Finding the treatment that best meets your needs

Obstructive sleep apnea syndrome (OSAS) is a medical condition that requires careful attention and
proper treatment. This disorder, which can be life threatening, involves frequent collapse of the
breathing passageway during sleep, with partial or complete blockage resulting. Symptoms can
include excessive daytime sleepiness, poor performance at home or work, and depression.

The process by which the airway gets blocked off during sleep is rather complicated. During sleep, the
muscles in the throat relax and are more likely to close than when you are awake. The negative
pressure of air pulled by the lungs through a narrow airway may cause a breathing passage to
collapse, much as a straw flattens and collapses if you pinch one end closed while sucking on the
other end.

Treatment can prevent or reverse the serious consequences associated with OSAS.

If you have been diagnosed with OSAS by a sleep specialist, you and your health care provider will
have a number of treatment options to consider. Correcting your breathing problem during sleep may
involve one or more of the following treatments:
Lifestyle changes
Some behaviors or habits can make OSAS worse. For some people, certain lifestyle changes can
reduce or eliminate sleep apnea.

Sleep-position training

Sleeping on your back allows gravity to pull on the soft tissues at the back of your throat and neck,
causing the breathing passageway to narrow or collapse completely.

Sleep-position training can be used to keep you on your side during sleep, which can lead to an
improvement in your symptoms. Sleep-position training can be accomplished in several ways. The
simplest approach, called the "tennis ball technique," involves sewing a pocket onto the back of your
pajama top and inserting tennis balls into it.

If you start to roll onto your back during sleep, the pressure from the balls will encourage you to roll
back to your side during sleep. A foam wedge strapped to your back can accomplish the same result.
Commercial devices with alarms are also available to help you stay on side during sleeping. Check
with your health care provider to find out how long this type of treatment should be used. If you are
overweight, consult a health care provider to find out about weight-loss programs.

Weight loss and regular exercise

For some people, weight loss alone is a helpful treatment. Once you reach your desired weight, it is
important to maintain that weight, because snoring and apneas are likely to return with weight gain. If
you are overweight, consult a health care provider to find out about weight-loss programs.

Avoiding alcohol and sedatives

Even one glass of wine just before bed can result in a worsening of your snoring and apnea. You
should avoid drinking alcohol for at least four hours before bed. Alcohol and sedative medications,
such as sleeping pills, muscle relaxants, anti-anxiety drugs and some pain medications, can cause
the tissues in your throat to relax more than usual and cause an airway obstruction. Alcohol and
sedative drugs also make it more difficult for the brain to "wake up" and notice a lack of oxygen in the
system, which results in longer and more dangerous abnormal breathing periods. More information on
the effects of alcohol on sleep...
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Mandibular Splints (oral or dental appliances)
These devices work to keep the airway open by holding the tongue or jaw forward, increasing the
airway space behind the tongue. A clear airway is needed in order for most of these devices to be
successful. They are usually fitted by a physician associated with a sleep disorders center or
laboratory.More...
Tongue-retaining devices
These devices are placed in the mouth just before bed can create a slight suction, which holds the
tongue forward to keep it from falling back into the throat. They can be effective in people who have mild
to moderate apnea but are, as a rule, not well-tolerated.
Continuous positive airway pressure (CPAP) devices
Continuous positive airway pressure (CPAP) is a highly effective therapy that uses air pressure to prop
the airway open during sleep. CPAP machines work by pumping room air through a compressor that is
connected by a hose to a mask that fits over the nose or the nose and mouth. The mask fits over the
top of the head and is held in place with straps. The appropriate CPAP pressure level is determined
during a sleep study or by other clinical assessment.

Nasal pillows are an alternative to the mask method of CPAP delivery. These are soft pieces of plastic
that are placed directly into the nostrils.

While most patients do well with CPAP therapy, a few may experience dryness in the nose or feelings
of claustrophobia. These and other problems can be overcome with a few adjustments. A humidifier
can be used to reduce dryness, and relaxation techniques can help relieve feelings of claustrophobia.
More on CPAP...
Surgery
An operation may be an option if your health care provider finds an obstruction in your airway or if more
conservative treatments have not worked. Whatever type of operation is recommended, be sure you are
aware of all possible risks and side effects before proceeding. While an operation can be an effective
treatment for some patients, it is not the right choice for everyone.

Nasal operations

Nasal surgery is used to remove blockages in the nose (such as growths), or to repair a deviated
septum (a displacement of the wall that divides the nose into halves). These operations may be one
part of an overall plan to treat apnea, and are generally used along with other forms of treatment or
other operations.

Uvulopalatopharyngoplasty (UPPP)

This operation involves removing the uvula (the soft, fleshy projection that hangs in the back of the
throat), the tonsils, and part of the soft palate. The cure rate is about 20% but approximately 50% of
patients who undergo this operation are helped by it, at least temporarily. Side effects, such as severe
throat pain, nasal sounding speech, and the regurgitation of liquids into the nose when swallowing,
have been reported.

