What is CPAP? What are other treatments for sleep apnea?

What are the treatments for obstructive sleep apnea?

There are a few treatments for obstructive sleep apnea. The most popular and most studied treatment options include CPAP, oral appliances, weight loss, and oral surgery.

The most popular, and most successful treatment is CPAP - Continuous Positive Airway Pressure. CPAP is applied through a mask that is placed over the nose and/or mouth, and delivers air pressure in order to keep the airway open. It is attached to a CPAP machine which acts somewhat like an air compressor.

The air that CPAP delivers is generally 'regular air' - not concentrated oxygen. As such, CPAP is a relatively very safe medical treatment.

The air pressures acts like a 'air splint' to keep the airway open. During obstructive sleep apnea, the airway in the back of the throat is prone to closure during sleep. CPAP prevents this closure by pushing the throat tissues open.

CPAP is effective at treating the majority of cases of sleep apnea for patients that regularly use CPAP. The major problem with CPAP is that some individuals have difficulty tolerating CPAP. Some complain of a claustrophobia. Others report an uncomfortable air pressure sensation in the nose or throat.

For those that use CPAP, the effect is often dramatic. CPAP usually eliminates the majority of obstructive breathing events. It also eliminates and attenuates snoring.

Since CPAP utilizes air as its main component, it is very safe, and is often used as a primary treatment option for patients with obstructive sleep apnea.

CPAP is usually ordered after completing a sleep study. The appropriate CPAP pressure is determined by the night technologist. Contrary to popular belief, most patients who undergo a sleep study with or without CPAP, do fall asleep during the study.

Oral appliances (OA's) have been studied for over a decade. Some appliances are also know as 'JAD's' or 'MAD's' - Jaw Advancing Devices - or Mandibular Advancing Devices. These devices attempt to bring the lower jaw forward, thus opening up the airway in the back of the throat. They are worn only during sleep.

OA's have been demonstrated to be effective - especially in patients with mild to moderate sleep apnea (5 -30 events per hour). However, it is not always effective in all patients. Sometimes the appliance needs to be adjusted in order to further increase the airway. A sleep study is often indicated to determine the efficacy of the OA.

One complication/complaint of using an OA is temporal-mandibular joint (TMJ) discomfort. Patients who already have TMJ complaints may have an exacerbation with use of the OA. Additionally, some patients complain of 'malocclusion' symptoms - when the upper teeth and lower teeth don't align appropriately. This often subsides a few hours after removing the OA in the morning.

A third treatment option is weight loss. Excess weight is the most powerful risk factor with sleep apnea. Losing extra weight may improve sleep breathing significantly. Although most patients who have sleep apnea are overweight, many are not.

Because weight loss is usually a gradual process, often additional sleep apnea treatments are recommended concurrently - like CPAP, OA, or oral surgery.

A fourth treatment option is oral surgery. There are several oral surgeries that may benefit patients with obstructive sleep apnea. The most common one is call uvulopalatopharyngoplasty (UPPP or UP3) named after the parts of the oropharynx that are treated. An ENT surgeon often will remove with laser, scalpel, or other modalities, the uvula, parts of the soft palate and part of the lateral pharyngeal walls.

As this is a major surgery, there are risks associated with this procedure. In addition to being somewhat painful, there a small risk of bleeding and infection - as there is with all surgeries.

Some patients who have this procedure report that their voice has changed somewhat. Some report a sensation of food/drink entering the nasalpharynx - nose area.

The surgery does not guarantee success, but often demonstrates significant improvement is the severity of sleep apnea. A sleep study is often recommended after the surgery to determine efficacy.

Sometimes, body positioning - avoiding the supine/back position during sleep may be helpful. Devices aimed at preventing an individual from sleep in this position have not been well studied.

Throat sprays, nose stickers, 'sleep apnea pillows' and other non-FDA regulated treatments sold over the counter have not been demonstrated to be effective in large, reproduced, randomized, reputable studies.

 

  Reviewed September, 2007

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