Obstructive Sleep Apnea

Treatment

No one-size-fits-all treatment exists for obstructive sleep apnea. Treatment depends on the cause of the obstruction, the severity of the apneas, other medical problems a patient may have and the patient's preference. A team of specialists collaborates to develop an integrated treatment plan for each individual, which may include any of several options:

Risk factor modifications

Some known risk factors for OSA can be reduced or eliminated through lifestyle or behavioral changes, which in some cases can sufficiently treat mild OSA. Such changes may also be combined with other treatments to reduce moderate or severe OSA. Potential changes may include:

• Losing weight
• Avoiding alcohol, muscle relaxants and sedatives (sleeping pills)
• Sleeping on one's side instead of one's back
• Treating nasal congestion

Nonsurgical treatment options

Positive pressure breathing (also referred to as CPAP [continuous positive airway pressure])
A small electrical unit with a fan gently blows air through a tube and mask (attached to the nose, or nose and mouth) into the back of the throat to keep the airway open. The level of air pressure depends on an individual patient's needs. Some devices lower the level for exhalation (bilevel PAP) and some automatically increase the pressure if breathing stops and lower it again when breathing is normal (auto-adjusting PAP). It's important that the device fit properly. Mayo Clinic has a specially-trained nursing staff for troubleshooting problems with CPAP devices.

Oral appliance (also called dental device, mouthpiece or mandibular advancement device)
The appliance moves the bottom jaw and tongue forward to keep the upper airway open. Mayo Clinic dentists have special expertise in fabricating oral appliances to treat OSA.

Surgical treatment options

A number of surgical options, sometimes used in combination, can be effective for certain patients:

Uvulopalatopharyngoplasty (UPPP)
While the patient is under general anesthesia, the surgeon trims throat tissue, including the uvula, soft palate and tonsils. Full recovery may take about a month.

Laser-assisted uvulopalatoplasty surgery (LAUP)
This procedure is performed as a series of sessions in the surgeon's office under local anesthesia, incorporating a hand-held laser beam to trim throat tissue. Each surgical session takes about 30 minutes; a typical patient will undergo 2 to 5 such sessions, each spaced 4 to 6 weeks apart. This operation is essentially for snoring relief only.

Radiofrequency ablation (RFA, also called somnoplasty)
This procedure is performed in the surgeon's office under local anesthesia. A low-intensity radiofrequency signal is used to reduce tissue from the uvula, soft palate, tongue and/or nasal turbinates by heating and scarring the tissues in question. Multiple sessions may be required for full effect.

Adenenotonsillectomy (removal of the tonsils and adenoids)
Sometimes only the tonsils need removal (tonsillectomy) and sometimes only the adenoids (adenoidectomy).

Septoplasty, turbinate reduction
Septoplasty straightens a deviated (crooked) septum (bony partition between the nostrils), and turbinate reduction trims or removes one or more of the curved bones along the wall of the nasal passage. Any nasal polyps are also removed. These procedures can help open up the nasal passage and thereby ease breathing during sleep.

Palatal restoration (also referred to as the Pillar Procedure)
In this new minimally invasive procedure, three small (.7 inches long, .08 inches wide) synthetic strips are inserted into the soft palate with a specially designed hand piece. Inserts stiffen the soft palate so it doesn't vibrate and cause snoring or fall into the airway and cause apneas/hypopneas. The procedure is performed in doctor's office using local anesthesia. Patients can usually return to normal activities (including eating) later the same day.

Jaw surgery (orthognathic surgery)
In this surgery, the upper jaw, lower jaw and/or chin may be moved forward. The surgery is usually a good option for patients whose jaw structure worsens blockage of the upper airway and who haven't been helped by other treatments. Mayo Clinic surgeons in Rochester have extensive experience and expertise in this complex but highly effective surgery. Learn more about jaw surgery for sleep apnea.

Roux-en-Y gastric bypass surgery (bariatric surgery)
This surgery reduces the size of the stomach and reroutes food in order to limit the body's ability to absorb nutrients and calories. Mayo Clinic has a well-established bariatrics practice in both Rochester and Arizona to help severely obese patients whose OSA is caused by extra weight.

Tracheostomy/tracheotomy
In order to entirely bypass a blocked upper airway, a surgeon makes an opening in the patient's neck and inserts a metal or plastic tube. The opening is kept covered while the patient is awake but is uncovered before going to sleep. This surgery is performed only in the most severe cases.