Treatment options for Snoring and Sleep Apnea

Treatment Options For Snoring & Obstructive Sleep Apnea (OSA) Syndrome

Obstructive sleep apnea (OSA) is a medical condition that requires careful attention and proper treatment. This disorder, which can be life threatening involves frequent collapse of the breathing passageway during sleep, resulting in partial or complete blockage leading to changes in breathing pattern and blood oxygen levels during sleep. Symptoms can include excessive daytime sleepiness, poor performance at home or work, and depression.

The process by which the airway gets blocked off during sleep is rather complicated. During sleep, the muscles in the throat relax and are more likely to close than when you are awake. The negative pressure of air pulled by the lungs through a narrow airway may cause the breathing passageway to collapse, much as a straw flattens and collapses if you pinch one and closed while sucking on the other end. Treatment can prevent or reverse the serious consequence associated with OSAS.

If a sleep specialist has diagnosed you with Sleep Apnea, you and your referring doctor will have a number of treatment options to consider. Correcting your breathing problem during sleep may involve one or more of the following treatments.

Lifestyle changes

Some behaviours or habits can make OSA worse. For some people, certain lifestyle changes can reduce or eliminate sleep apnea.

Sleep – position training

Sleeping on your back allows gravity to pull on the soft tissues at the back of your throat and neck, causing the breathing passageway to narrow or collapse completely. Sleep- position training can be used to help keep you on your side during sleep, which can lead to an improvement in your symptoms.

Sleep – position training can be accomplished in several ways. The simplest approach, called the “tennis ball technique”, involves sewing a pocket onto the back of your pajama top and inserting tennis balls into it. If you start to roll on to your back during sleep, the pressure from the balls will courage you to roll back to your side. A form wedge strapped to your back can accomplish the same result. Commercial devices with alarms are also available to help you stay on your side during sleeping.

Weight loss and regular exercise

For some people, weight loss alone is a helpful treatment. Once you reach your desired weight, it is important to maintain that weight, because snoring and apneas are likely to return with weight gain. If you are overweight, consult a healthcare professional to find out about weight loss programs.

Oral appliances

These devices work to keep the airway open by holding the tongue or jaw forward, increasing the airway space behind the tongue. A clear airway is needed in order for most of these devices to be successful. They are usually fitted by an experienced dentists associated with a sleep disorders center or laboratory.

Tongue – retaining devices

These devices are placed in the mouth just before bed and create a slight suction, which holds the tongue forward to keep it from falling back into the throat. They can be effective in people who have mild to moderate apnea.

Jaw – advancement device

These appliances are made to fit the top and bottom teeth in a way that pulls the lower jaw slightly forward.

Continuous Positive Airway Pressure (CPAP) devices

Continuous Positive airway pressure (PAP) is a highly effective therapy that uses air pressure to prop the airway open during sleep. PAP machines work by pumping room air through a compressor that is connected by a hose to a mask that fits over the nose or the nose and mouth. The mask fits over the top of the head and is held in place with straps. The appropriate PAP pressure level is determined during what is called a CPAP titration study.

Positive airway pressure is a highly effective therapy that uses air pressure to prop the airway open during sleep.

Nasal pillows are an alternative to the mask method of PAP delivery. These are soft pieces of plastic that are placed directly into the nostrils. Several brands of PAP are currently available and it is best to discuss with your healthcare professional and seek his/her recommendations.

While most patients do well with PAP therapy, a few may experience dryness in the nose or feelings of claustrophobia. These and other problems can be overcome with a few adjustments. A humidifier can be used to reduce dryness, and relaxation techniques can help relieve feelings of claustrophobia.

CPAP Machines

Surgery

An operation may be an option if your healthcare professional finds an obstruction in your airway or if more conservative treatments have not worked. Whatever surgery is recommended, be sure you are aware of all possible risks and side effects before proceeding. While an operation can be an effective treatment for some patients, it is not the right choice for everyone. There have also been reports of recurrence of symptoms few years after surgery.

Nasal operations

Nasal surgery is used to remove blockages in the nose (such as growths), or to repair a deviated septum (a displacement of the wall that divides the nose into halves). These operations may be one part of an overall plan to treatment apnea, and are generally used along with other forms of treatment or other operations.

