What is sleep apnea?

While we sleep (often during a night’s sleep), relaxation of the pharynx muscles usually makes the airway narrow. If this narrowing is not significant, it does not pose a health threat. The highest normal scenario, in this case, can be uniform snoring – a consequence of the vibration of relaxed muscles under the influence of the airflow. However, if the airways are completely blocked, an obstacle arises in the air path, and the sleeping person stops breathing for a while. These stops and breaks in breathing are called apnea episodes.

The sections that follow include an introduction to the different important aspects of obstructive sleep apnea treatment. Obstructive sleep apnea treatment often entails several components and is personalized for the needs of different individual patients. In this article, we will take an analytical look at each of these treatment options and their comparative advantage and disadvantages.

Sleep Apnea treatment options

Positive Airway Pressure Devices (PAP)

Positive airway pressure devices (PAP) are among the most used treatment methods for mild to extreme sleep apneas. They are also usually used in combination with different types of breathing masks.

The mask, which is worn during sleep comfortably over the nose or occasionally over the nose and mouth, provides constant pressurized air that flows into the patient’s throat. This high air pressure ultimately prevents the collapse of the patient’s airway. Pressurized air is delivered through one of the popular airway pressure devices via a flexible tube. The most commonly used machines are Continuous Positive Airway Pressure (CPAP), Variable Positive Airway Pressure (VPAP), Bilevel Positive Airway Pressure (BiPAP), etc. Studies have been done to determine the impact of PAP therapy. It indicated that people with sleep apnea who use their devices regularly feel better and experience fewer signs of the condition due to the reduction in apnea and hypopnea episodes during sleep.

Pros of Positive airway devices

1. The serious effects of obstructive sleep apnea may be avoided or reversed by CPAP. This medication will help avoid those severe health risks;
2. Heart disease
3. Stroke
4. Diabetes: PAP helps improve the sensitivity of insulin.
5. PAP Reduce day time sleepiness, which helps improve the ability to concentrate, think, and make decisions.
6. The risk of developing depression is increased by untreated sleep apnea. PAP can boost the mood, decrease the risk of depression, and increase an individual’s quality of life.

The disadvantage of Positive airway devices

1. PAP must be used every single night
2. Dryness in the nose and throat
3. Mask inconvenience

Neuro-stimulation Therapy

Some individuals with obstructive sleep apnea, despite their best efforts, are unable to use continuous positive airway pressure (CPAP) therapy. For certain people with mild to serious OSA, there are new, clinically tested therapies now.

1. Hypoglossal Neuro-stimulation (For Obstructive Sleep Apnea): This therapy has been developed to treat patients with mild to extreme OSA who are unable or reluctant to undergo therapy using CPAP. Implant therapy has been designed primarily to provide muscle tone to the tongue’s key muscles, regulate upper airway flow efficiently, and minimize or eradicate sleep apnea substantially.
2. Neuro-stimulation therapy (for Central Sleep Apnea): To transmit signals to the large muscle that regulates breathing (the diaphragm), implantable systems stimulate a nerve in the chest (phrenic nerve). These signals activate breathing in the same way the neural pathways stimulate breathing. A cardiologist places the implant during a minimally invasive outpatient surgery. The implants are battery-powered systems mounted with two small thin wires under the skin in the upper chest region.

One is meant to do the stimulation, which is the intended therapy. The other is meant to sense the presence/absence of breathing (also called stimulation and sensing lead)

Advantages of neurostimulation therapy

Studies published in major scientific journals found that a significant change or resolution of sleep apnea was achieved by 2 out of 3 patients who obtained the Upper Airway Stimulation system. Significant changes in sleepiness and other impacts on everyday tasks have been made. In addition, there was no or soft snoring for 85 percent of patients. This means that the upper airway stimulation is usually effective for the treatment of mild or severe sleep apnea.

