What is Sleep Apnea?
To understand the treatment options for sleep apnea, let’s first discuss what sleep apnea is. Sleep apnea is a potentially dangerous illness. It is categorized as sleep-disordered breathing, which is an umbrella term for conditions that cause people to breathe abnormally or make them experience lapses in breathing during sleep.
There are two main types of sleep apnea: obstructive sleep apnea (OSA) and central sleep apnea (CSA). Treatment options vary between the two. OSA involves pauses or reduced breathing due to obstructed airways. In CSA, breathing stops during sleep due to issues with the central nervous system.
Therapy Treatment Options
There are multiple non-invasive treatment options for sleep apnea, some of which are more effective than others. Non-invasive options fall into two categories: positive airway pressure (PAP) devices and oral appliances.
Continuous Positive Airway Pressure (CPAP)
By far, CPAP is considered to be the gold standard for obstructive sleep apnea treatment, and it is the first treatment option offered to people who are diagnosed with moderate to severe OSA. The CPAP machine connects to the user's face via a tube leading to a mask that covers either their mouth or nose. The main function of the CPAP machine is to blow air into the patient's airway, reducing the likelihood that the patient stops breathing during sleep.
CPAP is hailed as the gold standard and is deemed a very effective OSA treatment method. However, it is suggested that many people prescribed CPAP do not regularly use it. This is problematic as, without the machine, the patient can lose oxygen supply to their brain for an extended period.
Although very effective for OSA, CPAP is less effective with central sleep apnea. Some people also find it difficult to exhale due to the high pressure when connected to the CPAP machine. Other treatment options are available for these people.
Bilevel Positive Airway Pressure (BiPAP)
For people having difficulty exhaling, doctors prescribe a BiPAP machine. This machine releases air at a higher pressure during inhalation and at a lower pressure during exhalation. This machine is also used to treat patients with sleep apnea who are morbidly obese or have hyperventilation. This machine works for them as it is very hard for them to exhale into a high-pressure airstream with the CPAP.
Other PAP machines
In addition to CPAP and BiPAP, there are a few other machines that rely on positive airway pressure as well. Some of them are Automatic Positive Airway Pressure (APAP), Expiratory Positive Airway Pressure (EPAP), and Adaptive Servo-Ventilation (ASV). They all differ in their operations, but their main principle is the same: positive airway pressure to force patients to breathe. Some of them also incorporate supplemental oxygen, which can help CSA patients.
The main goal of oral appliances is to reduce OSA symptoms by physically opening the airways. Oral appliances do not work the same for everybody, and their effectiveness varies from person to person, unlike PAP machines which are effective almost across the board. Thus, oral appliances are often only prescribed if the patient cannot tolerate PAP machines.
The most commonly prescribed oral appliances are mandibular advanced splints (MAS) and tongue-retaining devices. Both these devices try to keep the tongue pushed forward, although by different means, so that the patient’s airways are likely to stay open.
Treating Underlying Problems
It is important to note that central sleep apnea depends on issues with your central nervous system. Thus, PAP devices or oral appliances will only treat the symptoms at best. CSA can be potentially caused by heart or neuromuscular disorders, among other CNS issues. Thus, treating these disorders can help alleviate CSA as well.
Surgery is only considered after almost all other options have failed. Generally, other options are tested for at least 3 months to see their effectiveness, and only after that fail is surgery considered an option. However, people suffering from some jaw deformities as a result of birth or physical injury might find surgery to be a good first option.
This type of surgery typically involves removing tissue from the rear side of your mouth and the top of your throat. Your tonsils and adenoids are usually removed as well. This surgery might be effective in minimizing snoring as it cuts off any loose tissue that can vibrate; however, it is less effective than CPAP and is not considered a very reliable treatment method.
For people whose jaws are physically obstructing their airways from being fully utilised, this surgery can be effective. The jaw is moved forward from your other facial bones to create a larger space behind the tongue so that airway obstruction is less likely.
People can get implants, nerve stimulation, and tracheostomies as well. Implants are not that well researched, and their effectiveness is under question. Nerve stimulation helps keep the tongue in a position that keeps airways open by neural stimulation.
Tracheostomy involves the creation of a new airway. This is only performed if every treatment option has failed and the patient has life-threatening sleep apnea. It involves cutting a hole in the neck and inserting a tube that will allow you to breathe. Understandably, this is not a desirable procedure and is only used as a last resort.
What Can You Do?
Make lifestyle changes. Don’t smoke, start exercising, try losing excess weight, and avoid alcohol and sleeping pills. These changes can greatly improve your condition.
Talk to a sleep specialist. Find what treatment works for you best. If you are having trouble searching for options, head over to SleepRx to contact a sleep specialist and even get a sleeping kit that can help manage your sleeping apnea. SleepRx will guide you through your journey with sleep apnea from diagnosis to treatment with sleeping kits, tests, specialists, and even freely available information. You can even take a free sleep quiz to see what quality of sleep you’re getting currently!