How to Treat Sleep Apnea?

Individualized specific therapy is necessary for sleep apnea. Medical history, physical examination, and the results of polysomnography are all important to design specific therapy for patients with sleep apnea.

Drug therapy
Medications are generally NOT effective.

Behavioral Therapy
Behavioral modifications are important, especially in mild cases. Behavioral therapy may be all that is needed. Alcohol consumption, smoking, and sleeping pills should be withheld. They make the airway more likely to collapse during sleep and prolong the apneic periods. Overweight persons will need weight reduction. A 10 percent weight loss may be sufficient to reduce the number of apneic events for most patients. Use of special pillows and other devices to keep them sleeping in a side position can help patients with mild sleep apnea who develop breathing pauses only when they sleep on their backs.

Physical or Mechanical Therapy
Nasal continuous positive airway pressure (CPAP) is the most common effective and widely accepted treatment for sleep apnea. Patient wears a mask over the nose at sleep. Positive pressure from an air blower forces air through the nasal passages to "scaffolding" the airway. The air pressure is adjusted so that it is just enough to prevent the throat from collapsing during sleep. The pressure is constant and continuous. Addition CPAP device tries to minimize side effects that sometimes occur, for examples, nasal irritation and drying, facial skin irritation, abdominal bloating, mask leaks, sore eyes, and headaches. Some CPAP machine can vary the pressure automatically to coincide with the person's breathing pattern. Some start with low pressure, slowly increasing it to allow the person to fall asleep before the full prescribed pressure is applied.

Dental appliances
Dental appliances that reposition the lower jaw and the tongue have been helpful to some patients with mild sleep apnea with receded jaw. Possible side effects include damage to teeth, soft tissues, and the jaw joint. A dentist or orthodontist is often the one to fit the patient with such a device.

Surgery
Children with enlarged adenoid and tonsils prone to develop obstructive sleep apnea syndrome. Most of them will be benefit from removal of adenoid and tonsils.

Compared to the young counterparts, only selective groups of adult patients will be benefit from surgery.

Uvulopalatopharyngoplasty (UPPP) using CO2 Laser is the most commonly adopted procedure to remove excess tissue at the back of the throat (tonsils, uvula, and part of the soft palate). The success of this technique may range from 30 to 50 percent. Stringent assessment by ENT surgeon is needed to predict which patients will do well with this procedure.

Removal of nasal polyps and tonsillectomy are indicated in patients with nasal polyposis and enlarged tonsils respectively.

Tracheostomy is used in persons with severe, life-threatening sleep apnea. In this procedure, a small hole is made in the windpipe and a tube is inserted into the opening. This tube stays closed during waking hours, and the person breathes and speaks normally. It is opened for sleep so that air flows directly into the lungs, bypassing any upper airway obstruction. Although this procedure is highly effective, it is an extreme measure that is poorly tolerated by patients and rarely used.

Other procedures: Patients in whom sleep apnea is due to deformities of the lower jaw may benefit from surgical reconstruction. Finally, surgical procedures to treat obesity are sometimes recommended for sleep apnea patients who are morbidly obese.