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Sleep apnea is a common sleep disorder that affects millions of people around the world. It occurs when breathing is interrupted during sleep. There are often pauses in breathing or shallow breathing events that last 10 seconds or more. These episodes, called apneas (pause in breathing) or hypopneas (partial breathing), disrupt sleep throughout the night. As a result, sleep apnea can dramatically reduce sleep quality and cause someone to feel tired during the day. There are two main types of sleep apnea – obstructive sleep apnea (OSA) and central sleep apnea (CSA). OSA is the more common type and occurs when throat muscles relax during sleep, blocking the airway. CSA happens when the brain fails to signal breathing muscles to work properly.
Continuous Positive Airway Pressure Therapy
CPAP therapy is considered the gold standard treatment for OSA. A CPAP machine consists of a mask that fits over the nose, a hose and a machine that delivers pressurized air through the hose. The positive air pressure acts like a splint, keeping the airway open to prevent it from collapsing during sleep. Many studies have shown CPAP therapy reduces apnea events and improves daytime sleepiness. For most patients, just a few hours of CPAP use each night can significantly improve their quality of life. Compliance can be an issue for some as the mask and hose can feel uncomfortable. Newer CPAP machines aim to address comfort with features like smaller sizes, adjustable pressures and heated humidification.
Oral Appliances for Mild to Moderate Sleep Apnea
Another non-invasive option is an oral appliance worn in the mouth while sleeping. Dental appliances like mouthpieces and mandibular advancement devices work by repositioning the jaw and tongue to open airways. They can be an effective treatment, especially for people with mild to moderate OSA who do not tolerate CPAP therapy well. Oral appliances require an examination by a dentist or orthodontist and regular adjustments may be needed. Though generally well-tolerated, some individuals experience jaw pain, dry mouth or tooth discomfort with long-term use. However, compliance tends to be better than CPAP as no mask or hose is involved.
Surgical Options for Sleep Apnea
Surgery is an option for carefully selected patients when other treatments have failed or are not appropriate. Some common surgeries for sleep apnea include:
– Uvulopalatopharyngoplasty (UPPP surgery): This removes excess tissue in the throat like the uvula and tonsils to open the airway. It is effective in about 50-70% of patients.
– Tracheostomy: A small hole is made in the windpipe to bypass the airway obstruction. This is usually a last resort due to the invasiveness and long recovery time. Still, it virtually eliminates apnea events.
– Maxillomandibular advancement (MMA): The jaw and chin are surgically moved forward and lengthened to widen the upper airway. MMA gives excellent results in properly selected patients but the procedure is complex.
– Other procedures: Radiofrequency ablation, pillar procedure and hypoglossal nerve stimulation are newer options still under investigation for effectiveness. Generally, surgery yields better success for OSA than CSA and works best in non-obese individuals with isolated retropalatal or -glossal obstructions.
Positive Airway Pressure Alternatives
For those unable to tolerate CPAP, several newer treatment options provide alternatives to conventional positive pressure therapy:
– Oral Pressure Therapy (OPT): Delivers a stream of pressurized air into the mouth through a mouthpiece rather than a nasal mask. Some find it more comfortable than CPAP.
– Adaptive Servo-Ventilation (ASV): Devices like the ResMed ASV monitor breathing and apply positive or negative pressures to improve ventilation during sleep, addressing both OSA and CSA.
– Neurostimulation Devices: Inspire upper airway stimulation uses a mild electrical pulse to stimulate the hypoglossal nerve and keep the tongue positioned to maintain an open airway without PAP. FDA approved.
– Mandibular Advancement Devices: In addition to standard oral appliances, new smart variants like the Zyppah monitor jaw position, titrating pressure to just what is needed each night.
With so many treatment choices, sleep specialists can work with patients to determine the best non-drug solution based on factors like apnea severity, anatomy and lifestyle needs to effectively manage sleep apnea symptoms. Following a treatment plan is key to regaining restorative, uninterrupted sleep and maximizing daytime functioning.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
