Depending on the type and severity of sleep apnea that you have, you may have several possible options to treat your sleep apnea.
Continuous positive airway pressure (CPAP) therapy is the most common medical treatment for OSA. When using CPAP, you wear a small mask that is attached to a lightweight hose. The hose attaches to a small machine responsible for creating the air pressure. This machine is the CPAP device. CPAP masks come in many shapes and sizes. Nasal masks cover only the nose, while nasal pillows are designed to fit in the edge of your nose. If you breathe through your mouth, a full face mask can be used to cover your nose and mouth so you do not have to try to keep your mouth closed. CPAP machines and masks must be prescribed by a physician and are usually provided by a home care company. Over the last few years, there have been further refinements of the available masks and machines aimed at providing more choices for individual patients.
Automatic positive airway pressure (APAP) therapy differs from CPAP in that these devices automatically change the pressure level delivered during sleep. This change, called titration, helps ensure that the patient is receiving the minimum necessary amount of air pressure to keep the airway open. These devices are more dynamic and respond to changes in the user’s breathing in real-time. APAP devices work with the same masks and tubing as CPAP machines, and these devices must be prescribed by your physician. Some insurance companies require the use of APAP rather than CPAP since APAP may be prescribed without requiring an in-lab study for the purpose of choosing CPAP pressure.
Bi-level positive airway pressure (BPAP) therapy, sometimes called variable positive airway pressure therapy or BiPAP, applies air pressure at two different levels. These levels are inspiratory positive airway pressure ( IPAP) and expiratory positive airway pressure (EPAP), which is normally lower than the IPAP. These levels are for inhalation and expiration, respectively, and allow for easier breathing. These devices may be prescribed when CPAP is not well tolerated or if there is a need to provide the lungs with extra ventilatory support.
Adaptive servo-ventilation (ASV) is one of the primary methods of treating central sleep apnea or complex sleep apnea (when central apneas occur during CPAP titration). ASV works similarly to BiPAP in that it provides the user with positive inspiratory and expiratory pressure (IPAP and EPAP, respectively) at separate levels. However, ASV can detect both obstructive and central sleep apnea events and can automatically adjust air pressures to help prevent both types of events.
It had been hoped that therapy would be useful for patients with heart failure who have central sleep apnea. However, in May 2015 the results of a large clinical trial that evaluated this treatment in patients with heart failure and sleep apnea showed that this therapy resulted in a higher heart disease death rate than no treatment. Therefore, this treatment is not recommended for use in patients with symptomatic heart failure.
Oral appliance therapy is a type of sleep apnea treatment that uses a customized, mechanical device (mandibular advancement device) to help reposition the jaw and mouth structure. A majority of current devices work to either reposition the lower jaw, moving it forward and providing the airway more structural room, or fix the position of the tongue while asleep, so that it doesn’t restrict the opening of the airway. Oral appliance therapy is usually only helpful to treat OSA. These devices must be prescribed by your physician, and will need to be fitted by a dentist or oral surgeon who specializes in the treatment of sleep apnea with oral appliances. The devices usually don’t improve the AHI as much as CPAP and therefore are usually used when CPAP is not tolerated. However, some patients are able to wear the devices for longer periods each night than CPAP, and thus might derive benefit.
Tonsillectomy, sometimes paired with adenoidectomy, is usually the first treatment for children with obstructive sleep apnea. This is due to the fact that enlarged tonsils can limit the opening of the airway in the back of the throat, resulting in obstructions in air flow during sleep. For children with obstructive sleep apnea, tonsillectomy has proven to be very effective, with upwards of 75% of patients seeing improvements. In children, tonsillectomy has been shown to improve behavior, alertness, and quality of life.
There are a variety of surgeries available as treatment options for sleep apnea. UPPP ( uvulopalatopharyngoplasty) is surgery that removes excess tissue in the throat - including the tonsils, uvula, and parts of the soft palate. It is estimated that about 50% of patients receive some benefit from this surgery.
Jaw surgery usually involves surgically moving the jaw bones to make room in the airway. Sometimes jaw surgery is done along with UPPP.
Nasal deviation surgery is intended to improve airflow through the nose. Sometimes this surgery is used to help patients better adjust to their CPAP machines.
Bariatric surgery is used to reduce food intake by changing the room in the stomach or how the intestines absorb nutrients. This type of surgery can be effective in weight loss and can improve sleep apnea in patients whose sleep apnea is related to being overweight.
If you are considering a surgical procedure, it is important that you and your health care provider tailor the selected surgery to the type of sleep apnea you have, and the primary cause of your apnea. Whichever treatment method you decide to use, it is important that you stick to the treatment schedule. Left untreated or improperly treated, sleep apnea can lead to worsening health conditions, including obesity, heart failure, and depression.
