Treatment of obstructive sleep apnea

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PantherMedia / Graham Oliver

A wide variety of treatments are available for the relief of sleep symptoms. They include machines that support breathing during the night, surgery, and other special aids. therapy, which supports breathing using mild air pressure, is the standard treatment.

People who have obstructive sleep often snore loudly and have long breathing pauses () while they are sleeping. This causes them to frequently wake up at night, makes their sleep less restful, and leaves them worn out and tired during the day. The snoring itself is harmless.

What can you do to reduce sleep apnea?

You can first try to relieve the symptoms by making changes in your lifestyle and sleeping habits. But this won’t necessarily reduce the pauses in breathing. There are different ways to improve your general sleeping habits that will have a positive effect on your sleep. For instance:

  • Avoid stimulants like coffee and tea four to six hours before going to sleep, as well as large meals in the evening, 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 worse.
  • Find a quiet, dark, and most importantly comfortable place to sleep with a pleasant temperature.

Some sleeping pills and sedatives have many side effects when taken over the long term, and can make sleep worse. These mainly include . 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 – 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 have a generally positive effect on the health of people who are very overweight (obese). The sleep also improves as a result, but weight loss alone is rarely enough to make it go away completely. Combining a low-calorie diet with more exercise can help you lose weight.

Sleeping on your back can make snoring and breathing pauses worse because your tongue falls further back into your throat. If sleep only occurs while sleeping on your back, you can try sleeping on your side. 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. Sometimes even something as simple as raising the position of your head can help to make breathing easier while lying on your back.

Sleeping in a different position doesn't usually make a big enough difference on its own. Although it can lower the number of breathing pauses, studies have shown that changing position didn't help people to feel more awake during the day. therapy, in which a breathing mask is worn during the night, is generally more effective.

There is also a wide range of products such as nasal strips, sprays, and solutions for gargling that are claimed to improve sleep and reduce snoring. But it's not clear whether they help because there’s a lack of conclusive scientific research in this area.

How can assisted nighttime breathing (CPAP) help?

therapy is the most common treatment for obstructive sleep – and is regarded as the standard treatment. stands for “continuous positive airway pressure.” 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.

Illustration: Obstructive sleep apnea – as described in the article
Illustration: CPAP therapy – as described in the article

In therapy, air is blown into the airways using mild air pressure while you are sleeping. The air pressure is created by a small pump which 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.

Special types of CPAP:

  • APAP – auto-CPAP: Unlike , 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 machine or whose sleep only occurs in certain positions.
  • BiPAP – bi-level PAP: BiPAP machines lower the pressure every time you exhale. They are mostly used if it’s difficult to breathe out against the pressure created by . These machines are also suitable for obstructive lung disease.

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

But therapy can’t cure obstructive sleep – 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. It's not clear whether therapy also lowers the risk of heart disease or stroke.

Using the CPAP machine

Wearing a mask while sleeping takes some getting used to, and some people find 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 machines.

Modern 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 machines for at least five hours per night.

therapy is the most effective treatment for sleep . So it may be worth finding ways to make it easier to use the machine. Studies show that some people tend to use it for longer at night and continue therapy if they always have someone to talk to about any problems they encounter during the therapy. They could talk to their doctor, caregivers or other people who have sleep . It is especially important to be able to ask questions during the first few weeks of using the machine. Psychological support may also be a good idea.

If you are having practical problems dealing with the machine or if you just can’t get used to 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 a humidifier might help.

When are mouth guards considered?

Some people who have sleep 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 – or as an alternative for people who have trouble using a machine. Some people find wearing a mouth guard at night 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 and orthodontists. In Germany, the costs are usually not covered by health insurance companies. Pre-adjusted mouth guards are also available, but it's a good idea to have a dentist fit them individually.

What can be expected from surgery?

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

  • 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 . The tonsils may also be removed or reduced in size during this procedure.
  • In a technique known as 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.
  • In some people, the lower jaw is shifted backward so far that it impairs breathing. In this case 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.

Can medication help?

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. Because no drug has yet been proven to help reduce sleep , medication isn't currently used as part of treatment.

But it may be used to treat certain conditions that can make sleep more likely or cause existing sleep to get worse. These medical conditions include things like hay fever or a dust mite allergy.

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IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on January 3, 2019
Next planned update: 2021

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Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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