Sleep Apnea

author

Medically Reviewed by

Dr. Ealena Callender

Written by

Eric Suni

Obstructive sleep apnea (OSA) is one of the most common sleep disorders and one that can have significant health consequences if left untreated. It is marked by disrupted breathing, fragmented sleep, and a decreased oxygen level in the body.

The following sections provide an introduction to important aspects of treatment for obstructive sleep apnea. Treatment for obstructive sleep apnea often involves multiple components and is tailored to each individual patient. A health professional can explain the condition, review treatment options, and describe the benefits and downsides of different approaches to managing the condition for any specific person.

Patient Education and Lifestyle Changes

An initial component of treatment for obstructive sleep apnea is informing the patient about the condition and how it may be helped by specific lifestyle changes.

Obstructive sleep apnea can cause significant daytime drowsiness, and it’s important for people with OSA to be aware of this issue, especially if they spend significant time driving or operating heavy machinery.

Patient education also involves explaining the factors that contribute to OSA. Making lifestyle changes described in the following sections — losing weight, exercising regularly, limiting use of alcohol and sedatives, avoiding cigarette smoking, and adjusting sleeping position — can reduce the severity of OSA.
While these changes can play an important part in obstructive sleep apnea treatment, they may not resolve the condition completely and often need to be combined with other therapies to reduce symptoms of OSA.

Weight Loss

Excess weight and obesity are driving factors behind many cases of obstructive sleep apnea, and research has found that losing weight can lessen the severity of OSA. A lower body weight can decrease the size of fat deposits in the tongue and back of the throat that can restrict the airway. Weight loss can also reduce abdominal girth that affects lung capacity.

Weight loss can cut down on OSA-related symptoms and improve both cardiovascular health and overall quality of life. The benefits of weight loss can be considerable; In moderately obese males, for example, loss of 10-15% of body weight can reduce OSA severity by as much as 50%. Weight loss from diet and exercise as well as from bariatric surgery has shown an effect on reducing OSA and its symptoms. Working with a nutritionist or dietician can help develop a dietary plan that encourages healthy and sustainable weight loss.

Exercise

Exercise has far-reaching positive effects on health, and studies have shown that making time to be physically active every day can help curtail OSA (9). While exercise is often thought of as a means to weight loss, research has demonstrated that exercise can cause lasting improvements in OSA severity and symptoms even without a reduction in body weight.

Limiting Alcohol and Sedatives

Alcohol and sedative medications cause slackening of the tissues near the airway, contributing to a heightened risk of airway collapse and OSA. Alcohol can cause fragmented and lower-quality sleep because of its effects on sleep cycles. For these reasons, reducing or eliminating the use of alcohol and sedatives, especially in the hours leading up to bedtime, is frequently advised for patients with OSA.

Avoid Cigarettes

Active smokers have an increased risk of obstructive sleep apnea relative to former smokers and people who have never smoked. This research indicates that quitting smoking or never starting to smoke in the first place can help prevent and/or treat OSA. One large study also found that cigarette smoking can cause a more severe form of obstructive sleep apnea and increased daytime sleepiness.

Don’t Sleep on Your Back

Sleeping on your back is a risk factor for sleep apnea. In this position, gravity draws the tongue and other tissues down and toward the airway, exacerbating the risk of disordered breathing. Adjusting to a different sleeping position may prevent this airway constriction in some patients and can work in conjunction with other types of OSA therapy.

Changing your sleeping position is easier said than done. Some natural back sleepers will struggle to fall asleep in another position, or they may revert to lying on their back while asleep. Different methods have been developed to discourage back sleeping.

One basic method involves sewing a tennis ball into the back of a shirt, which prevents lying in a supine position. While this is effective in the short-term, few people stick with this technique.

Positive Airway Pressure (PAP) Devices

A core component of treatment for obstructive sleep apnea is the use of a positive airway pressure (PAP) device. PAP machines work by pumping pressurized air through a hose and into the airway. The stable, steady flow of air prevents airway collapse (14) and promotes regular breathing without sleep fragmentation.

Treatment with a PAP device is considered to be the current gold standard in sleep apnea treatment and is offered as initial therapy to the majority of patients (15). The most common way of receiving PAP therapy is with continuous positive airway pressure (CPAP) devices, which deliver air with a consistent pressure level.

Other types of PAP therapy include bi-level (BPAP) and automatic or autotitrating (APAP) devices. BPAP uses one pressure level for inhalation and another for exhalation. APAP varies pressure levels as needed during sleep.

