Treatment

Treatment for obstructive sleep apnea falls into 3 main categories. These are medical, dental, and surgical.

Medical Treatment: PAP therapy, the Gold Standad

The “gold standard” and most common treatment for obstructive sleep apnea is CPAP or continuous positive airway pressure (also called PAP therapy). In CPAP treatment, the patient sleeps with a mask that delivers a steady and constant stream of room-temperate filtered air. The stream of air pressure holds the airway open and prevents obstruction by the tongue or soft palate. Ninety-five percent of patients who use CPAP see a 90-95% reduction in the number of apneas and hypopneas they experience which makes CPAP the optimal treatment for sleep apnea patients 

CPAP Titration

CPAPs are used at home, although they must be calibrated by a sleep technician in a sleep lab prior to being used so the correct pressure can be obtained. This process is called a CPAP titration. During titration, the patient is fit with the CPAP machine and a mask that goes under or over the nose or one that goes over the nose and mouth. The sleep technician will adjust the air pressure level in order to resolve all obstructive and snoring events. When titration is completed, the patient can begin using the CPAP at home. It is recommended that CPAP titrations should be done once a year due to changes in airway resistance, weight, and medical conditions.

APAP: No Titration Needed

In contrast to the CPAP, the APAP (automatic positive airway pressure, also called “automatic PAP” or “auto-titrating PAP”) are self-titrating and automatically adjusts the air pressure each night to maximize sleep quality and resolve obstructive apneas. When a person is breathing normally, the pressure delivered is low. The APAP is equipped with sensors that track respiration. When the APAP senses an apnea or hypopnea, it automatically increases its air pressure to keep the airway open and unobstructed.

The end result is that sleep quality is preserved while delivering up to 40% less pressure than the traditional CPAP (which has one constant pressure) leading to a better night sleep. The APAP guarantees that the correct pressure will always be delivered and that sleep will be uninterrupted. There is no need for titration in a sleep lab and the machines can be used immediately.

Dental Devices

Dental appliances may be useful in shifting the tongue and jaw to prevent the airway from closing. They are helpful in treating OSA but are not as immediate as PAP therapy. Dental devices may need to be changed relatively frequently as the teeth may shift around, especially in older age. Dental devices can be expensive with some costing between $4,000-$5,000, not including the sleep study.

Surgery

A third option for patients is surgery. There are several types of surgeries that can be done, all focusing on different parts of the airway. Some of the surgeries available include; resection or hardening of the palate, removing the tonsils, advancing the tongue, and advancing the jaw line. On average, 50% percent of patients may see a 50% reduction in their apnea-hypopnea index with simple surgeries. Those surgeries, however, are more effective at eliminating snoring than eliminating apneas. Patients with moderate to severe sleep apnea would benefit from jaw advancement if they are unable to tolerate PAP therapy. Jaw advancement surgery is more complicated and requires a hospital stay.

Lifestyle Changes

Some patients may be able to alleviate their symptoms considerably by making lifestyle changes that may increase the airway diameter. Those suffering with sleep apnea should consider making these changes in addition to, but not instead of, medical treatment.

• Losing weight

• Quitting smoking
• Opening or clearing the nasal passages using a nasal dilator, saline wash, or breathing strip,
• Avoiding alcohol, sleeping pills, and sedatives before bedtime
• Avoid sleep deprivation
• Avoid sleeping on the back
• Elevate the head four to six inches above the rest of the body

To find out more about APAP, click here.