CPAP Therapy and Other Treatment Options
CPAP Therapy / Other Treatment Options
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:
- CPAP Therapy
- Behavioral Modification (Conservative Treatment)
- Oral Appliances
Continuous Positive Airway Pressure
CPAP became commercially available in 1981, and is the most common therapy for moderate and severe OSA due to its effectiveness in treating this condition. CPAP (Continuous Positive Airway Pressure) is a small device that provides a gentle flow of positive air pressure through a mask that fits over your nose and keeps the airway open during sleep. This allows for normal respiration and a peaceful sleeping pattern. Although CPAP is the treatment of choice, some patients find it can be challenging and hard to adapt to its daily use. However, OSA is a life long condition and will come back if one discontinues the therapy. Please do not stop CPAP without consulting your doctor and or Respiratory Therapist first. Clinical Sleep Solutions experts can help you trouble shoot any concerns and discuss the pros and cons of alternative treatments if you are unable to tolerate CPAP. CPAP use in the beginning can be a challenge and it involves a period of adjustment. Some people may give up if they do not notice a big change right away. Problems such as mask fit, sores or redness around the nose, and dryness or nasal stuffiness are common obstacles that discourage patients. Your therapist can work with you to resolve all of these issues. When problems are solved, you begin to feel more rested and have more energy. Clinical Sleep Solutions has an experienced team of therapists who are dedicated to enhancing your success with CPAP therapy. The founder of our company also has sleep apnea, so we are first to be empathetic to your concerns.
Appropriate behavioral 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 behavioral 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. Investigating other therapies may be warranted for those patients who continue to experience symptoms.
Oral appliances presently in use and properly researched now fall into two categories. The first category is the Tongue Retaining Device and the other is called 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.
On the other hand, CPAP is not “site-specific” and is the only treatment 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 proven more effective at reducing the number of apneas and treating the patients’ condition.
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 may be helpful.
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.
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 nasal cavity. When applied exclusively to the uvula and soft palate it is also effective in curing chronic snoring, and like Uvulopalatopharyngoplasty (UPPP) has limited efficiency on OSA.
Facial Reconstructive Surgery
In some OSA patients, abnormal facial structures are obvious while in others the abnormalities may not be so apparent. Correcting and improving these anatomic factors in OSA have been found to be somewhat effective. However such surgery is expensive and invasive and can present complications afterwards. These procedures are usually combined with nasal airway procedures, and UPPP. The procedures include tongue advancement, as well as mandibular and sometimes jaw bone procedures (requiring extensive dental work).
Before CPAP therapy, a Tracheostomy was considered highly successful in eliminating sleep apnea and was the main method used to treat OSA. However, Tracheostomy are very invasive, both physically and psychologically and is no longer widely used. It is only done in rare and severe OSA patients when CPAP is not tolerated or in emergency situations. Due to newer methods of ventilation mentioned above, it is extremely unique to require a tracheostomy.