Sleep Apnea Treatment

Increased risk groups include: middle-aged men and post-menopausal women, people who are overweight (BMI of 25-29.9) and obese (BMI over 30), men and women with large neck sizes (17 inches for men, 16 for women), people with abnormities of the bone and soft tissue structure of the head and neck (especially people with small chins), adults and children with Down’s Syndrome, children with large tonsils and adenoids, anyone with a family history of OSA, smokers and users of alcohol, people who use central nervous system depressants and people who have night time nasal congestion due to their anatomy or inflammation of their nasal passages. Even though obesity is a risk factor, sleep apnea occurs in all weight groups.

The diagnosis of the condition must be made by a physician trained in this area of medicine. The physician will make the diagnoses based on the patient’s medical and family history, a physical exam, and the results of a sleep study commonly done at a sleep center called a polysomnogram or PSG. This sleep study measures vital signs such as brain waves, heart beat, and breathing while the patient sleeps. It is from here that the AHI is determined. Since there are different types of sleep apnea with different causes, the physician’s diagnosis is critical. One type of apnea is called central apnea. Here there is no physical blockage in the airway, but a pause in the signal from the brain to the body telling the body to breathe.

Obstructive sleep apnea which is what we are concerned here is by far the most common type of apnea. The blockage can occur at different areas in the upper airway such as the soft palate, uvula, and the back of the tongue. Increase weight leads to fatty deposits around the airway narrowing it. Large tonsils and adenoids can block the airway. Clogged nasal passages can also make breathing difficult. The third type of apnea is called mixed apnea. This begins as central apnea and develops an obstructive component and is treated as obstructive apnea.

The physician must also decide which treatment is best for the patient. Good sleep hygiene such as sleeping with the head raised and not sleeping on one’s back, weight loss, exercise, avoiding alcohol and other central nerve depressants, and not smoking are things the patient can do on their own and depending on the severity of the apnea, can eliminate it or at least improve it.

The gold standard of treatment is through a Continuous Positive Air Pressure machine or also known as CPAP. High pressure is supplied to a tube to a mask that covers the nose. The air pressure balloons the structures in the back of the throat open keeping the airway patent during sleep. CPAP nearly always for any degree of sleep apnea will resolve it completely. The problem with CPAP is that it could be uncomfortable or difficult to wear and some people may feel claustrophobic using it. Its long-term compliance is below 50%.

Oral appliances have been found to be an effective treatment option for people with mild to moderate OSA who either prefer it to CPAP or can’t tolerate CPAP. Oral appliances often look like sports mouth guards and help maintain an uninterrupted airway by repositioning the lower jaw and tongue forward and stabilizing the soft palate and uvula by increasing their muscle tone. Some appliances are made for snoring and others are made for snoring and OSA. Appliances can be made to be either in a fixed position or can be made to be adjustable. Snoring is improved and often eliminated in almost 100% of patients with oral appliances. There are over 40 different oral appliances that are approved by the FDA, each with their own advantages and disadvantages. Some appliances called Tongue Retention Devices look like suction bulbs which are used to pull the tongue forward opening the airway.

Surgery is an option for the treatment of OSA when non-invasive treatment such as CPAP or oral appliance therapy is not successful. Surgery is most successful when an obvious anatomic deformity is present. Most treatment involves removing tissue from the soft palate, uvula, tonsils, adenoids and/or the tongue. Surgery may also require advancing the jaws to open the airway. Beneficial results from surgery may not be permanent, however.

Sleep Apnea Treatment with Oral Appliances>