Sleep Apnea Treatment Options

Obstructive sleep apnea occurs when the upper airway at the back of the throat become partially or completely blocked repeatedly during sleep. Obstructive sleep apnea (OSA) affects 9%–26% of the middle-aged population and is characterized by loud snoring and other symptoms like excessive daytime sleepiness, repeated episodes of interrupted breathing during sleep, and waking up with a gasp, choking sensation, or a body jerks, amongst others.

Untreated OSA can lead to poor quality of sleep, low blood oxygen levels, high blood pressure (hypertension), diabetes, stroke, heart failure, heart attacks, cardiomyopathy (a heart disease that makes it more difficult for your heart to pump blood to your body), and other heart problems. It also causes decreased productivity at home, school, work, and society at large.

Sleep Apnea Treatments

Positive Airway Pressure Devices

Continuous Positive Airway Pressure(CPAP)

CPAP is the traditional gold standard for the management of sleep apnea. This is because the use of CPAP has been proven to improve sleep-disordered breathing and quality of life. CPAP stands for Continuous Positive Airway Pressure and it works by pumping room pressurized air through a hose into a nasal mask that is strapped to the patient’s head. Constant pressure in the airway pushes the collapsible tissues out of the way and maintains and open/stable airway. Over the years, the use of continuous positive airway pressure (CPAP) machines has been found to decrease the apnea-hypopnea index (AHI) significantly.

The apnea-hypopnea index (AHI) is an average that indicate the severity of sleep apnea. It shows the number of apnea and hypopnea episodes that occur per hour of sleep. The AHI is calculated by dividing the number of apneic episodes by the number of hours of sleep. For adults, AHI values are grouped as:

  • Normal: AHI<5
  • Mild sleep apnea: 5≤AHI<15
  • Moderate sleep apnea: 15≤AHI<30
  • Severe sleep apnea: AHI≥30

While highly effective at managing sleep apnea, CPAP has proven to be difficult to tolerate for many patients and a large majority of CPAP users are “non-compliant” within 6 months. These are usually due to mask discomfort, extreme fear of enclosed spaces (claustrophobia), skin irritation where the mask touches the skin, feeling bloated with air, etc. If you are having a hard time wearing your CPAP every night please contact us, there are other options and it is imperative that you do something to manage your OSA.

Cpap Sleep Apnea Machine

Autotitrating Positive Airway Pressure (APAP)

Devices that use autotitrating positive airway pressure (APAP) have pressure of air set to a particular range. However, the levels of the delivered pressure are adjusted automatically if the device senses increased airway resistance. Both continuous positive airway pressure (CPAP) and and bilevel positive airway pressure (BPAP) devices are available in autotitrating modes.

APAP devices may be useful for patients who may experience fluctuations in weight such as pregnant women or those undergoing bariatric surgery. APAP is contraindicated for patients with central sleep apnea, do not snore, lung disease, congestive heart failure, or obesity hypoventilation syndrome.

Bilevel Positive Airway Pressure (BiPAP)

This device or machine is a ventilator that helps you breathe. Unlike CPAP, it uses two kinds of pressure, one for breathing in and a lower one for breathing out. This helps patients tolerate higher pressures as exhaling becomes easier. When you inhale or breathe in, the BPAP delivers air at a higher pressure to combat any upper airway blockage. It is used when CPAP does not produce the required outcome and even essentially treats nonobstructive sleep-related hypoventilation in patients with obesity or neuromuscular disease.

 

Oral Appliance

Oral appliances are also known as dental devices or mouthpieces. The appliance works by holding your mandible (lower jaw) in a precise open and forward position and by doing so all the soft tissues in your throat and neck are no longer able to collapse and cause the nighttime choking and suffocating episodes. They could be bought over-the-counter or custom-made. However studies show that custom oral appliances significantly reduce AHI values when compared to non-custom ones.

Our practice specializes in fitting patients with a custom fabricated oral appliance to manage sleep apnea. The appliance we make will be custom made for your teeth and will fit much like a sports mouth guard. Oral appliances are a very comfortable and easy to use solution for managing sleep apnea and snoring and they are also an excellent alternative to CPAP therapy for patients who find it difficult to tolerate., as well as comprehensive surgeries.

According to the American Sleep Apnea Association(ASAA), mouthpieces can be used to treat a variety of sleep issues. In 2015, the American Academy of Sleep Medicine issued updated practice parameters recommending the use of custom fabricated oral appliances made by specially trained dentists for patients with snoring and obstructive sleep apnea who prefer the mouthpiece over CPAP or who have tried CPAP and are unable to continue daily use.

