7 WAYS TO TREAT OBSTRUCTIVE SLEEP APNEA: WITH & WITHOUT SURGERY

Sleep apnea is a common medical condition where patients develop repetitive long breathing pauses while sleeping.  People with sleep apnea usually have frequent pauses during sleep, with each lasting more than 10 seconds. This deprives your body of oxygen and causes low-quality sleep. This is why excessive daytime sleepiness, constant fatigue, and inability to concentrate are common sleep apnea symptoms. 

Sleep apnea can exacerbate and lead to several medical conditions like heart disease, hypertension, and diabetes.  This is why it’s important to seek treatment if you suspect that you have sleep apnea. Treatment includes a variety of lifestyle changes, home remedies, the use of special devices, and surgery.  

Lifestyle Changes

The first and most important part of your obstructive sleep apnea treatment plan is lifestyle modification. There are several simple things that you can change and habits that you can adopt to treat sleep apnea without CPAP and without surgery: 

• Losing weight: Obesity and being overweight are both associated with obstructive sleep apnea. Losing even just a few pounds can make all the difference, and might lead to a full resolution of sleep apnea without further treatment. 
• Staying Active: It has been shown that staying active and exercising even for as little as 30 minutes a day can help cure sleep apnea (even if you don’t lose any weight). 
• Reducing alcohol consumption: Alcohol can interfere with our breathing process and can weaken your throat muscles, increasing the likelihood of them collapsing as you sleep. That’s why it’s recommended that you avoid alcohol if you have sleep apnea. 
• Quitting smoking: Smoking is a risk factor for sleep apnea as it can weaken your throat muscles and contribute to low oxygen. 
• Change your sleeping position: Sleeping on your stomach or sides can counteract the effect of gravity on your palate and throat and can hence prevent your airway from collapsing when you sleep. 

Continuous positive airway pressure (CPAP) ventilators

Continuous positive airway pressure (CPAP) devices are the mainstay of treatment in moderate and severe obstructive sleep apnea. This is a device that pumps pressurized air through a mask that you wear at night to keep your throat and upper airway open. The continuous pressure prevents the airway from collapsing.

Wearing a plastic mask at night might sound uncomfortable, however, it will improve your oxygen levels and sleep quality. Once you’re used to wearing your mask at night, you will start noticing the dramatic difference in your daytime energy. 

You can either wear a small mask that fits around your nose only or a big mask that fits around both your nose and mouth. The mask will be connected to an electronic ventilator which will pump air at the required pressure. 

The use of CPAP has been shown to have many benefits, such as: 

• Improving your overall health 
• Reducing your risk of diabetes 
• Reducing the risk of heart disease 
• Improving your focus and energy during daytime 

Oral Appliances 

Oral appliances are a simpler treatment for mild sleep apnea. These are custom-fit oral devices that you wear in your mouth before you sleep. 

Sleep apnea oral appliances work by preventing your lower jaw and tongue from sliding backward while you sleep to cause airway obstruction. They fix them in a forward position and keep your airway open. 

Oral appliances are a good option for you if you are not comfortable wearing CPAP while you sleep. A dentist will help you try out and find an appliance that fits you well. 

Adaptive servo-ventilation (ASV)

This is a newly approved ventilation method to treat obstructive sleep apnea. ASV is very similar to CPAP when it comes to how it looks: a nasal or full face mask connected to a ventilator. You wear this when sleeping, just as with CPAP. 

The only difference is how the pressure is adjusted with each breath. With CPAP, there’s a continuous fixed pressure in the airways - it does not change unless you change it manually. Adaptive servo-ventilation devices, on the other hand, have a built-in computer that analyzes your breath cycles and adjusts the pressure to ensure a perfect balance between comfort and airway patency. 

According to one study published in 2007 in the journal Sleep, ASV might be even more effective in treating some types of apnea compared to CPAP. 

Uvulopalatopharyngoplasty 

It’s okay if you weren’t able to pronounce that. To simplify, uvulopalatopharyngoplasty is a surgery done to reshape the roof of your mouth (soft palate) and the back of your mouth chamber (pharynx), which is the uppermost part of your airway. It’s the main sleep apnea surgery. 

During a uvulopalatopharyngoplasty, your ENT surgeon will remove the excess tissue and reshape the sides and back of your upper airway and the posterior roof of your mouth so that it does not collapse on itself while you sleep. It aims to stop snoring and keep your airway patent. 

Sleep apnea surgery is recommended for patients who cannot stand wearing CPAP when sleeping. Nevertheless, studies have shown that it is less effective compared to CPAP. 

Your surgeon might use one of several techniques, like traditional surgical tissue removal or radiofrequency ablation (removing and shrinking tissue with radio waves). 

Jaw repositioning

This is another sleep apnea surgery. If the mechanism of airway collapse in your case is the retraction of the lower jaw while you sleep, then surgery can be beneficial for you. 

Jaw repositioning surgery can treat obstructive sleep apnea resulting from a hypermobile jaw. During this surgery, your surgeon will fix the jaw permanently in a forward position, preventing it from obstructing your airway as you sleep. 

Inspire Implants (Nerve Stimulation) 

A newly emerging one-of-a-kind treatment for obstructive sleep apnea has been recently gaining popularity, and it involves a device called the Inspire Implant. The Inspire device is implanted inside your neck or upper chest and is connected to your upper airway muscle. 

The implant works by electrically stimulating the upper airway muscles so that they stay slightly tense to hold your airway wide open as you sleep. Inspire surgery can be a future permanent solution to sleep apnea without CPAP or uvulopalatopharyngoplasty. 

According to one study, the Inspire implant was effective in reducing sleep apnea episodes by 68% after one year of surgery. This had lead to an improvement in the quality of sleep and quality of life in the study population. 

The inspire implant is turned on before you sleep and is automatically turned off after 8 hours. The downside is the price - the surgery and implant can cost up to 40,000$, but this largely depends on where you are getting your operation and what kind of medical coverage you have. 

Conculsion 

We spend nearly one-third of our lives sleeping, and for a good reason: our body desperately needs it. Having low-quality sleep can make life unbearable - constant fatigue, sleepiness, irritation, moodiness. If you suspect that you have sleep apnea or not sleeping well for any reason, don’t hesitate in contacting a sleep specialist. There are many treatments for sleep apnea that would give you back the happy energetic days you’ve been missing on. 

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Sources

• https://www.nejm.org/doi/10.1056/NEJMoa1308659
• https://journals.physiology.org/doi/abs/10.1152/jappl.1993.75.3.1053
• https://pubmed.ncbi.nlm.nih.gov/17520791/
• https://academic.oup.com/sleep/article/30/4/468/2708207
• https://www.inspiresleep.com/
• https://www.sleepfoundation.org/sleep-apnea

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