Obstructive Sleep Apnea Treatment

Sleep Apnea, Solutions

Obstructive Sleep Apnea Treatment

If you’ve been diagnosed with obstructive sleep apnea (OSA) or think you might have the condition, you may have questions about how to treat it.

There are several treatment options; the most effective way to treat your sleep apnea depends on the severity of your condition.

Generally, mild to moderate cases can be effectively managed with the same techniques used to treat primary snoring (i.e. non-apnea). Severe cases where your AHI is over 30 are best managed with CPAP.

In extreme cases where CPAP is not tolerated and there is a clear physical obstruction, surgery can also be an option.

This article explores the various methods that can be used to manage obstructive sleep apnea.

Each category has links to other useful SnoreLab articles on the subject.

Side note: what determines sleep apnea severity?

The severity of sleep apnea is split into mild, moderate and severe. These designations are based on how many times you experience apnea or hypopnea episodes per hour – your AHI score. This is where your breathing completely stops or partially stops for 10 seconds or more.

Make sure to read our article about sleep apnea diagnosis to understand sleep studies, the AHI score and classifying the severity of obstructive sleep apnea.

Making suitable lifestyle changes

If your sleep apnea is at the milder end of the spectrum, you can treat it by making some targeted lifestyle changes.

What is most effective depends greatly on what is responsible for your sleep apnea in the first place. Generally speaking, the following lifestyle changes have the most positive impact:

1. Lose weight

Your weight has a significant influence on your likelihood of developing obstructive sleep apnea. Simply put, the heavier you are, the more likely you are to suffer from OSA.

Side note: the statistics of weight loss and sleep apnea

Some epidemiological studies indicate that 70% of patients experiencing sleep apnea are obese, and 40% of obese people are suffering from sleep apnea [1].

Promisingly, research has demonstrated that losing 10-15% of your body weight can half the severity of your sleep apnea [2], and that losing 60% of body fat can eradicate sleep apnea for around 86% of obese people [3].

There’s no shortage of advice or special diets when it comes to losing weight. It can all be a bit confusing and overwhelming. No single technique works wonders for everyone, and drastic solutions are rarely stuck at for very long.

Instead, be sure to check out SnoreLab’s SMART strategy for effective, sustainable weight loss and also have a read of our full article of the impact of weight on snoring and sleep apnea.

2. Stop smoking and reduce alcohol consumption

Smokers, and even passive smokers are more at risk of snoring and experiencing sleep disordered breathing [4][5].

Some studies have found that smokers are 2.5 times more likely to suffer from obstructive sleep apnea [6].

Quitting smoking has shown to reduce your likelihood of experiencing sleep disordered breathing [7]. This is because smoking contributes to greater inflammation and irritation in the upper airway which predisposes it to vibration and collapse [8].

Further, a nightcap is also not ideal for healthy sleep. Alcohol causes your muscles to relax – even more than they do normally when you fall asleep. It therefore increases the collapsibility of your airway and heightens the risk of experiencing apneas.

SnoreLab users amongst many others have found that reducing their alcohol consumption yields drastic reductions in their snoring and sleep apnea.

3. Alter your sleeping position

More than half of all obstructive sleep apnea cases are referred to as “position-induced” sleep apnea [9], where the severity of the condition is made worse by back-sleeping.

By sleeping on your back, your mouth has a tendency to fall open. This changes the shape of your upper airway and makes obstruction more likely.

Sleep apnea can therefore be massively reduced by switching to side-sleeping. There are many techniques you can use to make this change – be sure to check out our guide to sleeping position and snoring.

Anti-snoring mouthpieces

Whilst not recommended for severe cases of OSA, a mandibular advancement device (MAD) can be a good option for those with mild to moderate OSA, or those who do not tolerate CPAP.

MADs brings your lower jaw (mandible) forward (or advance it) to tighten the tissues in your airway that are prone to slackening and causing obstruction.

There are many different types of MAD available so finding the right one can be a bit confusing. To get the best quality we recommend getting a mouthpiece custom fitted by a dentist, though this can be quite expensive.

