None of us need more risk for these problems than we already have. Patients who already have these health problems often find that successful treatment for the sleep problem can improve their condition or allow them to use less medication. With successful treatment, you will likely sleep better, feel better, have more energy, live longer, and be more healthy! Please consider seeking treatment if you or someone you care about has signs or symptoms of sleep apnea.
Sleep Apnea Treatment Options
We take a comprehensive approach at McKay Dee Sleep Center. Many patients ask me to review their options for the treatment of their sleep apnea. The following treatment options are for obstructive sleep apnea, which is the most common variety of sleep apnea. Another variety, central sleep apnea, may be treated with some of these options but may also require different treatment. Consult with your doctor about your specific needs.
Basically, obstructive sleep apnea happens because the upper throat is closing off when a person is trying to breath during sleep. Therefore the treatment is often directed at keeping the throat open. There are various ways of doing this.
1) PAP (also known as CPAP, Continuous Positive Airway Pressure, BiPAP, ASV, APAP, VPAP, BiLevel PAP, etc.) is a small, quiet air compressor, which sits at your bedside and blows some air into a mask on your nose. In most patients a minimal stream of air pressure keeps their throat from closing off and it eliminates snoring and sleep apnea. It is the most popular treatment for snoring and sleep apnea because it works very well for most people and has very low risk. The drawback is—just like wearing eyeglasses—PAP only works if you are wearing it. Thankfully, sleep apnea only happens when you are sleeping so you only wear PAP while sleeping.
Most people get used to PAP quickly and are able to use it for most of each night. Some people struggle to get used to it and then stop using it. We have found the large majority of these people did not have a professional helping them. There are many things we can do to make PAP treatment successful. There are many types of masks. It’s like finding a comfortable pair of shoes; they might feel fine in the store, but the real test is to wear them for a while.
Most health plans will cover PAP, but some may not pay for the more expensive types of machines. If our doctors prescribed a type of PAP your insurance does not pay for, we recommend that you speak with your insurance company and try to convince them to change their minds. Our doctors only recommend what they believe is best for your medical treatment.
If you select PAP as your treatment, your physician will send a PAP prescription to a local durable medical device (DME) company. This DME company functions like a pharmacy for medical equipment, and they will give you the PAP device and mask, etc. They will help you get comfortable with PAP and provide maintenance as needed. Once you are all set, chances are you only have to return to the sleep clinic for a doctor visit once a year, and maybe get a another sleep study in five to ten years. If you gain weight, you may need those visits sooner – which is just more motivation to keep the weight off!
2) Weight loss – People who have sleep apnea are much more likely to be overweight. The weight problem may actually be causing part of the sleep apnea! Weight loss is regularly recommended as a way to help reduce sleep apnea. Once an overweight person reaches their ideal body weight, their sleep apnea might be gone! It is also a good idea to be at your ideal body weight for many other health reasons. However, losing weight on your own can be very difficult. Weight management programs recommended by your doctor are a great place to get started. Weight management programs can greatly increase your odds of reaching and staying at your most healthy weight. Some weight management programs include surgery (bariatric weight loss surgery) as an option, which can be quite effective at helping to reduce weight and sleep apnea—but may not be covered by insurance.
3) Dental Appliances (aka: dental device, oral appliance, mandibular advancement device, etc.) are like retainers that are fitted to your teeth and hold your jaw slightly forward and slightly open while you sleep. By doing so, dental appliances pull the tongue forward, help keep the throat open, and prevent snoring and sleep apnea. They are usually made by a dentist. The do-it-yourself ones are not recommended because they have less of a chance of working and more of a chance of side effects (problems with teeth, gums, bite, jaw discomfort, etc.). Also, not all dentists are equally qualified to make these. Try to see someone who has a lot of experience in this area. It is easy to make these devices, but it is hard to make really good ones—that takes an expert.
If you can you answer positively to three or more of these questions you are in the high-risk category for sleep apnea:
• Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?
• Do you often feel tired, fatigued, or sleepy during daytime?
• Has anyone observed you stop breathing during your sleep?
