Choosing the best treatment for apnea
If you are suffering from sleep apnea, there are several treatments for it. An obvious next step is continuous positive airway pressure. Other treatments include oral and dental devices to keep your airway open. If all else fails, surgery is an option.
To assess snoring and other symptoms of sleep apnea, have the patient run a tape recorder to record the sounds he or she makes while sleeping. Snoring related to sleep apnea differs from innocuous snoring. Benign snoring has a very monotonous, repetitive sound, but intermittent quiet periods between the loud snoring noises may be indicative of apnea.
Symptoms of apnea indicate referral to a sleep disorder clinic for complete polysomnography, because the diagnosis and classification of apnea can be made only in this setting.
Treatment of obstructive sleep apnea syndrome is multifaceted. The first intervention is advice-the advice you would give anyone who wanted to control snoring:
- Lose weight (if appropriate)
- Sleep on the stomach or on a side, not on the back
- Avoid alcohol at least 3-4 hours before retiring
- Avoid pharmacologic sleep aids
- Get enough hours of sleep each night.
An overnight polysomnogram is used to confirm the diagnosis and assess severity of physiologic disturbances. Initially, simple measures, such as avoidance of alcohol and sedatives before bedtime and sleeping on the side rather than the back, may be tried. Nasal continuous positive airway pressure is considered first-line therapy, and compliance can be improved by education and counseling of the patient.
A first-line medical treatment includes use of a nasal continuous positive air pressure (CPAP) device, which supplies pressure to the upper airway and prevents the airway from collapsing while the patient is asleep. The pressure appropriate for a given patient must be determined in a sleep laboratory.
Another procedure gaining popularity is uvulopalatopharyngoplastysurgical removal of redundant tissue from the soft palate. This procedure is most often used in patients who do not respond to CPAP because of a lack of patency in the upper air-way due to trauma, infections, or allergies. Uvulopalatopharyngoplasty is beneficial in only 50% of patients.
Tracheostomy gives the most consistent long-term benefit but is accompanied by significant emotional morbidity. Tracheostomy may be required for the 5% of patients whose apnea does not respond to other therapy.
Those patients may be able to clear their airway with a prescription dental device that holds the tongue in place or repositions the jaw. But those devices may also be uncomfortable, and they work much less reliably than the mask and pump.
A more effective alternative is surgery, which widens the airway by removing any flabby or enlarged tissue, making a groove in the back of the tongue, or sliding the jaw slightly forward.