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What are the treatment options for obstructive sleep apnea?

Paul T. Hoff, MD
Ear, Nose & Throat (Otolaryngology)
The first treatment option for obstructive sleep apnea (OSA) for most people is continuous positive airway pressure (CPAP).  Although CPAP is very effective, and is considered the “gold standard,” patient compliance and adherence to therapy is less than ideal. For those who fail conservative measures (weight loss, oral appliance therapy, positional therapy), surgical alternatives should be considered.

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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.
There are a number of treatments for obstructive sleep apnea (OSA) that have proven effective.
  • A CPAP, or continuous positive airway pressure machine, is the most common treatment option for sleep apnea. Sleepers wear a mask which pushes a constant stream of air through the airway, preventing the airway from collapsing and cutting off breathing. CPAP machines have proven to be very effective in treating sleep apnea -- and eliminating the snoring that so often accompanies it. The machine often takes some getting used to for patients, but the rewards -- restful sleep, protection against health problems associated with OSA -- are worth it.
  • A MAD, or mandibular advancement device, also called an oral appliance, is a mouthpiece that keeps the jaw in a forward position and the airway open during sleep. An oral appliance is custom fitted by a dentist. There are over-the-counter mouthpieces sold as anti-snoring devices, but these are not the same thing as the oral appliance; you should speak to your doctor before using an anti-snoring mouth guard.
  • There is a fairly new treatment available, called Provent, that uses a small disposable one-way valve placed over each nostril that can be used as alternative to CPAP. Provent requires a doctor’s prescription.
These treatment options for sleep apnea have been well-researched. We know they are safe, and we know they work. There are a surgical options for sleep apnea, which involves removal of tissue at the back of the throat to widen the airway. It’s not yet clear that surgery is as effective as the other treatment choices available, but we know surgery involves more inherent risk.
Dr. Mehmet Oz, MD
Cardiology (Cardiovascular Disease)
If you've tried natural remedies like diet, exercise, and positional therapy for obstructive sleep apnea, chances are you're still waking up repeatedly each night and still feel terribly fatigued during the day. Let’s fix that once and for all:

1. Continuous positive airway pressure (CPAP): A CPAP will help you breathe regularly while you’re sleeping by increasing air pressure in your throat, so it doesn’t close. People who regularly use their CPAP devices feel better. Even people who use it every night for half the time feel better. They reduce their risk of disease. They’re better able to manage their mood and weight. I highly recommend a CPAP for people with sleep apnea.

2. Oral Appliance Therapy: With oral appliance therapy, a type of mouth guard fits over your teeth and helps move the tongue and/or jaw forward while you sleep. This mechanically expands your airway so you can breathe. It’s not as effective as a CPAP—it reduces the obstruction by about 50%—and a CPAP is more like 100%. If you’re considering this option, know that it’s most successful in young people who are not overweight and experience most of their sleep apnea while on their back.

3. Medication: Unfortunately, no medications are available to help treat sleep apnea—only the resulting sleepiness. If you have a mild case of sleep apnea with snoring, a nasal decongestant or nasal surgery may help with the snoring. Be aware that some medications can be dangerous for people with sleep apnea, including many sleep aids. If you are taking any medications, let your doctor know which ones.

4. Surgery: In adults, it’s difficult for us surgeons to know which soft tissue is causing the obstruction, so multiple surgeries may be required. The most common type of surgery is uvulopalatopharyngoplasty (UPPP); it’s effective about 50% of the time, and in most cases, the patient still needs a CPAP afterward. In children with sleep apnea or snoring, having their tonsils removed helps in 75% of cases.

The most common treatment is a positive air pressure device, called a CPAP, that is a mask over the face connected with a tube to a small, quiet box - this puts a little air pressure behind the tongue to keep the breathing passages open.

Most people who should use CPAP, however, don't. Alternatives include custom mouthguards that hold the lower jaw forward a bit - that lifts the tongue off the back of the throat and keeps the airway open.

For people with mild cases of apnea, oral appliances are often the first choice, and they are used for everyone else who can't use a CPAP. Other treatments include surgery and a patch people put on their noses called Provent.

 

Many treatment options are available for sleep apnea. Your doctor will be able to suggest the option that is best for you. Your doctor may recommend changes to your lifestyle, such as losing weight, not drinking alcohol, not taking certain medications, and not smoking. The main medical treatment is CPAP, a device that can keep your airway open while you sleep. Your doctor may also suggest treating your allergies or sleeping in a different position. The American College of Physicians says surgery is not recommended for initial therapy, because evidence for efficacy is limited and adverse events can be serious. 

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.