Sleep Apnea - Treatment Overview
SYMPTOMS & TREATMENTS
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Treatment for obstructive sleep apnea (OSA) includes lifestyle changes, continuous positive airway pressure (CPAP) (to prevent the airway from closing during sleep), the use of dental devices (oral breathing devices) to help keep your airway open, medicine to help you stay awake during the day, and surgery. The goals of treatment are to relieve symptoms such as snoring and excessive daytime sleepiness and prevent other problems, such as high blood pressure. Your doctor will base your treatment on how severe your sleep apnea is.
In general, your doctor will have you try lifestyle changes and CPAP first. Surgery might be a first choice only if the sleep apnea is caused by a blockage that is easily fixed.
You may need to be treated for other health problems before you are treated for sleep apnea. For example, people who also have inflammation of the nasal passages (rhinitis) may need to use nose spray to reduce the inflammation. People who have an underactive thyroid gland (hypothyroidism) need to take thyroid medicine.
Children have the same treatment options as adults. But surgery (tonsillectomy and adenoidectomy) typically is the first choice because enlarged tonsils or adenoids cause most cases of sleep apnea in children. If surgery is not possible or does not work, children are treated using CPAP.
Initial treatment
The first treatment for obstructive sleep apnea (OSA) consists of making lifestyle changes. Your sleep apnea may be helped if you:
- Lose weight (if needed). Small studies haveshown that losing weight decreases the number of times an hour that you stopbreathing (apnea) or that a reduced amount of air enters your lungs(hypopnea).9 Experts agree that weight loss should bepart of managing sleep apnea.9
- Wake up at the same time everymorning.
- Sleepon your side. Try this: Sew a pocket in the middle of the back of your pajamatop, put a tennis ball into the pocket, and stitch it shut. This will help keepyou from sleeping on your back. Sleeping on your side may eliminate mild sleepapnea.5
- Avoid the use of alcohol and somemedicines, especially sleeping pills andsedatives, before bed.
- Quit smoking. Thenicotine in tobacco relaxes the muscles that keep the airways open. If youdon't smoke, those muscles are less likely to collapse at night and narrow theairways.
- Raise the head of your bed4 in. (10 cm) to6 in. (15 cm) by putting bricksunder the legs of the bed. You can also use a special pillow (called a cervicalpillow) when you sleep. A cervical pillow can help your head stay in a positionthat reduces sleep apnea. Using regular pillows to raise your head and upperbody will not work.
- Promptly treat breathing problems, such as astuffy nose caused by a cold or allergies.
All people who have sleep apnea should make these lifestyle changes. They may be all that is needed to relieve mild sleep apnea.
Some people use nasal strips, which widen the nostrils and improve airflow. Although these strips may decrease snoring, they cannot treat sleep apnea.
First medical treatment
Continuous positive airway pressure (CPAP) is nearly always the first medical treatment for sleepapnea.
- With CPAP, you use a breathing device that prevents your airways from closing during sleep.
- CPAP is the preferred treatment for moderate or severe sleep apnea.
- It may take time for you to be at ease when you use CPAP. You may find that you want to take the mask off, or you may find it difficult to sleep while using it. If you can't get used to it, talk to your doctor. You might be able to try another type of mask or make other adjustments.
- CPAP does not always get rid of daytime sleepiness. If you still feel sleepy during the day while using CPAP at night, tell your doctor.
- Some CPAP devices automatically adjust air pressure or use different air pressures when you breathe in or out. They are easier and more comfortable for some people to use.
Other medical treatment includesoral breathing devices. These devices reposition your tongue and jaw duringsleep, which opens up your airways.
Surgery might be thefirst treatment only when a blockage can be fixed easily,such as when you have overly large tonsils.
Ongoing treatment
Ongoing treatment forobstructivesleep apnea (OSA) includes usingcontinuous positive airway pressure (CPAP) or anoral breathing device and making changes in your lifestyle. Lifestyle changesinclude losing weight (if needed), improving sleep habits (such as sleeping onyour side and waking up at the same time every morning),avoiding the use of alcohol and certain medicines (especially sleeping pillsandsedatives) before bed, and stopping smoking. Sometimesmedicine to help you stay awake during the day is used along with CPAP.
If CPAP is not working, you may needanothersleep study to find out whether your CPAP machineneeds to be adjusted. You may also need to think about surgery. Surgicalchoices include:
- Uvulopalatopharyngoplasty, which removes excess tissue in the throat to make the airway wider. It is the most common surgery to treat sleep apnea in adults.
- Tonsillectomy and/or adenoidectomy, which removes the tonsils and/or the adenoids. It may be used if you have enlarged tonsils and adenoids that are blocking your airway during sleep. This is often the first treatment option for children because enlarged tonsils and adenoids are usually the cause of their sleep apnea.
- Other surgical procedures, which are used to repair bone and tissue problems in the mouth and throat.
Treatment if the condition gets worse
If your obstructive sleep apnea (OSA) gets worse, talk to your doctor. You may need another complete sleep study, and you may need to adjust your continuous positive airway pressure (CPAP) machine. You may be able to take medicine to help you stay awake during the day. You may also need treatment for problems that sleep apnea may cause, such as high blood pressure.
In some cases, you may need surgery. Surgical options include:
- Uvulopalatopharyngoplasty, whichremoves excess tissue in the throat to make the airway wider. It is the mostcommon surgery to treat sleep apnea in adults.
- Tonsillectomy and/or adenoidectomy, which removes thetonsils and/or the adenoids. It may be used if you have enlargedtonsils and adenoids that are blocking your airwayduring sleep. This is often the first treatment option for children, becauseenlarged tonsils and adenoids are usually the cause of their sleepapnea.
- Other surgical procedures, which are used to repairbone and tissue problems in the mouth and throat.
- Tracheostomy, which creates a hole in the windpipe(trachea). A tube is then put in the hole to bring air in. Doctors rarely usethis surgery, because it may cause other health problems. But when othertechniques have failed, almost all people who are treated with tracheostomywill be cured of their sleep apnea.
- Bariatric surgery if you are extremely overweight (severely obese) and the excessweight is making your sleep apnea worse. This surgery is done only for peoplewho cannot lose weight with diet and exercise. Bariatric surgery can promoteweight loss that improves sleep apnea.14
What To Think About
Research shows that continuous positive airway pressure (CPAP) decreases daytime sleepiness, especially in people who have moderate to severe sleep apnea.1, 9 But CPAP may not work as well for people who have mild sleep apnea.9
CPAP can lower daytime and nighttime blood pressure.10
If you use CPAP to treat sleep apnea, you need to use it every night. If you do not use it, your symptoms will return right away.
Treatment of obstructive sleep apnea in people with coronary artery disease lowers the risk of some heart problems.11
| By: | Healthwise Staff | Last Revised: July 9, 2009 |
| Medical Review: | E. Gregory Thompson, MD - Internal Medicine Mark A. Rasmus, MD - Pulmonology, Critical Care Medicine, Sleep Medicine | |
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