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 polysomnography. Medications are generally not effective in the treatment of sleep apnea. Oxygen administration may safely benefit certain patients but 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. It is important that the effectiveness of the selected treatment be verified; this is usually accomplished by polysomnography.

Behavioral Therapy
Behavioral changes are an important part of the treatment program, 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 persons can benefit from losing weight. Even a 10 percent weight loss can reduce the number of apneic events for most patients. 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 help them sleep in a side position is often helpful.

Physical or Mechanical Therapy
Nasal continuous positive airway pressure (CPAP) is the most common effective treatment for sleep apnea. In this procedure, the patient wears a mask over the nose during sleep, and pressure from an air blower forces air through the nasal passages. The air pressure is adjusted so that it is just enough to prevent the throat from collapsing during sleep. The pressure is constant and continuous. Nasal CPAP prevents airway closure while in use, but apnea episodes return when CPAP is stopped or used improperly.

Variations of the CPAP device attempt to minimize side effects that sometimes occur, such as nasal irritation and drying, facial skin irritation, abdominal bloating, mask leaks, sore eyes, and headaches. Some versions of CPAP vary the pressure to coincide with the person's breathing pattern, and others start with low pressure, slowly increasing it to allow the person to fall asleep before the full prescribed pressure is applied.

Dental appliances that reposition the lower jaw and the tongue have been helpful to some patients with mild sleep apnea or who snore but do not have apnea. Possible side effects include damage to teeth, soft tissues, and the jaw joint. A dentist or orthodontist is often the one to fit the patient with such a device.

Surgery
Some patients with sleep apnea may need surgery. 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 need to be tried before the patient realizes any benefits.

Some of the more common procedures include removal of adenoids and tonsils (especially in children), nasal polyps or other growths, or other tissue in the airway and correction of structural deformities. 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 not known, 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. To identify possible underlying sleep apnea, sleep studies are usually required before LAUP is performed.

Tracheostomy is used in persons with severe, life threatening sleep apnea.

Continuous positive airway pressure (CPAP) for obstructive sleep apnea

Treatment Overview
Continuous positive airway pressure (CPAP) is a machine that helps a person who has obstructive sleep apnea (OSA) breathe more easily during sleep. A CPAP machine increases air pressure in your throat so that your airway does not collapse when you breathe in. Your using CPAP may also help your bed partner sleep better.

You use CPAP at home every night while you sleep. The CPAP machine has a mask that covers your nose and mouth, a mask that covers your nose only (nasal continuous positive airway pressure, or NCPAP), or prongs that fit into your nose. The type of mask that fits over just the nose is used most frequently. See an illustration of CPAP .

You may want to try similar machines that have automatically adjustable air pressure or air pressures that are different when you breathe in than when you breathe out.

What To Expect After Treatment
It may take time for you to become comfortable with using CPAP. If you cannot get used to it, talk to your doctor. You might be able to try another type of mask or make other adjustments.

Why It Is Done
CPAP is the most effective non surgical treatment for obstructive sleep apnea. It is the first treatment choice and the most widely used.

•	Doctors use CPAP to treat people who have moderate to severe sleep apnea.
•	CPAP is the treatment of choice for people who have sleep apnea and coronary artery disease (CAD) or heart failure.
•	Doctors also use CPAP to treat mixed sleep apnea.

How Well It Works
Overall, CPAP is effective for moderate and severe obstructive sleep apnea:

•	Research shows that continuous positive airway pressure (CPAP) decreases daytime sleepiness, especially in those with moderate to severe sleep apnea. However, CPAP may not be as effective for people who have mild sleep apnea.
•	Two small studies show that in people who have moderate to severe sleep apnea, CPAP lowers blood pressure during both the day and the night.

Risks
Problems that may occur with CPAP include:

•	Nightmares and excessive dreaming during early use.
•	Dry nose, nosebleeds, and sore throat.
•	Nasal congestion, runny nose, and sneezing.
•	Irritation of the eyes and the skin on the face.
•	Abdominal bloating.
•	Headaches.

Rare complications of CPAP may include:

•	Bacterial infection in the lining around the brain and spinal cord (meningitis).
•	Severe nosebleeds.

You can expect mild discomfort in the morning when you first start using CPAP. Talk with your doctor if you do not feel comfortable after a few days.

Relieving side effects
You may be able to limit or stop some of the side effects:

•	Your doctor may be able to adjust your CPAP to reduce or eliminate problems.
•	Be sure the mask or nasal prongs fit you properly. Air should not leak around the mask.
•	Use a dehumidifier or a corticosteroid nasal spray medication to reduce nasal irritation and drainage.
•	Use a device that gradually increases the amount of pressure during the night to reduce discomfort caused by too much pressure in your nose. If this is not helpful, consider trying a bilevel positive airway pressure machine (BiPAP), which uses different air pressure when you breathe in than when you breathe out. BiPAP machines are more expensive than CPAP machines.
•	If your nose is runny or congested, talk with your doctor about using decongestants or corticosteroid nasal spray medications.

What To Think About
When you are using CPAP, you need to see your doctor or sleep specialist regularly and perhaps have additional sleep studies to adjust the CPAP machine to proper pressures and check to see whether the treatment is working.

The machines are expensive.

The most common problem with CPAP is that people do not use the machine every night, or they take off the mask during the night because it becomes uncomfortable. Even one night of not using the machine can make you sleepy the next day.

You might not use the machine consistently or stop using it because:

•	You don't like wearing a mask at night because of nasal discomfort.
•	The machine is noisy.
•	It may discourage intimacy with your sleeping partner, even though you use the machine only while you are sleeping.

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.

Other Procedures

Patients in whom sleep apnea is due to deformities of the lower jaw may benefit from surgical reconstruction. Finally, surgical procedures to treat obesity are sometimes recommended for sleep apnea patients who are morbidly obese.

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