The key to optimal treatment lies in the proper diagnosis. To do this, one should obtain an overnight sleep study (polysomnography) from a qualified sleep physician/sleep lab. This is because that in addition to mild, moderate, severe obstructive sleep apnea, there are many other types of sleep disorders such as central sleep apnea, restless leg syndrome and narcolepsy. And no matter how knowledgeable or experienced a sleep health professional claims to be, there is no way of diagnosing all the sleep disorders without a sleep study.
Current Obstructive Sleep Apnea Treatment Options (not in order)
- CPAP (Continuous Positive Airway Pressure): This is the most common and standard form of treatment of obstructive sleep apnea. The CPAP machine consists of a face or nasal mask that is connected to a pump, providing a positive flow of air into the nasal passages in order to keep the airway open. This pressure ensures that the airway doesn’t collapse during sleep. CPAP is recommended as the first line of treatment for patients with severe obstructive sleep apnea. Patients with mild-to-moderate sleep apnea can usually choose which therapy they would prefer.
- Oral appliance Therapy: An appliance is placed in the mouth and is worn much like an orthodontic appliance or sports mouth protector. Worn during sleep to prevent the collapse of the tongue and soft tissues in the back of the throat, oral appliances promote adequate air intake and help to provide normal sleep in people who snore and have sleep apnea.
Oral appliances can be used as the first-line treatment for patients who have been diagnosed with mild-to-moderate obstructive sleep apnea, or severe obstructive sleep apnea that cannot tolerate their prescribed CPAP. They can also be used in conjunction with other therapies such as CPAP and positional sleep therapy. Determination of proper therapy can only be made by joint consultation of your sleep physician and a qualified sleep medicine dentist.
To read about oral appliance therapy, please click here.
- Surgery: The most common type of surgery involves the removal of soft tissues in the back of the throat. This procedure is called a UPPP. A less frequent option is full reconstruction of the mandible or jaw bone.
Surgery is usually not the first treatment option, but an option for those who are intolerant to CPAP and oral appliances. Its reported success rates are highly variable considering the different types of surgical procedures available and also the different definitions for which one defines success. The surgical procedure of choice will depend on the location of obstruction down the airway. Regardless of which surgical procedure, one could possibly still need to wear a CPAP or oral appliance. Its main drawback is that it is invasive considering its success rates. Tonsils and adenoid removal are more common in children than adults.
- Weight loss: This can be effective if an individual is slightly overweight with mild OSA. If used in conjunction with any of the above treatments, it can be very effective (with the proper diagnosis), regardless of the type of obstructive sleep apnea.
Currently, with only four common ways to treat obstructive sleep apnea (others are on the horizon), there is a lot of confusion, even in the medical and dental communities, over the best treatment. We strongly feel there is not one best treatment option. This is in part because obstructive sleep apnea is a chronic disease. We feel a multi-disciplinary approach to treatment will give individuals the best chances for successful resolution. Each individual is unique in his or her biological make-up, adaptability and personality. Each individual can therefore face unique challenges in treating this chronic disease. For some more than others, it may involve encouragement to make lifestyle changes.
To make things more complex, each health professional from dentist, internist, neurologist, pulmonologist, ENT, Surgeon, Pediatrician, to Nutritionist, etc. will have different views, based on their training, experience and values. We feel it should begin with the proper diagnosis. Then, with proper input and communication from involved health care providers, a treatment recommendation can be made for an individual. CPAP adjusted at the wrong level as well as an oral appliance titrated at the incorrect setting will not be effective. Furthermore, an ill fitting and improperly adjusted CPAP or oral appliance can be dangerous. It is not just the machine/appliance that will make an individual better, but the care in using one or more tools which will allow an individual to be successfully treated for obstructive sleep apnea. Please contact us if you have any questions or concerns, we are here to help.