• Do you have or are you being treated for high blood pressure?
• Is your BMI more than 35 kg/m2?
• Are you 50 years of age or older? • Is your neck circumference greater than 17 inches?
• Are you a male?
The dental device is worn during sleep and is removed when you are awake. It is usually only recommended for folks who have at least eight teeth on the top and eight on the bottom. After the device is fitted to you, a follow-up sleep study is recommended to find out if it sufficiently reduces your sleep apnea. It works in about half of the cases that are considered mild or moderate sleep apnea. Some people will use a dental appliance when they travel and a PAP machine when they are sleeping at home. This treatment may or may not be covered by your insurance. (It is usually part of your medical coverage, not dental coverage.)
4) Surgery – There are various surgeries that can help open up the throat and reduce snoring and sleep apnea. Surgery is the first choice for sleep apnea treatment in most children, because the results are often very good and kids often have a tough time tolerating PAP. In adults, surgery may or may not work well. The best way to find out if surgery can help you is to see a surgeon for a consultation. We recommend seeing someone who is very experienced in this specific area, because the results depend greatly on the type of surgery chosen for you and the surgeon who is doing the procedure. A sleep study is often done several months after surgery to see how well it worked for you.
5) Provent – This device is like a small oval Band-Aid, with a valve, that sticks to the end of your nose and prevents some of the air from escaping when you breathe out. This produces a type of back pressure in your throat, and this back pressure tends to keep the throat from closing off while you sleep. It may or may not work and tends to be recommended for mild or moderate sleep apnea only. Sleep doctors usually recommend a follow-up sleep study to make sure it works well enough for you. If your insurance does not cover this treatment, it costs about a dollar or two per night.
The Provent oval devices are discarded after each nights use.
6) Newly Approved Treatments – Inspire is like a pacemaker for your throat muscles. It senses when you breathe in while sleeping and will send a message to the throat muscles to keep them firm. This helps keep the throat open and reduces sleep apnea. It is FDA approved. Visit www.inspiresleep.com to learn more.
Winx is like the opposite of PAP. It has a mouth piece that produces suction rather than positive pressure and has shown some encouraging results. The manufacturer’s website is http://apnicure.com/.
7) Body Position – Certain body positions can help reduce snoring and sleep apnea. Sleeping on your back can increase the chance of these problems, and sleeping on your side can reduce the chance of these problems. Of course you are unconscious when you are asleep, so it can be hard to reliably stay off your back all night. Also, during REM (dreaming) sleep, studies have shown that some people lose the beneficial aspects of sleeping on their sides. Before you rely on positional treatment, you should discuss it with your doctor because it is not as straightforward as it seems.
8) Nasal Passages – Although sleep apnea does not happen in the nose, it can be worse if the nasal passages are clogged. If you have regularly congested nasal passages, please consider discussing treatment for them with your doctor as this may help snoring and sleep apnea. Clearing your nasal passages may help you get greater benefit from some of the other treatments like PAP.
9) Pillows – At least one pillow has been approved for snoring and even mild sleep apnea, but many pillow marketers just make unsubstantiated claims. Although the position of the head and neck can make a difference to healthy sleep and breathing, beware of false claims.
10) Other Remedies – Many other treatments have been suggested for sleep apnea like strengthening the throat muscles with exercises or using homeopathic sprays, etc. To date, none have been shown to reliably treat sleep apnea. Throat exercises are being looked at again and may be promising, so stay tuned! Review any sleep apnea treatment you select with your doctor before using it.
Finally: The bottom line is you really need to consider successfully treating your sleep apnea if you want to be healthy and enjoy your life and family, to the fullest. At the very least, take the first step and see your doctor or visit a sleep specialist in your area. We’re anxious to help out!
Here are some good websites for more information to help your decision:
• National sleep foundation: http://sleepfoundation.org/
• Harvard Medical School sleep http://healthysleep.med.harvard.edu/
• National Institutes of Health: www.nhlbi.nih.gov/about/ncsdr
• American Academy of Sleep Medicine: http://yoursleep.aasmnet.org/