How to Treat Obstructive Sleep Apnea

Expert Insights from Dr. Luis Javier Peña-Hernández, MD, FCCP, a lung health specialist at PCSI, the largest integrated pulmonary and chest specialty group in Palm Beach County.

Snoring. It’s a funny word that conjures up a comic image: a drooling sleeper with mouth agape making otherworldly sounds that could wake the dead, all the while oblivious to the racket they’re creating. But ask anyone who sleeps with a snorer (that’s a funny one, too), and they’ll tell you snoring is no laughing matter. Of course, they’re right. And not just because they lose sleep every night. Snoring can be a sign of obstructive sleep apnea (OSA), a serious health problem that affects nearly 18 million Americans.

“Some of the most common signs of a case of obstructive sleep apnea are excessive nighttime snoring and daytime sleepiness,” explains Dr. Luis Javier Peña-Hernández.

Not all snoring indicates OSA, but OSA is almost always heralded by loud, frequent snoring. Snoring occurs when the soft tissues in your throat collapse and close off your airway. As you struggle to inhale through the obstructed airway, the tissues vibrate, causing the characteristic rattle and roar of snoring.

When the obstruction is severe, snorers may suffer from sleep apnea, a chronic condition characterized by pauses in breathing. People with OSA may stop breathing as many as 30 times each hour they are trying to sleep. As you might imagine, such breathing disruptions also disrupt the snorer’s sleep and prevent them from achieving the deep sleep stages, leaving them exhausted the next day.

Daytime sleepiness is just the beginning of the problems associated with lack of sleep. Left untreated sleep apnea can lead to:

• Weight gain
• Heart disease and heart failure
• Irregular heartbeat
• High blood pressure
• Stroke
• Diabetes
• Poor judgment
• Depression
• Increase in severity of ADHA symptoms
• Increased accidents

Ask any new parents how they feel (or just look at them) and most will tell you “exhausted.” At least when sleep disruptions are caused by a newborn baby, there’s hope for relief as the baby learns to sleep through the night. But sleep apnea? It’s here to stay without some kind of intervention. The good news is there are several different types of therapies that can alleviate obstructive sleep apnea and let you and your partner get the rest you both need.

Treatments for sleep apnea

“A sleep specialist can diagnose a case of obstructive sleep apnea and prescribe treatment,” says Dr. Peña-Hernández. “Your doctor will likely recommend you partake in an overnight sleep study to determine the best treatment plan for you.”

You will likely need to participate in a polysomnogram, which is an overnight sleep study. This painless test requires you simply to sleep for at least seven hours while electrodes attached to your head and body monitor your:

• Brainwaves
• Rapid eye movements
• Oxygen levels
• Breathing patterns
• Respiratory efforts
• Snoring
• Muscle tone and leg movements
• Heart rate
• Sleep stages

The results will tell your doctor how much your snoring and/or apnea impairs your sleep and what type of therapy is appropriate for you. “In some cases, it’s possible to circumvent treatment with a few simple lifestyle changes,” says Dr. Peña-Hernández. “By losing weight and avoiding alcohol and smoking, you may be able to minimize or eliminate your sleep apnea. However, if the cause of your sleep apnea is related to anatomical abnormalities or a more serious underlying condition, treatment is likely needed.”

Here are some of the options available to you.

Read More: Types of Products to Treat Sleep Apnea

Positive Airway Pressure (PAP) therapy

There are three kinds of Positive Airway Pressure therapies. All are designed to prevent your airways from collapsing while you are relaxed and trying to sleep. 

CPAP

According to the National Sleep Foundation, the most effective and most frequently prescribed treatment option for obstructive sleep apnea is a Continuous Positive Airway Pressure device, or CPAP machine. CPAP provides a constant stream of air at a prescribed pressure to keep your airways open while you sleep.

Unfortunately, many patients who would benefit from CPAP cannot tolerate sleeping with the device. In fact, while more than 5 million patients own CPAP machines in North America, more than 46% do not comply with their CPAP prescription. The most common complaint from patients is the difficulty they experience exhaling while the airflow blows into their nasal passages. This is especially problematic for patients with moderate to severe sleep apnea who require significant pressure to keep their airways unobstructed. Patients also complain about the discomfort and inconvenience in wearing a mask every night, all night long.

