisture as well as warmer air.

I personally use a traditional CPAP machine since my pressure prescription is not too high or uncomfortable. I also use a nasal mask which helps me to breathe through my nose rather than my mouth. It helps me to avoid dry mouth and sore throats that way. I don’t normally use the humidifier with my machine most of the year. However, in the dead of winter when the air is really dry I will use it without any heat. I find that with heat it gets too moist for me.

Read more about CPAP machines.

Oral Appliances

Mouthpieces are another common treatment for sleep apnea. These are sometimes referred to as dental devices or oral appliances. They are worn in the mouth during the night and will position the tongue and/or lower jaw to keep the airway open.

Once again, they do not treat the underlying failure of the muscles to keep the airway open.

Many people find that a mouthpiece is more comfortable and easier to use than a CPAP machine. They also do not require electrical power so they are convenient if you travel a lot or like to camp out in the wilderness. You are also not hooked up to anything so getting up at night is easier to manage.

While it is possible to get a generic mouthpiece for sleep apnea, most patients who go this route will have a specially fitted mouthpiece designed by a dentist who is trained to do this. If you want to go this route your sleep clinic will be able to refer you to a qualified dentist.

One drawback to this treatment is that it isn’t effective in every case. Mouthpieces only affect part of the airway so you may still have reduced airflow or blockage deeper in your throat that they cannot deal with. It can be quite expensive to have a mouthpiece custom built for you only to find that it doesn’t fully treat your apnea.

Surgery

One area that has a lot of controversy is the use of surgery to correct sleep apnea. While surgery has often been effective at reducing and eliminating snoring, the results for sleep apnea are less promising. However, it does work for some people.

Common Surgery Techniques

As a sleep apnea treatment, surgery is usually focused on removing the uvula, part of the soft palate, part of the sides of the throat (pharynx) and possibly tonsils and adenoids. The goal in this type of surgery is to reduce the tissue that blocks the airway. It can be done using a scalpel (UPPP — uvulopalatopharyngoplasty) or a laser (LAUP — laser assisted uvuloplasty). In the laser surgery, the tonsils and pharynx are not affected.

A newer procedure which shows some promise is somnoplasty. This uses targeted high frequency radio waves to shrink and tighten the tissues that cause problems. This procedure is simpler and less painful than UPPP or LAUP. It can also be more specifically targeted and may be able to deal with problem areas deeper into the throat.

Less Common Techniques

In some cases, problems are caused by the facial structure of the patient. In these cases surgery to move the tongue and/or jaw forward to open the airway. Nasal surgery is also beneficial to some patients. However, these cases are rare.

Problems

Like any surgical procedure, there is risk involved with surgical sleep apnea treatments. There can be damage to the speech, infections, and other side effects from all of these surgeries. The laser and RF treatments are the least invasive and are usually performed on an outpatient basis, but there are still risks.

The other problem is that they do not guarantee to eliminate sleep apnea. Even if they do, it may not be permanent.

You will need to talk to your doctor about surgical options and make an informed decision.

Lifestyle Changes

Probably one of the most important areas of sleep apnea treatment is your lifestyle. This will have a tremendous impact on the success of the other treatment options. It is also the most important factor in achieving the second goal of treatment — less fatigue and sleep deprivation symptoms.

While lifestyle changes alone is often not enough to eliminate sleep apnea, they will increase the effectiveness of other treatments and are a benefit for your life in general.

Weight Loss

Obesity is one of the most common risk factors associated with sleep apnea. While the jury seems to be out on whether it is a cause or not, there is pretty solid evidence that it is an aggravating factor. Losing weight and building your cardiovascular health will help reduce the severity of your apnea and you’ll get more quality sleep as well.

Dieting alone is not the best way to lose weight. Regular exercise and healthy, balanced diet are your best bets here. I write about what I’m learning about weight loss at Heathy Weight Loss if you want to read more about that.

Substance Abuse

Two of the biggest contributors to sleep apnea are smoking and drinking (sorry guys). Many studies have shown an increase in snoring and apnea among smokers (2.5 times more for men, 4 times more for women). Alcohol consumption, especially just before bed, increases snoring and apnea affects as well. So the less you do of these two things, the better.

Sleep Patterns

It is also important to have regular sleep patterns. A consistent sleep and wake time is beneficial if you can make it happen. You also need to get enough sleep. Most North Americans are sleep deprived whether they have a sleep disorder or not.

A calming pre-sleep routine and comfortable sleeping arrangements are also important. Light, temperature, noise and comfort all affect the quality of your sleep.

Stress

Do we even need to talk about this one? Stress is probably one of the biggest problems we face in our culture today. It affects us physically, emotionally, mentally and spiritually. It is particularly disruptive for sleep. So do whatever you can to reduce and deal with stress.

Some of the lifestyle changes mentioned above can be helpful with this — exercise is a great stress reliever. Talk to your health providers about ways you can reduce stress to manageable and healthy levels.

Natural Treatments

When we get into the arena of natural sleep apnea treatments, there is a lot of conflicting information. Not to mention name calling and back stabbing. But this is true in any area where Western medicine and Natural medicine collide. There are many claims for products that cure or treat sleep apnea naturally but it is up to you and your medical professionals to find out what works or doesn’t for you.

My naturopath has not recommended any cure for me. But he does recommend herbal and other natural treatments that help me to improve my sleep quality. And as we work to improve my overall health I’m sure that there will be some improvement in my apnea symptoms as well.

If you are comfortable with different natural medicine then talk with your health professional about what is available. They can help you to make lifestyle changes and sleep patterns that, in conjunction with the other treatments, will help you achieve the two treatment goals.

Bill (LoneWolf) Nickerson

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