Treatment of obstructive sleep apnea

You can first try to relieve the symptoms by making changes to your lifestyle and sleep habits. Although this won’t necessarily reduce the pauses in breathing, it might have a positive effect on your sleep overall. You could try one or more of these things:

• Avoid large meals in the evening, as well as stimulants like coffee and tea four to six hours before going to sleep, because they can affect your sleep.
• Do not drink alcohol or smoke in the evening because this can also result in a poor night’s sleep. Alcohol relaxes your throat muscles even more, making sleep apnea worse.
• Sleep in a quiet, dark and (most importantly) comfortable place with a pleasant room temperature.
• Get enough physical activity during the day and exercise regularly.

People who have sleep problems sometimes try out sleeping pills and sedatives. Some of these medications have a lot of side effects when taken over the long term, though, and they can even make sleep apnea worse. These mainly include benzodiazepines. Medications that belong to this group of drugs should be avoided, or only taken for a few days at the lowest dose possible. Other sleeping pills (non-benzodiazepines) probably don’t cause more breathing pauses.

Overweight people are more prone to sleep apnea – probably because too much stomach fat makes breathing more difficult. Fat in the neck and throat area narrows the airways even more. Losing weight can generally have a positive effect on the health of people who are very overweight (obese). The sleep apnea also improves as a result, but weight loss alone is rarely enough to make it go away completely.

Tongue exercises may also help – the technical term for this is myofunctional therapy. It is offered at some speech therapy practices, but it can also be done on your own. You can do special exercises to strengthen the muscles in your tongue. This can prevent that tissue from blocking your airways at night.

There are also a wide range of products such as nasal strips, sprays, and solutions for gargling that are claimed to improve sleep and reduce snoring. It is not clear whether they can provide relief. There is a lack of conclusive scientific research on those kinds of products.

CPAP stands for “continuous positive airway pressure.” It is a very common treatment for obstructive sleep apnea. The therapy involves wearing a breathing mask while sleeping. Depending on the model, the mask covers either both the mouth and nose, or just the nose. Treatment with nasal pillows, where two soft plastic inserts are placed directly inside the nostrils, is also an option.

In CPAP therapy, air is blown into the airways using gentle air pressure while you are sleeping. The air pressure is created by a small pump that is attached to the mask by a tube. This incoming air keeps the upper airways open, significantly decreasing the number of breathing pauses, increasing blood oxygen levels, and improving the quality of sleep. The snoring problems usually stop, too.

• APAP – auto-adjusting PAP: Unlike CPAP, APAP doesn’t produce continuous pressure. The pressure of the air delivered is determined by the machine for each breath and adjusted to the person’s breathing. APAP may be an option for people who don’t respond well to the continuous pressure of the CPAP machine or whose sleep apnea only occurs in certain positions.
• BiPAP – bilevel PAP: BiPAP machines lower the pressure every time you exhale. They are mostly used if people find it difficult to breathe out against the pressure created by CPAP. These machines are also suitable for obstructive lung disease.

Studies have shown that CPAP therapy can relieve the symptoms of sleep apnea. Being less tired during the day can improve your mood and your general quality of life. The different types of CPAP machines are about as effective as each other.

But CPAP therapy can’t cure obstructive sleep apnea – it can only relieve the symptoms. If the treatment is stopped, the symptoms usually come back right away.

The treatment can also help reduce high blood pressure. This can also lower the risk of heart disease or a stroke.

Wearing a mask while sleeping takes some getting used to, and some people find CPAP therapy to be unpleasant and restrictive. It can sometimes lead to a blocked nose or a dry throat. In those cases, the air pressure can be adjusted. A humidifier can be attached to more modern CPAP machines.

Modern CPAP machines are quiet and hardly disturb your sleep. But some people still find wearing a mask at night so uncomfortable that they stop the therapy altogether. Others put on the mask for only a few hours a night and then hardly benefit from the treatment. Doctors recommend using CPAP machines for at least five hours per night.

CPAP therapy is the most effective treatment for severe sleep apnea. So it is worth finding ways to make it easier to use the machine. Research found that surgery led to an infection or a fever, or the need for a blood transfusion, in People tend to use it for longer at night and continue therapy if they have someone to talk to about any problems they encounter during the therapy. These may be doctors or nurses, or other people who have sleep apnea themselves, like members of a support group. It is especially important to be able to ask questions during the first few weeks of using the CPAP machine. Psychological support may also be a good idea.

