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How is sleep apnea treated?

Medications are usually not helpful in treating sleep apnea. The most common and effective treatment is nasal continuous positive airway pressure (CPAP). You wear a mask over your nose while you sleep, and a machine gently blows air through your nasal passages to prevent your throat from collapsing during sleep. The device must be worn every night to be effective.

There are a number of other treatments. Behavioral changes are an important part of the treatment program, and in mild cases, behavioral therapy may be all that is needed. You should avoid using alcohol, tobacco and sleeping pills, which make your airway more likely to collapse during sleep and prolong the apneic periods. Overweight people almost invariably benefit from losing weight; even a 10% weight loss can significantly reduce the number of apneic events. Sometimes in mild sleep apnea, breathing pauses occur only when you sleep on your back; in this case, using pillows and other devices that help you sleep in a side position can reduce apneic events.

In addition to CPAP, cases of mild to moderate sleep apnea can be treated using a dental appliance that repositions the lower jaw and the tongue. Possible side effects include damage to teeth, soft tissues and the jaw joint. These should be fitted by a dentist or orthodontist with experience in the use of these devices.

Several surgical procedures can increase the size of the airway, but they all have risks, and the success rate for curing sleep apnea is not high. Some of the more common procedures performed include:

  • Uvulopalatopharyngoplasty (UPPP). This involves removing portions of the uvula and soft palate to stop throat structures from vibrating and causing snoring.
  • Removing nasal polyps. This sometimes improves, but almost never cures, sleep apnea.
  • Surgically correcting structural deformities in the face and/or lower jaw.
  • Tracheostomy. This is used in people with severe, life-threatening sleep apnea. In this procedure, a small hole is made in the windpipe and a tube inserted into the opening. The tube remains closed during waking hours and is only opened during sleep so air flows directly into the windpipe and lungs, bypassing any upper airway obstruction. Although this procedure is highly effective, it is an extreme measure and is not often used.
  • Surgical procedures to treat obesity. Surgery can result in weight loss and thus improve the severity of sleep apnea.

Snoring predisposes a person to sleep apnea (disordered breathing during sleep). As you get older, the tissues at the back of your throat become less rigid and more loose. Surgery is one way to correct the problem. Another is to use a "CPAP mask," which stands for continuous positive airway pressure mask. The mask is tight fitting and pushes air into your airway. This air blows the soft tissue around your throat away from your airway. A third solution is to lose weight and reduce the "double-chin" inside your airway.

There are a variety of treatments for sleep apnea, depending on an individual's medical history and the severity of the disorder. Most treatment regimens begin with lifestyle changes, such as avoiding alcohol and medications that relax the central nervous system (for example, sedatives and muscle relaxants), losing weight, and quitting smoking. Some people are helped by special pillows or devices that keep them from sleeping on their backs, or oral appliances to keep the airway open during sleep. If these conservative methods are inadequate, doctors often recommend continuous positive airway pressure (CPAP), in which a face mask is attached to a tube and a machine that blows pressurized air into the mask and through the airway to keep it open. Surgical procedures too can be used to remove tissue and widen the airway. Some individuals may need a combination of therapies to treat their sleep apnea.

This answer is based on source information from the National Institute of Neurological Disorders and Stroke.

There are many ways of treating sleep apnea and each is individual to the particular person. Common strategies include weight loss, stopping smoking, improving sleep habits and other lifestyle issues. From a medical intervention perspective, use of a mask with air pressure to open the airway (CPAP), surgery of the soft parts of the airway, and dental devices aimed at keeping the tongue from blocking breathing are all viable treatment options.

The most common treatment for sleep apnea is continuous positive airway pressure (CPAP) therapy. The CPAP machine keeps the airway open by providing forced air through flexible tubing. CPAP therapy requires people to wear a mask as they sleep. Although CPAP therapy is effective, some people are unable to adhere to it. People who are unable to tolerate CPAP therapy or prefer an alternate treatment should get a prescription for a sleep apnea appliance. Many people like an oral appliance because it is comfortable, quiet, portable and easy to wear. In some severe cases of sleep apnea, upper airway surgery may be another treatment option.

