Treatment Options

Electromechanical Devices

These xPAP machines are the standard or traditional treatments for Sleep Apnea and are also the most effective treatment available. Side effects are minimal and while they can take some getting used to and adjustment, the benefits are great.

CPAP Machines

CPAP stands for Continuous Positive Airway Pressure and these machines blow a fixed amount of air pressure, specifically set for each patient, constantly throughout the night or sleep cycle. This air pressure forces the airway or air passage open and eliminates the apneas, hypopneas, and often the snoring, almost entirely, allowing the patient to get a restorative and restful sleep. The machines used to be large in size but have become smaller with time. The newer machines are about the size of two video cassettes (VHS tapes) stacked on top of one another. The user wears some type of interface such as a nasal mask or a full face mask, one that covers the nose and mouth. This mask is connected to machine usually by a 6 foot flexible hose or tube. The CPAP machine is prescribed by the doctor and the pressure is indicated on the prescription for each patient. The pressure setting expressed in centimeters of water pressure or CM H2O is derived for each patient from their sleep study.

APAP Machines

APAP is an acronym for Automatic Positive Airway Pressure and is similar to a CPAP however instead of delivering one constant pressure set specifically for each individual patient, the APAP machines will automatically find just the amount of pressure needed to keep the airway open on a breath by breath basis and often the APAP machines have more advanced features such a data reporting or software capabilities, auto altitude adjustment, and more.

These machines have some advantages over a regular CPAP, since someone's pressure needs can change in one night or over a long period of time. Even in one night or night to night several factors could cause the pressure settings to need adjustment. For instance, things like sleep position, tiredness and fatigue, deep sleep versus light sleep, a drink or two, or other factors can all cause someone's pressure needs to change. Also, over time if someone gains or loses weight this could cause an increase or decrease in the pressure needs. The APAP machines change with the patient automatically.

BiPap, VPAP, or BiLevel Machines

VPAP is defined as Variable Positive Airway Pressure and is also known as a BiPap or BiLevel machine. These machines deliver two distinct pressures; one for inhalation and a lower pressure upon exhalation, also known as IPAP and EPAP (Inhale Positive Airway Pressure and Exhale Positive Airway Pressure, respectively). This allows total control of the sleep therapy and these machines also are capable of delivering much higher pressures than a CPAP and have more complex motors, therefore are more expensive. They are usually prescribed in severe cases or for people who need higher pressures which make it difficult to exhale and therefore need a lower pressure on exhalation to make breathing out more comfortable. Some of these machines have an ST feature which stands for Synchronous Timed and will force a breath if the patient does not take a certain number of breaths per minute, also known as a backup rate or BPM rate.

Sometimes, these machines are prescribed for something other than Sleep Apnea, such as respiratory failure due to ALS (Lou Gehrig's disease), Cystic Fibrosis, or COPD (Chronic Obstructive Pulmonary Disease); usually associated with chronic bronchitis or chronic emphysema, which can be complicated by chronic asthma as well.

Surgery or Surgical Treatments

There are several different types of surgeries available for Sleep Apnea, depending on the patient, but any surgery comes with inherent risks or possible complications, and can be painful. xPAP machines are still the most effective treatment for Sleep Apnea with very minimal risk to the end-user. Often the surgery success rate is relatively low and many people report being back on a CPAP machine, or the like, within a year, albeit often at a lower pressure.

Here are some of the more common surgeries available, although doctors are always innovating and coming up with new procedures. Not all are covered here. Talk to a sleep doctor to find out more about what the newest and best options are in your own case.

Tonsillectomy or Adenoidectomy

This is performed to increase the size or opening of the air passage in the case of Sleep Apnea treatment.

Uvulopalatopharyngoplasty

UPPP is performed to reduce or remove or reshape parts of the soft palate and the uvula. It may also involve removal of part of the soft tissue from the pharyngeal areas.

Laser-assisted Uvulopalatoplasty

LAUP is similar to the above description of Uvulopalatopharyngoplasty however it uses lasers or radiofrequency waves to remove and shape the tissue.

