Obstructive sleep apnea (OSA) can leave you sleep-deprived and in search of relief. Getting on the right treatment will reduce your snoring and other symptoms, and could help you avoid complications like heart failure, type 2 diabetes, and accidents.
But how do you know which treatment is right for you?
Continuous positive airway pressure (CPAP) is the main treatment for OSA, but it’s not the only way to reduce symptoms. You can also try healthy lifestyle changes, oral devices, and surgery to manage this common sleep disorder.
Positive Airway Pressure
In sleep apnea, tissues in the back of your throat relax and block the flow of air into your airway while you sleep. That's why your breathing stops and starts, and you wake up many times a night.
Positive airway pressure (PAP) is a machine that gently pushes air into your airways while you sleep. The air flows through a mask that you wear over your nose and/or mouth. Your doctor might recommend PAP if you have moderate to severe OSA, which means your breathing stops 15 or more times each hour you sleep.
The most common type of PAP is continuous positive airway pressure, or CPAP. It delivers a constant stream of air into your lungs during the night. Auto-titrating positive airway pressure (APAP) is another type where the air pressure changes based on your breathing patterns. Bilevel positive airway pressure (BiPAP) delivers air at one pressure when you breathe in, and a different pressure when you breathe out.
Pros: CPAP is the “gold-standard” OSA treatment because it works. It reduces the number of breathing pauses and prevents daytime sleepiness.
Cons: CPAP only works if you wear it. Some people find the device too clunky, uncomfortable, and loud to use every night. CPAP can also cause side effects like dry mouth, nosebleeds, and dry eyes.
Oral Devices
While you sleep, an oral device or appliance holds your jaw or tongue in place to stop it from blocking your airway. A dentist fits the device to your mouth. Your doctor might recommend this treatment if you have mild to moderate OSA, or if you have severe OSA but you can't use CPAP.
There are also newer types of oral devices that work differently, including what's called a tongue muscle stimulation device and complete airway repositioning and expansion devices.
Pros: An oral device may be more comfortable than CPAP. It's also quiet and easy to take with you when you travel. In many people with OSA, it works just as well as CPAP.
Cons: It can take time to get used to wearing an oral device. It might make you drool more. Sometimes it pushes the teeth out of place. Ask your dentist how to manage these problems if you have them.
Nerve Stimulators
Hypoglossal nerve stimulation is a newer type of OSA treatment for people with moderate to severe OSA who can't use CPAP.
While you sleep, a device implanted under the skin of your chest sends signals to the hypoglossal nerve in your neck. This nerve controls your tongue movements. The signals push your tongue forward and away from your airway.
Pros: Nerve stimulators work for OSA, and you don't have to wear a bulky mask. In studies, the stimulator reduced nighttime pauses in breathing. It also improved daytime sleepiness and quality of life.
Cons: You will need minor surgery to implant the device. Rarely, people get an infection or their device moves out of place after surgery. Other possible side effects include soreness or weakness in the tongue, but these often improve with time.
Surgery
Surgery might be an option if you've tried CPAP and other treatments and your OSA hasn't improved. Doctors use a few different procedures to move or remove the tissue that blocks your airway.
These procedures are done in your doctor's office:
Uvulopalatoplasty. If you have mild OSA, your doctor can use a laser or a needle with an electric current to burn away the tissues that block your throat.
Implants. The doctor numbs the back of your throat and places three strips of plastic in the roof of your mouth. The plastic stiffens the tissues so they don't droop down over your airway while you sleep. Implants may be an option for treating mild OSA that CPAP and other treatments hasn't helped.
These procedures are done in a hospital or surgery center:
Uvulopalatopharyngoplasty (UPPP). While you are asleep, the surgeon removes part or all of your uvula, tonsils, and adenoids. This leaves more room in the back of your throat for air to flow through.
Maxillomandibular advancement. The surgeon moves your upper and lower jaw forward to pull tissue in the back of your mouth away from your throat.
Tongue surgeries. These procedures remove tissue from your tongue or push your tongue toward the front of your mouth so it doesn't block your airway.
Pros: Surgery can improve or stop OSA so you won't need CPAP anymore.
Cons: Procedures have risks like pain, infection, and bleeding. Recovery from inpatient surgery can take a few weeks.
Lifestyle Changes
A few changes to your routine during the day might help you breathe better at night. These lifestyle changes work best when you do them with CPAP and other OSA treatments.
Trim extra pounds. Weight gain increases your risk for OSA. Excess fat creates deposits in the neck that block the flow of air. Weight loss plus diet and exercise could make OSA less severe.
Diet and exercise. A well-balanced diet and aerobic exercise promote weight loss and may make OSA less severe. The Mediterranean diet, which is high in fruits, vegetables, and fish, may help reduce apnea symptoms. Exercise also improves daytime sleepiness.
Change your sleep position. When you sleep on your back, your tongue falls down over your throat and can block your airway. Sleeping on your side or stomach may improve apnea symptoms.
Quit smoking. The nicotine in tobacco products relaxes the upper airway. Nicotine also disrupts sleep.
Cut back on drinking. Alcohol relaxes your tongue muscles and can cause more apnea episodes. Heavy drinkers (15 drinks a week for men, eight drinks for women) are at higher risk for OSA. But even people who drink smaller amounts of alcohol may have more severe sleep apnea.
How to Choose the Right Treatment for You
Your primary care doctor or ear, nose, and throat specialist can help you find the treatment that's most likely to help you. Which method you choose depends on how severe your sleep apnea is, your lifestyle, and your preferences.
Some people don't mind sleeping with a CPAP machine. Others would rather have surgery and be done with the problem. You might need to try a few OSA treatments to find the one that fits you best.
Show Sources
Photo Credit: EyeEm / Getty Images
SOURCES:
American Thoracic Society: "Oral Appliances for Sleep Apnea in Adults."
Cleveland Clinic: "Oral Appliance Therapy for Sleep Apnea," "Sleep Apnea."
Cureus: "Cultivating Lifestyle Transformations in Obstructive Sleep Apnea."
JAMA Otolaryngology-Head & Neck Surgery: "Targeted Hypoglossal Nerve Stimulation for Patients with Obstructive Sleep Apnea: A Randomized Clinical Trial."
Mayo Clinic: "Obstructive Sleep Apnea," "Sleep Apnea," "The emerging option of upper airway stimulation therapy."
Missouri Medicine: "Obstructive Sleep Apnea Diagnosis and Management."
National Heart, Lung, and Blood Institute: "Sleep Apnea Treatment."
NYU Langone: "Surgery for Obstructive Sleep Apnea."
Respirology: "Clinical Side Effects of Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnoea."
Sleep Foundation: "Surgery for Sleep Apnea."
UpToDate: "Obstructive Sleep Apnea: Overview of Management in Adults."