This content originally appeared on the American Academy of Dental Sleep Medicine (AADSM) website.

Dr. Phil Westbrook
Sleep Medicine Specialist

First, the good news. Obstructive sleep apnea (OSA) is pretty easy to diagnose and it can be treated successfully. The bad news is that treating it is not always easy. OSA is a life-long disease, and like many other chronic diseases it can be managed over a patient's lifetime, but rarely "cured". The person who treats a chronic disease like OSA is the patient with the disease, and treatment almost always carries not only benefit but also some burden. So if you are a patient with OSA the success of your prescribed treatment depends on your willingness to use it.

The answer to how OSA is treated is too important and too complicated to cover adequately in the space allotted here, so for now I will just cover some general principles that you (here I am assuming that you are a patient with OSA) and your doctor might consider. I will list the treatments available and then cover each one in more detail in the answers to questions about specific treatments.

The goals of treatment are to prevent the abnormal breathing events in sleep. You want the signs and symptoms of OSA to disappear, and your sleep quality to improve. You want to avoid the long-term cardiovascular and neurologic consequences of OSA.

You also want to avoid situations that could place you in danger, situations that might not be so risky for patients without OSA. This means that you need to fully understand OSA, the risks having it, and the importance of treating it. You should know that alcohol within two hours of your bedtime can make your sleep apnea worse. You should know that smoking can make OSA worse. Certain sleeping medications should be avoided. It is terribly important that other doctors you see know that you have sleep apnea, so make sure you give them a copy of your sleep study report. Surgery in patients with OSA carries increased risk, especially if opioid (narcotic) pain relief will be required.

The treatments that are currently available include:

  • Weight loss, both by diet alone or diet plus weight loss surgery
  • Restricting sleeping position (avoiding back sleeping)
  • Devices that hold the lower jaw and or tongue forward
  • Positive airway pressure
  • Upper airway surgery
  • Stimulant medication for sleepiness

The bottom line is that treatment for OSA is available. However you must be a full participant in that treatment, be fully informed about your OSA, and be prepared to inform other caregivers.

Dr. Michael Breus, PhD
Psychology Specialist

CPAP—continuous positive airway pressure—is the most commonly prescribed treatment for obstructive sleep apnea (OSA). CPAP works by pushing air constantly through the airway, keeping it open and allowing un-interrupted breathing through a night's sleep. It's a safe, effective, well-tested treatment for OSA that has proven results. The biggest challenge to CPAP success? Getting patients to use the device consistently.

Watch as Dr. Michael Breus discusses some treatment options for sleep apnea.

Dr. Scott M. Leibowitz, MD
Sleep Medicine Specialist

Treatments for sleep apnea include a machine called a CPAP, surgery, or wearing a dental device. Watch this video to learn more from Dr. Scott Leibowitz about treatments for sleep apnea.

I suspect that we will discover some people inherit genes that make them likely to develop sleep apnea. But just as you can avoid diseases such as type 2 diabetes and coronary artery disease by making healthy lifestyle choices early in life, we may find ways to avoid sleep apnea.

Take body size as an example. Obese people have a higher risk of developing apnea compared to people that are not overweight. Yet, many thin people who are fit have sleep apnea and some extremely obese people don't.

The most common symptoms of sleep apnea are loud snoring, poor sleep quality and excessive sleepiness during the day. Although you might not be able to completely relieve these symptoms without specific therapy, the following can help:

  • Lose weight if needed
  • Become more physically active. Do at least 30 minutes of aerobic exercise most days of the week
  • Limit alcohol consumption. This means no more than one drink per day for women and two drinks per day for men. You might also try stopping all alcohol consumption to see if it helps.

Although not proven, it seems quite reasonable that stress and extreme fatigue would make the symptoms of sleep apnea worse. But I doubt these factors alone would be the actual cause.