If you are having practical problems dealing with the machine or if you can’t get used to CPAP therapy, it’s a good idea to seek professional advice. It may be worth trying out a different type of mask. If your airways are too dry, using the humidifier might help.

Sleeping on your back can make snoring and breathing pauses worse because your tongue falls further back into your throat. If sleep apnea only occurs while sleeping on your back, you can try to avoid sleeping on your back at night. Some people, for instance, sew a tennis ball onto the back of their pajamas, place a pillow behind their back, or use a bumper belt that is strapped around their chest and worn like a backpack. There are also active positioning aids like an alarm device that vibrates if you change into an unfavorable position, which can prevent you from turning onto your back. Sometimes even something as simple as raising the position of your head can help to make breathing easier while lying on your back.

Studies show that although certain positioning aids usually aren't as effective as CPAP therapy, they're better than doing nothing. Some people say it helps them to feel more awake during the day – just like CPAP does.

Some people who have sleep apnea wear a plastic mouth guard at night. This pulls their lower jaw forward and keeps it there while they sleep. It can stop their tongue from moving back and blocking their airways.

Mouth guards can be used to treat milder forms of sleep apnea – or as an alternative for people who have trouble using a CPAP machine. Some people find their mouth guard unpleasant, though. It may cause increased flow of saliva, a dry mouth, and feelings of pressure or pain in the jaw joint.

Mouth guards are fitted by dentists or orthodontists. If CPAP treatment is not effective, public health insurance plans in Germany will usually cover the cost of a mouth guard. But it's best to ask about that beforehand. Pre-adjusted mouth guards are also available, but it's a good idea to have mouth guards fitted individually by a medical professional.

There are different types of surgery to permanently improve breathing in people who have sleep apnea. Most procedures tighten or remove tissue in order to widen the airways. The following options are available:

• A special procedure known as uvulopalatopharyngoplasty, or UPPP, is used to tighten the uvula (the small piece of tissue that hangs down at the back of the throat) and remove soft tissue from the palate (roof of the mouth). These tissues narrow the airways in people who have sleep apnea. The tonsils may also be removed or reduced in size during this procedure.
• In a technique called radiofrequency ablation (RFA), a small probe is used to remove tissue from the palate, the nasal cavity or tonsils. This causes scars that pull at the tissue, tightening it.
• The palate tissue can also be tightened using a laser. This method (laser-assisted uvulopalatopharyngoplasty or LAUP) is rarely used nowadays, though, not least because it's so painful.
• A tongue pacemaker can be implanted. This approach is also called hypoglossal stimulation because it involves the hypoglossal nerve, which controls your tongue. The pacemaker consists has two parts that are connected to each other: a stimulation electrode in the lower jaw and a pulse generator placed in the chest, below the collarbone. The pacemaker monitors the action of your breathing and sends electrical signals to the tongue muscle. This helps prevent the tongue from falling back, keeping the airways more open.
• In some people, the lower jaw is shifted backward so far that it impairs breathing. Then the jaw can be moved forward surgically.

Whether a particular operation can help will mainly depend on what's causing the constriction of the airways. But it's still not clear how effective the various procedures are and who benefits most from them. There are only very few and very small-scale studies on this.

Each of the procedures has risks such as bleeding, pain, or trouble swallowing. The likelihood of side effects depends on the type of surgery. Before any surgical procedure, doctors are required to tell you about any side effects you might have.

There are various medications that are claimed to make it easier to breathe at night, for instance by affecting the muscles of the airways or increasing control over breathing. But it's not clear whether they are effective. They are not approved in Germany, and have not yet been part of treatment plans here.

There are approved medications for daytime sleepiness, though. They are intended to improve alertness and reduce excessive daytime sleepiness. These include, among others, the drugs pitolisant and solriamfetol.

Some medications can also be used to treat certain conditions that can make sleep apnea more likely or cause existing sleep apnea to get worse. They include medicines for things like hay fever or a dust mite allergy. There are also medications that help with weight loss.