Apneas tend to be worse when sleeping on the back (the supine position) as gravity makes it more likely for the tongue to fall back over the airway and/or for the airway muscles and other tissues (like the tonsils) to collapse and block the airway. Hence not sleeping on the back may reduce the number of apneas. To avoid the supine position, some people use homemade remedies, such as putting tennis balls in a tube sock and pinning the sock to the back of their nightshirt. Others purchase products such as a tube or cushion designed specifically to prevent supine sleeping.
Sleep apnea can be weight-related. Additional fat around the neck may make the airway narrower, making obstructions more likely to occur. For some overweight people, especially those with mild cases, losing weight can be an effective treatment. Or weight loss may reduce the severity of the sleep apnea. However, it may be hard to lose weight when you have untreated sleep apnea: you may be too tired to exercise and you may eat to stay awake. Also, it may take some time before the weight loss is achieved, so in light of the potential consequences of untreated OSA, using another treatment option while working towards the weight loss goal may be an option. Losing weight may also improve your health in other ways, but it is always advisable to talk to your doctor before beginning a weight-loss program. Remember that sleep apnea occurs in thin people as well; the airway can close during sleep for a number of reasons, not just excess weight.
Alcohol and medications that act as central nervous system (CNS) depressants, such as pain killers, sedatives, and muscle relaxants, can worsen sleep apnea by relaxing the airway muscles further and/or by reducing the respiratory drive and causing more apneas to occur. Hence avoiding alcohol and CNS depressants close to bedtime may be helpful. Ask your doctor or pharmacist if any of the prescription or over-the-counter drugs you take can affect your sleep apnea.
The intention of surgery is to create a more open airway so obstructions are less likely to occur. These surgeries often include removal or reduction in size of the soft palate, uvula, tonsils, and tongue. These procedures are often painful, ineffective, and they are irreversible.
CPAP works by blowing pressurized room air through the nasal passages and into the airway at a pressure high enough to keep the throat open. This pressurized air acts as a “splint.” The pressure is set according to the patient’s needs at a level that eliminates the apneas that cause awakenings and sleep fragmentation. Pressure that is too low will not be as effective in eliminating the apneas. Nasal CPAP is an effective treatment option for obstructive sleep apnea and snoring when used on a regular basis. It is still considered the “gold standard” in much of the medical community. However, many patients find CPAP uncomfortable and inconvenient and are unwilling or unable to wear it long enough to experience the benefits. Many find it hard to sleep soundly with large volumes of cold, dry air blown through and around their nose and face. A patient may sleep through the night, only to wake with dry and congested nasal passages. Over time the nose, sinuses and throat may become irritated and/or inflamed. Other patients complain of the large facemask that must be worn with the attached air hose that can prevent normal changes in body position. Some patients say that wearing the apparatus makes them feel “suffocated” and “bloated”. The units are inconvenient to pack and travel with due to their size and need for set-up. Less than fifty percent of patients report regular use of their CPAP machines over a 5 year period.
Oral appliance therapy involves the selection, design, fitting and use of a custom designed oral appliance that, when worn during sleep, maintains an opened, unobstructed airway in the throat. Oral appliances that treat snoring and obstructive sleep apnea are devices worn in the mouth, similar to orthodontic retainers or sports mouthguards. They have several advantages over other forms of therapy. Oral appliances are comfortable and easy to wear and care for. They are small and convenient, making them easy to carry with you when you travel. Treatment with oral appliances is reversible and non-invasive. Because of their effectiveness and advantages, the American Academy of Dental Sleep Medicine now considers oral appliances as the best choice to initially treat mild to moderate sleep apnea and snoring.
- By repositioning the lower jaw (mandible) forward to open the airway and prevent tissues from collapsing during sleep.
- By stabilizing the lower jaw and tongue.
- By increasing the muscle tone of the tongue.