lung and airway disorders
Sleep Apnea
Treatment of Sleep Apnea
Control of risk factors Continuous positive airway pressure or mouth guards or other devices fitted by a dentist Possibly airway surgery or electrical stimulation of the upper airway Treatment is directed at both risk factors and sleep apnea itself. People should be warned of the risks of driving, operating heavy machinery, or engaging in other activities during which falling asleep would be hazardous. People who are undergoing surgery should inform their anesthesiologist that they have sleep apnea, because anesthesia can sometimes cause additional airway narrowing. Support groups can provide information and help people with sleep apnea and their family members cope with the condition. If people are prescribed treatment and they follow that treatment, the prognosis is usually excellent. Life span is not affected, and most serious complications can be prevented. Blood pressure usually drops a few points. Losing weight, quitting smoking, and not using alcohol excessively can help. Nasal infections and allergies should be treated. Hypothyroidism and acromegaly should be treated. Weight loss is helpful but can be very difficult, particularly for people who are sleepy and fatigued. Thus, weight-loss (bariatric) surgery is often recommended for people who are very overweight (have severe obesity). In such people, bariatric surgery reduces sleep apnea and reverses symptoms in about 85% of people. Heavy snorers and people who often choke in their sleep should not consume alcohol or take sleep aids, sedating antihistamines, or other medications that cause drowsiness. Sleeping on the side or elevating the head of the bed can help reduce snoring. Special devices strapped on the back help prevent people from sleeping on their back. The various other devices and sprays marketed to reduce snoring may help simple snoring, but they have not been shown to relieve obstructive sleep apnea. There are several surgical procedures marketed for snoring as well, but there is little proof of how well they work and how long they are effective. Continuous positive airway pressure(CPAP) is the main treatment for people with obstructive sleep apnea, particularly those who have excessive daytime sleepiness. With CPAP, people breathe through a face or nose mask connected to a device that provides a slightly higher pressure in the airway. This increased pressure props the throat open as the person breathes in. CPAP can be given with or without humidifying the delivered air. Close follow-up by a health care practitioner is needed during the first 2 weeks of use to ensure proper mask fit and provide appropriate encouragement as the person learns to sleep with the mask. If a person has a deviated nasal septum, doctors may recommend surgery to repair the deviated septum (septoplasty) because repair may make CPAP treatment more successful. However, many people find CPAP hard to tolerate and so they stop using it or use it only sometimes. If doctors and technicians help people find a device that fits them properly and encourage them, people are more likely to have long-term success with CPAP. Some people who use CPAP still have excessive daytime sleepiness. These people may benefit from taking a mild stimulant used to treat daytime sleepiness in people with obstructive sleep apnea (for example,modafinilorsolriamfetol). Other medications are also being tested for people with obstructive sleep apnea. Removable oral appliances,fitted by dentists, can help relieve obstructive sleep apnea (and snoring) in people with mild to moderate sleep apnea. These appliances, which are worn only while sleeping, help keep the airway open. Most appliances consist of two pieces of plastic molded to the shape of the upper and lower teeth. The two pieces link together and are designed to pull the lower jaw forward so the tongue cannot move backward to block the throat. Because snoring is common and troubles some and because CPAP use can be difficult, some alternative devices that have not been thoroughly studied are marketed and sold directly to consumers. Prior to starting any treatment plan, people should discuss their treatment options with a health care provider. is a procedure in which an implanted electrical device is used to stimulate one of the Overview of the Cranial Nerves that controls the tongue (the hypoglossal nerve). Stimulating this nerve activates muscles that push the tongue forward and help keep the airway open. This therapy can be successful in some people with moderate to severe obstructive sleep apnea who are unable to tolerate CPAP therapy. Surgeryof the head or neck as a treatment for sleep apnea is useful if there are enlarged tonsils or an obvious blockage of the upper airway by another structure. In children, surgery to remove the tonsils and adenoids is the most common treatment (called adenoidectomy). This type of surgery usually relieves sleep apnea, particularly if the tonsils or adenoids are enlarged. Surgery is sometimes used in people without obvious blockage if no other treatments have worked. Uvulopalatopharyngoplasty is a surgical procedure that opens the upper airway by removing some tissue from the upper airways (for example, from the palate, uvula, tonsils, and adenoids). It is most often helpful in people who have mild sleep apnea. However, this procedure has been largely replaced by less aggressive approaches that, for example, attempt to stabilize the walls of the pharynx (the cavity behind the nose and mouth). Other surgical procedures are sometimes used, but they have not been studied as thoroughly for predictability and durability. Tracheostomy(making a permanent opening in the windpipe to insert a breathing tube) is the most effective treatment for obstructive sleep apnea. However, tracheostomy is done only as a last resort for people with the worst disease who have not responded to other treatments. In people with central sleep apnea, the underlying disorder is treated if possible. For example, medications may be given to reduce the severity of Heart Failure (HF) . People also are advised to avoid or reduce alcohol and any drugs that worsen the sleep apnea. Oxygen delivered by nasal prongs (not under pressure) may reduce episodes of apnea in people whose levels of blood oxygen become low while sleeping. Some people with central sleep apnea may benefit from low levels of CPAP. People with central apnea of the Cheyne-Stokes type have fewer episodes of apnea and better heart function with this treatment but do not survive longer. People who have central sleep apnea caused by high altitude, and some who have heart failure, may benefit from the drugacetazolamide. Some people benefit from a procedure to implant a device that stimulates the nerves controlling the diaphragm (a diaphragmatic/phrenic nerve stimulator) to help the person breathe. 