Obstructive Sleep Apnea Treatment
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Treatment options for obstructive sleep apnea (OSA) include the following:
- Lifestyle changes to reduce symptoms.
- Positive airway pressure (PAP), the most common and effective treatment.
- Oral appliances, such as a mouthpiece fitted by a dentist or orthodontist.
- Surgery to remove, shrink, or stiffen throat tissue.
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A long list of drugs has been tried for the treatment of obstructive sleep apnea (OSA). Most of these have been medications that tend to stimulate breathing during wakefulness, such as progesterone, protripyline, nicotine, theophyline, naloxone, and acetazolamide. The hope was that these medications might increase the activity of the dilating muscles of the upper airway, activity that is normally decreased during sleep. Serotonin re-uptake blockers can increase activity in one of the dilating muscles, the tongue, but they have not been shown to significantly improve OSA. Unfortunately the search for a safe and effective "pill" to treat OSA has come up empty so far. There is no drug that can be recommended for treating the sleep induced collapse of the upper airway.
That is not the case for the symptom of daytime sleepiness. Excessive sleepiness is a primary consequence of OSA, one that does not always resolve completely with currently available treatments of the sleep-disordered breathing. The Food and Drug Administration has recently approved a drug – modafinil (Provigil®) – for the treatment of sleepiness that remains in spite of continuous positive airway pressure (CPAP) therapy for OSA. The mechanism of action of modafinil is not completely understood, but it clearly causes increased alertness, and is relatively free of unwanted side effects. Specifically it does not seem to have the unwanted effect on the heart and blood pressure that can occur with other stimulant medication. One concern is that patients might use the drug to make up for poor compliance with prescribed CPAP treatment of their OSA. Modafinil is NOT a treatment for sleep apnea; it is just a treatment for excessive sleepiness from any cause. It does not lessen the risk of serious cardiovascular consequences from inadequately treated OSA.
There are other central nervous system stimulants that can increase alertness. The most widely used is caffeine. Amphetamine-like drugs such as methylphenidate (Ritalin) are often prescribed for sleep disorders such as narcolepsy that cause severe excessive sleepiness.
Before you consider using a drug to treat your daytime sleepiness, be sure that you have treated your OSA as well as possible, and that you are getting enough sleep at night. Drugs are not a substitute for adequate sleep.
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Obstructive sleep apnea is a chronic disease for most people who are diagnosed. There are some patients who have had obstructive sleep apnea resolve. This may be with significant weight loss when obesity was the cause of the sleep apnea. In other cases, patients have sleep apnea because of very large tonsils, and surgical removal of the tonsils may help these patients to resolve their apnea.
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Oral appliance therapy (OAT) for obstructive sleep apnea is one alternative to surgery or a CPAP (continuous positive air pressure) machine. Many sleep apnea patients opt for OAT therapy because it is less invasive than surgery and much easier to sleep with than using a CPAP machine.
The oral appliance is usually a mandibular repositioning device that holds the lower jaw in a protruded position. Because the tongue is attached to the lower jaw (mandible) the tongue is moved forward along with the lower jaw and this helps keep the airway open.
Typically, when sleep apnea patients lie down and fall asleep the muscles of the mandible relax as do the tissues that surround the airway, i.e. the tongue. The tissues collapse and the airway closes until the patient wakes up gasping for air. This can take place dozens or hundreds of times per night depending upon the severity of the sleep apnea.
Because these devices are anchored to the teeth, and thus can effect the teeth, they should be delivered by a dentist or dental specialist that is familiar with the treatment of sleep apnea.
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Diet and exercise may be able to help ease symptoms of obstructive sleep apnea, especially exercise four to five hours before bed, weight loss, and avoiding caffeine and alcohol, but it's almost impossible to beat sleep apnea with these lifestyle changes alone. Without enough quality sleep, it's hard to even imagine mustering up the energy for either one. What's more, sleep deprivation has been shown to inhibit your ability to lose weight, even if you're eating and exercising right.
