Treatments for Sleep Apnea

Your physician will determine the most appropriate form of treatment, based on the severity of your sleep apnea and other medical considerations.

There are a variety of approaches, which include:

• Behavioral Modification (Conservative Treatment)
• CPAP Therapy
• Oral Appliances
• Surgery

Please call us to discuss the relative merits of each approach.

Behavioural Modification

Appropriate behavioural treatment should be implemented for all patients, even those requiring additional interventions. These measures include:

• Weight loss
• Reduction of alcohol consumption
• Sleeping laterally (on your side)
• Cessation of smoking

Patients treated with behavioural techniques should be re-evaluated periodically after initiation of treatment. If they show improvement with these simple techniques, then continued support and positive reinforcement is extremely helpful. Other therapies are warranted for those patients who continue to experience symptoms.

Continuous Positive Airway

CPAP became commercially available in 1981, and is now the most common therapy for moderate and severe OSA.

CPAP (Continuous Positive Airway Pressure - pronounced see-PAP) is a small device that provides a gentle flow of positive pressure through a mask that fits over your nose to keep the airway open during sleep. This then allows for normal respiration and a peaceful sleeping pattern.

It is well documented and proven that CPAP is a very effective treatment for Obstructive Sleep Apnea.

Although CPAP is the treatment of choice, some patients find it challenging to accept and use. Please do not stop CPAP without talking to your doctor, who can help you with other treatments if you are unable to use CPAP.

CPAP is not an easy therapy to use and people tend to give up if they do not notice a big change right away. Education and follow-up on using CPAP effectively are very important to keeping up with your CPAP treatment. Problems such as mask fit, sores or redness around the nose, and dryness or nasal stuffiness are common reasons that people feel like giving up. Your therapist can usually resolve all of these issues.

When problems are solved, you begin to feel rested and have more energy.

At Clinical Sleep Solutions, we have an experienced team of therapists who are dedicated to enhancing your success with CPAP therapy. The founders of this clinic have sleep apnea themselves, so we are empathetic with your concerns.

Humidification

Many people using CPAP complain of nasal dryness, dryness in the throat and mouth, sore tongue, nasal stuffiness, or nose bleeds. Complying with your CPAP therapy is difficult when you have these problems. Upper airway dryness is a side effect of CPAP use and is one of the reasons people stop using their CPAP therapy.

Normally, the nose humidifies and warms the air we breathe. However, the delicate tissue on the inside of the nose changes when you use CPAP due to the increased airflow. To maintain CPAP therapy, you may need a medical assessment of the condition of your nose and throat, and a humidifier attached to the CPAP unit to provide warm, moist air.

For conditions of nasal stuffiness due to rhinitis, sinusitis, or allergies, your doctor can prescribe nasal sprays or medications to manage the disorder so you can breathe easier with your CPAP.

If your dryness or stuffiness is related to CPAP, using a humidifier attached to the CPAP unit may help.

Oral Appliances

Oral appliances presently in use and properly researched now fall into two categories. The first category is that of the Tongue Retaining Device and the other is that of the Mandibular Repositioning Device.

Patients must be aware that treatment with an oral appliance is not universally successful for patients with obstructive sleep apnea. An oral appliance is "site-specific" and will have no effect on obstructions high in the upper airway or low in the upper airway. CPAP is not "site-specific" and is the only treatment now available that is effective, regardless of the location of the obstruction, and the severity of the disease. Patients sometimes prefer to use an oral appliance rather than CPAP, but CPAP is better at reducing the number of apneas and increasing the patients' oxygen level.

Surgical Treatments

There are a variety of surgical approaches to treating OSA, depending on the anatomical location of the obstruction, the severity of the OSA, and the ingenuity and experience of the surgeon.

For OSA patients with more severe disease, several procedures or a combination of procedures may need to be performed. It is important that sleep studies be repeated after completion of surgical procedures to confirm effectiveness.

Success rates for surgery can be lower than for other types of therapy, depending on the individual. If a patient is unable to tolerate CPAP therapy and/or oral appliances haven’t worked, surgery can be helpful.

Nasal Surgery

A variety of procedures can be useful in selected patients with nasal obstruction, and may be used alone or in conjunction with other procedures. A specific advantage of nasal surgery for some OSA patients may be a reduction in the required CPAP pressure.

Somnoplasty

This is a recent advancement in surgical technology for treatment of OSA. Delivering radio frequency energy submucosally through a partially insulated electrode, Somnoplasty reduces tissue volume with minimal, if any, crusting or bleeding. For chronic nasal obstruction, the procedure typically takes less than 2 minutes per turbinate. When applied exclusively to the uvula and soft palate it is also effective in curing chronic snoring, and, like UPPP, has limited efficacy on OSA. Whether or not somnoplasty of the tongue will be effective in OSA is currently unknown.

Facial Reconstructive Surgery

Many OSA patients have obvious abnormal facial structure while in others the abnormalities may not be so apparent. Correcting and improving these anatomic factors in OSA have been found to be effective. However such surgery is expensive and not generally available. These procedures are usually combined with nasal airway procedures, and uvulopalatoplasty. The procedures include tongue advancement, as well as mandibular and at times maxillary procedures (requiring extensive dental work).

Tracheostomy

Although highly successful in eliminating sleep apnea, Tracheostomy is very invasive, both physically and psychologically. It was the main method of treating severe OSA prior to the development of CPAP. It is currently indicated only in very severe OSA when CPAP is not tolerated. It is now extremely rare to require a tracheostomy, due to newer methods of ventilation.


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