You can still find great quality mouthpieces without paying loads for a custom-made one. Have a read of our guide to anti-snoring mouthpieces so you know what to look out for when buying generic devices online.

If your tongue causes obstruction in your airway, a different type of mouthpiece called a “tongue retainer” can also be effective for mild to moderate OSA.

CPAP

CPAP stands for continuous positive airway pressure and is a treatment suitable for moderate to severe sleep apnea sufferers. It is the primary method for managing OSA and has a wealth of evidence to support its efficacy.

In most countries, it is only available with a prescription after confirmed diagnosis of sleep apnea.

A CPAP device uses a mask to force air into your nose and throat to keep your airways open.
CPAP does not give you more oxygen. Instead, it introduces a current of normal air that creates positive pressure; this props open your airway to stop it from collapsing.

Many people are fearful of CPAP. Users can also struggle with their devices, experiencing discomfort, claustrophobia and air leakage.

Despite its scary reputation, it’s important to know that CPAP can be a life-saving tool. There are measures you can take to get the most out of it and cope with any difficulties you may have.

 

SnoreLab’s guide to dealing with CPAP issues

Check out

Performing mouth exercises

Research has shown that exercising the muscles in your airway can have a positive impact on mild to moderate sleep apnea.

These techniques are adapted from speech and language therapy and consist of repeated movements in the tongue, cheeks, jaw and soft palate in order to increase muscular tone.

Several studies demonstrate that patients with sleep apnea can reduce their AHI scores and sleepiness by performing these exercises regularly [10] [11] [12] [13].

You can read about all of the evidence and also learn the 5 exercises we recommend.

Surgery

Surgery is usually a last resort only when other techniques to manage your sleep apnea have failed.

Whilst there is some research to show that surgery can produce positive outcomes for OSA, there isn’t enough evidence for surgery to be routinely recommended ahead of alternatives like CPAP.

Usually, to be considered for surgery, there are several requirements that will be assessed by an ENT (ear, nose and throat) specialist first:

  • A diagnosis of severe obstructive sleep apnea, confirmed by a sleep study
  • A clear physical obstruction that can be rectified by surgery
  • Failed treatment with alternative methods such as CPAP and mouthpieces
  • Evidence that the condition is severely affecting your quality of life

There are many types of surgery for snoring and not all are recommended for OSA sufferers.

To get an overview of the surgical interventions available and the important considerations when exploring surgical options, be sure to read our article on surgery for snoring and sleep apnea.

Conclusion

Obstructive sleep apnea can be managed via a number of different means. What is most effective depends on the causes of your condition and its severity.

Regardless of which treatment route you take, many countries have support groups for people with OSA.

These organisations aim to educate and provide support with all facets of OSA.

They give helpful information on living with the condition, provide practical support with CPAP and other treatments, fund and publish the latest research into sleep apnea as well as organising support meetings in person.

Surgery for Snoring and Sleep Apnea

Science, Sleep Apnea, Solutions

Surgery for Snoring and Sleep Apnea

Surgery is perhaps the most drastic snoring remedy available and has the potential to be very effective for some people. There are a number of surgical interventions to reduce snoring and sleep apnea.

In this article, we summarise the different types of surgery for snoring and sleep apnea, as well as exploring some of the important considerations to be made before opting for surgery.

Some important considerations

Surgery should be a last resort

Surgical intervention should only be considered if other methods you have tried have failed.

Surgery is invasive and sometimes irreversible, so careful consideration should be given as to whether alternatives have been pursued to their full capacity.

Though it will usually be discussed in any consultation prior to surgery, some of the most effective methods of treating snoring are non-surgical and always worth mentioning. These include:

Surgery types vary and what is most suitable depends on YOU

There are several different types of surgery that can reduce snoring. Like non-surgical snoring remedies, there is no one solution that will work for everybody.

The most effective type of surgery depends on your snoring and what is causing it in the first place.

Your suitability will need to be assessed with a physical examination

For surgery to be effective to treat snoring, there must be a clear physical cause of snoring. This means you’ll need to undergo a thorough examination by an ENT (ear, nose and throat) specialist to identify the source of the snoring.

