Treatment for sleep apnea depends on the severity of the problem. Given the data on the long-term complications of sleep apnea, it is important for patients to treat the problem as they would any chronic disease. Simply trying to treat snoring will not treat sleep apnea. Because of its association with heart problems and stroke, sleep apnea that does not respond to lifestyle measures should be treated by a doctor, ideally a sleep disorders specialist.
At this time, the most effective treatments for sleep apnea are devices that deliver slightly pressurized air to keep the throat open during the night. There are a number of such devices available.
The best treatment for symptomatic obstructive sleep apnea is a system known as continuous positive airflow pressure (CPAP), sometimes referred to as nasal continuous positive airflow pressure (nCPAP). It is safe and effective in sleep apnea patients of all ages, including children.
CPAP may not recommended for patients who have mild-sleep apnea as identified in sleep studies but who do not have daytime sleepiness, as they generally report little or no benefit from this treatment. Those with more moderate sleep apnea are more likely to receive a trial of CPAP, but not always. When severe sleep apnea is present, most patients will receive CPAP. Overall, CPAP is considered first-line treatment for mild-to-moderate, or severe obstructive sleep apnea.
CPAP works in the following way:
Effects on Sleep and Wakefulness. CPAP improves both objective and subjective measures of sleep. After using CPAP regularly many patients report the following benefits:
If patients comply with the CPAP regimen but do not feel less sleepy after a period of time, or their sleep apnea symptoms do not improve, the airflow pressure may not be high enough. Patients may need to be retested. Likewise, if patients have started using an oral appliance or had a surgical procedure, their doctor probably needs to reevaluate them.
CPAP works well for both adults and children, but many patients have problems getting used to the device. Unfortunately, CPAP devices are often cumbersome, which can lead to patients becoming discouraged and stopping treatment. All patients should be warned that the first few nights of CPAP therapy are unnerving. The mask may cause some patients to feel anxious. Starting out with low pressure to get used to the mask may help. Patients may actually sleep less, or have different sleep quality, at the start of treatment.
Nearly all patients complain of at least one side effect. Nearly half of complaints are related to the mask. Many of these problems can be minimized with a well-chosen mask that is comfortable and reduces leakage as much as possible. Thorough education and ongoing support are essential for successful treatment with CPAP.
Common complaints include:
Studies have reported that long-term compliance with CPAP systems is low, with about one-third of patients giving up the treatment. Compliance may be improving, however, due to better technologies and better education. Factors that may help include:
Not surprisingly, patients whose symptoms are noticeably relieved by the procedure early on are more likely to continue the therapy.
Because many patients find CPAP uncomfortable and difficult, they tend not to use it for the duration of the entire night. However, while some patients‚ ' daytime sleepiness may improve after 4 - 6 hours of CPAP use each night, maximum benefits in quality of life require at least 7.5 hours of nightly CPAP use. It appears that longer nightly duration of CPAP use is best for achieving normal daytime functioning.
Bilevel Positive Airway Pressure. Bilevel positive airway pressure (BPAP) systems may be particularly helpful for patients with coexisting lung disease and those with excessive levels of carbon dioxide. These devices have a sensing feature that helps determine and vary the appropriate pressure depending on whether a person is breathing in or out. Greater pressure is needed on inhalation and less on exhalation. These machines are more expensive than the CPAP and may not be covered by insurance.
Autotitrating Positive Airway Pressure Devices. Traditional CPAP devices provide a set pressure based on findings from polysomnography. This pressure does not fluctuate during the night or between nights unless it is reset. Autotitrating positive airway pressure (APAP) devices are also available. These devices automatically customize air pressure for the individual patient. For some patients, APAP devices can be used to begin therapy at home without any supervision.
Patients with chronic lung disease, heart failure, obesity hypoventilation syndrome, who do not snore, or who have central sleep apnea syndrome are not considered candidates for APAP.
APAP devices usually use one of three methods:
APAP devices are more expensive than CPAP devices. However, APAP devices may improve compliance, particularly in patients who have needed high CPAP use. They may be especially helpful for patients who require varying levels of pressure due to other conditions, such as seasonal allergies. They may also be useful as home diagnostic tools for sleep apnea.
In general, drugs have not been very beneficial except for specific situations. Medications that treat accompanying disorders associated with sleep apnea may be helpful. The following drugs may be helpful for certain patients:
Note on Sedatives. Sedatives, narcotics, and anti-anxiety drugs can actually worsen the breathing disturbances and arousal conditions that occur with sleep apnea. These substances cause the soft tissues in the throat to sag and diminish the body's ability to inhale. Apnea sufferers should never use sleeping pills or tranquilizers. Apnea patients undergoing surgery should be sure that their surgeons, anesthesiologists, and other doctors are aware of their sleeping disorder in considering sedatives, anesthetics, and medications taken to relieve pain due to surgery.
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