What’s the best way to treat obstructive sleep apnea?

Woman yawning in bed

That loud snoring you do every night may be a sign of a serious medical problem. If you wake up abruptly several times a night, feel tired in the morning or have attention problems during the day, it might be time to seek professional help.

The potential cause of these symptoms is known as obstructive sleep apnea — when your airway intermittently closes, usually behind your tongue and soft palate — while you sleep. Obstructive sleep apnea is concerning because if left untreated, it’s associated with health issues such as high blood pressure and coronary artery disease.

The most effective treatment for obstructive sleep apnea is continuous positive airway pressure, or CPAP. It’s like a vacuum in reverse. Patients wear a mask that attaches to a machine with a hose. When they turn the machine on, it blows air through the nose, which acts as a pneumatic splint to open the airway during sleep. CPAP therapy has been shown to resolve snoring, improve sleep quality and boost energy levels. Adherence to CPAP is associated with reduction in blood pressure as well.

While CPAP is a highly effective treatment, only about 50% of patients are able to use it nightly. Issues using CPAP can include discomfort with the mask, leaks, dryness and feeling suffocated by air.

The link between your bedtime and your heart health

Alternative treatments for obstructive sleep apnea

Oral appliance

The most common type of oral appliance is a mandibular repositioning device. It looks like an adjustable mouth guard and is custom made by a dentist. It moves the lower jaw forward while you sleep to increase the upper airway space and hold the airway open, so you don’t snore and you feel like your sleep is improved. We do a sleep study with it in to see if it’s effective for you.

The oral appliance is mainly indicated for mild to moderate obstructive sleep apnea. It’s not as effective as CPAP, but if someone is having trouble using the CPAP, an oral appliance might be a good alternative.

There is a potential to change your bite over time but, for the most part, your jaw should go back to its original position when you take the device out.

Upper airway stimulation

Upper airway stimulation, also known as hypoglossal nerve stimulation, is the process of implanting a device in the chest with two leads. One lead senses when you’re going to take a breath. The other stimulates the hypoglossal nerve, activating the muscles that push your tongue forward, and increases tension on the muscles of the upper airway, opening it up.

Upper airway stimulation is approved by the U.S. Food and Drug Administration for moderate to severe obstructive sleep apnea. To qualify for the device, you should have a body mass index less than or equal to 35. You also need to have drug-induced sleep endoscopy or DISE. This is a procedure done by an ear, nose and throat physician. You’ll be made sleepy to see how the airway closes to ensure the device will work to treat your sleep apnea. You have to be evaluated by a sleep medicine doctor and referred to an ear, nose and throat doctor to have the device implanted. Additional appointments are needed to turn it on, fine tune the stimulation during a sleep study and for periodic follow-up care. It’s not as effective as CPAP, but an alternative if you can’t tolerate CPAP.

Surgery

There are also some upper airway surgeries that can be done to treat obstructive sleep apnea. Uvulopalatopharyngoplasty is a procedure during which surgeons trim redundant tissue from the soft palate and uvula. Other upper airway surgeries include hyoid suspension surgery and mandibular advancement surgery.

Lifestyle changes

You don’t have to be overweight to have obstructive sleep apnea but, for most patients, weight is a factor. Making lifestyle changes such as losing weight through a combination of nutrition and exercise can improve and sometimes alleviate obstructive sleep apnea. Even in patients who are using CPAP, studies have shown exercise can improve energy more than CPAP alone. Also, CPAP pressure needs may decrease, which may help with tolerability.

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