CPAP: For Mild-to-Moderate Obstructive Sleep Apnea

CPAP is the most commonly used form for PAP thanks to its efficacy for those with mild-to-moderate obstructive sleep apnea. For those who fall into this group, the continuous pressure of the CPAP can help to keep your airway open throughout the night, allowing you to sleep soundly.

But just because CPAP therapy is not the right fit for you doesn’t mean you have to struggle to sleep with OSA or bothersome snoring. Alternative therapies can help you and your sleep partner sleep better.

BiPAP™

Bilevel Positive Airway Pressure or BiPAP therapy is designed to address the most common complaint from CPAP users: trying to exhale through the resistance created by the airflow that props your airway open during inhaling. The solution? Two airflow pressure settings. A BiPAP device delivers one pressure for inhalation (that is prescribed based on the results of your sleep study) and a lower pressure that facilitates exhaling. For patients who require high pressure for inhaling, a BiPAP machine provides a more comfortable breathing therapy and encourages more consistent compliance. 

BiPAP: For Sever Sleep Apnea and Other Conditions

Unlike the CPAP machine, the BiPAP machine is used not only for those with obstructive sleep apnea, but those with other disordered breathing at night. BiPAP is typically used for those with:

• Severe sleep apnea
• Central sleep apnea
• Neuromuscular disorders
• Congestive heart failure
• Chronic obstructive pulmonary disorder (COPD)
• Diseases affecting the lungs and heart (pneumonia, asthma)

The variable pressure of the BiPAP machine is particularly helpful for those with disordered sleep caused by something other than airway constriction. Patients with conditions like congestive heart failure or central sleep apnea will simply stop breathing at night or not breath sufficiently.

Thanks to the changes in pressure between the inhale and the exhale, the BiPAP machine can be set for a certain number of breaths per minute, allowing a unique type of breathing assistance for those whose breathing ceases at nighttime.

This isn’t to say that those with mild-to-moderate sleep apnea cannot benefit from the BiPAP machine. There are those who switch over from the CPAP machine due to an inability to adjust to the singular pressure of the CPAP.

APAP

Automatic Positive Airway Pressure or APAP therapy is the most adaptable of the positive airway pressure therapies. Similar to CPAP and BiPAP, APAP delivers air pressure to prop open your airways, but instead of providing constant positive pressure or two alternating pressures, APAP delivers a range of pressure levels to meet a patient’s fluctuating breathing needs throughout the night. This flexibility makes the machine more comfortable than CPAP or BiPAP devices, which may be providing more pressure than is sometimes necessary, making it difficult to breathe naturally.

APAP therapy is a good choice for patients

• Who need greater pressure when they lie on their backs than when they lie on their side
• Who suffer from obstruction because of periodic congestion from allergies, colds, or respiratory infections
• Who only experience apneas during REM sleep
• Whose fluctuating weight affects the severity of their apnea
• Whose alcohol consumption affects the severity of their obstructive apnea

Your sleep specialist can help you determine which type of positive airway pressure device is the best fit for you.

5 alternative treatments for sleep apnea

Even with comfortable air pressure, some people cannot get used to sleeping with a mask on their face or tubes up their nose and tethered to a PAP machine. If you are one of these people, you have alternatives to PAP devices.

1. Sleep apnea dental appliances. There are two types of oral appliances that can be worn to reduce or eliminate snoring and sleep apnea. One type, a mandibular advancement appliance, holds the lower jaw forward to keep your airway open. The other type, a tongue retainer, secures your tongue to prevent it from falling backward and obstructing your airway.

Sleep apnea dental appliances are good alternatives for patients whose apnea is mild and who cannot tolerate any type of positive airway pressure machine. A patient with severe sleep apnea can also use a dental device as a supplement to their PAP machine. With the dental appliance helping to keep the airway open, the PAP machine can be set to a lower pressure, making it a more comfortable therapy.

