Treatment Options

Treatment options for obstructive sleep apnea include  weight loss, sleeping on your side, CPAP, surgery, and use of a dental appliance.  People tend to be highly opinionated regarding which treatment is best and may express their views as fact. Each of these treatment options has its advantages and disadvantages.  It is important to select the treatment that makes the most sense to you and your lifestyle.

Behavioral Treatment Options:

Weight loss and sleeping on your side will help most individuals with sleep apnea. The severity of sleep apnea, individual anatomy, and body mass index will determine if these options will be curative or beneficial.  It is best to discuss these options with your physician.  Neither of these treatment options are as easy as they sound. Alcohol, certain medications including sleeping aids, and sleep deprivation will make obstructive sleep apnea worse.

CPAP/BiPAP:

CPAP (continuous positive airway pressure) is a non-invasive device which is nearly 100% effective in the sleep lab. In the real world, effectiveness drops to approximately 50% due to compliance issues. Proper support, equipment, and education can significantly improve compliance rates.  CPAP is not curative, and needs to be used every night.  Its effectiveness is also dependent on the number of hours the device is used each night. Comfort, convenience, and social issues also affect CPAP use.

A person must complete a CPAP titration study to determine the pressure setting that is required to keep his/her airway open. The pressure required to prevent obstructive events will determine whether someone is placed on CPAP or BiPAP (bilevel positive airway pressure). The pressure level in CPAP is the same for both inspiration (breathing in) and expiration (breathing out). At high pressures, this can be difficult to tolerate when exhaling. In these instances BiPAP will be used which allows the inspiratory pressure to be set higher than the expiratory pressure.  Once an individual receives a CPAP or BiPAP prescription from his/her physician, a durable medical equipment (DME) company will provide CPAP equipment and training.  Education and support by a DME company should be comprehensive and provided on a one to one basis.

Surgery:

Surgery can potentially cure sleep apnea.  A single or multiple procedures may be required to achieve this goal. Even if not successful, some studies suggest that surgery can increase life expectancy relative to untreated individuals.  Success rates vary with individual anatomy and the procedure(s) selected.  Many surgeons describe success rates for the initial procedure(s) in the 50-70% range.  A number of surgeons have reported increased success rates by addressing tongue base obstruction. Surgery is painful and typically involves a one to three week recovery period. For more information, contact an otolaryngologist (ENT) with an interest in sleep medicine.

Dental Appliance:

A dental appliance is also a non-invasive device which can be used to treat mild to moderate OSA.  It is less cumbersome than CPAP but is often not effective. The device works by advancing the lower jaw. This may open the airway by bringing the tongue, which is attached to the jaw, forward. These appliances may increase the risk of Temporomandibular joint dysfunction (TMJ) and are not indicated for severe sleep apnea. A dentist with an interest in sleep medicine can fit you for this device.

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