Initial examinations will include basic observations of your nose, tongue and throat. The procedure is also likely to involve flexible endoscopy.

Here, a flexible tube with a fibre optic camera is inserted into the nose and down the back of the throat to look for structural abnormalities.

Whilst this tube is in place, the examiner may ask you to recreate a snoring sound to help identify the tissue that is producing the noise.

You may have to undergo a sleep study first

It is important to distinguish between primary snoring and obstructive sleep apnea. This is because certain types of surgery are not recommended for obstructive sleep apnea (OSA) sufferers.

For that reason, if OSA cannot be ruled out after a physical examination, you may have to undergo a sleep study. This can be done either in a specialist sleep clinic or at home.

 

SnoreLab’s article on what to expect from a sleep study

Read

The benefits may not be permanent

The body has a remarkable way of adapting to change, and unfortunately this isn’t always a good thing.

Snoring surgery that addresses soft tissue works by causing intentional scarring to certain parts of the airway to stiffen them. Your body will automatically work to heal these scars, therefore whilst the snoring is reduced in the short term, you may find that it returns in the long term.

You could experience side effects

Whilst the side effect profile depends on the type of surgery you have, surgery will always involve breaking tissue which carries risks.

It is common for patients to experience some mild pain after surgical interventions.

Availability varies depending on where you live

Every country’s health system is different, and for that reason what is recommended, available and suitable in one location may not be so in another.

For example, pillar implants are considered suitable to treat mild-moderate obstructive sleep apnea in the USA but not in the UK [1].

The healthcare system in your location may also affect whether or not you are eligible for snoring surgery. Because snoring is usually considered a trivial condition (though those that live with it would argue otherwise), state funded medical systems are reluctant to fund snoring surgery. Further, snoring surgeries may not be covered by certain insurance policies.

The different types of surgery

There are three main categories of surgery that can help to directly reduce snoring:

  1. Soft Tissue surgery.
  2. Maxillofacial surgery.
  3. Neural stimulation.

1. Soft tissue surgery

The least invasive option, this involves making changes to the soft noisemakers themselves.

Soft tissue surgery aims to remove or stiffen the flappy parts of the airway which vibrate and cause the snoring noise.

Other soft tissue procedures involve making changes to structures in the nose that can cause “downstream” snoring via nasal blockage.

Most types of soft tissue surgery are not recommended for OSA sufferers, though this does vary.

Usually, these procedures can be performed in an outpatient clinic under local anaesthetic (i.e. you are awake but cannot feel pain in that region).

Uvulopalatopharyngoplasty

Also known as UPPP or UP3, this surgery aims to open the upper airway by removing tissue from the uvula, soft palate and pharynx. If they are still present, it can also involve removal of the tonsils and adenoids (the latter usually disappearing in adolescence).

It is the most invasive form of soft palate surgery and must therefore be performed under general anaesthetic (i.e. you are unconscious).

Whilst UPPP is one of the few soft tissue procedures recommended for OSA, it is performed less often than it used to be. This is because less invasive techniques with lower side effect profiles have emerged. It has also fallen out of favour because UPPP can reduce the effectiveness of CPAP.

Laser-assisted uvulopalatoplasty

Using a similar principle to UPPP, as the name suggests, laser-assisted uvulopalatoplasty (LAUP) uses carbon dioxide lasers to stiffen and remove tissue from the soft palate and uvula to widen the airway [2].

Because of the enhanced precision of lasers, it is considered a safer alternative to UPPP.

This procedure is usually done under local anaesthetic in a clinic and is done over three to four separate sessions.

Despite it being said that LAUP is suitable to treat mild to moderate OSA, studies have not demonstrated consistent improvements for these patients [3].

Radio frequency ablation

Also known as “somnoplasty”, this type of snoring surgery uses radiofrequency energy to generate heat for creating controlled lesions in soft tissue. The basis here is that the lesions become scarred and retract, reducing the amount of flappy tissue and stiffening what remains.

This can be performed on different parts of the airway depending on where the blockage is, including the turbinates of the nose (folds of tissue in the nasal cavities), the soft palate and the base of the tongue.

A minimally invasive technique, it is performed under local anaesthetic in an outpatient setting [2].

