Sleep Apnea Treatment Options
Treatment options are very patient-specific. What works for one person may not work for another. Treatment options should always be decided with the aid and advice of a physician.
Some treatment options might work for individuals with mild sleep apnea, while others may work for mild, moderate, and severe sleep apnea.
Conservative Treatment Options for OSA
Weight Loss: If overweight or obese, weight loss can very effective at reducing or eliminating sleep apnea. In studies, even mild weight loss demonstrated measurable improvements in the diameter of the upper airway.
There are several methods for safely losing weight. Conservative lifestyle changes, including diet and exercise can be effective. Medications have demonstrated mixed results. Bariatric surgery is also an option. Since weight loss can take significant time to accomplish, weight loss strategies are often recommended in conjunction with other sleep apnea treatments.
Positional Therapy: For a subset of sleep apnea patients, avoiding the supine (back) position can be beneficial in the reduction or elimination of sleep apnea. There are a few products on the market that assist with this goal. Unfortunately, most of them on not well studied.
Prescription Therapy Options for the Treatment of Sleep Apnea
CPAP: Continuous Positive Airway Pressure uses a machine, a mask, and hose to deliver air to the upper airway. These keeps the airway open and prevents closure and apneas during sleep.
Sleep Apnea Oral Appliances: Also called JAD (Jaw Advancing Devices) and MAD (Mandibular advancing device) brings the lower jaw forward, opening the airway.
Sleep Apnea Surgery: There are several sleep apnea surgeries available for the treatment of sleep apnea. They are usually performed by ENT physicians.
Other Treatment Options: Every year, new treatment options are uncovered. Often, the efficacy and consequences of new treatment is not known for several years. More on Sleep Apnea Devices.
Newer treatments that are being studied include the Pillar Procedure (outpatient surgical procedure), Inspire (pacemaker-like device that controls the airway muscles), and negative intra-oral pressure devices.
As mentioned, some patients are not ideal candidates for certain sleep apnea treatments. It is important for the patient to be aware of the symptoms of sleep apnea and to monitor symptoms post-treatment. Often, a sleep study is recommended before and after treatment to assess the efficacy of the intervention.
It is important to have regular follow up with a clinician to periodically assess the effectiveness of sleep apnea treatment, and to monitor from side effects or other complications. As we get older, there is tendency for the body to change, and for sleep apnea to get worse. Often adjustments in therapy are needed.
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5 NEW TREATMENTS FOR OBSTRUCTIVE SLEEP APNEA (OSA)
One of the most common sleep disorders that increases the risk for health problems is obstructive sleep apnea.
OSA is characterized by periods of shallow or absent breathing while sleeping at night (mostly) due to temporary blockage of upper respiratory airways by relaxed muscle tone of uvula or rolling back of tongue while sleeping. The blockage of airway causes decreased oxygen saturation of blood and this decreased saturation of blood ultimately leads to hypoxia (decreased oxygen concentration).
In our body, the brain acts as a very diligent security guard always keeping an eye on the internal body condition and whenever it detects any change it alarms the body and initiate many counter-acting responses. Similarly, whenever there is decreasing oxygen concentration, the brain control center senses this change and awakes us in order to check the decreasing concentration by providing a proficient supply of oxygen due to opening of respiratory passages.
Apart from day time fatigue, lethargy and drowsiness the lack of sleep may entangles a person in a vicious circle of heart problems, diabetes (more commonly type II), liver problems and a series of metabolic malfunctions called the ‘metabolic syndrome’.
Above all, a person may face social isolation or a severe break-up in a romantic relationship because the periodic episodes of snoring in such individuals may drive the partners to separate rooms.
In short, sufferers of OSA are presented with a very miserable and grief-stricken condition. Most of them consult their physicians and find a way to make their sleeps better and comfortable. In the past, there was no suitable or appropriate treatment for the patients of OSA and such persons had to live their whole lives by compromising their sleep.
But owing to the advancement in technology and increased rate of researches in the field of public health by the health care providers in recent past has created many ways to lessen this miserable condition. The most effective and common treatment for such patients was administration of continuous positive airway pressure (abbreviated as CPAP).
Patients with OSA were conventionally treated with CPAP and this was the most effective treatment to relieve them. The success rate of CPAP is around 90% and surveys suggests that it actually making the lives easier and sleeps peaceful. But here the question arises, Is this really the best treatment for everyone?
Many patients with OSA are afraid of CPAP and found this a troublesome therapy because they have to wear the CPAP mask and manage their nights with a hose for the rest of their lives. This trouble transforms into a state of claustrophobia due to leakage of masks and tangling of hoses around necks.
For many patients, now there are many successful and efficient therapies and treatments upon which they can rely on. The following are some of the new treatments for OSA. All these OSA management techniques are approved by the FDA.
1-Using Oral Appliances
The collapsing of tongue and other soft tissues during sleep (when there is relaxed muscle tone) can be prevented by Oral appliance therapy (OAT). In OAT, jaw is supported in a forward direction so it tends to prevent the collapsing. It treats mild to moderates cases of OSA.
Such oral appliances therapy is seen to be effective in 50% of the cases of mild to moderate OSA.
The only limitation to its application is that a physician alone can’t finalize the decision of OAT. A proper intraoral examination in collaboration with a dentist is required.
Night shift is a device that is worn on the back of neck and its significance is clinically proven. It is an effective therapy for patients with positional obstructive sleep apnea (a type of OSA which onsets due to position). Whenever the patient starts to back-sleep this device vibrates and compels the user to change his position after that it stops vibrating. The intensity of vibrations is proportional to time of back-sleep. The beauty of this treatment lies in two facts; a person can self-monitor his sleep and degree of sleep fragmentation and he can track his behavioral adaptation to position therapy.
It is recommended in combination with CPAP or oral appliance therapy and has proved its positive effects in relieving the patients. The administration of this therapy in patients of cardiovascular diseases, acute to chronic neck and shoulder pain is being discouraged by health care providers.
Pillar is a minimally invasive device meant for the treatment of OSA and snoring. It is done by a minor surgery which is non-destructive in nature and involves surgical placement of small rods of polyester in the soft palate of sufferer. After a week or so the respective tissue heals and it makes the soft palate stiff as compared to previous.
The study of 45,000 cases including two meta-analysis proved that there is no risk of rejection, extrusion or infection in case of this treatment- of which many people are afraid of.
The term somnoplasty as the name indicates meant for the modification (plasty) in sleep (somno). In this technique the tissue mass is reduced by a precise estimation by employing radiofrequency current.
The patients who faced refusal of CPAP are referred for somnoplastic treatment. It is approved by Food and Drug Administration (FDA) to treat OSA including two other conditions, chronic nasal obstruction and habitual snoring also.
5-Inspire upper way stimulation
It is used in patients with refusal or complete intolerance to CPAP older than 22 years of their ages. In this treatment, there is an implantation of a small battery which is placed in the upper chest under the skin. The battery is linked with lingual nerve (nerve of tongue) through a wire. For monitoring the breathing patterns another wire is employed which supplies the rib cage. The electrical stimulus keeps the tongue in a bit contracted form and maintains its tonicity. This serves the purpose of preventing the tongue from rolling back into the posterior throat.
Other treatments may include surgical operations, adaptive changes in lifestyle and acquired positional changes. But they all require much patience, time and guts to face the challenges in case of surgery which is recommended only as a end-stage treatment.
Labeeq Afzal is a medical writer and is currently completing an MBBS from KEMU.