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In sleep apnea, airway obstruction results in interrupted breathing throughout the night. There are dental appliances that can be used to position the jaw or tongue during sleep to maintain an open airway. They are usually used if continuous positive airway pressure (CPAP) is not tolerated, and they can be effective treatment for some people. A CPAP machine requires wearing a mask over the nose and uses air blown through a tube to continuously maintain an open airway during sleep.

There are several treatment options for sleep apnea, which are listed below. Each option has advantages and disadvantages, and treatments have different success rates and levels of patient satisfaction. A full discussion of this is too complex for this format, so please discuss treatment options with your own physician. Treatment options are as follows:

  • Weight Loss
  • CPAP (Continuous Positive Airway Pressure) or BiPAP (Bilevel Positive Airway Pressure) - These are both worn during sleep and administered through a small mask or nasal pillows attached to a pressure machine.
  • Sleep Position Modification
  • Oral and Dental Appliances - These custom-made devices can help hold the jaw and tongue in a position that prevents airway obstruction.
  • Surgery - Several surgical options are available, including nasal/septal surgery, palate surgery, tonsillectomy and adenoidectomy, tongue base reduction or suspension surgery, mandibular advancement, maxillary advancement, hyoid suspension, and tracheotomy.
Dr. Fred Y. Lin, MD
Ear, Nose & Throat (ENT Specialist)

Every patient requires a customized treatment plan in the treatment of sleep apnea. The cause of airway obstruction varies among patients, and the management depends on the regions contributing to the obstruction of airflow. Areas of potential obstruction, which may be discovered during the evaluation include: the nose, palate, tongue, upper and lower jaws, and vocal cords.  First line therapy generally begins with Continuous Positive Airway Pressure (CPAP), which is a nasal mask you wear at night that blows air, and pneumatically stents open the airway. Other options include dental devices, nasal masks, and surgery.

After a diagnosis of obstructive sleep apnea, your healthcare provider may recommend one or more of the following medically supervised therapies:

  • Weight loss: If you are overweight, losing weight may help relieve the pressure on your airway that's causing nighttime pauses in breathing. Your doctor will probably recommend a weight loss program. If she or he doesn't, be sure to ask about weight loss as a treatment option.
  • Continuous Positive Airway Pressure (CPAP): Your doctor may recommend that you be fitted with a nasal mask through which air is gently forced into your nostrils to keep the upper airway open. Using the device takes some getting used to, and about two weeks of nightly use are needed for maximum benefit.
  • Oral appliances: If your sleep apnea is mild and you are not overweight, a dentist can fit you with an appliance that keeps your upper airway open. Snoring, even without sleep apnea, may decrease by using this device. It's similar to a sports mouth guard and works by repositioning the lower jaw, tongue, and soft palate. Similar appliances are available over-the-counter, but studies have found that they are much less effective than those fitted by a doctor.
  • Surgery: If your condition is severe and other therapies have failed, your doctor may recommend a uvulopalatopharyngoplasty, a surgical procedure that enlarges the airway by removing certain soft tissue from the throat. This may include the uvula, the tonsils, and the adenoids, as well as a portion of the soft palate. Remember, however, that any surgery carries some risk, and success rates for this operation vary, so discuss the pros and cons with your healthcare provider before proceeding with the operation.
  • Prescription medications: People who suffer from excessive daytime tiredness because of sleep apnea may benefit from modafinil (Provigil), a medication that improves wakefulness.

Warning: Do not take sleep aids if you have or suspect you have sleep apnea. Sleep aids are not recommended for people with sleep apnea because they depress the central nervous system and can exacerbate pauses in breathing.

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Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

If you have obstructive sleep apnea, which occurs when something is literally obstructing or blocking your airway while you sleep, your first line of defense is to lose weight if you are overweight. Any excess fat in your neck may contribute to the obstruction. Also quit smoking if you smoke. These two activities can go a long way to helping you breathe easy while you sleep. For some people, these activities alone can eliminate sleep apnea altogether.