Injection snoreplasty

In this snoring surgery, no tissue is removed. Instead, sodium tetradecyl sulphate, a chemical used to treat varicose veins, is injected into the soft palate in order to scar it.

Whilst there are advantages here in that it is minimally invasive and doesn’t involve the removal of tissue, this is a fringe therapy and won’t be recommended by many clinicians. This is because the evidence to support its effectiveness is somewhat lacking, with only a few studies with small sample sizes.

Pillar procedure

This popular outpatient procedure performed under local anaesthetic involves inserting three or four small polyester implants into the soft palate to increase its stiffness and reduce vibration.

The pillar procedure has shown to reduce snoring for many patients. However, studies indicate that their effectiveness starts to decline after they have been in place for more than one year [4].

Septoplasty

A slightly different procedure, this surgery involves straightening the nasal septum – the cartilage which separates the two nasal cavities.

A deviated septum is where this cartilage is bent. It is therefore more difficult to breathe through your nose. This causes you to make a switch to mouth breathing which is known to increase the risk of snoring.

A septoplasty is usually performed in an outpatient setting and has very few/rare complications and side effects.

2. Maxillofacial surgery

Maxillofacial surgery makes structural changes to the bones of the face, jaws and neck. This aims to increase the space in the upper airway.

They are quite serious procedures which need to be done under general anaesthetic and will involve a hospital stay.

hese procedures are further reaching that soft tissue surgery. As a result, maxillofacial surgery can have life-changing benefits for patients with severe obstructive sleep apnea.

Maxilla/Mandible Advancement

This simply refers to repositioning the bones of the jaw. It usually involves moving the lower jaw (mandible) forward. This is done by cutting the bone and holding it in a more advanced position with metal plates and screws.

A receded lower jaw reduces the airway space behind your tongue; moving it forward widens this space and makes obstruction less likely.

This surgery can be likened to a permanent version of what an anti-snoring mouthpiece is designed to do.

If necessary, surgery can also be performed to move both the upper (maxilla) and lower (mandible) jaws forward.

Whilst this surgical option is quite drastic and will involve a period of recovery, it is the only procedure that is considered curative for severe obstructive sleep apnea. In multiple published trials over the years, patients consistently show a decreased AHI and reduced sleepiness.

Because of the changes to the bones of the face, this surgery will often cause irreversible changes to your appearance (often, patients report, for the better).

Hyoid suspension

The hyoid bone rests in the upper part of your neck. It is the only bone in the body that doesn’t connect to any other bone (and is therefore referred to as a “floating bone”).

Anti-snoring surgery can be performed on the ligaments that hold the hyoid bone in place. This helps to move the base of the tongue forward to create more space in the airway.

3. Neural stimulation

This is an exciting, new type of surgery which involves electrical stimulation of the tongue muscles to keep the airway open. It is only ever performed on patients with obstructive sleep apnea.

The system usually consists of three small parts:

  • An electrode wrapped around one of the key nerves that stimulates the tongue to move forward.
  • A generator which creates the electrical impulse. This is implanted in the chest and can be switched off in the morning wirelessly via a remote.
  • A sensor which helps to synchronise the neural stimulation with inward breaths. This is implanted in muscles of the ribs but isn’t always included.

To be considered for neural stimulation surgery, you’ll need a diagnosis of obstructive sleep apnea with an AHI of 20-50 (i.e. moderate to severe) [5].

It is usually recommended only if CPAP has failed. As this is an emerging therapy with restricted approval and a limited number of surgeons trained to perform it, it is not an option available everywhere.

Conclusion

Surgery can be a very effective solution for some snorers and sleep apnea sufferers. However, like all snoring remedies, it isn’t suitable for everybody.

For surgery to work, there needs to be a clear physical abnormality that can be corrected.

Surgery should be a last resort only when other techniques to manage your snoring or sleep apnea have failed.

This article aims to give you insight into all of the different types of surgery available: the established techniques, the emerging procedures and those falling out of favour. It is important to note that what may be offered for you will depend on your symptoms, snoring causes, anatomy and the medical facilities where you live.

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