What are the treatment options for sleep apnea?

Q:

What are the treatment options for sleep apnea?

A:

Treating sleep apnea consists of ensuring continuous breathing while sleeping, bringing back a good quality of sleep with a sufficient duration and in regular periods of time, and treating other adjacent symptoms such as loud snoring.

Treatment options can be categorized in three distinct groups depending on the severity of symptoms. Often, treatments are used in combination to best suit the needs of individual patient cases and type of sleep apnea diagnosed (Central Sleep Apnea, Mixed Sleep Apnea, Obstructive Sleep Apnea, etc).

Lifestyle changes: These aim mainly at relieving one or more risk factors and can help to reduce the severity of symptoms. The changes may include weight loss, exercise (including throat and tongue exercises to strengthen the muscles), controlling alcohol and sedating medication intake, stopping smoking, changing the sleeping position (usually from sleeping on the back to sleeping on the side or elevating the head), using medicines and other products that keep the nasal passages open while sleeping, and avoiding coffee and restricting eating right before sleeping. This type of treatment is usually a first line of treatment and sometimes offered before a sleep study or positive diagnosis of sleep apnea is made. It is the least invasive type of treatment but may not be completely effective for many patients. Some of the changes take time to become effective as well. For example, weight loss may take many months to reach a level needed to make a difference in nighttime breathing.

Therapies relying on devices: These devices aim mainly to bring enough air to keep the upper airways open and breath well, whether by opening up mechanically the upper airways through air pressure (i.e. continuous positive airway pressure device (CPAP), bilevel positive airway pressure, nasal expiratory positive airway pressure, adaptive servo-ventilation), physical means (i.e. dental appliances), or by stimulating the inner mechanisms (i.e. hypoglossal nerve stimulation using pacemakers). Devices to supply airflow during sleep or nerve stimulation devices would only be prescribed after a specific diagnosis of a specific type of sleep apnea, generally after a sleep study and other testing. It is important that the type of device be specific for the user's needs and address the specific needs of each specific type of sleep apnea being treated. Although patients may have some practical difficulties in getting used to wearing an air mask while sleeping, continuous positive airway pressure device is generally the first device used for several types of sleep apnea.

Dental Treatments: Often called oral appliance therapy, this treatment for sleep apnea uses removable dental appliances similar to a sports mouth guard or an orthodonic retainer to help keep the wearer's mouth and jaw in a position to lessen breathing problems during sleep. These oral appliances are custom made and fit, and do require occasional adjustments. They are generally considered comfortable and easy to use.

Surgery: Surgery usually involves at reducing the extra-tissue in the upper airway or repositioning the jaw to help prevent airway collapse during sleep. Other surgeries to address contributing factors, such as weight loss surgery may also be considered. This type of treatment is usually a last resort treatment due to the cost and risks of the procedures. Surgery may also not be possible depending on the patient's general health or the type of sleep apnea diagnosed.

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