Oral appliances is of two types; mandibular advancement devices (MADs) and tongue retaining devices. However, mandibular advancement devices (MADs) are the ones mostly used. They cover the teeth, adjust the jaw, and prevent the tongue from blocking the upper airway.

Oral Appliance Candidate

Am I A Candidate For An Oral Appliance?

Most people are great candidates for an oral appliance. The only way to tell for sure would be to come in for a complimentary consultation at our office. When you come in we will test your airway using our Eccovision Acoustic Diagnostic Imaging system and we may also send you home with a portable sleep apnea monitor. Once everything is reviewed the doctor will discuss treatment options with you.

Usually, MADs are indicated for patients

  • with mild to moderate obstructive sleep apnea (OSA)
  • with severe obstructive sleep apnea (OSA) who are unwilling or unable to use CPAP
  • who have good dentition
  • who have a body mass index (BMI) below 30 kg/m2.

Not All Oral Appliances Are The Same

At our practice, we work with the Respire line of oral appliances. These devices are manufactured to strict standards and are FDA cleared specifically to manage Sleep Apnea. Additionally, we use state-of-the-art acoustic imaging technology to ensure your jaw is held in precisely the correct position with the appliance. “at home appliance kits” and other bulky non-custom devices may claim to help with snoring but are not nearly as comfortable or successful as the appliances we use.

 

 

 

Oral Appliance Options
Advantages Oral Appliance

Benefits of Oral Appliances

Studies have shown that patients adhere more to oral appliance therapy than CPAP therapy. The benefits usually reported include the following:
  • Effective
  • Comfortable
  • Non-invasive
  • Affordable
  • Easy to wear
  • Portable
  • Noiseless
  • Convenient for travel
  • Easy to care for

Trust 35 Years of TMJ Experience Paired With The Latest Technology

Surgery

There are a few surgical options designed to reduce or remove excess tissue in the airway. Our doctor will review and discuss these options with you if indicated.

However, the following are types of surgery used to treat sleep apnea, particularly obstructive sleep apnea:

Adenotonsillectomy

This surgery is for the removal of enlarged tonsils and adenoids. Enlarged tonsils and adenoids have been found to be one of the major causes of obstructive sleep apnea in children. However, this surgery is rarely used as a sole treatment for obstructive sleep apnea in adult patients.

Palatal Surgeries

Uvulopalatopharyngoplasty (UPPP)

This surgery involves rearranging the tissues of the uvula, palate, and throat to help reduce snoring and treat obstructive sleep apnea. It s aimed at increasing the airway and preventing tissue collapse and vibrations. Usually, patients with moderate to severe OSA after the surgery still require further treatment, either with PAP therapy or oral appliance therapy. There is also a similar, more effective procedure known as laser-assisted uvulopalatopharyngoplasty (LA-UPPP) that uses laser to perform the surgery.

Pillar procedure

This type of palatal surgery and inserting small, braided plastic strands into the soft palate of your mouth. It prevents the soft palate from collapsing and eliminate snoring and treat mild to moderate obstructive sleep apnea efficiently.

Hypoglossal Nerve Stimulation

This is also known as upper airway stimulation. It involves the use of a small, implanted device that works from within. It senses breathing patterns of the patient and delivers mild stimulation to the hypoglossal nerve. The hypoglossal nerve is the nerve that controls the tongue. When signals are delivered to it, it prevents blockage by the tongue and keeps the airway open during sleep.

The device is turned on before going to bed and it delivers stimulation that makes the tongue and throat muscles to shorten and moves your tongue and palate forward to keep the airway open throughout the night.

Nasal Surgeries

Nasal surgery is used to correct nasal obstructions due to deviated nasal septum, nasal polyps, etc. These nasal obstructions usually cause and/or worsen snoring and obstructive sleep apnea. Some nasal surgeries help to prevent airway blockage and cure obstructive sleep apnea while some make it easier to use a CPAP machine.

Maxillomandibular Advancement (MMA)

This is also known as jaw advancement. MMA increases the area the velo-orohypopharyngeal airway (the area of the upper airway at the base of the tongue and soft palate) by moving the upper and lower jaws forward. By moving the lower jaw forward, the airway is enlarged and other lower jaw that contribute to obstructive sleep apnea are treated. This procedure is sometimes reserved for patients with major maxillomandibular deficiency such as hypopharyngeal stenosis, velo-orohypopharyngeal narrowing, and retrognathia (where the lower jaw/mandible is located behind or posterior than normal).

