Sleep Apnea Treatments

There are several treatments for sleep apnea. Find out what they are, including two peoples' experiences with surgery.

Trying to sleep with someone who snores can be challenging. But snoring can be more than just annoying. According to the Sleep Foundation, it can be a sign of sleep apnea, a sleep disorder that involves intermittent pauses in breathing while sleeping. Besides snoring, a person with sleep apnea is also likely to gasp for air or make high-pitched wheezing noises due to the breaks in breathing.

People with sleep apnea don't get enough quality sleep; as a result, they tend to be tired all the time, regardless of how many hours they spend in bed. This may have something to do with why someone with sleep apnea is 2-7 times more likely to be involved in a motor vehicle accident than someone without sleep apnea, according to a 2020 study in the journal Sleep & Breathing.

As if never feeling well-rested wasn't enough, sleep apnea also increases the risk of other health issues, including cardiovascular risks like stroke, hypertension, arrhythmias (irregular heartbeats), and coronary heart disease, according to the Centers for Disease Control and Prevention (CDC). Sleep apnea places people at higher risk for diabetes and depression, too, and overall quality of life suffers.

Treatments for Sleep Apnea

Positive Airway Pressure Machine

When first diagnosed with sleep apnea, a healthcare provider will likely recommend conservative, non-invasive treatments, like a continuous positive airway pressure machine, aka a CPAP. There are also other versions of this machine, the APAP (automatic positive airway pressure) and BiPAP (or BPAP, bi-level positive airway pressure). A sleep specialist determines which one is needed for each person based on their medical history.

Some people find the necessary relief from their sleep apnea with the CPAP (or one of the other airway machines), which motivates them to continue using it. For some, though, being hooked up to a machine with a face mask all night can be cumbersome and as irritating as the sleep apnea itself.

Surgery

If CPAP doesn't work or isn't tolerated, surgery might be another option to correct sleep apnea. What type of surgery is recommended will depend on the type and cause of the sleep apnea. For example, according to the Sleep Foundation, for obstructive sleep apnea (OSA), which is caused by physical blockages in the mouth and throat, surgery involves removing the tissue that appears to be blocking the airway during sleep. It can also involve adjusting the placement of the tongue or jaw.

While surgery is not a magic fix, in a 2020 study published in JAMA, researchers compared two groups of people with OSA. One group chose to have surgery, and the other continued with ongoing medical management of OSA, including weight loss, alcohol reduction, sleep posture modification, and medical management of nasal obstruction, as well as assistance with using CPAP or mandibular advancement device therapies if participants were willing.

The results of this study showed that at six months following initial interventions (surgery or other medical interventions), 26% of the surgery group had resolution of OSA compared to 8% of the ongoing medical management intervention group.

Implantable Devices

Surgery to remove tissue from the mouth and throat can be extremely painful (see some real-life stories below). Thankfully, according to the American Academy of Sleep Medicine, there is another option for OSA: upper airway stimulation. This involves an implantable device that is controlled with a "sleep remote." It's turned on at bedtime and turned off upon waking. It works by gently stimulating the key airway muscles, which enables the airway to stay open during sleep.

Another type of sleep apnea is called central sleep apnea (CSA). Rather than a physical obstruction causing the apnea, CSA is caused by a problem with the nervous system and the signals being sent from the brain stem to the diaphragm, the muscle that aids in breathing. This, in turn, causes interruptions in breathing while sleeping, according to the Sleep Foundation.

For CSA, traditional sleep apnea surgery to remove tissue from the mouth and throat doesn't work since it's a problem with the nervous system. According to a study published in the Journal of Thoracic Disease, in 2017, the Food and Drug Administration (FDA) approved an implantable electrical nerve stimulation device similar to the one for OSA, but this one stimulates the phrenic nerve, a nerve that runs from the brain to the diaphragm.

Real-Life Surgery Experiences

Surgery Success

Before going under the knife for any elective surgery, it's always a good idea to hear about other people's experiences. For example, when Jim Latza was diagnosed with sleep apnea in his early 30s, his ear, nose, and throat doctor suggested surgery. "He told me I had a classic case in which my soft palate was too large and was sagging down to cover my airways," said Latza.

Hoping for relief from the sleep apnea, Latza got the works: soft palate cut back, tonsils and uvula removed, and a deviated septum repaired. The surgery was intense, with a long recovery. "When they take your uvula, they warn you that you're going to choke for a while because the throat has to learn to close on its own," recounted Latza.

Despite the initial challenges, Latza noticed an immediate improvement in his sleep. "I couldn't believe how well I slept right after the surgery, even with the pain and the stitches. The doctor told me that was normal and that he'd had people sleep for three days straight after the operation because they'd been so deprived for so long."

Several months following surgery, Latza's snoring returned, but not to the extent that it was. Thanks to the earlier operation, Latza's apnea was mild enough to keep it under control with lifestyle habits, such as weight loss and sleeping on his side.

Surgery Failure

When David Yu was in his 40s, he struggled with a CPAP machine for a year and a half, unable to wear a mask comfortably through the night. When his blood pressure spiked to unhealthy levels, exacerbated by the sleep apnea, he decided to take the next step and have sleep apnea surgery to correct it.

An ear, nose, and throat surgeon tightened Yu's upper palate and removed scar tissue left behind from a childhood tonsillectomy. The operation left him barely able to swallow for two full weeks. "It was so painful to drink that I was rinsing with Lanacane just to try and get water down," said Yu. "I couldn't even swallow my own spit. It was the most painful 14 days I've ever been through."

Yu lost a significant amount of weight in those two weeks, something he thought would improve his sleep apnea even more. Studies show that weight loss can improve OSA, including a 10-year study published in 2021 in the American Journal of Respiratory and Critical Care Medicine.

But just five months later, his wife noticed his snoring again. "Slowly, the signs of apnea started coming back," said Yu. "Waking up in the middle of the night, going more frequently to the bathroom, not feeling rested, blackness under the eyes—all signs of not getting enough sleep."

Yu stated that if he had to do it over again, he wouldn't have gotten the surgery. He mentions a couple of coworkers who are also considering sleep apnea surgery. "I tell them, unless there's another reason to have their palate excised, don't do it."

If you struggle with sleep apnea, it's important to try to correct it since it can cause other serious medical issues. Work with your healthcare team to make necessary lifestyle changes that may be exacerbating your condition. Explore your treatment options and choose what you feel is best for you.

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