Sleep Apnea Treatments


The erratic breathing and noises of people with sleep apnea is usually just as rough on a partner as it is on the person who has it.
The erratic breathing and noises of people with sleep apnea is usually just as rough on a partner as it is on the person who has it.
iStockphoto/Thinkstock

The time we spend asleep is meant to be the most relaxing and restorative period of our days. Yet for those who suffer from sleep apnea, nighttime can become a struggle to breathe; a true nightmare in which the body's need for rest is continuously interrupted by its even greater need to breathe.

Sleep apnea affects more than 100 million people worldwide [source: World Health Organization] and is thought to afflict millions more who remain undiagnosed. It is more common in men, those who are overweight, those with a history of the condition in their family and those who are of African American, Hispanic or Pacific Island descent [source: National Heart Lung and Blood Institute]. It is also more prevalent in people over 40 [source: FamilyDoctor].

There are two main types of sleep apnea, a term that takes its name from the Greek phrase for "want of breath." In obstructive sleep apnea, a portion of the airway actually closes while sleeping, causing a pause in breathing that can last for a few seconds to as long as two minutes. These breathing pauses can occur up to 30 times per hour.

With central sleep apnea, the brain fails to send the proper signals to the muscles that control breathing. This also causes repeated interruptions to the sleep cycle.

In both cases, the lack of solid sleep and a steady flow of oxygen can have serious consequences. The U.S. National Commission on Sleep Disorders has estimated that roughly 38,000 deaths per year occur from cardiovascular issues connected to sleep apnea, including hypertension, stroke and high blood pressure [source: Sleep Disorders Guide]. Sleep apnea has also been linked to an increased risk of type II diabetes. And the condition can put other people at risk, not only in the bedroom -- since the partners of people with sleep apnea often experience lost sleep as well -- sometimes even on the roadways. It is estimated that men and women who have sleep apnea issues are three to five times more likely to be involved in a serious car crash involving personal injury than people without the disease [source: University of British Columbia].

In addition to the excessive daytime sleepiness that can lead to these motor vehicle accidents, another key symptom of sleep apnea is restless sleep and/or excessive snoring. For this reason, sleep apnea is best spotted by a partner, who can notice the pauses in breathing followed by a gasp or grunt as the afflicted person struggles to resume breathing. Other symptoms include difficulty concentrating, morning headaches and/or a dry throat, shortness of breath that gets better when sitting up, and mood swings or irritability.

Fortunately, the cure for sleep apnea in most cases is relatively simple and pain free, as well see on the next page.

CPAP Breathing Machines

Many patients with sleep apnea experience sounder sleep with the use of a CPAP machine.
Many patients with sleep apnea experience sounder sleep with the use of a CPAP machine.
iStockphoto/Thinkstock

The most common treatment for both types of sleep apnea is the use of a Continuous Positive Airway Pressure (CPAP) machine. The machine consists of a small boxy unit that contains a motor, and a tube that delivers air to a mask, which is worn either over the nose or over both the nose and mouth. The air is delivered at a high enough pressure to keep the airway open during sleep. The machine tends to be quiet and produces a gentle rhythmic sound that does not interfere with most patients' sleep. Some units have additional features such as heated humidifiers, tracking software and power outage backup technology.

In order to get a CPAP machine, you'll need a prescription from your doctor.

Typically, once you've purchased the machine, a technician will come to your home to set up the machine and show you how to use it. A few subsequent adjustments might be needed to get the level of pressure just right for your needs.

The side effects from using CPAP machines are relatively few and minor and include the following: skin irritation around the mask area, headaches, dry mouth, and dry or clogged nose. In some cases, the stomach may fill with air causing some discomfort. If this occurs, a change in sleeping position or air pressure level can help.

BIPAP Vs. CPAP

With a CPAP machine, the pressure of the air delivered to the patient is continuous. This can sometimes make it a little uncomfortable for the wearer of the device to exhale, as he or she is actually exhaling against inbound pressure.

With a bilevel positive airway pressure (BiPAP) machine, also known as a BiLevel or VPAP machine, two levels of pressure are delivered -- one at a higher level when the patient inhales, and another at a lower pressure when he or she exhales. Just as with a CPAP machine, the levels of pressure are prescribed by a physician. Because of the reduced effort to exhale, BiPAP machines are often more comfortable for the wearer and tend to lead to fewer side effects like sore throat.

Both BiPAP and CPAP machines are helpful in eliminating central and obstructive sleep apnea.

