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For milder cases of obstructive sleep apnea, your doctor may recommend lifestyle changes:
- Lose weight.
- Drink alcohol moderately, if at all, and don’t drink several hours before bedtime.
- Quit smoking.
- Use a nasal decongestant.
- Don’t sleep on your back.
- If these measures don’t improve your sleep or if your apnea is moderate to severe, other treatments are available. Certain devices can help open up a blocked airway. In other cases, surgery may be necessary.
Positive airway pressure. If you have obstructive sleep apnea, you may benefit from a machine that delivers air pressure through a mask placed over your nose while you sleep. The most common type is called continuous positive airway pressure, or CPAP (SEE-pap). With this treatment, the pressure of the air breathed is continuous and somewhat greater than that of the surrounding air, which is just enough to keep your upper airway passages open. This prevents obstructive apnea and snoring.
There are two types of CPAP — fixed and autotitrating. Fixed CPAP delivers airway pressure at a constant level. Autotitrating adjusts the level of pressure if it senses increased airway resistance.
Although CPAP is the most consistently successful and most commonly used method of treating obstructive sleep apnea, some people find it cumbersome and uncomfortable. With some practice, most people learn to adjust the mask to obtain a comfortable and secure fit. You may need to try different types to find a suitable mask. If you’re having particular difficulties tolerating pressure, there are machines that have special adaptive pressure functions to improve comfort. Many people also benefit from using a humidifier along with their CPAP system.
There are also bi-level positive airway pressure (BPAP) appliances, which deliver a preset amount of pressure when you breathe in and a different amount of pressure when you breathe out. CPAP is more commonly used because it’s been well studied for obstructive sleep apnea. For people who have difficulty tolerating fixed CPAP, BPAP or autotitrating CPAP may be worth a try.
Don’t stop using your positive airway pressure machine if you have problems. Check with your doctor to see what adjustments you can make to improve its comfort. In addition, contact your doctor if you still snore despite treatment or begin snoring again. If your weight changes, your doctor may need to adjust the pressure settings.
Mouthpiece (oral device). While positive airway pressure is nearly always an effective treatment, oral appliances are a successful alternative for some people. These devices are designed to keep your throat open. Some do so by bringing your jaw forward, which can sometimes relieve snoring and obstructive sleep apnea. Others hold your tongue in a different position.
If you and your doctor decide to explore this option, you’ll need to see a dentist experienced in dental sleep medicine appliances for the fitting and follow-up therapy. A number of devices are available. Close follow-up is needed to ensure successful treatment.
Surgery or Other Procedures
The goal of surgery for obstructive sleep apnea is to prevent blockage of the upper airway during sleep. Surgical options may include:
Surgical removal of tissue. Uvulopalatopharyngoplasty (UPPP) is a procedure in which your doctor removes tissue from the rear of your mouth and top of your throat. Your tonsils and adenoids are commonly removed as well. This type of surgery may be successful in stopping throat structures from vibrating and causing snoring. UPPP usually is performed in a hospital and requires a general anesthetic.
Jaw surgery. In this procedure, called maxillomandibular advancement, the upper and lower parts of your jaw are moved forward from the rest of your facial bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely. This procedure requires an oral surgeon and possibly an orthodontist, and at times may be combined with another procedure to improve the likelihood of success.
Surgical opening in the neck. You may need this form of surgery if other treatments have failed and you have severe, life-threatening obstructive sleep apnea. In this procedure, called a tracheostomy, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe. You keep the opening covered during the day. But at night you uncover it to allow air to pass in and out of your lungs, bypassing the blocked air passage in your throat.
Implants. The Pillar procedure is a minimally invasive treatment that involves placement of three tiny polyester rods in the soft palate. These inserts stiffen and support the tissue of the soft palate and reduce upper airway collapse and snoring. This treatment is recommended only for people with mild obstructive sleep apnea.
Doctors sometimes remove tissue from the back of the throat with a laser (laser-assisted uvulopalatoplasty) or with radiofrequency energy (radiofrequency ablation) to treat snoring. However, these procedures aren’t recommended for treating obstructive sleep apnea.
Other types of surgery may help reduce snoring and sleep apnea by clearing or enlarging air passages, including:
- Nasal surgery to remove polyps or straighten a crooked partition between your nostrils (deviated nasal septum)
- Surgery to remove enlarged tonsils or adenoids