Sleep Apnea Treatment Options

Patients with sleep apnea are not “one size fits all”.  Different people will do better with different options.  Here are some of the available treatment selections:

Man wearing a CPAP mask sleeping next to a woman in bed

  • Oral Appliance Therapy is effective and efficient in treating Obstructive Sleep Apnea (OSA).  It has a better adherence rate from patients since it’s small and comfortable.  It is considered as efficacious as CPAP for the treatment of Mild to Moderate sleep apnea.  It is a “first line of treatment” for OSA, but many doctors may not know this is an alternative and will only prescribe CPAP.
  • CPAP, Bi PAP, Auto PAP, ASV are machines that deliver pressurized oxygen through a nasal mask to limit obstruction at night.  Considered “the gold standard” treatment for OSA, it’s an effective and efficient treatment for sleep apnea but a very high number of patients have a hard time getting used to it.
  • Combination Therapy is the use of a CPAP device with an oral appliance.  This will help reduce the pressures necessary for the CPAP to keep the airway open in patients with severe sleep apnea, making the CPAP machine more comfortable and efficient.

Over 50% OF PATIENTS DISCONTINUE CPAP THERAPY WITHIN THE FIRST YEAR BECAUSE THEY FIND THEIR MACHINE, THE MASK AND THE TUBES UNCOMFORTABLE.  

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  • Uvulo-palato-pharyngo-plasty (UPPP) is a surgical procedure where part of the structures in the back of the soft palate and throat are removed.  Not commonly performed nowadays due to the low success rate.
  • Hypoglossal Nerve Stimulation Surgery (Inspire surgery): is a “pacemaker” for your tongue.  A device is implanted under the skin on your chest to stimulate the hypoglossus nerve.  When stimulated, the nerve will signal the tongue muscles to push your tongue out of the mouth to open the airway on the back of the throat.  The device has to be turned on and off each day and cannot be removed once placed.  This is a major surgical intervention, not everyone qualifies for the procedure and it that may need extra surgeries in the future to change the batteries of the device or if there are issues with the components.  It has a long recovery time before it can be activated and adjusted by your doctor.  In many cases, it can reduce the apnea events per hour but may not get rid of it completely.  IT’S IMPORTANT TO KNOW THAT AN ORAL APPLIANCE DOES THE SAME THING TO THE AIRWAY AS THIS SURGERY WITHOUT BEING INVASIVE!
  • Orthognathic surgery: the bones of the upper and lower jaw may be separated and repositioned to increase the size of the airway.  This procedure is done in the hospital under general anesthesia and requires a one to two day overnight stay followed by significant down time.  Not everyone qualifies for this procedure since it significantly alters the physical appearance of the person.

                                                 

  • Significant weight loss can help by reducing excess fatty tissue around the neck and tongue and lowering the Body Mass Index (BMI). It can improve sleep apnea and snoring and make it more manageable.  In the majority of cases, the apnea persists in a milder form that still requires treatment.  A balanced diet, excersise, Bariatric Surgery and GLP1s can all help loose weight and make apnea more manageable.
  • Decongestants help clear a stuffy nose and improve airflow; unfortunately it’s only temporary.
  • ENT consult may be helpful if part of the breathing issue is due to polyps, nasal septum deviation, enlarged turbinates, etc that may need surgical correction or treatment.
  • Changing sleep positions may help with symptoms.  Sleeping on the side may help some patients whose obstructive sleep apnea gets worse when they sleep on their back.