The catch is, it's very difficult to accomplish either of those things when you are sleep deprived. So you may need treatment—most frequently in the form of a CPAP (continuous positive airway pressure) machine.

A CPAP will help you breathe regularly while you're sleeping by increasing air pressure in your throat, so it doesn't close. It's often 100% effective in treating obstructive sleep apnea and it stops your snoring too. But you may need to use it for the rest of your life.

For extreme cases, surgery is an option. Obese people may consider bariatric surgery to lose weight. Others may have surgery to remove some of the soft tissue in the throat, though this isn't always effective.

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Treatments for sleep apnea include weight loss, oral applicances, and surgical options. Another option is CPAP therapy, which uses mild air pressure to keep airways open.

If obstructive sleep apnea can't be reduced by losing weight, avoiding alcohol, and discontinuing medications that may suppress breathing, then your doctor will recommend treatment. This might consist of use of a machine to improve breathing, drugs, or surgery.

It can be treated by 4 ways.

  • Things you can do on your own like weight loss and avoid sleeping on your back.
  • Surgery; there are many types of surgeries and the advantages and disadvantages should be discussed with the treating doctor.
  • An oral appliance that moves the lower jaw forward keeping the airway open.
  • CPAP; a machine that blows air down the throat to keep the airway open.

If a person has sleep apnea, each of these areas should be discussed with their doctor to find what is most appropriate.

There are a number of treatments for sleep apnea. The most accepted is by way of a device called a CPAP (continuous positive airway pressure) machine. These work by blowing air under pressure into the patient's mouth or nose by way of a flexible tube, keeping the airway open during sleep. Other treatments include dental appliances that hold the jaw slightly forward and occasionally surgery to create more room in the nose and throat.

There are several options for treating sleep apnea, including oral appliances and, in some cases, surgery. Although some patients experience discomfort with the nighttime masks that are the most effective treatment for sleep apnea, the majority of patients are able to acclimate to the therapy, often after initial adjustments, Ravi Aysola, MD, pulmonologist and sleep specialist, says.

Dr. Steven C. Smart, MD
Cardiologist (Heart Specialist)

Weight loss and exercise are often the first recommendation to help treat sleep apnea. There are also oral appliances that help position the tongue in the mouth and there are a growing number of masks and CPAP devices that help keep pressure on the airway so it does not narrow and collapse while sleeping.

There are a lot of options today with CPAPs; people with sleep disorders should work with a sleep specialist who can help find a solution.

Dr. Craig L. Schwimmer, MD
Ear, Nose & Throat (ENT Specialist)

Sleep apnea can be treated in a number of ways—from behavioral and lifestyle changes such as weight loss, to devices such as CPAP and oral appliances, to office based procedures such as the Pillar Procedure and Turbinate Coblation, all the way to aggressive surgical procedures. While all of these options play a role, none of them are perfect. The most important thing is discussing your options with an expert, so that you can determine the best set of compromises for you. Leaving your sleep apnea untreated is not an option!

Deborah Davis, DNP
OBGYN (Obstetrician & Gynecologist)

For milder cases of obstructive sleep apnea, lifestyle changes may be recommended such as losing weight or quitting smoking. If these measures don't improve your signs and symptoms or if your apnea is moderate to severe, a number of other treatments like continuous positive airway pressure, or CPAP are available. Mouthpiece (oral device) can help open up a blocked airway. In other cases, surgery may be necessary.

Sleep apnea is a serious sleep disorder that needs to be treated. The sleep team at a board-certified sleep center can help you select a treatment plan that is right for you. Depending on the treatment, you might have a sleep team that includes dentists, psychologists, physician assistants, nurses and technologists. Your plan may include any combination of these treatments:

  • Continuous positive airway pressure
  • Oral appliance therapy
  • Surgery
  • Weight management
  • Positional therapy
  • Lifestyle changes

This content originally appeared on the American Academy of Sleep Medicine website.

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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.