What are the treatments for sleep apnea?

Conservative treatments—In mild cases of obstructive sleep apnea, conservative therapy may be all that is needed. Overweight persons can benefit from losing weight. Even a 10 percent weight loss can reduce the number of apneic events for most patients. However, losing weight can be difficult to do with untreated obstructive sleep apnea due to increased appetite and metabolism changes that can occur with obstructive sleep apnea. Individuals with obstructive sleep apnea should avoid the use of alcohol and certain sleeping pills, which make the airway more likely to collapse during sleep and prolong the apneic periods. In some patients with mild obstructive sleep apnea, breathing pauses occur only when they sleep on their backs. In such cases, using pillows and other devices that help them sleep in a side position may be helpful. People with sinus problems or nasal congestion should use nasal sprays or breathing strips to reduce snoring and improve airflow for more comfortable nighttime breathing. Avoiding sleep deprivation is important for all patients with sleep disorders.

Mechanical therapyPositive Airway Pressure (PAP) therapy is the preferred initial treatment for most people with obstructive sleep apnea. With PAP therapy, patients wear a mask over their nose and/or mouth. An air blower gently forces air through the nose and/or mouth. The air pressure is adjusted so that it is just enough to prevent the upper airway tissues from collapsing during sleep. PAP therapy prevents airway closure while in use, but apnea episodes return when PAP is stopped or if it is used improperly. There are several styles, and types of positive airway pressure devices depending on specific needs of patients.

  • CPAP (Continuous Positive Airway Pressure) is the most widely used of the PAP devices. The machine is set at one single pressure.
  • Bi-Level PAP uses one pressure during inspiration, and a lower pressure during expiration. There is a criterion that must be met before insurance will cover the Bi-Level. This usually means that the CPAP machine must be tried first with no success and these results documented before insurance will pay for a Bi-Level.
  • Auto CPAP or Auto Bi-Level PAP uses a range of pressures that self-regulates during use depending on pressure requirements detected by the machine.
  • Adaptive Servo-Ventilation (ASV) is a type of non-invasive ventilation that is used for patients with central sleep apnea, which acts to keep the airway open and delivers a mandatory breath when needed.

Mandibular advancement devices—These are devices for patients with mild to moderate obstructive sleep apnea. Dental appliances or oral mandibular advancement devices that help to prevent the tongue from blocking the throat and/or advance the lower jaw forward can be made. These devices help keep the airway open during sleep. A sleep specialist and dentist (with expertise in oral appliances for this purpose) should jointly determine if this treatment is best for you.

Nasal Expiratory Positive Airway Pressure – The device is worn over both nostrils with the mouth closed to cause an increase in the airway caliber by increasing expiratory resistance.

Oral Pressure Therapy – The device is worn in the mouth with the patient breathing through the nose. A vacuum pump with negative pressure pulls the soft palate forward to open the airway.

Hypoglossal Nerve Stimulator – A stimulator is implanted under the skin on the right side of the chest with electrodes tunneled under the skin to the hypoglossal nerve in the neck and to intercostal muscles in the chest. When the hypoglossal nerve is stimulated, the tongue moves forward out of the airway and the airway is opened.

SurgerySurgical procedures may help people with obstructive sleep apnea and others who snore but do not have sleep apnea. There are many types of surgical procedures, some of which are performed as outpatient procedures. Surgery is reserved for people who have excessive or malformed tissue obstructing airflow through the nose or throat, such as a deviated nasal septum, markedly enlarged tonsils, or small lower jaw with an overbite that causes the throat to be abnormally narrow. These procedures are typically performed after sleep apnea has failed to respond to conservative measures and a trial of CPAP. Types of surgery include:

  • Somnoplasty is a minimally invasive procedure that uses radiofrequency energy to reduce the soft tissue in the upper airway.
  • Tonsillectomy is a procedure that removes the tonsillar tissue in the back of the throat which is a common cause of obstruction in children with sleep apnea.
  • Uvulopalatopharyngoplasty (UPPP) is a procedure that removes soft tissue on the back of the throat and palate, increasing the width of the airway at the throat opening.
  • Mandibular/maxillary advancement surgery is a surgical correction of certain facial abnormalities or throat obstructions that contribute to obstructive sleep apnea. This is an invasive procedure that is reserved for patients with severe obstructive sleep apnea with head-face abnormalities.
  • Nasal surgery includes correction of nasal obstructions, such as a deviated septum.