Laser-assisted uvulopalatoplasty (LAUP)

This procedure is used mainly for the treatment of snoring and is similar to the UPP. With LAUP, the
surgeon uses a laser to remove a part of the uvula and soft palate. The procedure takes place in
several sessions in a doctor's office and avoids the use of general anesthesia. Success rates are
similar to those of the UPPP above.

Inferior sagittal mandibular osteotomy (ISO) and geniohyoid advancement with hyoid myotomy
(GAHM).

The ISO and GAHM are procedures that enlarge the airway. ISO is an operation that includes bringing
the lower bone of the jaw forward. The GAHM operation includes attaching the hyoid (the u-shaped
bone where your bottom teeth are located) to the windpipe. The effectiveness of these operations can
depend on a person's weight and lower jaw structure.

Maxillomandibular advancement (MMO)

This reconstructive surgery involves cutting the bone that connects the jaw to the face and moving the
upper and lower jaws forward. This operation is done under general anesthesia and requires a
hospital stay of a few days. After the operation, the jaw is wired shut to hold it in place for about four
weeks. A liquid diet is required, and weight loss often results. Once the wires are removed, orthodontic
work may be needed to realign the teeth so they fit together properly. This treatment is time-consuming
and expensive, but its results are positive for some patients. The best candidates for this type of
treatment are those born with smaller than normal jaw or a jaw that is set too far back.

Tracheostomy

This surgery is rarely used to treat sleep apnea, and is only applicable to an immediately
life-threatening sleep apnea condition or when all other options have been exhausted. It involves the
creation of a small surgical opening and the placement of a in the windpipe through the front of the
neck. The tracheostomy bypasses any obstructions in the throat and allows air to flow freely into the
lungs while the patient is sleeping. The opening is covered during the day and normal breathing and
speech resume.
Medications and Alternative Treatments
Medications used alone are of limited benefit for the successful treatment of snoring and obstructive
sleep apnea. They may be most useful in cases of mild apnea or used as part of a combination
treatment program.

Nasal sprays

Over-the-counter nasal sprays that help clear the nasal passages can be habit-forming and should not
be used for more than a few days. Prescription nasal sprays can help unblock the nose, but
sometimes take days or weeks to work. Nasal sprays are usually not helpful of there is a permanent
blockage caused by a growth or a deviated septum. Although nasal sprays may help reduce snoring,
they are not considered effective treatment for sleep apnea.

Decongestants

Medications to relieve congestion in the nose are sometimes helpful for snoring, but are not
considered to be a treatment for sleep apnea itself. Although decongestants help you breathe better,
they may cause difficulty falling asleep, staying asleep, or both.

Respiratory stimulants

Protriptyline and fluoxetine are medications used rarely to treat mild cases of apnea. It is an
antidepressant that decreases REM (dreaming) sleep, a time when apneas are likely to be longer and
more frequent. Protriptyline and fluoxetine may help strengthen and tone the muscles of the throat. It
can produce mild side effects (such as dry mouth and constipation), and it is not recommended for
people with high blood pressure or an abnormal heart rhythm. An even less-frequently prescribed
medication for the treatment of OSAS is medroxyprogesterone, a hormone known to act as a
respiratory stimulant, which can produce such side effects as unwanted hair growth, mood changes,
and fluid retention.

Oxygen

This treatment may be used to correct low oxygen levels in the blood due to heart or lung disease in
addition to sleep apnea. It may be used along with CPAP treatment for best results or as an alternative
treatment when all other options have been exhausted.
Follow-up Care

No matter which form of treatment is used for OSAS, it is important that a follow-up sleep study be done
by a sleep professional to determine success. Regular follow-up appointments with your health care
provider are also essential because the severity of your apnea may change with age. If your snoring
resumes or if you are sleepy during the day, it may mean the apnea has returned, and additional or
other treatment may be necessary.
Good Sleep Habits
These guidelines can be used for all types of sleep disorders. They will help most people, including
those with obstructive sleep apnea syndrome sleep better:

  • Get up about the same time every day.

  • Go to bed only when sleepy.

  • Establish relaxing pre-sleep rituals, such as a warm bath, light bedtime snack, or ten minutes
    of reading.

  • Exercise regularly.

  • Consult a health care provider before beginning an exercise program. Vigorous exercise
    should be confined to the early part of the day (at least six hours before bedtime), and mild
    exercise -- such as simple stretching or walking --should take place at least four hours before
    bedtime.

  • Maintain a regular schedule. Our inner clocks run most efficiently when eating meals, taking
    medications, performing chores and other activities are done at regular times.

  • Avoid caffeine within six hours of bedtime.

  • Even a small dose of alcohol can have a potent effect when you are tired.

  • Avoid smoking close to bedtime.

  • If you nap, try to do so for less than one hour at the same time every day. Mid-afternoon is best
    for most people.

  • If sleeping pills are prescribed, they should be used conservatively. Most doctors avoid
    prescribing sleeping pills for periods longer than three weeks. Never combine sleeping pills
    and alcohol.

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