APNEA-SNORING.COM 

THE WEBSITE OF ALLEN J. MOSES,DDS

SEARS TOWER - CHICAGO

MEDICAL TREATMENT OF OBSTRUCTIVE SLEEP APNEA

Obstructive sleep apnea and snoring pose difficult and complex issues to healthcare clinicians.  No single regimen currently in use is successful on all patients. Each treatment modality has its successes and its not so successful results. OSA, if untreated will not get better and it will get worse. The life threatening morbidity of obstructive sleep disorders means the one alternative that is not acceptable is ignoring the problem.  There are three recognized treatment modalities in the domain of medical practice 1) continuous positive airway pressure, 2) surgery and 3) lifestyle changes.  In the domain of dentistry there is another modality that is safe, painless, noninvasive and rapidly gaining in popularity – oral appliances.  They will be discussed on another webpage.

Continuous Positive Airway Pressure (CPAP) is the most common long term treatment recommended for obstructive sleep apnea, hypopnea, upper airway resistance syndrome, snoring and even central apnea. The patient wears a mask over their nose, or nose and mouth during sleep. The CPAP machine blows air via a tube through the mask, and the pressure is adjusted to a level sufficient to prevent the airway from collapsing during sleep. Polysomnography is used to set the appropriate CPAP level during a night's sleep at the sleep lab. The advantage of CPAP is that it almost always works, its cost is reasonable and it is easily titrated. One of the few contraindications is a patient with complete nasal blockade. Among its disadvantages are that patient compliance is low. It is difficult to travel with CPAP, it seems to be a deterrent to sex life, the mask is often uncomfortable, The masks can develop air leaks, skin can become irritated from the mask, excessive morning dry mouth is possible, some complain of abdominal bloat and noise of the pump is obtrusive.

 

 

Different Models of CPAP Mask

 

 

Lifestyle Changes should not be overlooked as an important part of a comprehensive program to treat OSA. Positive lifestyle changes do work, but based on the human psyche, they are difficult to maintain and keep. They require a strong lifetime commitment. They should be utilized, but in perspective to each patient. They usually are most effective as augmentation to other physical regimens.

  • No alcohol - alcohol relaxes the muscles of the upper airway during sleep
  • No sedatives - sedatives also relax the muscles of the upper airway during sleep, thus facilitating airway collapse
  • Eliminate the source of nasal congestion - irritants and allergens can stimulate an allergic reaction, swelling nasal membranes and blocking nasal airflow
  • No smoking - smoking causes inflammations and swelling of the upper airway which restricts airflow.
  • Regulate sleep hours - the body regulated by a circadian rhythm cycle, a natural internal body clock; there are patterns of brain wave activity and hormone regulation and regeneration that depend on cues given by the biological clock; upsetting these rhythms can disrupt normal biological function and distress the entire system
  • Weight loss - excessive weight causes deposition of fat in the pharyngeal tissue, adding to a narrower airway passage and increased chance of collapse
  • Sleep on the side - in some patients the apnea or snoring only occurs when they sleep on their back; there are some physical devices of the market to help but retraining sleep position to the side is of major importance

Surgery is a widely utilized treatment regimen for OSA, hypopnea, UARS and snoring. The goal of surgery is to prevent the airway from collapsing during sleep. The many different surgical procedures are directed at increasing airway size and stiffness, eliminate excess tissue in the airway, and correcting jaw deformities that predispose or contribute to compromised airway function.

The key to success is to correctly identify before surgery, the tissue that is causing the airway collapse so the correct procedure can be performed. At this point in the state of the science surgery by most estimates is successful at eliminating OSA 40 - 50% of the time. More than one procedure is often tried before the patient perceives any benefit.

There is debate in the medical literature whether OSA is an anatomic problem or not. Some academics argue that upper airway obstructers are not essential to have apnea. Their position is that apnea is based on a reduced neural compensation by the brain that initially lowers the muscle activity before the actual airway collapse. To strengthen their case they point out that all people with narrow airways and large tonsils get apnea. They believe that is why surgery is not more successful. The focus of their research is directed at optimizing neural drive to the muscles that maintain airway patency during sleep. "Keep the airway awake and let the brain sleep" is their operative goal.

Certainly apnea and snoring are difficult and complex problems. No regimen currently in use is successful on all patients. Each treatment modality has its successes and its not so successful results. OSA, if untreated will not get better and it will get worse. The life threatening morbidity of obstructive sleep disorders means the one alternative that is not acceptable is ignoring the problem.

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