Treating Sleep Apnea

Finding out you have sleep apnea can feel like a big deal - maybe even a little scary. But getting a diagnosis is the first step toward better sleep and health. Now that you know what’s going on, you can take action to treat it and start feeling like yourself again.

Whether your symptoms are mild or severe, there are plenty of effective treatment options to help you breathe easier and sleep more soundly. 

Lifestyle changes

Simple changes to your daily habits may help improve your symptoms and complement other treatments. Lifestyle changes may often be the first step to treating sleep apnea. 

Your provider may recommend you:

• Lose weight: Extra weight, especially around the neck, can put pressure on the airway and make it harder to breathe while sleeping. In some cases, losing weight can reduce and even stop sleep apnea.
• Change your sleeping position: Sleeping on your back can worsen sleep apnea. This causes your tongue and soft tissues to block your airway. Switching to your side can help keep your airway open. Special pillows, wearable devices or even tennis balls sewn into the back of your pajamas can prevent you from rolling onto your back.
• Avoid alcohol or sedatives: These substances relax the muscles in your throat, which can make airway blockages more likely. 
• Quit smoking: If you stop smoking, it may reduce your symptoms. Smoking can irritate and inflame the airways, making sleep apnea worse. 
• Use a humidifier: Dry air can irritate your throat and nasal passages, making breathing harder. A humidifier adds moisture to the air and may ease breathing while you sleep.

Continuous positive airway pressure (CPAP)

A CPAP machine is the gold standard for treating obstructive sleep apnea (OSA). OSA happens when the muscles in the back of the throat relax too much while sleeping. This causes the airway to narrow or close, leading to pauses in your breathing.

CPAP machines push a steady stream of air through a mask you wear over your nose or mouth. The constant air pressure keeps your airway open, improving your breathing, reducing snoring and improving your sleep. 

BiPAP, APAP and ASV machines

If CPAP therapy doesn’t work for you, your health care provider may suggest alternative machines:

• Bilevel positive airway pressure (BiPAP or BPAP): This device provides two different air pressure levels: one for inhaling (breathing in) and a lower one for exhaling (breathing out). BiPAP machines are often used for people with central sleep apnea (CSA) or those who find CPAP uncomfortable. CSA happens when your brain doesn’t signal to the muscles that control your breathing. This can cause your breathing to stop.
• Auto-adjusting positive airway pressure (APAP): This device automatically adjusts the air pressure throughout the night based on a breath-by-breath basis. APAP machines are often used for people with OSA, especially those who need variable pressure. Many people find APAP more comfortable than CPAP because the machine only delivers as much pressure as needed. 
• Adaptive servo-ventilation (ASV): This device is a more advanced type of therapy used to treat CSA or complex sleep apnea, a mix of OSA and CSA. Unlike CPAP and BiPAP machines, ASV continuously monitors your breathing patterns in real time and adjusts both the air pressure and the volume of air it delivers. Some people find ASV machines more comfortable because they’re responsive to subtle changes in breathing. But they can take time to adjust to.

Setting up mask therapy takes time and you may need to work with the company supplying your equipment to ensure you have the right equipment to be effective and comfortable. Your doctor may also need to work with your insurance company if devices other than CPAP are being considered.

Thus, follow up is very important. For mask therapy your response to therapy will be monitored and changes can be made if necessary. This monitoring can usually be done remotely while you are using your CPAP machine and can be downloaded at your appointment. 

Oral appliances

Oral appliances (also known as mandibular advancement devices [MADs]) are custom-fit mouthpieces, like mouthguards or retainers. Some are designed to bring your jaw forward to open your airway. Others hold your tongue in place. 

Medications

Medications can’t cure sleep apnea but they may help relieve symptoms. They are rarely used as the sole treatment and are usually used alongside other therapies.

• Nasal congestion: Over-the-counter (OTC) nasal decongestants like Afrin (oxymetazoline) and Sudafed (pseudoephedrine) can help open up nasal passages, making it easier to breathe through your nose while you sleep. However, to avoid rebound congestion, these should only be used in the short term (no more than three days).
• Daytime sleepiness: Stimulate medications like Provigil (modafinil) and Nuvigil (armodafinil) can help reduce daytime sleepiness. These medicines improve alertness but don’t treat sleep apnea. 
• Obesity: Studies show that Zepbound (tirzepatide) improves OSA by reducing body weight. The FDA approved this drug to treat moderate-to-severe OSA in adults with obesity.

Weight loss surgery

For people with obesity-related sleep apnea, weight loss surgery or bariatric surgery may be an option. This procedure helps reduce weight, which can improve or even resolve sleep apnea symptoms. However, weight loss surgery is typically recommended for people who are unable to lose weight through diet and exercise and have other health risks related to obesity.

Surgical options

When other treatments don’t work, your health care provider may talk to you about surgery for sleep apnea. Surgery is usually a last resort when CPAP, oral appliances and/or lifestyle changes haven’t helped enough. The type of surgery depends on what’s causing your sleep apnea, such as a blocked airway, a small jaw or a large tongue.

Here are some surgical procedures that may help with sleep apnea:

• Nasal surgery: If a blocked nose makes breathing hard while sleeping, your provider may suggest fixing a deviated septum (when cartilage in the nose is crooked) or reducing swollen tissues in the nose. 
• Tongue-related surgery: People with large tongues can have them fall back into the throat while sleeping, blocking airflow. Tongue reduction surgery can remove extra tissue from the tongue, or a tongue suspension procedure can help keep it from blocking the airway.
• Jaw surgery: If the shape of your jaw is causing sleep apnea, your doctor may suggest maxillomandibular advancement (MMA) surgery. This moves the upper and lower jaw forward to make more space in the airway, improving breathing.
• Tissue removal surgery: Sometimes, extra tissue in the throat, soft palate or tonsils can block the airway. Uvulopalatopharyngoplasty (UPPP) removes tissue from the soft palate and throat to open the airway. Tonsillectomy (removal of the tonsils) may also help if large tonsils are the cause.
• Nerve stimulation: For some people, a device called a hypoglossal nerve stimulator can help keep the airway open. This implant sends small electrical signals to the nerve that controls the tongue, preventing it from blocking the throat while sleeping. One example of this treatment is the Inspire® device.

For those who undergo surgery both surgical and sleep study follow up will be needed. 

Talk to your provider or a Banner Health specialist about whether surgery is the right option for you.

Still have questions?

Learn about your treatment options or schedule a consultation with a Banner Health sleep specialist to start improving your sleep quality today.