Maxillomandibular Advancement

MMA, also known as (MMO) Maxillomandibular Osteotomy or (Bi-Max) Bimaxillary Advancement, is usually reserved for severe cases which have not responded to other surgeries or an xPAP machine well or where craniofacial syndromes or structures are suspected as the cause of the problem. It is more invasive and involves removing the top and bottom jaw and moving them forward or restructuring the chin, maxilla or mandible. Often it is performed in conjunction with Genioglossus Advancement.

Genioglossus Advancement

This procedure, commonly known as tongue advancement, is designed to move or pull the tongue forward to increase the size of the airway. It is sometimes performed along with Maxillomandibular Advancement (see description above).

Hyoid Suspension

This procedure involves pulling forward the hyoid bone in the neck to place it in front of the larynx. The hyoid bone is one of the attachment points for the tongue.

Pillar Procedure

This is one of the newer procedures whereby 3 stints are placed or injected into the soft palate offering support of the soft tissue and widening the opening in the air passage.

Medications, Prescriptions, or Pharmaceuticals

Currently there are no drugs on the market that are effective for the treatment of Obstructive Sleep Apnea.

Methylxanthine Theophylline is often used to treat those afflicted with Central Sleep Apnea and sometimes children or infants with Sleep Apnea but is not indicated for adults with OSA.

If normal treatments are not effective, sometimes a doctor may prescribe drugs that usually are reserved for narcolepsy or to help combat somnolence, such a stimulants or amphetamines. Modafinil, an anti-narcoleptic medication or wakefulness promoting drug, is sometimes used in this capacity.

Protriptiline, a tricyclic antidepressant, is helpful for a small number of Sleep Apnea patients. Sometimes acetazolamide and Medroxyprogesterone are prescribed to stimulate normal breathing. Prescription steroids or nasal decongestants can be useful in some cases to assist in widening the upper air passage.

Orthodontic Treatment and Dental Appliances

Dental Devices or Oral Devices are sometimes used to treat Obstructive Sleep Apnea. There are several dental devices or procedures available and approved for use in treating Sleep Apnea. Usually one must go to a dentist to discuss which one would be the best choice based on the individual and to have the device custom made or fitted. They are often relatively expensive and have a moderate success rate, but could be a good option for some individuals. In general it seems the dental devices have an overall higher success rate than surgery but still lower than CPAP therapy. There are often some side effects that could be uncomfortable or cause other problems. Talk to a qualified dentist about these potential issues. Here are just a few:

The most popular treatment is MAD or the Mandibular Advancement Device. It forces the lower jaw down and forward which can help keep the air passage open and it looks like a mouth or tooth guard used commonly in sports.

Sometimes Sleep Splints are used that hold the tongue in a certain position increasing the size of the airway.

There is a functional magnetic system as well that places two magnets opposite of each other on the sides of the jaws to help keep the airway open.

Rapid Maxillary Expansion is an orthodontic procedure that involves inserting a temporary screw device which is applied to the upper teeth and then turned or tightened periodically over a 3 to 4 week period. It can help reduce nasal pressure and is a non-surgical procedure that may improve breathing in people with a narrow upper jaw.

Alternative Treatments and Lifestyle Changes

Usually these are things to be tried in conjunction with traditional treatments. Always consult with your doctor about any alternative treatment methods before trying them.

Some people have reported that playing a didgeridoo has helped strengthen the muscles in the pharynx and upper air passage and improved the number of apnea events or allowed them to lower their pressure.

In obese or overweight individuals, losing weight often has a profound effect on their Sleep Apnea and pressure needs for the CPAP machine. Eating a healthy diet combined with exercise, can promote loss of weight and with weight loss often comes the need for less pressure on the CPAP machine.

It is recommended to avoid alcohol or other depressants or drugs that can adversely affect those with Sleep Apnea. Avoiding cigarette smoke or quitting smoking and avoiding other pollutants can help with irritation of the mucous membranes in the nose and air passage that may cause swelling.

Trying different sleeping positions can help in some cases, especially sleeping in a somewhat upright position if one is not using a CPAP machine.

Yoga and Breathing Exercises such as those found in the Buteyko Method or in some Meditation techniques may be helpful.