Treatments and drugs

By Mayo Clinic Staff

For milder cases of sleep apnea, your doctor may recommend only lifestyle changes, such as losing weight or quitting smoking. And if you have nasal allergies, your doctor will recommend treatment for your allergies. If these measures don't improve your signs and symptoms or if your apnea is moderate to severe, a number of other treatments are available.

Certain devices can help open up a blocked airway. In other cases, surgery may be necessary. Treatments for obstructive sleep apnea may include:

Therapies

  • Continuous positive airway pressure (CPAP). If you have moderate to severe sleep apnea, you may benefit from a machine that delivers air pressure through a mask placed over your nose while you sleep. With CPAP (SEE-pap), the air pressure is somewhat greater than that of the surrounding air, and is just enough to keep your upper airway passages open, preventing apnea and snoring.

    Although CPAP is the most common and reliable method of treating sleep apnea, some people find it cumbersome or uncomfortable. Some people give up on CPAP, but with some practice, most people learn to adjust the tension of the straps to obtain a comfortable and secure fit.

    You may need to try more than one type of mask to find one that's comfortable. Some people benefit from also using a humidifier along with their CPAP systems. Don't just stop using the CPAP machine if you experience problems. Check with your doctor to see what modifications can be made to make you more comfortable.

    Additionally, contact your doctor if you are still snoring despite treatment or begin snoring again. If your weight changes, the pressure settings of the CPAP machine may need to be adjusted.

  • Other airway pressure devices. If CPAP continues to be a problem for you, you may be able to use a different type of airway pressure device that automatically adjusts the pressure while you're sleeping (Auto-CPAP). Units that supply bilevel positive airway pressure (BiPAP) are also available. These provide more pressure when you inhale and less when you exhale.
  • Expiratory positive airway pressure (EPAP). These small, single-use devices are placed over each nostril before you go to sleep. The device is a valve that allows air to move freely in, but when you exhale, air must go through small holes in the valve. This increases pressure in the airway and keeps it open.

    The device may help reduce snoring and daytime sleepiness in people with mild obstructive sleep apnea. And it may be an option for some who can't tolerate CPAP.

  • Oral appliances. Another option is wearing an oral appliance designed to keep your throat open. CPAP is more reliably effective than oral appliances, but oral appliances may be easier to use. Some are designed to open your throat by bringing your jaw forward, which can sometimes relieve snoring and mild obstructive sleep apnea.

    A number of devices are available from your dentist. You may need to try different devices before finding one that works for you. Once you find the right fit, you'll still need to follow up with your dentist repeatedly during the first year and then regularly after that to ensure that the fit is still good and to reassess your signs and symptoms.

Surgery

Surgery is usually only an option after other treatments have failed. Generally, at least a three-month trial of other treatment options is suggested before considering surgery. However, for those few people with certain jaw structure problems, it's a good first option.

The goal of surgery for sleep apnea is to enlarge the airway through your nose or throat that may be vibrating and causing you to snore or that may be blocking your upper air passages and causing sleep apnea. Surgical options may include:

  • Tissue removal. During this procedure, which is called uvulopalatopharyngoplasty, your doctor removes tissue from the rear of your mouth and top of your throat. Your tonsils and adenoids usually are removed as well. This type of surgery may be successful in stopping throat structures from vibrating and causing snoring. It's less effective than CPAP, and isn't considered a reliable treatment for obstructive sleep apnea.

    Removing tissues in the back of your throat with radiofrequency energy (radiofrequency ablation) may be an option for people who can't tolerate CPAP or oral appliances.

  • Jaw repositioning. In this procedure, your jaw is moved forward from the remainder of your face bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely. This procedure is known as maxillomandibular advancement.
  • Implants. Plastic rods are surgically implanted into the soft palate after you've received local anesthetic.
  • Creating a new air passageway (tracheostomy). You may need this form of surgery if other treatments have failed and you have severe, life-threatening sleep apnea. In this procedure, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe.

    You keep the opening covered during the day. But at night you uncover it to allow air to pass in and out of your lungs, bypassing the blocked air passage in your throat.

Other types of surgery may help reduce snoring and contribute to the treatment of sleep apnea by clearing or enlarging air passages:

  • Nasal surgery to remove polyps or straighten a crooked partition between your nostrils (deviated nasal septum)
  • Surgery to remove enlarged tonsils or adenoids
  • Weight-loss surgery

Treatments for central and complex sleep apnea may include:

Therapies

  • Treatment for associated medical problems. Possible causes of central sleep apnea include heart or neuromuscular disorders, and treating those conditions may help. For example, optimizing therapy for heart failure may eliminate central sleep apnea.
  • Supplemental oxygen. Using supplemental oxygen while you sleep may help if you have central sleep apnea. Various forms of oxygen are available as well as different devices to deliver oxygen to your lungs.
  • Adaptive servo-ventilation (ASV). This more recently approved airflow device learns your normal breathing pattern and stores the information in a built-in computer. After you fall asleep, the machine uses pressure to normalize your breathing pattern and prevent pauses in your breathing. ASV appears to be more successful than other forms of positive airway pressure at treating complex sleep apnea in some people.
  • Continuous positive airway pressure (CPAP). This method, also used in obstructive sleep apnea, involves wearing a pressurized mask over your nose while you sleep. CPAP may eliminate snoring and prevent sleep apnea. As with obstructive sleep apnea, it's important that you use the device as directed. If your mask is uncomfortable or the pressure feels too strong, talk with your doctor so that adjustments can be made.
  • Bilevel positive airway pressure (BiPAP). Unlike CPAP, which supplies steady, constant pressure to your upper airway as you breathe in and out, BiPAP builds to a higher pressure when you inhale and decreases to a lower pressure when you exhale.

    The goal of this treatment is to assist the weak breathing pattern of central sleep apnea. Some BiPAP devices can be set to automatically deliver a breath if the device detects you haven't taken one after so many seconds.

Along with these treatments, you may read, hear or see TV ads about different treatments for sleep apnea. Talk with your doctor about any treatment before you try it to find out how useful it might be.

Aug. 25, 2015