Obstructive Sleep Apnea Treatment Options

For milder cases of sleep apnea, your doctor may recommend only lifestyle changes, such as losing weight or quitting smoking. If these measures don't improve your signs and symptoms, or if your apnea is moderate to severe, other treatment options are available. Certain devices can help open up a blocked airway. In other cases, surgery may be necessary.

Treatments for obstructive sleep apnea may include:

Therapies

Continuous Positive Airway Pressure (CPAP)
If you have moderate to severe sleep apnea, you may benefit from a CPAP machine that delivers air pressure through a mask placed over your nose while you sleep. The air pressure from the CPAP keeps your upper airway passages open, preventing apnea and snoring.

Although CPAP is the most common and reliable method of treating sleep apnea, some people find it cumbersome or uncomfortable. Many people give up on CPAP, but with some practice, most people learn to adjust the tension of the straps to obtain a comfortable and secure fit.

Don't just stop using the CPAP machine if you experience problems. Check with your doctor to see what modifications can be made to make you more comfortable.

Adjustable Airway Pressure Devices
If you cannot tolerate the CPAP even after modifications made by your health care professional, you may be able to use a different type of airway pressure device that automatically adjusts the pressure while you're sleeping. For example, units that supply bilevel positive airway pressure (BPAP) are available. These provide more pressure when you inhale and less when you exhale.

Expiratory Positive Airway Pressure (EPAP)
This is the most recent treatment approved by the Food and Drug Administration (FDA). These small, single-use devices are placed over each nostril before you go to sleep. The device is a valve that allows air to move freely in, but when you exhale, air must go through small holes in the valve. This increases pressure in the airway and keeps it open. The device helped reduce snoring and daytime sleepiness. Therefore, it may be an option for some who can't tolerate CPAP.

Oral Appliances
Another option is wearing an oral appliance designed to keep your throat open. Oral appliances may be easier to use. Some are designed to open your throat by bringing your lower jaw forward, which can sometimes relieve snoring and mild obstructive sleep apnea. A number of devices are available from your dentist. Once you find the right fit, you'll still need to follow up with your dentist every six months to ensure that the fit is still good and to reassess your signs and symptoms.

Surgical Options
Surgery is usually only an option after other treatments have failed. Generally, at least a three-month trial of other treatment options is suggested before considering surgery. However, for those few people with certain jaw structure problems, it's a good first option. The goal of surgery for sleep apnea is to enlarge the airway through your nose or throat that may be vibrating and causing you to snore, or that may be blocking your upper air passages and causing sleep apnea.

Surgical options may include:

Tissue Removal
Uvulopalatopharyngoplasty (UPPP) involves removal of tissue from the rear of your mouth and top of your throat. Your tonsils and adenoids are usually removed as well. This type of surgery may be successful in stopping throat structures from vibrating and causing snoring. However, it may be less successful in treating sleep apnea because tissue farther down your throat may still block your air passage.

Laser Assisted Tissue Removal - LAUP
There is also Laser Assisted Uvuloplasty (LAUP), a surgical procedure to remove the uvula and surrounding tissue to open the airway behind the palate. This procedure has been used to relieve snoring. This procedure has been used somewhat successfully in treating sleep apnea.

Radio Ablation
Radiofrequency energy (radiofrequency ablation) may be an option for people who can't tolerate CPAP or oral appliances. This procedure involves the use of radio waves to destroy (or ablate) tissue at the base of the tongue. This shrinks the area and increases breathing flow during sleep.

Multiple treatments may be required, and the ablation technique can also be applied in the nasal passages (called turbinates) to boost nasal breathing. These surgeries may be combined with tonsillectomy or palate surgeries, or done separately. The tongue ablation procedure is nearly painless. Patients recover from radio frequency ablation swiftly, but results may take up to two months as the tissues shrink.

Jaw Repositioning Surgery
In this procedure, your lower jaw is moved forward from the remainder of your facial bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely. This procedure, which is known as maxillomandibular advancement, will require the cooperation of an oral surgeon and an orthodontist, and at times may be combined with another procedure to improve the likelihood of success.

Pillar Palatal Implants
This is a quick (approximately 30 minutes under local anesthesia) and effective procedure, and it is the most minimally invasive surgical treatment available to patients who snore or are suffering from mild to moderate sleep apnea. It has clinically proven results with high patient and bed partner satisfaction. During the Pillar Procedure, three tiny implants are placed into the soft palate, adding structural support. This stiffening of the soft palate reduces or completely eliminates the tissue vibration and/or collapse that can cause snoring and OSA. More than 30,000 people have had the Pillar Procedure and it is quickly gaining popularity for the treatment of sleep apnea/snoring. Not all patients will be the right candidate for this procedure.

Plastic rods are surgically implanted into the soft palate while you're under local anesthetic. This procedure may be an option for those with snoring or milder sleep apnea who can't tolerate CPAP.

Creating A new Air Passageway (Tracheotomy)
You may need this form of surgery if other treatments have failed and you have severe, life-threatening sleep apnea. In this procedure, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe. You keep the opening covered during the day. But at night you uncover it to allow air to pass in and out of your lungs, bypassing the blocked air passage in your throat.

Other types of surgery may help reduce snoring and contribute to the treatment of sleep apnea by clearing or enlarging air passages: