Mercy Regional Health Center
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Obstructive Sleep Apnea Treatment

When someone has obstructive sleep apnea (OSA) or obstructive sleep apnea/hypopnea syndrome, the airways partially or totally collapse, limiting the amount of air that can get into the lungs with each breath. Events lasts at least 10 seconds and result in either a short arousal from sleep or a decrease in the oxygen level in the blood. Treatment is essential to prevent the significant, life-changing complications of untreated OSA.

Treatment of obstructive sleep apnea (OSA) falls into one of four areas:


Home Remedies
Home remedies — or common-sense types of therapy — are the least effective modes of treating OSA. Before delving into some of these options, a few generalizations must be understood.

First, airway potency is generally worse when you are sleeping supine, or on your back. This is in part due to gravitational effects on the body's tissue. The weight of the body presses down on the airway, contributing to the obstruction.

Second, OSA is more severe following episodes of sleep deprivation and alcohol consumption.

The first home remedy is to sew a pocket big enough to hold two tennis balls onto the back of your pajama top, between the shoulder blades. Place the tennis balls in the pocket prior to going to bed. During the night, when you attempt to roll onto your back, the tennis balls make the position so uncomfortable that you roll to your side. In time, the supine position is associated subconsciously with discomfort, and you won't attempt to sleep on your back.

Good sleep is important for everyone. It is even more important for individuals with sleep-related breathing disorders such as OSA. Sleep deprivation aggravates OSA, increasing apneic events and disrupting sleep.

This is also true of alcohol consumption. Although it is true that a "nightcap" may help an individual fall asleep, generally alcohol creates micro-arousal or awakenings during the night, decreasing the restfulness of the sleep. Alcohol also relaxes the airway muscles, making the events worse.

Often, but not always, individuals with obstructive sleep apnea also carry more weight than is ideal. Weight loss can improve obstructive sleep apnea. Keep in mind that weight by itself is not indicative of sleep apnea, but it can make the problem worse. Also, patients with OSA often find it very difficult to lose weight until their OSA has been treated. That said, a weight loss of even five pounds can have a dramatic impact on the severity of OSA.

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Continuous Positive Airway Pressure (CPAP)
The treatment of choice for OSA is continuous positive airway pressure (CPAP) therapy. It is non-invasive, well tolerated by patients, and relatively inexpensive. CPAP is nearly 100% effective when patients are compliant with the therapy.

This treatment entails wearing a mask — generally over the nose but possibly covering the mouth as well — through which a steady flow of air passes from a small blower unit. This air creates a pressure build-up in the upper airway, preventing the airways from collapsing. This air-splint or column allows you to breathe without obstructions or resistance. The amount of pressure necessary to open the airways and keep them open is unique to each patient and therefore must be determined during a second polysomnogram called a CPAP titration.

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Oral Appliances
As the name implies, oral appliances are devices that are placed in the mouth in an attempt to open or stabilize the upper airway. Most appliances are designed to move the lower jaw and pull the tongue forward.

Resembling a football mouth guard or a dental retainer, oral appliances are a non-invasive, relatively inexpensive approach to treating very mild obstructive sleep apnea.

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Surgery
Surgical treatment of obstructive sleep apnea has not been overly successful.

The mainstay in the surgical treatment of OSA is the UP3. This procedure involves removing the uvula (the "hangy-down thing" in your throat) and some of the soft tissue in the back of your throat. This makes the air passage larger and allows air flow through the upper airway more easily, reducing the chances of obstruction.

When successful, UP3 is generally well accepted. A repeat polysomnogram should be performed to determine the success of the procedure.

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Selecting a method of treatment is an important decision and should be made after reviewing all the facts with your physician.

For more information, contact us.