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The treatment of sleep apnea is basically directed at maintaining the patency of the upper airway. There is no clear drug treatment of sleep apnea, at present.
The various methods of treatment of sleep apnea are as follows:
1) CPAP- continuous positive airway pressure
2) OA- oral appliance therapy
3) Bi PAP- bilevel positive airway pressure
4) Surgical methods
CPAP
Continuous positive airway pressure is the first method of treatment for obstructive sleep apnea. Here a nasal mask or oronasal mask or a nasal pillow is applied to the nose, and air is pumped at sufficient pressure to help the patient breathe, with the emphasis being on keeping the upper airway patent. Only if CPAP fails, should the next alternative be tried, namely Bi PAP or bilevel positive airway pressure therapy. Many patients are hesitant or cannot accept CPAP. In these patients BiPAP is definitely a good, next option. If BiPAP fails to correct the airway obstruction in sleep apnea, the next available method is OA or oral appliance therapy. In each case, it is necessary to try every possible modification to the method before moving on to the next option. It must be emphasized that CPAP remains the best available alternative and every effort should be made to elicit patient cooperation to use this technique. Only when all the above conservative and non surgical methods have been tried, should surgery be considered. This too must be done after making the patient aware of the potentially wide reaching complications and failure rates as well as the risks associated with surgery.
What is CPAP?
CPAP or continuous positive airway pressure is nothing more that a machine that supplies air at a slightly higher pressure via a nasal mask to the upper respiratory tract, thus forcibly keeping this part of the airway patent. This positive pressure acts as a pneumatic support or splint for the upper airway, by stretching the walls of the pharynx and upper trachea or wind pipe. Among the immediate effects of CPAP are improvements in daytime alertness and relatively good sleep at night. The patient using CPAP should also show improvement of the left and right heart functions and lowering of blood pressure. In fact CPAP is also useful in treating certain cases of mixed (both central and obstructive) and central apneas. The main challenge is getting patients to continue the therapy regime. Many sleep centers report as many as 20 to 25 % of patients giving up on this method.
What is OAT?
Oral appliance therapy is the placement of a retaining type device in the mouth to hold the tongue in a position such that air passages remain free. These devices are a rather uncomplicated and risk free approach to addressing snoring problems in general and sleep apnea as well. Patients will need to go through a process to chose the appropriate device type and have it fitted properly for maximum comfort.
What is BiPAP?
Bilevel positive airway pressure devices are similar to CPAP except that they provide two levels of air pressure instead of just one. Exhalation is supported by a different pressure level than inhalation.
Supportive methods
Along with the above methods, it is important to emphasize the use of supportive techniques like reduction of obesity and weight loss as equally important. Reduction of fatty tissue helps improve the airway obstruction in the upper part of the respiratory tract. Additionally, the patient should be advised to avoid alcohol use. Sedatives may be used with caution. The patient is also told to lie in the supine position whenever possible. Treatment of other associated illnesses is also important as they may complicate the treatment of sleep apnea.
Sleep apnea signs, risk factors and treatments.
