How is obstructive sleep apnea treated?

There are many treatments for sleep apnea including surgical procedures, Continuous Positive Airway Pressure (CPAP) machines, and oral appliances that keep the jaw in place during sleep.

Practical Measures

1. Lose weight. People with severe sleep apnea are almost always overweight. Losing weight will reduce excess tissue volume in the upper airway, decrease the load in the chest wall and abdomen, and improve respiratory muscular efficiency. In mild cases, weight loss alone may result in a cure. In other cases it enhances the effects of other treatments.
2. Sleep on your side. Many studies have shown that patients who sleep on their back have a significantly higher level of sleep disturbance. It’s believed that sleeping on your back causes the tongue to come in contact with the pharyngeal wall.
3. Avoid alcohol within two to three hours of bedtime. Alcohol is a central nervous system (CNS) depressant and relaxes the muscles that control normal breathing causing the airway to collapse.
4. Avoid certain pharmacological agents. Benzodiazepines, narcotics, barbiturates, and testosterone have all been reported to affect the occurrence of sleep apnea episodes. For example, Flurazepam has been shown to worsen apnea episodes in patients who already suffer from this disease and triggers apnea in patients who have no history of a problem.

Surgeries

Uvulopalatopharyngoplasty (UPPP) was first introduced in 1964 and later in 1981. This surgical procedure enlarges the air space by removing tissue from the palate, uvula, tonsils and pharyngeal walls. Most clinical investigations indicate that the success rate of this surgical approach is less than 50%. This is due to the level and cause of obstruction often being misdiagnosed. Removing some of the vibrating tissues may resolve snoring, but it does not prevent an obstruction by the base of the tongue when the jaw rotates backward during sleep. This is a very serious, expensive, and invasive surgery that is not without complications. Post-operative stenosis (an abnormal constriction or narrowing of the airway), significant post-operative pain, and infection are all possible complications.

A Laser Assisted Uvulectomy (LAUP) is a modification of UPPP surgery. It is accomplished using lasers and is considered a less invasive procedure. It is constantly being used to remove soft tissue of the palate believed to cause snoring.

A Somnoplasty is a procedure which utilizes radio frequencies to heat the tissues of the airway to a very precise temperature creating a finely controlled lesion of coagulation within the tissue. Over a period of four to six weeks, the injured tissue heals and in the process the tissue shrinks and tightens. This technique can be used to reduce excess tissue in the soft palate, the nasal turbinates and the tongue. The procedure generally takes two to three treatments to shrink the tissue enough to have an effect. Patients seem to have minimal side effects making it one of the more promising procedures for treating snoring and sleep apnea.

Continuous Positive Airway Pressure (CPAP)

This technique involves wearing a mask tightly over the nose during sleep. Pressure from an air compressor is used to force air through the nasal passages and into the airway. The forced air keeps the airway open. This treatment is effective but it’s not for everyone. The mask and straps are uncomfortable, it’s inconvenient, it restricts movement and it dries out the airway and can dry out the nose and eyes. One patient described the machine as “blowing air out of every orifice of her head.” Daily compliance by users of the CPAP is less than 50% due to these problems.