Sleep Apnea Treatment: CPAP Masks, Surgery and Oral Devices

Sleep Apnea is a breathing problem during sleep that affects 20 million Americans- often without their knowledge. (For the symptoms, causes and serious health risks of the condition see this page: Sleep-Apnea.)

Treatments

The most common sleep apnea cures are

• masks worn at night which deliver air to keep breathing passages open
• oral devices which pull the tongue or jaw forward to relieve blockages in the throat
• surgery to open the airways.

For many mild and moderate sleep apnea cases, the position that a person sleeps in can affect the number of apnea episodes in a night (see below for details) and treatment can be as simple as ensuring a sufferer sleeps on their side.

Sleep Apnea Masks

The most common type of treatment for sleep apnea involves the use of a CPAP mask with a machine that delivers a constant but adjustable flow of air to keep the airway open. The best air pressure for each person is usually calculated during a sleep study. As time passes the pressure may need to be adjusted by further sleep studies. If the person loses or gains weight for example the air pressure needs to be changed.

Bi-level positive airway pressure (BPAP) systems use different air pressures on the in-breath and the out-breath. This helps the patient breath more easily and is especially useful in central sleep apnea ie when the brain is not sending the right signals to maintain breathing at night. A sensor in the mask detects the change in breathing and adjusts the air flow.

APAPs are auto-adjusting positive air pressure masks which can reduce the number of visits to a doctor or sleep center but there is a question mark over their effectiveness in reducing heart problems
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Problems with Masks

Fifty percent of sufferers give up with CPAP masks. For most people, the problem is the discomfort of sleeping with a mask. Some experience feelings of claustrophobia. Nasal congestion is also common as the compressed air dries the nose. Humidifiers can help with this.

Patience and repeated practice with different masks and fittings may be needed to find a system an individual is comfortable with. Education on the very real dangers of sleep apnea encourages persistence.

Oral Appliance Therapy

These are devices that can be placed in the mouth to help keep airways open.

The devices fit over the teeth and pull either the tongue or the jaw forward.The Snoreguard is an inexpensive, off the shelf device. It is designed to reduce snoring but can help with sleep apnea. The TAP is a more expensive device (around $1500). It is purpose designed to prevent sleep apnea and is adjustable to suit the individual. Care needs to be used in adjustments as jaw problems can result.

Doctors often avoid using these devices because they are awkward to fit properly, taking many visits and often weeks to adjust. Orthodontists are more likely to be helpful. 'Sleep Dentistry' is an emerging speciality.

Some people prefer these devices to masks. Some find them difficult to adjust to.

Reveiws of the more common oral devices that can help with obstructive sleep apnea: http://www.drsylvanmintz.com/oral_devices.html

The snoreguard: http://www.snoreguard.com

A forum for discussing oral devices.
http://www.apneasupport.org/forum-20.html

Surgery for Obstructive Sleep Apnea

Soft Pallette Surgery

This involves trimming the soft tissues at the top back of the mouth to help with breathing. This can be done with a scalpel under general anaesthetic or with a laser under local anaesthetic.

Basal Tongue Surgery

The base of the tongue is reduced so that it does not block air flow (see video below).

Somnoplasty

This is a relatively new procedure with little study of its success rate. The tongue is reduced in size by radio frequency ablation. It is a simple procedure that can be performed in a doctor’s surgery.

Tongue Suspension Procedure

A screw is inserted in the jaw. The tongue is anchored to the screw so that it cannot fall back and block breathing. Again, there are few studies of success rates.

Jaw Advancement Surgery

The lower jaw is brought forward slightly to increase air flow. This is a long and involved operation that has risks of rejection by the patient and may need follow up operations. The patients ‘bite’ is changed by this procedure and dentistry will probably be required to deal with this. When performed by specialist surgeons it has been shown to be very effective.

Surgery Outcomes

Studies show, at best, a 60% success rate as measured by reductions in snoring and feelings of wellness. Most doctors only recommend surgery for people who have failed to do well with CPAP masks and oral devices.

Tracheostomy

This is surgery to make an opening in the windpipe. The opening is plugged during the day but unplugged at night. The patient then breathes through the opening rather than the mouth or nose. Given the social and psychological consequences of this extreme procedure it is only used when a patient’s life is at risk and CPAP has proven ineffective.

Positional Sleep Apnea

The position that a person sleeps in can affect the number of episodes of sleep apnea in a night. In about 50% of mild cases of sleep apnea and 20% of moderate sleep apnea cases, sleeping on the side can reduce apnea attacks by 90%.

Some equipment has been purpose made to prevent people sleeping on their backs (see link below).

http://www.sciencedaily.com/releases/2008/09/080926105027.htm

An old way of reducing snoring is with a pocket sewn into the back of sleep clothing (roughly between the shoulder blades) then stuffed with a tennis ball. This can persuade the sleeper to avoid sleeping on their back.