Disadvantages of neurostimulation therapy

This therapy is associated with risk just like other procedures;

1. Bleeding: Bleeding can sometimes be life-threatening and serious. However, this is relatively uncommon with the procedure.
2. Infection
3. Trouble swallowing due to the weakness of the tongue
4. Tingling sensation in the tongue or numbness.

Surgery

In the past, surgery was often the primary treatment for sleep apnea, but surgery is now less common. To expand the airways, the pharynx and soft palate’s soft tissues are surgically removed, the purpose of which is to eliminate obvious anatomical defects of the ENT organs, increase the lumen of the upper respiratory tract, and the rigidity of the soft tissues of the pharynx. However, this option is recommended only in the most extreme cases. Surgery is also a possible choice when significantly enlarged tonsils are the cause of breathing difficulties.

In order for the surgical treatment of sleep apnea to have a positive effect, it is very important to have a thorough preliminary examination with the determination of the number of disorders and their severity as well as predicting the consequences.

The most commonly used surgical procedure for the treatment of sleep apnea are;

1. Uvulopalatopharyngoplasty (UPPP): This surgery removes soft tissue from the back of the throat and palate, thereby causing the airway to be wider at the opening of the throat.  
2. Nasal surgery: This surgery is aimed at fixing nasal problems, e.g., deviated nasal septum.
3. Mandibular – maxillomandibular advancement surgery: This addresses any facial issues or blockages of the throat that play a role in sleep apnea.

Advantage of sleep apnea surgery

1. It is often an alternate option in cases where a patient couldn’t tolerate CPAP.
2. If the surgeon really understands the procedure and locates the origin of obstruction, surgery usually proves very effective for treating sleep apnea.

Disadvantages of sleep apnea surgery

1. It is more effective in treating snoring than treating obstructive sleep apnea. Thus the surgery may stop snoring while the sleep apnea may still persist.
2. A patient may still likely need CPAP after surgery.

Nasal Decongestant

In cases of snoring or mild sleep apnea, nasal decongestants are more likely to be successful. Surgery is an efficient means of enhancing airflow through the nose in some situations.

Improving the nasal tract’s patency through the use of decongestant may boost sleep quality, AHI, and the level of oxygen saturation during sleep.

Examples of over the counter nasal decongestant are Allegra (pill), Claritin (pill), and Zyrtec (pill). Other prescriptions are Astelin (spray), Beconase (Spray), Dymista (Spray), Nasonex (Spray), etc.

Advantage of Nasal decongestant

Nasal congestant are often more effective for apneas caused by the congestion of the nasal airway either due to allergies or other seasonal reasons. They are quick and can give short term solution to sleep apnea that is related to snoring.

Disadvantages of Nasal Decongestant

1. It is more effective in the treatment of snoring than in the treatment of sleep apnea.
2. In some cases, it doesn’t provide a permanent and long-lasting treatment for sleep apnea.

Weight Loss

Obesity and excess weight are one of the motivating factors of Obstructive sleep apnea (OSA)  about 70 % of people with OSA are overweight or obese. They are generally encouraged by their health care providers to lose weight. The degree of fat deposit in the back of the throat and tongue can determine how easily airflow through the airway. Weight loss can help reduce this as well as any abnormal girth that affects the capacity of the lung.

Surprisingly, few systematic studies have been performed about how successful weight loss leads to less snoring and decreased cases of sleep apnea and hypopnea. Nevertheless, practitioners’ personal observation has been the report of significant changes in both snoring and OSA in patients who had undergone weight loss.

Therefore, weight loss in combination with sleep apnea therapy is one of the steps to reduce the symptoms and severity of OSA and improve breathing parameters.

Advantages of weight loss for combating sleep apnea

1. Weight loss can help cut down on OSA and other related symptoms and also improve cardiovascular health and overall quality of life.
2. Loss of about 10 – 15 Percent of body weight can lead to a 50% reduction in OSA severity.

Disadvantages of weight loss for combating sleep apnea

1. Weight loss alone is usually not sufficient to eradicate the symptoms of sleep apnea. It often as to be used in combination with some other sleep apnea therapy.
2. Weight loss is sometimes considered a potential cure (or home remedy) for Obstructive sleep apnea.

