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Treatments and drugs
By Mayo Clinic staff
For milder cases of obstructive sleep apnea, your doctor may recommend lifestyle changes, such as losing weight or quitting smoking. If these measures don't improve your signs and symptoms or if your apnea is moderate to severe, a number of other treatments are available. Certain devices can help open up a blocked airway. In other cases, surgery may be necessary.
Therapies
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Positive airway pressure. If you have moderate to severe sleep apnea, you may benefit from a machine that delivers air pressure through a mask placed over your nose while you sleep. The most common type is called continuous positive airway pressure, or CPAP (SEE-pap). With this treatment, the pressure of the air breathed is continuous and somewhat greater than that of the surrounding air, which is just enough to keep your upper airway passages open. This prevents apnea and snoring.
Although CPAP is the most consistently successful and most commonly used method of treating sleep apnea, some people find it cumbersome and uncomfortable. With some practice, most people learn to adjust the mask to obtain a comfortable and secure fit. You may need to try different types to find a suitable mask. If you're having particular difficulties tolerating pressure, there are machines that have special adaptive pressure functions to improve comfort. Some people also benefit from using a humidifier along with their CPAP system.
Don't stop using the CPAP machine if you experience problems. Check with your doctor to see what adjustments you can make to improve its comfort. In addition, contact your doctor if you still snore despite treatment or begin snoring again. If your weight changes, your doctor may need to adjust the pressure settings.
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Mouthpiece (oral device). Another option is wearing a mouthpiece designed to keep your throat open. While positive airway pressure is nearly always an effective treatment, oral appliances are a successful alternative for some patients. Some are designed to open your throat by bringing your jaw forward, which can sometimes relieve snoring and mild obstructive sleep apnea. Others hold your tongue in a different position. If you and your doctor decide to explore this option, you'll need to see a dentist experienced in dental sleep medicine appliances for the fitting and follow-up therapy.
A number of devices are available from your dentist. You may need to try different devices before finding one that works for you. Because oral appliances aren't as consistently effective as CPAP, close follow-up is needed to ensure successful treatment of sleep apnea.
Surgery or other procedures
The goal of surgery for sleep apnea is to remove excess tissue from your nose or throat that may be vibrating and causing you to snore, or that may be blocking your upper air passages and causing sleep apnea. Surgical options may include:
- Surgical removal of tissue. Uvulopalatopharyngoplasty (UPPP) is a procedure in which your doctor removes tissue from the rear of your mouth and top of your throat. Your tonsils and adenoids are commonly removed as well. This type of surgery may be successful in stopping throat structures from vibrating and causing snoring. UPPP usually is performed in a hospital and requires a general anesthetic.
- Jaw correction. In this procedure, called maxillomandibular advancement, the upper and lower parts of your jaw are moved forward from the rest of your facial bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely. This procedure may require an oral surgeon and an orthodontist, and at times may be combined with another procedure to improve the likelihood of success.
- Surgical opening in the neck. You may need this form of surgery if other treatments have failed and you have severe, life-threatening sleep apnea. In this procedure, called a tracheostomy, your surgeon makes an opening in your neck and inserts a metal or plastic 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.
- Implants. The Pillar procedure is a minimally invasive treatment that involves placement of three tiny polyester rods in the soft palate. These inserts stiffen and support the tissue of the soft palate and reduce upper airway collapse and snoring. This treatment is recommended only for people with mild to moderate obstructive sleep apnea.
Removing tissues in the back of your throat with a laser (laser-assisted uvulopalatoplasty) or with radiofrequency energy (radiofrequency ablation) are procedures that doctors sometimes use to treat snoring. However, these procedures aren't recommended for treating obstructive sleep apnea.
Other types of surgery may help reduce snoring and sleep apnea by clearing or enlarging air passages:
- Nasal surgery to remove polyps or straighten a crooked partition between your nostrils (deviated nasal septum)
- Surgery to remove enlarged tonsils or adenoids
- Strohl KP. Overview of obstructive sleep apnea-hypopnea in adults. http://www.uptodate.com/home/index.html. Accessed March 16, 2009.
- Sleep apnea. National Heart, Lung and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_WhatIs.html. Accessed March 16, 2009.
- Kline LR. Clinical presentation and diagnosis of obstructive sleep apnea-hypopnea in adults. http://www.uptodate.com/home/index.html. Accessed March 16, 2009.
- Kryger MH. Management of obstructive sleep apnea-hypopnea in adults. http://www.uptodate.com/home/index.html. Accessed March 16, 2009.
- Olson E, et al. Obstructive sleep apnea-hypopnea syndrome. Primary care: Clinics in office practice. 2005;32:329.
- Ballard RD. Management of patients with obstructive sleep apnea. The Journal of Family Practice. 2008;57(suppl):S24.
- Welch KC, et al. Sleep disorders. In: Lalwani AK. Current Diagnosis and Treatment in Otolaryngology: Head and Neck Surgery. 2nd ed. New York, N.Y.: The McGraw-Hill Companies; 2008. http://www.accessmedicine.com/content.aspx?aID=2828912. Accessed March 16, 2009.
- 510(k) summary: Pillar palatal implant system. Food and Drug Administration. http://www.fda.gov/cdrh/pdf4/k040417.pdf. Accessed March 18, 2009.