Dental Devices for Sleep Apnea

Dental devices like the one shown here are sometimes prescribed for patients who can't tolerate the face mask of a breathing machine.
Dental devices like the one shown here are sometimes prescribed for patients who can't tolerate the face mask of a breathing machine.
iStockphoto/Thinkstock

Although the various air pressure machines are considered the best remedies for sleep apnea, the American Academy of Sleep Medicine recommends dental devices (also known as oral appliances) for people suffering from mild-to-moderate obstructive sleep apnea who can't tolerate a breathing machine.

The most commonly used dental device is known as a mandibular advancement device (MAD). It looks similar to an athlete's mouth guard and attaches to both the upper and lower parts of the mouth. It works by forcing the mandible (jaw bone) forward which has the effect keeping the airway in a more open position and reducing snoring.

The other dental device frequently used to combat sleep apnea is known as a tongue retraining device (TRD). It is made in soft rubber from a mold of the patient's mouth and tongue. It works by keeping the tongue slightly protruded through a suction action. This prevents the tongue from "falling" back into the airway. For this device to be successful, the patient must be able to breathe comfortably through his or her nose.

As with pressurized air machines, the side effects from using dental appliances are fairly benign and can include dry lips, excessive salivation, and discomfort -- especially in the teeth. But for many patients, the relative comfort of sleeping without a full breathing mask attached to a machine outweighs the negatives.

Natural Treatments for Sleep Apnea

Though it's natural to think that pharmaceutical sleep aids will ensure a more restful sleep, using them can actually contribute to sleep apnea.
Though it's natural to think that pharmaceutical sleep aids will ensure a more restful sleep, using them can actually contribute to sleep apnea.
iStockphoto/Thinkstock

If you suffer from sleep apnea, before you even try dental devices or breathing machines, you might want to consider some lifestyle changes that could help.

Paramount among these is weight loss. In fact, it is estimated that 70 percent of all sleep apnea sufferers are overweight [source: American Sleep Apnea Association]. Losing just 10 pounds can reduce your risk of sleep apnea by 30 percent [source: Oz]. In many cases, achieving a healthy weight for your height and body type can completely eliminate sleep apnea symptoms.

If you drink or take any kind of muscle relaxers, tranquilizers or sleeping pills, you might want to consider giving them up if you can. The problem is that with any kind of relaxant, the muscles in the back of the throat can relax as well and interfere with breathing. Plus -- as you probably hear with most health advice -- if you smoke, quit. Since smoke wreaks havoc on your respiratory system, getting rid of cigarettes can also improve your sleep apnea symptoms.

Another good idea if you suffer from sleep apnea is to do your best to keep your nasal passages open. If they are routinely stuffed, talk to your doctor about the possibility of using antihistamines, decongestants or nasal sprays to keep you breathing freely through your nose.

Lastly, experiment with the positions in which you sleep. Sleeping on your back can cause your tongue and soft pallet to move back towards your throat, which can restrict airflow, so side and stomach sleeping positions tend to work best.

Sleep Apnea and Surgery

If your sleep apnea is severe, and none of the previous solutions have provided relief, it might be time to talk to your doctor about surgery. Although surgery ranks behind breathing machines, dental appliances and weight loss in its effectiveness, if the surgeon is able to pinpoint the exact portion of the airway that is causing an obstruction (one of the major challenges of this surgery), there's a chance that you could find relief.

The most common type of surgery for sleep apnea -- and one that has roughly a 50 percent success rate -- is called uvulopalatopharyngoplasty, or UPPP. During this procedure, parts of the soft palate, throat tissue and the uvula (that dangly bit that you seen in cartoons when a character screams) are removed along with tonsils and adenoids, if present. If all goes well, the airway will be increased in size, the movement of the soft palate will be improved and some of the muscle action in the upper airway will be limited to help keep the breathing channel open. There's the potential for significant complications with this surgery, however. They include infection (which can affect up to 40 percent of all patients and requires another round of surgery), a hampered sense of smell, changes in the pitch of your voice, a lessened ability to keep fluids out of your airway and other swallowing problems.

A procedure that has been shown to be as effective as UPPP, but less invasive, is a pillar implant in which three short pieces of polyester string are inserted into the soft palate to reduce its vibration. This process is more successful in treating snoring than sleep apnea, but it is a possible avenue of relief.

Maxillomandibular advancement might also be considered if a mandibular advancement dental device is not appropriate for the patient. In this operation, the lower jaw is surgically moved forward, creating a greater space behind the tongue and soft palate.

Related Articles

Sources

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