What Is The Best Sleep Apnea Treatment?
I am often asked, “What is the best sleep apnea treatment?” The answer is simple: CPAP is the best sleep apnea treatment. But what many of my patient’s don’t realize is that CPAP is not the ONLY sleep apnea treatment.
There are five main ways to treat sleep apnea. In this article, I will briefly describe these five ways.
Tracheostomy
Prior to the development of CPAP, tracheostomy was the gold standard sleep apnea treatment. It may sound like an extreme option, but it makes a lot of logical sense. Since sleep apnea is a collapsing of the upper airway, if you “punch a hole” in the lower part of the airway (the trachea) air can enter and exit the lungs without concern for airway collapse. It goes without saying, that this was not a popular sleep apnea treatment. Luckily, CPAP was developed.
Continuous Positive Airway Pressure (CPAP)
CPAP was first used for the treatment of sleep apnea in 1981 by Sullivan and Associates. It has now become the gold standard sleep apnea treatment. It works so well because it uses basic principles of physics to keep the airway open at night. Much like inflating a balloon, continuously blowing air gently inflates the airway so it does not collapse or make vibrating snoring sounds. The patient wears a mask at night to receive this airway pressure. Although initially it is often difficult to tolerate, over time patients become accommodated to the equipment.
Surgery
There are a number of surgeries that have been developed for sleep apnea treatment, but the most popular is called a Uvulopalatopharyngoplasty (UPPP). UPPP involves trimming back the uvula (the “punching bag” in the back of your throat) and the floppy tissue on either side of it. The idea is by removing this floppy tissue the airway is less likely to vibrate (snore) and collapse. The nice thing about surgery is that if it works, there’s no more dragging that CPAP machine around everywhere you go. The downside is that it only works somewhere around 30% to 50% of the time and it is usually not effective enough for the severe cases of sleep apnea. Finally, it is usually not a permanent solution as sleep apnea symptoms can return with age.
Oral Appliance Therapy
Oral Appliance Therapy is probably the most convenient sleep apnea treatment. It involves going to a dentist who specializes in oral appliance therapy for sleep apnea, taking impressions of your teeth, and getting a plastic device that fits tightly on the upper and lower teeth. There is usually a “connector” that attaches to top to the bottom portion that “juts” the lower jaw forward. The idea is by pulling the jaw forward, you drag the tongue forward. When the tongue is pulled forward, it is pulled away from the back of the throat thus opening the airway and decreasing the probability of airway collapse. They are convenient in that they are easy to travel with, hike with, and camp with; you don’t have to be next to an electrical receptacle. The downside to oral appliance therapy is you can only pull the jaw so far forward before it can lead to temporomandibular joint problems (jaw joint). Thus it is only considered effective for mild to moderate cases of sleep apnea.
Medical Management
Medical management is the least effective sleep apnea treatment. It consists of three techniques: weight loss, avoiding sedating medications or alcohol at bedtime, and positional therapy (sleeping on the side or with the head of bed elevated). Unfortunately, although weight loss is a healthy thing to do in general, it usually does not have a significant enough impact on sleep apnea to be a reliable treatment option. For some patients who are very overweight and have only mild sleep apnea, significant weight loss can be helpful, but in someone with severe sleep apnea who is only moderately overweight, weight loss is not usually an viable sleep apnea treatment. Alcohol and sedating medications can definitely make sleep apnea worse, but it is rarely the sole cause of sleep apnea. Positional therapy can be helpful for some patients, but in general the moderate to severe cases of sleep apnea do not respond.
Those are the five main options for sleep apnea treatment. Be wary of anything that is not on this list. There are countless products and methods that are touted by various salesmen, manufacturers and advertisements to treat sleep apnea, but many of these are not helpful. As always, the first step is to make an appointment with a sleep physician who can evaluate you properly, perform an accurate sleep study, and help you make a decision based on the severity of your sleep apnea.
Disclaimer: As with all the content on this site, this article is to be viewed as educational only. In no way should this be construed as medical advice. If you are concerned that you might have a sleep disorder, make an appointment with a sleep physician for proper advice.