Laser – assisted uvulopalatoplasty (LAUP)

This relatively new procedure is used mainly for the treatment of snoring. With LAUP, the surgeon uses a laser to remove part of the uvula and soft palate. The procedure takes place in several sessions in a doctor’s office. While this technique appears promising, patients need to be aware that its effectiveness in the treatment of sleep apnea has not yet been completely evaluated.

Uvulopalatopharyngoplasty (UPPP)

This operation involves removing the uvula (the soft, fleshy projection that hangs in the back of the throat), the tonsils, and part of the soft palate. Approximately 50% of patients who undergo this operation are helped by it. Side effects, such as severe throat pain, nasal sounding speech, and the regurgitation of liquids into the nose when swallowing, have been reported.

Inferior sagittal mandibular osteotomy (ISO) and geniohyoid advancement with hyoid myotomy (GAHM)

The ISO and GAHM are procedures that enlarge the airway. ISO is an operation that includes bringing the lower bone of the jaw forward. The GAHM operation includes attaching the hyoid (the u-shaped bone where your bottom teeth are located) to the windpipe. The effectiveness of these operations can depend on a person’s weight and lower jaw structure.

Maxillomandibular advancement (MMO)

This reconstructive surgery involves cutting the bone that connects the jaw to the face and moving the upper and lower jaws forward. This operation is done under general anesthesia and requires a hospital stay of a few days. After the operation, the jaw is wired shut to hold it in place for bout 4 weeks. A liquid diet is required, and weight loss often results. Once the wires are removed, orthodontics work may be needed to realign the teeth so they fit together properly. This treatment is time – consuming and expensive, but its results are positive for some patients. The best candidates for this type of treatment are those born with a smaller – than – normal jaw or a jaw that is set too far back.

Laser midline glossectomy (LMG) and lingualplasty

These operations are rarely used. They involve enlarging the area behind the tongue by removing a portion of the back half of the tongue.

Tracheostomy

This surgery is rarely used to treat sleep apnea, and is only applicable to an immediately life threatening sleep apnea condition. It involves the creation of a small surgical opening in the windpipe. The tracheostomy by passes any obstruction in the throat and allows air to flow freely into the lungs while the patent is sleeping. The opening is covered during the day and normal breathing and speech resume.

Medications and Alternative Treatments

Medications used alone are not beneficial in the treatment of snoring and OSAS. They may be most useful in cases of mild apnea or used as part of an overall treatment program.

Medications used alone are of limited benefit for the treatment of snoring and OSAS.

Nasal sprays

Over-the-counter nasal sprays that help clear the nasal passages can be habit-forming and should not be used for more than a few days. Prescription nasal sprays can help unblock the nose, but sometimes take days or weeks to work. Nasal sprays are usually not helpful if there is a permanent blockage caused by a growth or a deviated septum.

Decongestants

Medications to relieve congestion in the nose are sometimes helpful, but are not considered to be a treatment for sleep apnea itself. Although decongestants may help you breathe better, they can cause difficulty falling asleep, staying asleep or both.

Respiratory stimulants

Protriptyline is one medication used to treat mild cases of apnea. It is an antidepressant that decreases REM (dreaming) sleep, a time when apneas are likely to be longer and more frequent. Protriptyline may help strengthen and the muscles of the throat. It can produce mild side effects (such as dry mouth and constipation) and is not recommended for people with high blood pressure or an abnormal heart rhythm. A less – frequently prescribed medication for the treatment of OSAS is medroxyprogesterone, a hormone which can produce such side effects as unwanted hair growth, mood changes, and fluid retention. Results from this treatment are inconsistent.

Oxygen

This treatment may be used to correct low oxygen levels in the blood due to heart or lung disease. It may be used along with PAP treatment for best results.

Follow-up care

No matter which form of treatment is used for Sleep Apnea, it is important that a follow up sleep study be done by a sleep professional to determine success. Regular follow – up appointments with your healthcare professional are also essential because the severity of your apnea may change with age. If your snoring resumes or if you are sleepy during the day, it may mean the apnea has returned, and additional or other treatment may be necessary.