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Treatment Options for Sleep Apnea
Many healthy people snore. Snoring is the sound made when loose tissue in the back of the throat vibrates because
the breathing passages are partially blocked. Snoring is not necessarily bad for you. Sleep apnea is what happens when
you completely block the back of the throat and stop breathing repeatedly during sleep. One way to estimate the severity
of sleep apnea is the Apnea Hypopnea Index (AHI), which is the average number of times per hour of sleep
that you stop or slow down breathing. As a rough estimate, AHI of 10 or less may be normal, greater than about 35 is
severe. Sleep apnea is clearly bad for you; in addition to ruining sleep it has been linked to high blood pressure,
heart disease, and stroke.
ENT Evaluation Anything that increases the amount of room in the back of the throat or unblocks the nose may be helpful in treating
sleep apnea. Many patients will benefit from evaluation by an Otolaryngologist ("ENT" physician) to see if
minor surgery or other treatment is indicated.
Dental Devices Another way to increase the amount of room in the back of the throat and improve apnea is by a mandibular advancer (dental
appliance). This is something that is worn during sleep that looks a lot like a mouthguard that a football player might
wear. It anchors top and bottom teeth to hold the lower jaw slightly forward during sleep. This moves the tongue
forward and opens up the airway. This has been very successful for treating snoring and mild to moderate apnea, but
may not be the first approach to severe apnea. You should be evaluated by a dentist with experience in treating apnea
if interested in this approach.
CPAP The most common, effective, and quick treatment for sleep apnea is nasal CPAP. CPAP stands for Continuous Positive
Airway Pressure. First described in 1982, the idea is to apply a small amount of air pressure to the back of the throat
using a tight fitting mask over the nose or "nasal pillows" that fit in the nostrils. Most patients find this
comfortable, and it very rapidly eliminates both snoring and apnea in almost all patients. This has become the "gold
standard" for treatment, and in almost all cases is paid for by medical insurance.
If nasal CPAP is planned, generally you will spend a second night in the Sleep Center. Most of the monitoring will be the same as the diagnostic sleep study done originally. Before going to bed, the technologist will try a few of the possible masks or nasal pillows ("interfaces"). You will be asked to sleep with a comfortable interface which will begin at a low pressure. As you sleep, the technologist will be adjusting the pressure (remotely, from the Control Room), until breathing is normal during sleep. Assuming you are comfortable with CPAP, the results of the CPAP titration study will be analyzed to find the best pressure, and a prescription will be forwarded to a Durable Medical Equipment (DME) provider. The DME provider we contact will usually be one that will participate in your insurance plan. DME providers will deliver the equipment and make sure you understand the treatment and are comfortable with it. Generally, you can expect to get CPAP delivered within about 10 days of your CPAP study, although this often depends on the time it takes for your insurance to approve it. Weight Loss and Avoiding Alcohol Weight loss is often helpful in treating Sleep Apnea (and snoring). As a general rule both Sleep Apnea and snoring worsen with weight gain and improve with weight loss in most patients. However, many Sleep Apnea patients are not overweight. Avoiding alcohol within a few hours of bedtime is also important. Alcohol can cause snoring in almost everyone and will worsen Sleep Apnea in most. |
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Steven H. Feinsilver, MD 2009
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