Treating Sleep Apnea

Lifestyle Modifications | CPAP | Oral Appliances | UPPP | Pillar Palatal Implant
Special Report: CPAP and Memory | Special Report: CPAP and the Heart

Once sleep apnea has been diagnosed with WatchPAT or a hospital sleep study, it’s time to consider treatment strategies. Lifestyle measures, including weight loss and smoking cessation, can certainly be effective for mild cases, but moderate to advanced sleep apnea will require respiratory equipment, a dental appliance, or a surgical procedure.

Lifestyle Modification for Sleep Apnea

For mild cases of sleep apnea, conservative therapy may be all that is needed. Conservative approaches include:

• Losing weight

• Avoiding alcohol

• Changing sleep positions to promote regular breathing

• Smoking Cessation

Weight reduction. Weight loss is very important because it decreases the amount of obstruction in the throat. Weight loss of 10% is often enough to reduce the number of apneic events for most people, while a significant amount of weight loss is oftentimes enough to stop sleep apnea symptoms altogether.

Changing body position. Raise the bed headboard between 30 and 45 degrees. Wear a fanny pack with tennis balls in it to prevent you from sleeping on your back.

Eliminating or reducing alcohol consumption. Alcohol (and other sedatives) relaxes the tongue and pharyngeal muscles and may exacerbate the apnea problem. Avoid alcohol consumption before bedtime.

Non-Surgical Treatment of Sleep Apnea

CPAP Therapy for Sleep Apnea

CPAP stands for Continuous Positive Airway Pressure. This is the gold standard and most often prescribed treatment for sleep apnea. CPAP is a mechanical device containing a fan that keeps your airway open as you sleep by providing a steady stream of air. Think of the air as a pneumatic splint that keeps the air passages open. In CPAP treatment, patients wear either a full mask that covers the nose and mouth, or else a mask that covers only the nose. Tubes then attach the mask to the CPAP machine.

Research clearly shows that treatment with CPAP reduces cardiovascular risk, lowers the incidence of motor vehicle accidents, and improves quality of life. CPAP, unfortunately, is not curative but it can certainly restore your sleep and improve your health and quality of life. 

Special Report: CPAP and the Heart

Special Report: CPAP and Memory

How CPAP Works

Most CPAP units are about the size of a small tissue box. Today’s units are smaller, lighter, and quieter than when first used to treat sleep apnea more than 25 years ago. Some units are as small as six or seven inches in length and weigh only two or three pounds. To power the unit, you simply plug it into the wall. The box has a fan that pushes air through a tube. The tube is connected to a mask that you wear as you sleep. The mask allows the air to gently blow into the back of your throat. This keeps the airway open and prevents pauses in breathing as you sleep.

The amount of air pressure needed is different for each person. ACPAP study during an overnight sleep study with WatchPAT or in a sleep laboratory will show your doctor the level that is right for you.

CPAP units come with a variety of features. Most units now have a pressure “ramp” setting.This timed setting starts the machine at a very low level of air pressure. It slowly raises the pressure until it reaches the right level.

Humidifiers are a common accessory for most CPAP units. They provide cool or heated moisture to the air coming from the CPAP unit. This can reduce side effects and make it easier for you to breathe through your mask. Some CPAP units now come with an integrated humidifier that is connected to the machine.

There are three kinds of mask systems that you can use with CPAP:

• Nasal Mask. This mask only covers your nose and is the most common CPAP mask.

• Full Facemask. This mask covers both your nose and your mouth. This type of mask may help if you have air leaks when using a nasal mask.

• Nasal Pillows. This system uses soft silicone tubes that fit directly into your nostrils. It can also help eliminate air leaks and may provide you with a greater sense of freedom.

No matter what type of mask you use, the most important thing is a proper fit. Your doctor will work with you to select the right size. The mask should fit snugly enough to prevent leaks without causing discomfort. You may need to make small adjustments to the mask, tubing, straps, and headgear until you get the right fit.

CPAP Benefits

People with moderate to severe sleep apnea will notice a difference the first night. After a couple of weeks of use, maximum benefit will be achieved. CPAP is not curative. Once a person stops using the device, however, sleep apnea will return.

