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How
Is Sleep Apnea Treated?
The
specific therapy for sleep apnea is tailored to the individual
patient based on medical history, physical examination, and
the results of a sleep study. Medications are generally not
effective in the treatment of sleep apnea. It is important
that the effectiveness of the selected treatment be verified;
this can usually be accomplished by a home sleep study. There
are a number of treatment modalities available for the therapy
of obstructive sleep apnea syndrome (OSAS).
Behavioral Therapy
Behavioral changes are an important part of all treatment
programs for OSAS, and in mild cases behavioral therapy may
be all that is needed. The individual should avoid the use
of alcohol, tobacco, and sleeping pills, which make the airway
more likely to collapse during sleep and prolong the apneic
periods. Overweight patients can benefit from losing weight.
Even a 10% weight loss can significantly reduce the number
of apneas. In some patients with mild sleep apnea, breathing
pauses occur only when they sleep on their backs. In such
cases, using pillows and other devices that promote sleeping
on their side is often helpful.
Nasal Continuous Positive
Airway Pressure Therapy
Nasal continuous positive airway pressure (CPAP)
is the most common and most effective treatment for the majority
of OSAS patients. This therapy requires that the patient wear
a nasal mask during sleep. Air from a blower is directed through
the nasal passages and into the back of the throat. The air
pressure is adjusted so that it is just enough to prevent
the throat from collapsing during sleep. Nasal CPAP prevents
airway closure while in use, but apnea episodes return when
CPAP is stopped or used improperly. The advantages of CPAP
are that it can be immediately effective and carries almost
no serious risk. The major limiting factor in its usefulness
is the amount of time the patient uses the machine.
Side effects
of CPAP are typically minor and include such things as nasal
irritation and drying, facial skin irritation, abdominal bloating,
mask leaks, dry eyes, and headaches. Modifications of the
CPAP device can help to minimize these side effects. Airflow
may be heated and humidified to minimize drying and nasal
irritation. Some CPAP machines vary the pressure to coincide
with the person's breathing pattern while others start with
a low pressure and slowly increase to allow the person to
fall asleep before the full prescribed pressure is applied.
Bi-Level
Therapy
Bi-Level therapy allows for the individual determination
of inspiratory and expiratory pressures. It is primarily indicated
when assisted ventilation is required. The advantages and
disadvantages are similar to CPAP therapy.
Oral Dental Devices
There are two types of oral dental devices, tongue retaining
devices and mandibular advancement devices. Each of these
devices function to increase the size of the airway and thus,
reduce the chance of obstruction. There is increasing evidence
that these are successful in certain well-selected patients
and may represent initial treatment of choice in those patients
with positional OSAS. They have also been useful for some
who snore but do not have apnea. Primary side effects include
mouth dryness, excessive salivation, gum tenderness, TMJ pain,
and most importantly irreversible alteration of occlusion.
Surgery
Although
CPAP is the treatment of choice for the majority of patients,
some may benefit from surgery. Careful patient selection is
crucial. Ideally, a determination of the site of airway obstruction
allows for a better choice among the surgical options. Although
several surgical procedures are used to increase the size
of the airway, none of them is completely successful or without
risks. More than one procedure may be needed before the patient
realizes any benefit.
Some of
the more common procedures include removal of the adenoids
and tonsils (especially in children), nasal polyps, or other
growths. Removal of other tissue in the airway and correction
of structural deformities are also considerations. Younger
patients seem to benefit from these surgical procedures more
than older patients.
Uvulopalatopharyngoplasty
(UPPP) is a procedure used to remove excess tissue at
the back of the throat (tonsils, uvula, and part of the soft
palate). The success of this technique may range from 30 to
50 percent. The long-term side effects and benefits are controversial,
and it is difficult to predict which patients will do well
with this procedure.
Laser-assisted
uvulopalatoplasty (LAUP) is done to eliminate snoring
but has not been shown to be effective in treating sleep apnea.
This procedure involves using a laser device to eliminate
tissue in the back of the throat. Like UPPP, LAUP may decrease
or eliminate snoring but not sleep apnea itself. Elimination
of snoring, the primary symptom of sleep apnea, without influencing
the condition may carry the risk of delaying the diagnosis
and possible treatment of sleep apnea in patients who elect
LAUP.
Other
surgeries such as Uvulopalatal Flap or Radiofrequency
Tissue Ablation are also being utilized.
Tracheostomy
can be used in persons with severe life-threatening sleep
apnea. In this procedure, a small hole is made in the windpipe
and a tube is inserted into the opening. This tube stays closed
during waking hours, and the person breathes and speaks normally.
It is opened for sleep so that air flows directly into the
lungs, bypassing any upper airway obstruction. Although this
procedure is highly effective, it is an extreme measure that
is poorly tolerated by patients and rarely used.
Patients
in whom sleep apnea is due to deformities of the lower jaw
may benefit from surgical reconstruction.
Surgical
procedures to treat obesity are sometimes recommended for
sleep apnea patients who are morbidly obese. These surgeries
are referred to as Gastric Bypass, Roux en-Y, Laparoscopic
Gastric Bypass, and Laparoscopic Adjustable Gastric Banding.
Learn more about
bariatric surgery.
Oxygen
Therapy
Oxygen
administration may safely benefit certain patients, particularly
those at altitude, but generally does not eliminate sleep
apnea or prevent daytime sleepiness. Thus, the role of oxygen
in the treatment of sleep apnea is controversial, and it is
difficult to predict which patients will respond well.
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Reference:
NATIONAL
CENTER ON SLEEP DISORDERS RESEARCH (NCSDR)
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