What is the best therapy for someone with obstructive sleep apnea?

Phil Westbrook
Sleep Medicine

There is no single "best" therapy for obstructive sleep apnea (OSA). However one way to answer your question is to say that the best therapy is the treatment you will actually be willing to use for the rest of your life, or at least until something better comes along.The current treatment of choice for severe or symptomatic OSA is continuous positive airway pressure (CPAP). This is a form of treatment first described about 25 years ago by Dr. Colin Sullivan, and it quickly replaced tracheotomy (making a hole in the windpipe below the site of obstruction). CPAP works primarily by maintaining a pressure in the airway that prevents its collapse. The pressure is generated by a small electric fan type blower that sits by the side of your bed. This unit is connected to you by means of a tube between the blower and a mask that fits snuggly over or in your nose, or over your nose and mouth. The mask must fit tight enough to prevent air from leaking out. The pressure required to keep your airway open during sleep is individually adjusted either by a technician while you sleep in a laboratory, or by a unit that automatically adjusts to the correct pressure while you sleep at home. CPAP can work wonderfully well, eliminating almost all obstructive apneas and hypopneas, and there are a lot of folks with OSA who would not sleep without it. The big drawback to CPAP is that, in spite of improvements in machines and masks, it remains cumbersome, and studies show that less than half the people for whom it is prescribed use it or use it adequately.That leaves a lot of folks untreated or poorly treated. Fortunately there are other successful treatments. These include position restriction for those who have trouble breathing only when they sleep on their back. OSA in fat people (and that is most of them), can be improved with weight loss by diet or diet plus surgery. Oral appliances are very successful in many and a new treatment is small valve you can wear in your nostrils that keeps the airway from collapsing by expiratory positive airway pressure (EPAP). Certain individuals can be successfully treated by surgical reconfiguration of their upper airway, but candidates for surgery have to be carefully selected.

Again, there are lots of treatment options, but nothing works if you don't use it.

The best therapy for obstructive sleep apnea depends on how severe your sleep apnea is. If you have a very mild case of sleep apnea, you might be able to treat it by improving your lifestyle, such as losing weight and quitting smoking. If this doesn't work, you might benefit from positive airway pressure. The most common form is CPAP (continuous positive airway pressure). With this treatment, the pressure is continuous and greater than that of the surrounding air, so it keeps your upper airway passages open, thus preventing obstructive apnea and snoring. If you can't tolerate CPAP, you could also try an oral appliance that will keep your throat open. Surgery is generally not recommended. 

The best type of therapy to treat obstructive sleep apnea will depend upon many factors including the severity of the condition, health of the patient, which part of the throat is causing the obstruction, structure of the mouth, and psychological factors.

It is best discussed with a sleep physician who can discuss the different options and find what is most effective and most likely to be successful.

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