Sleep Care

Choosing a Therapy for Sleep Apnea

There are a variety of therapies available for the treatment of obstructive sleep apnea (OSA), a condition in which a person stops breathing during the night.  As sleep apnea continues to be studied and researched in the medical field, new and more effective treatments continue to benefit those suffering from OSA.

In formulating a treatment plan for sleep apnea, it is important to work closely with your family doctor, who may recommend a consultation with a sleep specialist—a physician trained specifically in sleep medicine.  It is helpful to determine what the goals are for treatment—i.e., curing sleep apnea versus treating its symptoms—when developing a treatment plan.  Practicing good sleep hygiene habits will also aid in the success of treating sleep apnea.

Various treatments for OSA are discussed below.  Please note that this material is only for informational purposes and is not intended to be used as a treatment plan—your family doctor or another qualified medical professional can develop one with you.

CPAP, BiPAP, and Auto SV

The American Academy of Sleep Medicine, the governing body for the practice of sleep medicine in the United States, recommends Continuous Positive Airway Pressure (CPAP) as the first line of treatment for mild, moderate, and severe OSA. For most people, a CPAP trial in a sleep lab is a good place to start when treating their sleep apnea.

With advances in technology, new modes of pressure support for breathing have become available.  BiPAP (Bilevel positive airway pressure) uses two different air pressures instead of one continuous pressure to better mimic a person’s natural breathing and tends to be more comfortable for patients who have difficulty exhaling or catching their breath (hypoventilation).  Auto SV (Auto Servo Ventilation) uses a dynamic range of pressures throughout the night that provide better breathing support for patients suffering from complex sleep apneas, which are can be present in individuals suffering from cardiac or neurological conditions in addition to sleep apnea.

Various mask styles are available for people to choose from, and improvements to mask design, style, materials, and headgear are always ongoing based on feedback from individuals who use CPAP regularly.


Positional Sleep Therapy

For patients whose apnea is called position dependent, (meaning that it primarily occurs only in a certain position—typically while sleeping on the back), positional sleep therapy may be an option.  This involves avoiding sleep in the position where the sleep apnea is present.  One method often used to achieve this is the “tennis ball technique”, which involved wearing either a belt with a pocket or a T-shirt with a pocket in the back that has a tennis ball in it.  A person wearing this set-up to bed will feel the tennis ball in their back if they lay in that position while asleep, which will prompt them to turn onto his or her side.  Another option for avoiding supine sleep is the use of pillows, such as body pillows, wedge pillows, or some anti-snore pillows.


Oral Appliance Therapy

For patients unable to tolerate wearing a CPAP mask—such as those with significant claustrophobia or fine facial features—or those whose sleep apnea is mild or moderate, an oral appliance may be a good option to consider.  Made by a sleep dentist, an oral appliance typically works by repositioning the tongue or jaw to keep the airway open during sleep.  Studies have found that in addition to having more mild OSA, factors related to an improved response when using an oral appliance to treat sleep apnea include being younger, being female, having a lower body mass index, and having a smaller neck.  The most common problems or side effects associated with using an oral appliance are excessive drooling during the night and some jaw discomfort when first waking up in the morning.


Surgical Options

For those who would prefer not to deal with wearing a mask or oral appliance nightly to treat sleep apnea, there may be some surgical options to consider.  These typically involve a referral to an Ear Nose Throat (ENT) specialist who can evaluate the airway to see if a person is a good candidate for surgery.  Generally, the goal of most surgeries is to remove tissue or structures that crowd the airway, making it more susceptible to closing-off during the night.  Examples of these types of surgeries can include a tonsillectomy (removing the tonsils) or a uvulopalatoplasty (often abbreviated UPPP or UP3—it involves reducing or removing the uvula, which is the tear-shaped piece of tissue that hangs down at the back of the throat).

If successful, surgery may be able to “cure” a person’s sleep apnea—however, it is important to realize that the success rate for these surgeries tends to be lower and recovery from the surgery is a painful process.  A common result from these surgeries is for a person’s sleep apnea to be reduced by some degree, but not eliminated entirely.  However, because of the change to the airway, some people find they are able to respond better to CPAP therapy than when they initially tried it.

Weight Loss

For patients who are overweight with sleep apnea, weight loss can be an effective component to sleep apnea therapy—particularly for those whose weight is centered around their waist (as opposed to the thighs or hips) or for those with large necks due to excessive weight.  A variety of methods to lose weight—diet, exercise, and possibly bariatric surgery in severe cases—can be utilized.  While weight loss is not guaranteed to “cure” or resolve a person’s sleep apnea, for most people, it can significantly reduce their symptoms.  It may also open new avenues for treatment:  for example, a person with severe OSA who was unable to tolerate the high CPAP pressure needed to resolved his symptoms may only need a lower, more comfortable pressure after he’s lost weight and the severity of his sleep apnea is reduced.