What are common treatment options for Sleep Apnea?

Sleep apnea occurs when a person's breathing is interrupted during sleep. There are two primary forms of sleep apnea:

• Obstructive Sleep apnea: The upper airway is blocked leading to irregular flow of air hence obstructing breathing.
• Central sleep apnea: The brain fails to signal the muscles responsible for breathing.

The symptoms of sleep apnea include the following:

• Loud or frequent snoring
• Silent pauses in breathing
• Fatigue
• Insomnia
• Morning headaches
• Difficulty concentrating
• Memory loss
• Irritability

Risk factors

Some of the risk factors of sleep apnea include:

• Being male
• Being overweight
• Being over age 40
• Having a large neck size
• Having large tonsils
• Family history

Complications:

If not treated, sleep apnea can cause various complications, such as-

• Daytime fatigue
• Depression
• High blood pressure
• Heart problems
• Type 2 diabetes
• Liver problems

Some of the common treatments available today are discussed as follows:

1. CPAP therapy - CPAP stands for Continuous Positive Airway Pressure. A CPAP machine is the most common type of sleep therapy machine. It regulates the breathing of the patients so that they can breathe with comfort while sleeping.  This machine gently passes a constant flow of pressurized air through the airway, such that the air pressure in the throat is increased which prevents the airway from collapsing hence avoiding interruptions during breathing while sleeping. A sleep study termed as polysomnogram is performed for the patient, which reveals his/her severity of condition and accordingly the treatment is identified.

The next phase of the therapy is called CPAP titration study which is performed in the lab to ensure that the calibration of the air pressure in the machine are correct. This is done by letting the patient sleep overnight while wearing different sleep masks and other related machines with varying calibrations to identify the most ideal calibration that excludes any pauses during sleep. Once the machine with ideal calibrations is identified, the patient is advised to use it regularly while sleeping. It is considered the most effective non-surgical treatment for sleep apnea.

Usually, the patient starts to witness immediate results with the use of CPAP machine, which involves elimination of irregular breathing interruptions while sleeping, and improved quality of sleep. It also includes some long term benefits like prevention of serious cardiovascular diseases and stroke, and control of high blood pressure. It is noticed that once the patient discontinues the use of this machine,  the symptoms start to reoccur.

Some of the side effects involved in this therapy are dry nose and sore throat, nasal congestion, irritation in the eyes and sneezing. It might take some time to completely adjust to its regular use. If conditions like bloating occurs, you need to check with your doctor. It is advised to clean the mask and tube everyday and to follow your prescriptions accordingly to replace the instruments for the therapy to be effective.

2. UAS Therapy - Some people with moderate to severe obstructive sleep apnea are unable to use a CPAP machine, so for such people the alternative therapy suggested is UAS called Upper Airway Stimulation therapy. This therapy involves implantation of  a system with three internal components, i.e, an implanted pulse generator, a sensing lead and a stimulation lead, and an external component which is a small handheld sleep remote used to turn on and off the therapy before bed and after you wake up respectively.

The implanted pulse  generator also called an IPG has an algorithm to synchronize the hypoglossal nerve stimulation with respiration signals. It is attached to the sensing and the stimulation lead through a connector module.

The sensing lead comprises of a differential pressure sensor which detects the respiratory cycles by their pressure variations. This waveform is investigated by the IPG, which accordingly triggers the stimulation therapy. The stimulation lead consists of three electrodes which can be configured in different ways for stimulation. UAS therapy activates the neuromuscular anatomy to increase the upper airway motion without disturbing the soft tissues.

3. Oral Appliances - Oral appliances are set up by trained dentists who evaluate your teeth, jaw structure and joints to make sure that you are well suited to wear an oral appliance. However, there are different varieties of oral appliances available in the market, but if these are not fitted properly, it can lead to some side effects and might worsen the condition of sleep apnea. Therefore customised oral appliances are also provided as an option, which are adjustable and hence comfortable to wear. The oral device works by keeping the airway open while sleeping hence preventing the blockage of  the flow of air during breathing. The two most common oral devices are:

• Tongue retaining devices: These devices hold the tongue in such a way that it cannot fall backward and obstruct the flow of air.
• Lower jaw advancement devices: These devices bring the lower jaw slightly forward and hence leads to the opening of airway and smooth flow of air while breathing.

4. Surgery - Surgery is also an option although it is less effective in treating obstructive sleep apnea. The most important part of this method is to determine the possible site which is leading to the obstruction of airflow. Depending on these sites, the type of operation is decided. Few of the options are discussed below:

• Uvulopalatopharyngoplasty (UPPP)

This process involves making the airway wider by removing or remodelling the tissue in the throat, hence decreasing the tissue collapse. The tissues involved in this procedure are uvula, tonsils or some of the muscles of the soft palate. It might lead to some long term side effects like voice changes and swallowing problems.

• Radiofrequency Volumetric Tissue Reduction (RFVTR)

The purpose of this surgery is to shorten and stiffen the tissues in and around the throat. This procedure is used in the case of mild to moderate sleep apnea. The tissues targeted in this surgery are tongue, uvula, soft palate or tonsils. The goal of the surgery is to increase the intraoral space through tissue reduction in order to reduce the obstruction of airway hence treating the symptoms of snoring and obstructive sleep disorder.