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Next PagePrevious Page Obstructive Sleep Apnea is Treatable

Sleep apnea and snoring respond to several types of treatment. This page discusses treatments for the obstructive type of sleep apnea.

The figure below shows the value of several treatment options. Darker means more valuable.

Snoring Mild Sleep Apnea Moderate or Severe Sleep Apnea
Weight loss                                                                  
Nasal decongestant                          
Positional therapy                          
Surgery (adults)      
Surgery (children)      
Oral appliance                          
Breathing mask      

Note #1: The value of any treatment is always individualized. The figure is only a guide.
Note #2: It is assumed that sleep apnea and/or snoring are not due to a treatable cause, other than weight in adults or large tonsils in children. Sleep-breathing problems caused by heart failure, thyroid disorders, and so forth, are best treated by treating the underlying disorder.

Weight Loss
About 70% of persons with obstructive sleep apnea are overweight or obese. Weight loss in such persons is normally encouraged.

Surprisingly, there have been few formal studies of how effectively weight loss improves snoring and sleep apnea. Nevertheless, striking improvements in both sleep apnea and snoring have been observed in persons who lose weight.

In some situations a physician may wish to prescribe weight loss medications to an overweight or obese patient with sleep apnea.

Nasal Decongestant
Nasal decongestants are more likely to be effective in cases of snoring or mild sleep apnea. In some cases, surgery is an effective way to improve airflow through the nose.
Positional Therapy
Some persons snore or have sleep apnea only when lying on their back. In such persons, sleeping on their side can eliminate or lessen airway obstruction.

The traditional technique to ensure side-sleeping is to put a tennis ball in a sock, then pin the sock to the back of the pajama top.

Positional therapy generally works only in mild cases of sleep apnea. In more severe cases, the airway collapses no matter what position the patient assumes.

Surgery (Adults)
Surgery is effective in treating snoring.

Surgery is less effective in treating sleep apnea. The challenge confronting the surgeon is knowing what part of the upper airway is causing the obstruction to airflow. There are multiple possible sites, and conventional sleep testing does not usually identify the area the surgeon should modify. If the surgeon treats the wrong part of the airway, or if there are multiple sites of obstruction, it is unlikely that sleep apnea will improve to a degree where no other treatment is needed.

Given the several sites where airway obstruction may exist, there are several types of operations currently used to treat sleep apnea. The most common is UPPP (uvulo-palato-pharyngoplasty). The success rate of this operation is about 50%. Some surgeons have achieved very high success rates using multiple, staged operations.

Most authorities recommend routine re-assessment for sleep apnea after surgery. See the caution below.

Surgery (Children)
Most children with snoring or sleep apnea have enlarged tonsils and/or adenoids. In 75% of cases, surgical removal of these tissues cures sleep breathing problems.

The American Academy of Pediatrics has endorsed removal of the tonsils and adenoids as the initial treatment of choice for sleep breathing problems in children.

Oral Appliance
Oral appliances look like the mouthguards worn by football players. The oral appliances for treating sleep apnea and/or snoring are specially designed for that purpose.

The appliance is worn in the mouth during sleep. Most appliances work by positioning the jaw slightly forward of its usual rest position. This small change is, in many people, enough to keep the airway open during sleep.

You can simulate the effect of an oral appliance with a simple experiment. If you make a snoring sound right now and, in the middle of it, thrust your jaw forward, you will see that the snoring sound stops.

The American Sleep Disorders Association (now called the American Academy of Sleep Medicine) has endorsed oral appliance therapy for selected patients with sleep apnea.

Many authorities recommend routine assessment for sleep apnea after oral appliance therapy has been applied. See the caution below.

Breathing Mask
Breathing masks are the most widely used treatment for moderate and severe sleep apnea. They have been endorsed by the American Academy of Sleep Medicine.

The mask is worn tightly over the nose during sleep, supplying pressurized air into the nose. The air travels into the person's throat, where the pressure of the air keeps the person's airway from collapsing.

The mask has a tube connecting it to a machine that pressurizes air.

There are several types of breathing mask systems, with names like CPAP, BiPAP, and so on. Studies of the CPAP system show that it makes people with sleep apnea feel better, and that it decreases complications of sleep apnea.

Although breathing masks are not used to treat snoring alone, they do eliminate snoring in addition to treating obstructive sleep apnea.

Other
Abstinence from alcohol before bedtime is an important part of treating sleep apnea.

In a recent study, several persons who received cardiac pacemakers showed an improvement in their sleep apnea. No major organizations have endorsed this type of treatment. Further studies are underway.

CAUTION
Snoring, and certain details of snoring, can be a valuable early-warning alarm that sleep apnea is present. Treating snoring can remove this warning system.

Just as seeing smoke is a warning that a fire may be burning, hearing snoring is a warning that sleep apnea may be present. And just as smokeless fires may be discovered late, with unfortunate consequences, so too may snore-free sleep apnea.

Thus, when surgery or oral appliances are used to treat snoring, it is important to check for sleep apnea on a regular basis afterwards.

References


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Last modified 04:38 Pacific on 08 Sep 2003.