In our previous post Sleep Apnea: What is it and how is it diagnosed, we talked about the causes of Sleep Apnea. We also touched on how we can diagnose/test for sleep apnea in a patient.
Now that we know what apnea is, who gets it and how we test for it, we need to talk about treatment. We will discuss 4 options for treatment today. Keep in mind that not all treatments will work for all patients.
The first treatment we discuss is positional therapy. For patients who only have sleep apnea when they sleep on their back, forcing them to their side may be an effective treatment. The downside is that by sleeping on the side, the patient may develop joint pain — specifically hip and shoulder pain.
Second treatment is an adjustable oral appliance. This is a mouth piece made by the dentist or orthodontist. It essentially pulls the bottom jaw forward and pulls the tongue away from the base of the airway. This works well for patients who have snoring without apnea or mild apnea without any significant health issues. The biggest drawback to the OA is that it can worsen TMJ issues. The patient must also have good dental hygiene in order for the device to be an option.
The third option is surgery. Surgery is generally not a very good option as the best surgeries for sleep apnea carry about a 25-30% success rate in curing sleep apnea. These are extensive surgeries that require time from work and significant pain and expense.
The last option to treat sleep apnea is by far the most common. Most are familiar with CPAP machines. CPAP (continuous positive airway pressure) is a mask or other device that blows positive pressure in to the upper airway to splint the airway open. This treatment is 99.5% effective in treating apnea. They key is that CPAP must be worn nightly. Many patients are very hesitant to wear PAP. Why is that? I think it is because many have heard horror stories about the machines. 20 years ago when I started doing this, the equipment was terrible. The machines sounded like jet engines and the masks were big and uncomfortable. Today’s equipment is much more user friendly. Machines are small and whisper quiet. Masks are not even masks anymore. Nasal pillows are tiny prongs that just fit inside the nostril and are equally as effective in treating apnea. We also know that CPAP helps reduce blood pressure, helps treat diabetes and may help to prevent heart disease. If we had a pill that does those things, we would all take it. In fact, CPAP will do all of those things. I always tell my patients this: Is it a pain? Sometimes. Do I wish I didn’t have to wear it? Yes. Would I trade those things for how I feel when I wear it? No way. This is why CPAP IS the gold standard in treatment of moderate to severe sleep apnea.