2. Upper airway surgery. For patients who are unable to sleep using any kind of PAP machine, surgery to remove or reposition fleshy obstructions may be required. Areas for surgical modification include the

• soft palate and uvula
• tonsils and adenoids
• tongue
• upper and lower jaw

Just like any surgical procedure, surgery to alleviate sleep apnea entails risks and discomfort. These include pain, bleeding and throat swelling, several weeks of a limited diet, and your jaws wired shut for several days. In addition, the benefits may not be permanent, and you may find yourself snoring again at any time after surgery. But if you want the freedom to sleep unencumbered by a PAP device or other appliance, surgery may be the best option for you.

3. Positional therapy uses a device to keep you sleeping on your side to minimize or eliminate snoring and sleep apnea. This treatment is especially useful if you only experience breathing difficulties when you roll onto your back (called positional sleep apnea).

• Night Shift is a device worn around your neck that alerts you with a vibration when you roll onto your back.
• ZZoma and SlumberBUMP are small pillows that you secure around your waist to make it virtually impossible to switch to a supine position.

4. Nasal Expiratory Positive Airway Pressure or EPAP harnesses the power of your own breathing to alleviate snoring and sleep apnea. The nightly-use disposal pads, made by Provent Sleep Therapy, are placed over your nostrils to allow you to inhale easily, but they create pressure when you exhale. Your own exhalation inflates your airway and helps to prevent snoring and sleep apnea. EPAP has been shown to effectively reduce or eliminate mild, moderate, and severe OSA. No cumbersome machines, no need for electricity, and no bulky mask.
5. Upper airway stimulation uses a fully implanted device to monitor your breathing patterns and deliver mild stimulation to airway muscles when an obstruction is detected. In response, your muscles will contract and remain taut, allowing a free flow of air through your airway. If you suffer from moderate to severe OSA and are unable to use a CPAP machine, upper airway stimulation may be a good treatment option for you. Once it is surgically implanted, the device is easy to use and requires no additional equipment beyond a remote control to turn it on and off.

Do you really need treatment for sleep apnea?

Well, yes; if you suffer from sleep apnea you should take some form of action to eliminate it. But treatment may not be necessary if you can get the sleep you need by making some critical lifestyle modifications. By simply changing some of your daily habits, you may be able to minimize or eliminate your sleep apnea.

So, what can you do?

• Lose weight. Some people can actually cure their sleep apnea by losing weight. Overweight people often have extra flesh around their throats that may contribute to constricting their airways.
• Avoid alcohol. Alcohol makes your breathing muscles relax too much to stay rigid and out of the way. Flaccid airway muscles will collapse and obstruct your breathing.
• Quit smoking. Smoking can cause swelling in the upper airways making snoring and apnea worse. While quitting smoking may not eliminate your sleep apnea, it may make it less severe, making PAP therapies more tolerable.
• Take a decongestant. Patients with allergies can take decongestants to improve airflow through their nose when their allergies flare up.

Sources

• Everyday Health: everydayhealth.com/news/sleep-apnea-treatment-gets-wake-up-call/
• WebMD: webmd.com/sleep-disorders/features/10-results-sleep-loss#2
• National Sleep Foundation: sleepfoundation.org/sleep-disorders-problems/continuous-positive-airway
• LivaNova: imtheramedical.com/
• Sleep.org: sleep.org/articles/what-happens-during-sleep-study/
• American Association of Sleep Technologists: aastweb.org/blog/bipap-biphasic-positive-airway-pressure-vs.-cpap-therapy
• American Association of Sleep Technologists: aastweb.org/blog/benefits-of-sleep-apnea-dental-appliances-pros-and-cons
• American Association of Sleep Technologists: aastweb.org/blog/5-alternative-sleep-apnea-treatment-options
• Night Shift: nightshifttherapy.com/
• ZZOMA: zzomaosa.com/
• SlumberBUMP: slumberbump.com/?variant=24669490305
• Sleep Research Society: ncbi.nlm.nih.gov/pmc/articles/PMC3065258/
• Provent Sleep Apnea Therapy: proventtherapy.com/about-provent-sleep-apnea-therapy.php
• Inspire: inspiresleep.com/