A prescription is required to obtain and use any PAP machine, and its pressure settings come pre-set based on measurements taken by your health care team. Setting up your device properly helps you get used to sleeping with a CPAP so that you can get the most benefits from it.

To take in the pressurized air and keep your airway open, it is necessary to wear a mask attached to the device every time you sleep. A full-face mask covers both the nose and mouth while other masks cover or go underneath the nose. The choice of mask depends on various factors including whether you breathe through your mouth, your sleeping position, and whether you often suffer from nasal congestion.

Although using a PAP device is quite effective at treating obstructive sleep apnea, it can come with downsides. Some people find wearing the mask to be uncomfortable and may not adhere to their prescribed treatment. It’s important for patients to work closely with their health care team to make using CPAP as comfortable as possible through optimal mask selection, device settings, and addressing discomfort with the mask or other aspects of PAP therapy.

Oral Appliances

Oral appliances or mouthpieces are a treatment option for mild or moderate OSA, especially if a person is unable to adjust to using a PAP device. There are two main types of mouthpieces:

  • Mandibular advancement devices (MADs) work by keeping the lower jaw pulled forward so that it can’t constrict the airway and have been shown to reduce OSA. These devices also reduce chronic snoring and sleep-related bruxism (teeth grinding), both of which are associated with OSA.
  • Tongue retaining devices (TRDs) keep the tongue from sliding back in the mouth during the night. When the tongue moves back toward the airway, it can block the flow of air and contribute to disordered breathing. A study comparing TRD and MAD found them to have similar efficacy for sleep apnea, although patients generally preferred and slept better with a MAD mouthpiece.

Different models of oral appliances are sold over-the-counter, but dentists can make devices custom-fitted for a patient’s mouth.

Though oral appliances have few side effects, using them consistently isn’t for everyone. As with CPAP therapy, it’s necessary to use a mouthpiece for the entire time you sleep, and some people find that to be uncomfortable, making it difficult to sleep soundly.

Surgery

Several types of surgery can be employed as a treatment for obstructive sleep apnea. One goal of surgery can be to address anatomical features that cause airway restriction. For example, a surgical procedure called uvulopalatopharyngoplasty (UPPP) removes tissue at the back of the throat including the uvula (the flap that hangs down in the throat), part of the throat wall, and, if present, the tonsils and adenoids.

Another type of surgery known as upper airway stimulation (UAS) implants a device that activates the hypoglossal nerve, causing tightening of muscles near the airway. Research has found that UAS provides sustained improvement in OSA, but more research is needed to compare it with existing therapies.

In adults, surgery is rarely a first-line treatment for OSA. It is most often considered when a patient does not improve with other types of therapy, such as using a CPAP or oral appliances. In children, though, surgical removal of the tonsils and adenoids (adenotonsillectomy) is often the initial form of treatment.

Though these surgeries are normally well-tolerated, there are risks of complications such as infection, bleeding, pain, or other problems near the surgical site.

Mouth and Throat Exercises

As the body relaxes during sleep, the muscles behind the tongue can become floppy. Snoring occurs when air causes this slack tissue to vibrate. The floppy tissue can also constrict the airway and play a role in obstructive sleep apnea.

Special exercises of the mouth and throat, technically known as myofunctional therapy and/or oropharyngeal exercises, can tone these muscles so that they stay more taut during sleep. Doing these exercises daily for a few months has been found to reduce the severity of OSA. Though exercises may need to be combined with other treatments for optimal results, they have virtually no costs or side effects, making them a low-risk inclusion in sleep apnea treatment plans.

Medications

Medications are not a first-line treatment for obstructive sleep apnea and are rarely a central component of care. While some drugs to promote breathing have been studied, none have demonstrated sufficient effectiveness compared to existing standard therapies. As short-term supportive care, stimulant drugs may be prescribed for sleep apnea patients to treat significant daytime sleepiness. Researchers are also studying drugs aimed at weight loss, nasal decongestant, and reduction of upper airway swelling for use in improving OSA symptoms.

Who Provides Treatment for Obstructive Sleep Apnea?

Care for people with sleep apnea is typically directed by a medical doctor, and their health care team may include a respiratory therapist, sleep technician, dentist, dietician, and/or physical therapist. Primary care physicians as well as gastroenterologists, pulmonologists, cardiologists, otolaryngologists (ear, nose, and throat, or ENT, doctors), and surgeons may be involved in planning and monitoring a patient’s treatment plan.

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