Sleep Apnea

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Obstructive sleep apnea can be classified as mild, moderate, or severe, depending on how often the patient stops breathing during the night. With certain patients, mild sleep apnea may be managed without surgery or medical equipment. See the Managing section for more.

For moderate or severe sleep apnea, other treatment options are available. The most common and most effective is continuous positive airway pressure, or CPAP, a mask attached to a machine that blows air lightly to keep the airways open. Dental devices and surgery are also options for some people with obstructive sleep apnea.

This section contains more information on:

  • Continuous positive airway pressure (CPAP)
  • Bilevel positive airway pressure (BPAP)
  • Dental devices
  • Surgery
  • Treatment for central sleep apnea
  • There are no medications for treating sleep apnea. However, your doctor may prescribe modafinil, a medication that can help with daytime sleepiness, if you continue to have significant sleepiness despite appropriate therapy of your sleep apnea.

    CPAP

    If you are found to have obstructive sleep apnea, your doctor may prescribe CPAP (pronounced "SEE-pap"). CPAP is short for continuous positive airway pressure. This common and effective treatment provides pressure to the person's airway through a machine that blows air. The airflow from the CPAP machine is delivered through a mask that fits on the face and covers both the nose and mouth or just the nose. The compressed air flows into the airway and acts as a splint or a support to hold back the tongue, open the soft tissue that was obstructing the throat, and keep the airway open during sleep. This allows breathing to become more regular. Snoring stops and restful sleep is restored. Risk factors associated with untreated sleep apnea are greatly reduced when CPAP is used as prescribed by the doctor. In addition, the patient's quality of life often improves as the person is less tired and may have more energy.

    A DME (durable medical equipment) company will provide the CPAP equipment prescribed by your doctor. The insurance company involved may have an agreement with a specific company to provide this service to you. The DME provider should help you pick out a CPAP machine and mask. The provider should show you how to use and properly care for the equipment and also answer any questions you may have.

    It is important to make CPAP a part of your everyday life. It should be used at night for sleep, as well as for planned naps. The treatment works only if it is used daily.

    Getting used to the CPAP machine is different for each person. Some people may put the CPAP mask on the first night and wear it all night with great results. Others may struggle from the start, finding the system disruptive and uncomfortable. Most people fall in between these two extremes. CPAP users normally need a period of adjustment. Remember, CPAP can improve your quality of sleep and life, but it requires cooperation on your part. It is important not to get discouraged. It can take several weeks for some people to get used to using CPAP all night long. It may help to try to get used to the mask alone while awake, then later trying to sleep through the night with it connected to the machine.

    Side effects of CPAP may include headaches, dry or stuffy nose, sore eyes, or bloating of the stomach. You can work with your healthcare provider to alleviate these problems. For example, you may be able to get a better-fitting mask, or use a nasal spray to relieve a dry nose. If you have problems using CPAP, make sure to ask for help so you can get used to using your CPAP or can try another treatment. Contact your DME provider concerning problems with equipment or comfort. Contact your doctor for medical problems.

    The CPAP machine is portable. It will work with electricity (either 110 or 220 current), with an adapter for a car cigarette lighter, or with a 12-volt deep cycle marine battery. When flying, take CPAP as carry-on luggage only. Travel bags are available through the DME provider. CPAP can go anywhere.

    Your doctor may prescribe oxygen to be used with the CPAP equipment. The oxygen is added to the system with a special adaptor. If you will be traveling away from home, contact your DME provider. The DME provider can arrange for oxygen while you travel.

    BPAP

    Most patients with sleep apnea can be successfully treated with CPAP. In some cases, your doctor may prescribe BPAP instead of CPAP for obstructive sleep apnea. BPAP (pronounced "B-PAP") or BiPAP is short for bilevel positive airway pressure. The function of the BPAP machine is the same as CPAP; however, it provides two different levels of pressure. The machine provides a higher pressure when you are breathing in and a lower pressure when you are breathing out. This mimics normal breathing and may be more comfortable for some people.

    Dental devices

    Dental devices are designed to open the airway so that patients can breathe more easily at night. While dental devices are not as effective as CPAP, they are often easier to use, and patients who have given up on CPAP may wish to try dental devices. The American Academy of Sleep Medicine's guidelines on obstructive sleep apnea say that patients with mild to moderate sleep apnea can try an oral appliance first if they do not want to try CPAP. Dozens of dental devices are available to treat obstructive sleep apnea, but most fall into one of two types. Some are FDA-approved to treat snoring only, and some are approved to treat obstructive sleep apnea as well.

    The type of dental device most commonly used for obstructive sleep apnea is called a mandibular advancement device (MAD). The device looks similar to the mouth guards that athletes wear. It moves the lower jaw slightly down and forward, which may help hold the airway open. Worn at night, the device widens the throat and increases the size of the airway.

    Another kind of dental device is a tongue-retaining device or splint, which holds the tongue in a position that lets the airway remain open.

    Dental devices should be fitted by dentists. It may take several weeks to get used to the device, but most people find them comfortable for sleeping.

    A dental device may cause pain at the temporomandibular joint, where your jaw attaches to your skull, and can damage your teeth, gums, or jaw; be sure to follow up with your dentist, who can look for any side effects.

    Surgery

    For some people, surgery may help improve sleep apnea, depending on the cause. The main objective of surgery is to increase the size of the upper airway, to make breathing easier. A deviated nasal septum can be fixed, or enlarged adenoids or tonsils can be removed. Removal of adenoids and tonsils is the most common treatment for children with sleep apnea.

    More extensive surgery can also be performed, e.g., remodeling the air passages in the throat by removing the uvula, tonsils, and part of the soft palate (uvulopalatopharyngoplasty). This surgery appears to be more effective at treating loud snoring than improving sleep apnea. However, it can help some people.

    If no other treatment works, another surgical option is making an opening in the throat to bypass the upper airway (tracheostomy). Air passes through a tube inserted in the opening and into the lungs. When this operation is performed for sleep apnea, the patient keeps the tube covered during the day and opens it at night so air can flow freely during sleep.

    Other possible surgeries include jaw remodeling or surgery for obesity, such as gastric bypass surgery.

    Your doctor will help you decide if surgery is an option for you.

    Central sleep apnea

    Since many people with central sleep apnea have other medical conditions such as congestive heart failure, or stroke, treating those conditions may resolve the central sleep apnea, too.

    Continuous positive airway pressure, or CPAP, may also help people with central sleep apnea. Some people with central sleep apnea may also try bilevel positive pressure (BPAP or BiPAP).

    Supplemental oxygen is sometimes given for central sleep apnea.

    Drugs occasionally given for central sleep apnea include acetazolamide and theophylline. Acetazolamide is normally prescribed for epilepsy, glaucoma, and altitude sickness, but some studies have found that it decreases the apnea episodes in central sleep apnea if taken at bedtime. Theophylline is a bronchodilator normally prescribed for asthma, emphysema, and other lung diseases. For both of these drugs, the evidence is weak that they help people with central sleep apnea, but some doctors may prescribe them.

    Last reviewed on 09/20/2006

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