Sleep apnea is a common sleep condition that occurs when your breathing is interrupted throughout the sleep cycle. These interruptions are caused by the collapse of airway soft tissue, which prevents oxygen from reaching the lungs.
The most significant telltale sign of sleep apnea is how you feel during the day. It interferes with your quality of sleep, so you’re more likely to suffer from extreme fatigue and daytime sleepiness.
For people with sleep apnea, a combination of sleep disturbance and oxygen starvation may lead to:
- Heart disease
- Mood disorders
- Daytime sleepiness
- Poor memory
With the right treatment, however, you can control your sleep apnea. If you suspect that you may have sleep apnea, consult your doctor. Bring with you a record of your sleep, fatigue levels throughout the day, and any other symptoms you might be having. Be sure to take an updated list of medications when you visit your doctor.
Treatment for sleep apnea
Continuous Positive Airway Pressure (CPAP)
The gold-standard treatment for moderate-to-severe obstructive sleep apnea is the use of continuous airway pressure device (CPAP) machine during sleep.
CPAP is a mask that fits over the mouth and nose. The mask is connected to a machine that gently blows a continuous stream of pressurized air into the airway. It maintains your airway open as you sleep so that breathing is regular. With CPAP, the air pressure is somewhat more significant than that of the surrounding air and is just enough to keep your upper airway passages open, preventing apnea and snoring.
The CPAP machine consists of three parts:
- Mask that fits over your nose – or your nose and mouth – and is held in place with straps while you sleep
- The motor that blows air
- A large tube (cannula) that connects the motor to the mask
CPAP machines are small, lightweight, and relatively quiet. If you travel, you should bring your CPAP with you.
Although you will likely feel alert and better rested once you start using CPAP, it can take some time to get used to the device. Some people may be unable to sleep the first few nights of treatment.
Side effects CPAP are usually minor and may include:
- Feelings of confinement from the face mask
- Nasal congestion, sinusitis, runny nose, or nosebleeds
- Sore or dry mouth
- Irritation over the bridge of the nose
- Discomfort in chest muscles
- Stomach bloating and discomfort
If you are having any of these problems, call your doctor. An adjustment to your CPAP machine could make it more comfortable. If you are having difficulty adjusting your CPAP or you’re experiencing side effects of wearing the appliance, talk to the doctor for assistance. Some people find CPAP cumbersome or uncomfortable, but with practice, you can learn to adjust the tension of the straps on the mask to obtain a comfortable and secure fit. Use the CPAP machine as recommended by your doctor.
Bi-level positive airway pressure (BiPAP)
Bi-level positive airway pressure (BiPAP) is most recommended for people with central sleep apnea. BiPAP is similar to CPAP, but the airflow changes when you breathe in and out. In other words, BiPAP delivers air at variable pressurization rates based on your breathing patterns. The bi-level provides two levels of pressure to the patient throughout the night. Higher pressure is delivered on inhalation, while a lower pressure is delivered on exhalation.
Dental devices can keep the airway open during sleep in patients with mild-to-moderate sleep apnea. Such devices can be customized by dentists who specialize in sleep apnea. The mouthpiece manipulates the position of your tongue and jaw to keep it open when you’re sleeping – this means you’ll have more continuous airflow enter your mouth. It also helps to tighten the tissue in your airway that become slack during sleep. For people with mild-to-moderate sleep apnea, especially those who sleep on their stomachs or backs, dental devices may improve sleep and reduce snoring. Also, people are more likely to use dental appliances regularly than CPAP.
However, dental devices have some potential drawbacks, including altered bite, movement of teeth, pain, arthritis of the temporal mandibular joint (TMJ), dry lips, and excessive salivation.
If you’re fitted with a dental device, you should have a regular check-up to make sure its working and to make any necessary adjustments. If you experience discomfort or changes in your bite, your dentist or orthodontist who fitted your device may be able to make modifications to correct the problem.
There are two main types of oral devices for sleep apnea: Mandibular advancement device and tongue retaining mouthpiece.
Mandibular advancement device (MAD)
Mandibular advancement device (MAD) is the most widely used oral device for sleep apnea. It snaps over the dental arches and has metal hinges that advance the lower jaw (mandible) further forward. As a result, the size of the airway increases, thus reducing the air resistance.
Tongue retaining mouthpieces
Used less commonly than MAD, tongue retaining mouthpiece is a splint that holds the tongue in place to keep the airway open.
Many people with sleep apnea – especially those with obstructive sleep apnea – are more susceptible to snoring when you sleep on your back with your head at an elevated position. If you wish to continue sleeping on your back, you may be able to reduce snoring by using a pillow loft.
Adjustable beds allow you to adjust the angle of your sleep surface at the head and, in some cases, the feet as well. As is the case with pillow loft, inclining the head at the right angle can help reduce snoring in people with sleep apnea. Additionally, some adjustable beds come with dedicated ‘anti-snore’ presets.
If you have a deviated septum, enlarged tonsils, or a smaller lower jaw with an overbite causing the throat to be narrow, surgery may be needed. Surgery is usually only considered after other treatments have failed after at least three months.
Uvulopalatopharyngoplasty (UPPP) is a procedure that removes soft tissue from the rear of the throat and palate, increasing the width of the airway at the opening of the throat.
This type of surgery might stop throat structures from vibrating. It’s less effective than CPAP and isn’t a promising treatment for obstructive sleep apnea.
Another surgical alternative is to shrink the tissue at the back of your throat in people with mild-to-moderate sleep apnea. It is thought to have fewer surgical risks than tissue removal.
Jaw repositioning (maxillomandibular advancement)
In the jaw repositioning procedure, your jaw is moved forward to enlarge the space behind the soft palate and tongue, making obstruction less likely.
Plastic implants can be surgically inserted into the soft palate under local anesthesia.
This requires surgery to insert a nerve stimulator that controls tongue movement (hypoglossal nerve). The increased stimulation helps retain the tongue in a position that keeps the airway open.
You may need tracheostomy if you have severe, life-threatening sleep apnea or if other treatments have failed. In this procedure, your surgeon creates an opening in your neck to insert a tube through which you breathe. You keep the opening covered during the day. But at night, you uncover it to allow air to pass in and out of your lungs, bypassing the blocked air passage in your throat.
Lifestyle and home remedies
Lifestyle modifications and home remedies can go a long way in mitigating sleep apnea symptoms. There are many measures you can take on your own, especially for mild-to-moderate sleep apnea. However, they should not replace medical evaluation and treatment.
Lose excess weight
If you’re overweight, even a small amount of weight loss can relieve pressure on your throat and improve sleep apnea symptoms. But sleep apnea can recur if you regain the weight.
Regular exercise can aid your weight loss efforts and improve your quality of sleep. Aerobic and resistance training can help reduce sleep apnea symptoms. Try to get 30 minutes of moderate exercises, such as a brisk walk, several days a week.
Avoid alcohol and certain medications
Avoid alcohol and certain drugs, such as sleeping pills and tranquilizers, especially before bedtime. It can relax the muscles in the back of your throat, which can interfere with breathing.
Sleep on your side or abdomen
Sleeping on your back can cause your tongue and soft palate to rest against the rear of your throat and obstruct your airway. Hence, you should sleep on your side instead of on your back.
Cigarette smoking worsens the fluid retention and swelling in the upper airway, making sleep apnea worse. If you’re a smoker, it’s time to quit.