Sleep Apnea Treatments

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

Trying to sleep next to someone who snores can be challenging. But snoring can be more than just annoying. According to the National Heart, Lung, and Blood Institute (NHLBI), 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 two to seven 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.

Woman with sleep apnea machine

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Types of Sleep Apnea

There are two types of sleep apnea, per the NHLBI: obstructive sleep apnea (OSA) and central sleep apnea (CSA). With OSA, your upper airway becomes blocked while you sleep. This causes temporary pauses or slowdowns in your breathing. OSA is the most common form of sleep apnea, affecting approximately 15 to 30% of males and 10 to 15% of females in North America, per Up To Date.

CSA is far less common. A study published in the journal Sleep in 2016 examined a cohort of over 5,000 individuals. Less than 1% of the individuals in this study experienced CSA. Instead of an obstruction causing the sleep apnea, CSA is caused by the brain not sending the appropriate signals to breathe, per the NHLBI.

Sleep apnea can also involve a mixed diagnosis of both OSA and CSA, called complex sleep apnea. A study published in the journal Sleep Disorders in 2014, explained that with complex sleep apnea, periods of persistent central apneas continue to occur or appear after treatment for OSA.

Treatments for Sleep Apnea

Luckily, sleep apnea is something that can be dealt with. Here are some of the most common treatments available.

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, also known as 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.

The NHLBI explain CPAP machines work by using continuous mild air pressure to keep an individual's airways open while sleeping. APAP is similar—however, with APAP, the pressure auto adjusts depending on the user's needs, per a 2021 article in The Brazilian Journal of Pulmonology and International Databases. With BiPAP, the pressure level changes based on whether the person is inhaling or exhaling, per StatPearls.

While PAP devices can work for both types of sleep apnea, another type of treatment, called adaptive servo-ventilation (ASV) may be tried for those with CSA, per MedlinePlus. ASV is similar to other PAP devices. However, what is unique about ASV, per the American Thoracic Society, is that it measures an individual's breathing and adjusts the pressure based on the individual's needs.

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.

Surgical Procedures

If CPAP doesn't work or isn't tolerated, there are surgical options to correct sleep apnea. What type of surgery is recommended will depend on the type and cause of the sleep apnea.

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.

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. The phrenic nerve runs from the brain to the diaphragm.

Per the FDA, phrenic nerve stimulation is appropriate for those with moderate to severe CSA.

Other Surgical Options

According to the NHLBI, for obstructive sleep apnea (OSA), which is caused by physical blockages in the mouth and throat, there are several surgical options. Surgery may involve removing the tissue that appears to be blocking the airway during sleep. It can also involve adjusting the placement of the tongue or jaw.

Surgery is not a magic fix; however, 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.

Mandibular advancement therapies work by increasing the individual's airway diameter, per a 2018 article in the Journal of Thoracic Disease.

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.

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."

A Quick Review

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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