Tag: Treatment

Obstructive Sleep Apnea Treatment

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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.

Sleep Apnea: Screening, Testing and Treatment

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Science, Sleep Apnea, Solutions

Sleep Apnea: Screening, Testing and Treatment

Sleep apnea is a serious condition where your airway repeatedly closes during sleep, depriving you of oxygen until you gasp awake.

The combined effects of disturbed sleep and repeated bouts of low oxygen cause lots of problems for your physical and mental health. Despite this, many sufferers remain undiagnosed.

But how do you get diagnosed?

There are several steps towards understanding and addressing sleep apnea:

  1. Signs – know how to spot potential sleep apnea.
  2. Questionnaires – answer some questionnaires to assess your risk.
  3. Diagnosis – undergo a sleep study.
  4. Treatment – start treatment appropriate for the severity of your condition.

Signs of sleep apnea

Loud snoring alone does not necessarily mean you have sleep apnea. If you can’t tell where loud snoring ends and sleep apnea begins, ask yourself or your partner if you have any of the following:

  • Very loud snoring, with periodic silence followed by choking/gasping
  • Headaches and a sore throat in the morning
  • Excessive sleepiness in the daytime
  • Lack of concentration
  • Mood swings and changes in behaviour

Side note: Can SnoreLab identify sleep apnea?

This is a question we get asked a lot. Some users have discovered sounds in their recordings that indicate apnea events, and then found them useful in subsequent medical consultations. But, it is important to note that SnoreLab is not a tool for sleep apnea screening. It is our goal to create a system to identify risky periods in your session using the tell-tale sign of silence followed by gasping or choking. That said, once we have created this, it will not be diagnostic. This is because sleep apnea is characterised by more than sound profile alone and requires a sleep study to be properly assessed.

Screening questionnaires

If you are showing the signs of sleep apnea, before getting more in-depth diagnostic tests, it is useful to assess your risk using some screening questionnaires.

Epworth Sleepiness Scale

Feeling excessively sleepy during the day is a key symptom of sleep apnea. Therefore, it is a good idea to measure your fatigue by using the Epworth Sleepiness Scale [1]. This questionnaire gives you a numerical score based on your self-assessed likelihood of falling asleep in certain scenarios. A score of sixteen or higher shows that you are very sleepy during the day.

 

Assess your sleep apnea risk with

the Epworth Sleepiness Scale

STOP-Bang questionnaire

The STOP-Bang questionnaire [2] is the favored screening tool in the medical profession [3]. It is straightforward, highly effective and considers more than tiredness alone. It is a set of eight questions with yes/no answers in a handy acronym, where each letter refers to a sleep apnea risk factor:

  • S – snoring
  • T – tired
  • O – observed breathing cessation during sleep
  • P – pressure, specifically high blood pressure
  • B – body mass index greater than 35
  • A – age
  • N – neck size
  • G – gender

 

Assess your sleep apnea risk with the STOP-Bang questionnaire

the STOP-Bang questionnaire

Berlin questionnaire

Similar to the STOP-Bang questionnaire, the Berlin questionnaire looks at several factors but clusters them into three categories [3]:

  1. Snoring – frequency, volume and observed apnea
  2. Tiredness – fatigue after sleep, tiredness throughout the day, sleeping whilst driving
  3. Cardiovascular fitness – blood pressure and BMI

If for two or more of these categories, you score two or above, you are at high risk of sleep apnea.

Diagnosis – sleep studies

Despite there being some prominent indicators of sleep apnea, getting reliably diagnosed means undergoing a sleep study.

The Apnea-Hypopnea Index (AHI)

It is the purpose of a sleep study is to identify and quantify sleep apnea, giving you a severity score. This score depends on how many times you experience the characteristic low-oxygen events. The apnea-hypopnea index (AHI) is this measurement [4], counting how many times you experience apnea or hypopnea in an hour:

  • Apnea episode – complete airflow blockage for at least ten seconds.
  • Hypopnea episode – at least 50% reduction in airflow for at least ten seconds.

Your AHI score relates to the severity of sleep apnea which is helpful when deciding how to treat it:

  • 0-5 events per hour – normal
  • 5-15 events per hour – mild sleep apnea
  • 15-30 events per hour – moderate sleep apnea
  • 30+ events per hour – severe sleep apnea

Polysomnography at a sleep clinic

Because snoring sound alone is not a reliable indicator of sleep apnea, other qualities need measuring too. This is done via a procedure is called polysomnography (poly = many, somnus = sleep, graph = drawing/measurements) and is usually conducted by a trained professional at a sleep clinic.

Sleep might not seem likely once you have been wired up and attached to the various monitors. But by observing eye movements, brain activity, muscle activation, airflow, oxygen levels and heart rate, you can construct a detailed image of what is happening to your body whilst you sleep, and gain insight into your sleep apnea.

 

What happens in a sleep study

Find out more

Home tests

Although they are reliable, polysomnography tests in sleep clinics are impractical and expensive. Further, if you are lucky enough to get a referral for one, you’re likely to be waiting a while. Smaller scale tests done at home are therefore increasing in popularity.

Home testing uses portable devices with fewer parts, but importantly with enough measurements to get a good picture of your sleep apnea. Generally, they consist of:

  • Chest strap – monitors heart rate and chest expansion
  • Finger clamp sensor – uses infra-red to examine blood oxygen through your finger nail
  • Nasal tube – tracks your breathing
  • Audio unit – listens to your snoring patterns

If you are deemed to be at risk of sleep apnea, these kits can be supplied by your doctor. After performing the test at home, you return the kit for the results to be analyzed and a score to be generated.

Read Susan’s story, a SnoreLab user’s account of having a home sleep study to diagnose her severe obstructive sleep apnea.

Treating sleep apnea

The steps you take to improve your sleep apnea depend on the severity of your condition. If you suffer from mild to moderate sleep apnea, the techniques and consumer remedies you use to reduce normal snoring can still be very effective. Similar to so many other health issues, weight loss cannot be recommended enough.

If your condition is at the severe end of the scale, you are likely to be prescribed a device that keeps your airways open at night. This is called CPAP which stands for “continuous positive airway pressure”.

The device consists of a mask you fit over your face and an attached unit that draws in air. By introducing air into your throat and increasing air pressure, the soft parts of your throat are prevented from collapsing and causing obstruction.

With SnoreLab’s insights, you can read about the different types of CPAP mask and solving common issues with CPAP.

Conclusion

If you’re a loud snorer and find yourself feeling sleepy throughout the day, you may be suffering from sleep apnea without even knowing it. Being aware of the signs and using questionnaires is useful to assess your risk, after which it might be a good idea to present to your doctor.

With in-depth sleep studies that can be done at a specialist clinic or at home, you make that important step away from the masses of un-diagnosed people to become someone who understands their condition and knows what to do about it.

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