Oral Appliances (Dental Appliances)

Oral sleep apnea treatment appliances continue to rise in popularity as public understanding increases that oral appliances are an important first-line treatment for many patients suffering from sleep apnea.

These products, much like a sports mouthguard or an orthodontic brace, are worn in the mouth when you sleep. These dental devices help to hold the lower jaw forward to keep the airway open and deter the tongue and muscles in the upper respiratory tract from weakening and blocking the airway. The two common device category are;

• Mandibular advancement devices (MADs)
• Tongue retaining devices (TRDs)

Dental appliances are often recommended for patients that have severe OSA or unable to tolerate the use of PAP devices.

Advantages of Dental Appliance Therapy

This therapy is non-invasive and also effective, so people like it for many reasons.

1. It is comfortable
2. It is easy to wear and use.
3. They are usually portable devices that are convenient for travel.

Disadvantages of Dental Appliance Therapy

1. They often require that they should be custom made by the dentist to avoid complications.
2. They often can not just be purchased over the counter.
3. In some cases, in other to be more effective, they still have to be used in combination with other therapy such as CPAP.

Positional Therapy

A risk factor for sleep apnea is lying on your back. Gravity pulls the tongue and other tissues down and into the airway in this position, alleviating the likelihood of disordered breathing. In some patients, moving to another sleeping position may prevent this constriction of the airway and may function in combination with other OSA therapy forms. By simply learning to sleep on their side, such individuals may remove or minimize airway blockage.

One simple technique to force side sleeping involves stitching the back of a shirt with a tennis ball, which prevents the patient from lying in a supine position. Although this is successful in the short term, few individuals adhere to this method.

Advantages of Positional Therapy

1. Positional therapy works in patients that develop sleep apnea while lying on their backs.
2. It can be a very effective treatment method when combined with CPAP therapy.

Disadvantages of Positional Therapy

1. Positional therapy works only in mild cases of sleep apnea.
2. In severe cases, the airway still collapses irrespective of the position assumed by patients during sleep.

Surgery in children

Many kids have swollen tonsils, or adenoids, or both, with snoring or sleep apnea. Sleep breathing disorders can be treated by surgical removal of these tissues in about 75% of those cases.

As the initial treatment of choice for sleep breathing problems in infants, the American Academy of Pediatrics has recommended the removal of tonsils and adenoids.

Advantages of this meht0od in children

1. Removal of large adenoid or tonsils in children often reduces or eradicate sleep apnea.
2. It is easier to diagnose and decide on surgery in children.

Disadvantages

The disadvantages of this procedure are the associated risk that follows a surgical intervention.

1.  Difficulty in breathing from swelling after the surgery
2. Possible infection from surgery

Other Related Treatment options

A significant step in treating sleep apnea is abstinence from alcohol before bedtime. Alcohol and sedative drugs induce tissue slackening in the region around the airway, leading to an increased airway collapse and OSA risk.

Relative to former smokers and individuals who have never smoked, active smokers have an elevated risk of obstructive sleep apnea.

In one study, it was reported that many individuals who obtained cardiac pacemakers showed an improvement in their sleep apnea. However, no major organizations have approved this kind of therapy. More research still needs to be done to validate this treatment method.

Another device that can help an individual with obstructive sleep apnea is continuous pulse oximeter. The oximeter detects an individual oxygen saturation level along with the heart rate. When breathing becomes disrupted during sleep as it may happen  in obstructive sleep apnea, the oxygen level in the blood drops and the oximeter helps to detect the desaturation in oxygen level before leading to comorbidities like cardiovascular disease and GERD.

Pros and Cons of these alternative treatments

These various treatment options, such as abstinence from smoking and alcohol (lifestyle change), are more effective when used in combination with other treatment therapy. However, lifestyle change is always advisable to prevent the recurrent appearance of sleep apnea and increase other treatment methods’ effectiveness.