CPAP Compliance: You Have to Use it to Get The Benefit!

The biggest problem with CPAP therapy is adherence and compliance. Many patients report nasal dryness and congestion, claustrophobia, facial abrasions, and conjunctivitis (“pink eye”). These problems are enough to make them put the machine away for good.

There are a number of things you can do to improve CPAP compliance. To begin, your doctor or a staff member from the sleep center can try masks of varying sizes, shapes, and materials to optimize comfort.

Nasal pillows are an alternative to the CPAP mask. When nasal pillows are used, air is blown directly into the nostril and not the mouth, as is the case with a facemask.

In addition, you can try a nasal spray and a humidifier to improve nasal condition.

Oral Appliances for Sleep Apnea

Oral appliances that treat snoring and obstructive sleep apnea are small plastic devices that are worn in the mouth, similar to orthodontic retainers or sports mouth guards. These appliances help prevent the collapse of the tongue and soft tissues in the back of the throat, keeping the airway open during sleep and promoting adequate air intake.

Currently, there are more than 40 FDA-approved oral appliances available. Oral appliances may be used alone or in combination with other means of treating sleep apnea, including general health and weight management, surgery, or CPAP.

With so many different oral appliances available, a selection of a specific appliance may appear somewhat overwhelming. Nearly all appliances fall into one of two categories. The diverse variety is simply a variation of a few major themes. Oral appliances can be classified by either mode of action or design variation:

Tongue Retaining Appliances. Tongue retaining appliances function by holding the tongue in a forward position by means of a suction bulb. When the tongue is in a forward position, it serves to keep the back of the tongue from collapsing during sleep and obstructing the airway in the throat.

Mandibular Repositioning Appliances. These help to reposition and maintain the lower jaw (mandible) in a protruded position during sleep. This serves to open the airway by indirectly pulling the tongue forward, stimulating activity of the muscles in the tongue and making it more rigid. It also holds the lower jaw and other structures in a stable position to prevent opening of the mouth.

Dentists with training in oral appliance therapy are familiar with the various designs of appliances, and they can determine which one is best suited for your specific needs. The dentist will work with your physician as part of the medical team in your diagnosis, treatment, and ongoing care. Determination of effective treatment can only be made by joint consultation of your dentist and physician. The initial evaluation phase of oral appliance therapy can take anywhere from several weeks to several months to complete. This includes examination, evaluation to determine the most appropriate oral appliance, fitting, maximizing adaptation of the appliance, and its function.

To identify a dentist in your area who is trained in the diagnosis and treatment of sleep apnea, contact:

The American Academy of Dental Sleep Medicine

251 North Frontage Road
Darien, IL 60561
Tel: 630-737-9705
www.aadsm.org

Surgical Treatment of Sleep Apnea

Any surgical treatment for sleep apnea must address the anatomic problem areas. There may be one or several areas that compromise airflow and cause apnea. Surgical treatment can address the nose, palate, tongue, jaw, neck, obesity, or several of these areas at the same time.

Palatal Surgery for Sleep Apnea

Uvulopalatopharygoplasty (UPPP). Patients who cannot be treated adequately with CPAP or can’t use it and have failed other conservative measures will often have this procedure recommended to them. This is a surgical or laser procedure to remove part of the uvula (the small fleshy tissue hanging from the center of the back of the throat) and soft palate in an attempt to alleviate snoring and sleep-disordered breathing. Following surgery, a repeat sleep study is needed to determine whether the procedure reversed the sleep apnea.

Pillar Palatal Implant. This device is another option for sleep apnea, which reduces the fluttering of soft tissue responsible for snoring. Three polyester braids, each less than an inch long, are embedded in the back of the throat to stiffen the soft palate and reduce the vibration that causes snoring.

Here’s how the implant procedure works: The doctor numbs the area with a local anesthetic, and then embeds the inserts in the soft palate using a specially designed tool. Discomfort is minimal because tissue is not removed or damaged; most patients report a noticeable and lasting reduction in snoring.

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