It makes it difficult for the patient to breathe out and the pressure generated helps keep the airway open hence the name “expiratory positive airway pressure” which is maintained until the start of the next inspiration. Usually, it is an easier and natural alternative to CPAP.

Sonmoplasty

It also known as radiofrequency tissue ablation. It involves the use of low-level radiofrequency heat to remove or shrink tissues of the uvula and soft palate in treating sleep apnea. The procedure is performed under local anesthesia and takes about 30 minutes.
Other surgical procedures include thermal ablation palatoplasty (TAP), uvulopalatoplasty (LAUP), tonsillectomy, tracheostomy, and adenoidectomy.

Conservative Treatments

These are other sleep apnea treatment options that can help treat snoring and other obstructive sleep apnea symptoms in patients who do not want to use devices or have surgery. They are usually recommended alongside other major sleep apnea treatment options for best outcomes.

Weight Loss

Obese or overweight patients with obstructive sleep apnea (OSA) should be advised to and how to lose weight. Weight loss helps reduce the fatty tissue in the throat and eliminate snoring and treat OSA. You may lose weight through eating healthy and regular exercise. Eating healthy requires you to reduce your overall calorie intake, replacing your food options with whole grains, healthy fats, fruits, and vegetables to your diet. You also need to eat smaller portions at a time. A doctor or nutritionist could help you with getting that healthy weight you desire.

Research shows that obese people with obstructive sleep apnea benefit from losing weight. A 10 per cent weight loss can reduce the number of apneic episodes for people with sleep apnea. Weight loss can also reduce the treatment requirement for patients with OSA. For example, having a weight loss regimen with PAP therapy can allow for reduced PAP requirements.

Weight loss also helps manage, treat, and prevent complications such as diabetes, obesity, and high blood pressure.

Healthy diet

A healthy diet including fruits and vegetables can help treat mild obstructive sleep apnea (OSA).

Positional therapy

Positional therapy was developed to keep patients in a non-supine position (position where you do not sleep on your back). Sleep positions can determine can contribute to sleep apnea. If you are one to always sleep on your back, you need to change your sleeping position. Sleeping on your back makes gravity to pull your tongue and your tissues around your throat backwards, obstructing the air passage and causing snoring. Sleeping on your side eases breathing and helps in treating obstructive sleep apnea.

Patients who are interested in positional therapy are often counseled to use a special device, either a commercially available product or homemade positioner, to prevent supine sleep. They wear it around your waist or back. For a homemade remedy, you could use a tennis ball attached to your night wear through a sock sewn to the back of the cloth. The discomfort the ball causes when you roll on your back will make you sleep on your side (lateral position). After you do this for a while, your default sleep position changes.

Nasal Expiratory Positive Airway Pressure (Nasal EPAP)

Nasal expiratory positive airway pressure (nasal EPAP) is a FDA–cleared device that helps in relies on patent nasal passages. The device is a small valve that is attached to the a patient’s nostril and acts as a one-way resistor, permitting unobstructed inspiration. It allows easy airflow during inhalation but creates resistance to airflow through a small opening when the patient exhales.

It makes it difficult for the patient to breathe out and the pressure generated helps keep the airway open hence the name “expiratory positive airway pressure” which is maintained until the start of the next inspiration. Usually, it is an easier and natural alternative to CPAP.

Noninvasive Oral Pressure Therapy

Oral pressure therapy is delivered via a device that rests within the mouth. The device consists of a bedside console containing a pump, a soft polymer mouthpiece, and a flexible tube connecting the mouthpiece to the console.

The device creates negative pressure with a vacuum within the oral cavity, which pulls the soft palate forward and stabilizes the airway, thus preventing obstruction. It may be considered for patients who can tolerate the oral pressure device.

Nasal Decongestants

In some cases of mild obstructive sleep apnea, nasal decongestants can help open airways and improve sleep apnea symptoms.

Avoid alcohol, sedatives, and other drugs

Drinking alcohol relaxes your throat muscles, constrict your airway, and can cause obstructive sleep apnea. Drugs like sedatives, depressants, tranquilizers, and muscle relaxants can also cause sleep apnea. Hence, limiting their intake or use can help reverse mild to moderate cases of obstructive sleep apnea.

Quit smoking

Smoking affects the passages in your nose, muscles in your throat, chest and diaphragm resulting in snoring and sleep apnea. As an unhealthy habit, it is often difficult to stop. See your doctor to help as you may need therapies such as gums and patches. Quitting smoking is important as a sleep apnea treatment.
Our team has years of experience in providing Sleep Apnea treatments. Get in touch today!