How to Treat Sleep Apnea
Sleep apnea refers to a condition in which the patient stops breathing many times each night. It is usually accompanied by episodes of breathing too infrequently or taking shallow breaths, which is called hypopnea. Treatment for sleep apnea depends on what type of apnea the patient experiences.
There are four types of sleep apnea. The first is obstructive sleep apnea (OSA), in which airflow is blocked during sleep. A physical obstruction prevents the patient from breathing properly, but the patient continues to make attempts to breathe.
The second type, called central sleep apnea (CSA), means the respiratory control centers in the brain fail to signal the breathing muscles to inhale, and no effort is made to breathe. The third and fourth types, mixed sleep apnea and complex sleep apnea, involve the appearance of both OSA and CSA during sleep.
In order to treat sleep apnea successfully, it is necessary to know what type of apnea you suffer from. OSA is much more common than CSA, but without some kind of sleep study, it is impossible to determine whether you have either condition. There are two ways to record your breathing activity during sleep.
One type of recording, the home sleep study, requires using a sleep monitor to track your breathing, blood oxygenation, and movements during sleep. It's a small-scale way to replicate the kind of polysomnography that is performed in sleep laboratories, and you can purchase and use a home monitor on your own.
However, you will probably get more reliable results if your doctor refers you to a sleep laboratory for such a study.
Treatment recommendations include changes in behavior, using mouthpieces or dental devices, using breathing devices at home during sleeping hours, and surgery. Sometimes medication like nasal sprays or decongestants can reduce swelling, if that is what's producing a physical obstruction that leads to OSA.
For OSA, treatment to address the causes means removing or reducing the blockage that impedes airflow, whatever it may be. Remedies are designed to allow the patient to breathe in a normal fashion while asleep, which will alleviate the symptoms of OSA (which are primarily disruptive snoring and excessive sleepiness during daylight hours).
Natural Treatments for Obstructive Sleep Apnea
There is no non-medical treatment for CSA.
Behavioral Changes That Improve OSA
This approach sounds deceptively simple, but since the changes include breaking personal habits like overeating and smoking, which can represent addictions, some patients find it very difficult to follow through by altering the behaviors that contribute to their OSA.
Nevertheless, if by making these changes you can rid yourself of the burden of OSA and improve your general health, you'll find the effort was well worth your dedication.
- Lose weight. Obesity has been identified as both a cause of OSA (when excess fat in the neck narrows the airway) and one of its potential results.
- Avoid substances that relax muscles (for example, alcohol, sleeping pills, or any other medication that promotes deep sleep). Limp muscles can compress the throat and block airflow.
- Stop smoking and shun any other irritant that can cause swollen nasal passages. Any swelling in the airway contributes to OSA.
- Do not sleep on your back. That position alone leads to OSA. One suggestion for preventing that sleep position is to sew a golf ball into the back of a pajama shirt to train yourself to sleep only on your side, where gravity helps arrange the muscles in your jaw and throat in a non-obstructive configuration.
- Some people attribute success in treating OSA to exercises for the tongue and face. Even playing a wind instrument can help. The goal of the exercises is to increase muscle tone so that the relaxation induced by sleep does not cause airway obstruction.
Also called oral appliances, these plastic accessories are described by the American Academy of Dental Sleep Medicine as not unlike the mouth protectors worn during sports, or the retainers used in orthodontic therapy. Their function is to hold physical structures in the back of the throat apart during sleep, which keeps the airway open and relieves OSA.
One type is called a mandibular repositioning appliance. The patient wears the device while sleeping, and it thrusts the lower jaw slightly forward. You can see how this works if you imitate a snore, then move your jaw outward in the middle of the process: that movement interrupts and ends the snore.
Another, the tongue retainer, serves to pull the tongue forward, preventing it from falling into the throat. A dentist must make this device for you, and you must have your own teeth in order to wear it. After you adjust to its presence in your mouth, though, you'll find it very helpful.
Positive Airway Pressure (PAP) Machines
Used to treat both OSA and CSA, these medical devices require a doctor's prescription. They deliver a stream of air into the patient's airway during the night through a mask connected with tubing to the machine, which can fit on a bedside table. The air is pressurized so as to keep the airway open and prevent the patient from experiencing apnea during the night.
Some PAP machines can also record your sleep to show whether you experienced any apneic events during the treatment. If so, your doctor may adjust the pressure at which air is delivered. The reported downside of PAP treatment is the intrusive presence of the mask and the sound made by the device itself, which some people find interferes with sleep and discourages use of the device.
If you have that trouble, ask your doctor to recommend adjustments to the mask or machine that will ameliorate the problems. There is an adjustment curve, and you'll need time to acclimate to your PAP. There are several different types of PAP machine, and your doctor will help you decide which one is right for you. Here are the two most common:
- Continuous positive airway pressure (CPAP) machine. This delivers air at a single pressure continually. Usually air is blown through the nose, around which the mask fits. There are different mask designs, covering more or less of the face depending on your needs and preferences.
- Bilevel positive airway pressure (BIPAP) machine. This alternates different pressures representing inhalation (higher pressure) and exhalation (lower), in an attempt to please patients who dislike exhaling against positive pressure, which is what using CPAP necessitates.
- Other forms of breathing assistance include adaptive servo ventilation (ASV), added dead space, carbon dioxide inhalation, or simply oxygen.
The goal of surgery as a treatment for sleep apnea is to give the patient more room to breathe by making the airway, including the nasal passages and throat, wider during sleep. There are different ways of achieving that end: loose tissues can be stiffened, swollen tissue can be shrunk, excess tissue can be removed, and various physical structures can be repositioned.
- Stiffening procedures. Implants made of plastic and designed to fit the soft palate at the back of the mouth are the most common type. These "pillars" can be injected to make the palate less liable to collapse into the airway.
- Shrinking procedures. Somnoplasty uses radio frequency ablation to shrink different components of the airway, including the turbinates in the nose, the soft palate and uvula, and the base of the tongue.
- Removal procedures. There are many of these available, and their utility depends on .the exact causes of obstruction in the individual patient. Uvulopalatopharyngoplasty (UPPP) means removing the tonsils and uvula plus trimming the soft palate. Tongue reduction targets the base of the tongue, to free the back of the throat.
Enlarged adenoids may also be removed.
- Repositioning procedures. Some of these are genioglossus advancement (moving the muscle at the base of the tongue forward), hyoid suspension (moving the hyoid bone to change the position of the tongue), and maxillary-mandibular advancement (moving both jaws to push the palate and base of the tongue forward).
- There are also different types of nasal surgery to correct problems like a deviated septum, swollen turbinates, narrowing of the nasal valve, or nasal polyps.