Sleep Apnea Treatments

Posted on by Advanced ENT & Allergy

What Are the Most Common Sleep Apnea Treatments?

Continuous Positive Airway Pressure (CPAP)

The most popular type of treatment for obstructive sleep apnea is the CPAP (continuous positive airway pressure) device. This machine uses a face or nasal mask connected to a pump, which provides a positive flow of air powerful enough to keep your airway passage open. The device must be worn every night to be effective.

While some find it inconvenient and uncomfortable, the results are typically instantaneous and worth the discomfort. Both machines and masks are available in a variety of styles and sizes, which can be geared toward your individual needs. Some people benefit from a nasal mask that covers the nose, while others require a full-face mask that covers both the nose and mouth.

Nasal pillows that consist of soft silicone tubes placed directly in the nostrils are another popular choice. An optional humidifier can help prevent nasal irritation and drainage by providing a steady flow of heated and moisturized air.

Several alternative PAP devices are available. Autofiltrating positive airway pressure (APAP) automatically increases or decreases air pressure throughout the night as needed. Bi-level positive airway pressure (BPAP) devices increase the pressure level when the wearer breathes in and decrease it when they breathe out. These machines often help individuals who have trouble with the basic CPAP device.

Oral Appliances

While continuous positive airway pressure (CPAP) therapy is the preferred method of treatment, not everybody can tolerate sleeping with a mask attached to a machine that delivers bursts of air to the throat. Oral appliances are an alternative for these patients. They either move the lower jaw forward to keep the airway passages open or hold the tongue in place to prevent it from falling backward and blocking the airway.

Oral appliances may be either fixed or adjustable and are available in many different styles with as many as 40 different patents in existence. Some are custom designed to fit the individual’s mouth after impressions are made and must be prescribed by a dentist, oral surgeon or ENT physician with sleep medicine experience. Others are considered one-size-fits-all.

There are several advantages to using oral appliances over other sleep apnea treatment methods. They are easy to use, inexpensive and effective for treating many sleep disorders including snoring, upper airway resistance syndrome and obstructive sleep apnea. They are easy to insert and remove and tend to have higher compliance rates than CPAP. Younger patients who must moderate sleep apnea, lower BMI and smaller neck sizes are most likely to see positive results from oral appliances.

Uvulopalatopharyngoplasty (UPPP)

Uvulopalatopharyngoplasty (UPPP) is a surgical procedure to remove excess tissue in the throat to widen the airway, which makes it easier for the patient to breathe. This helps treat obstructive sleep apnea, a sleeping disorder that can cause serious health problems over time. UPPP involves the removal of tissues that may include the uvula, soft palate, tonsils, adenoids and pharynx. In some instances, a small portion of the tongue may be removed as well.

If you suffer from snoring and sleep apnea due to excess tissue in the throat or mouth that causes blockages of the upper airway, cannot use CPAP or do not respond to CPAP treatment, you may be a candidate for UPPP.

During the procedure, the patient receives general anesthesia. The surgeon then removes the tonsils and adenoids if needed, excises the uvula and trims or removes the soft palate. A brief hospital stay may be recommended so the patient can be closely monitored after surgery.

Side effects may include sore throat, swelling, infection, bleeding, difficulty swallowing, speech problems or changes to the voice, sleepiness or apnea from medications you’ll be given to promote healing. Other possible outcomes include changes in the way food tastes and narrowing of the airway related to scar tissue.

UPPP is not a viable solution for everybody and offers mixed results; some people report a drastic reduction in episodes of snoring and apnea, while others still require additional treatment (e.g., CPAP) afterwards. Your doctor can discuss the risks and help you to decide whether UPPP is right for you.

Inspire

While PAP therapy is the preferred treatment method, not everybody can tolerate this. Individuals looking for an alternative treatment for their sleep apnea might find relief from Inspire therapy.

Inspire is an implantable device, similar to a pacemaker, that monitors your breathing patterns while you sleep. It delivers mild stimulation to the nerve that controls movement of the tongue and airway muscles, keeping the airway open and preventing OSA.

The device contains three parts: a small generator, a breathing sensor lead and a stimulation lead. Patients use a small handheld remote to control the device, turning it on or off and pausing it during the night if needed. The stimulation is typically painless, and its strength can always be adjusted using the remote if needed.

The Inspire device is implanted during an outpatient surgical procedure using general anesthesia. It is placed beneath the skin of the neck and chest via three small incisions. Most patients recover fully from surgery within a couple of weeks.

Candidates for Inspire must have been diagnosed with moderate to severe OSA and are unable to benefit from PAP therapy. They must not be significantly overweight.

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