Treating Obstructive Sleep Apnea

Lifestyle Changes

Changes in lifestyle may be sufficient to control sleep apnea in mild cases and should be included in the treatment plan even in more severe cases.

• Weight loss is generally helpful in all overweight patients with sleep apnea. However, the relationship between weight reduction and improvement of sleep apnea is not linear (i.e. in some cases relatively modest weight loss can help whereas other patients need to lose a lot of weight to see a significant improvement). It is recommended that weight reduction be incorporated into an overall program of chronic disease management with appropriate supervision and support from healthcare professionals.
• Avoid sleeping on your back. Many people only snore or stop breathing while sleeping on their back. In such cases, avoidance of this position during sleep reduces both snoring and apnea. There are some simple procedures that can be used to reduce sleeping on your back such as attaching a sock to the back of your nightshirt with 1 or 2 tennis balls. Each time you roll onto your back, the discomfort will prompt you to roll onto your side. In time, you will favor sleeping on your side. Ask your doctor if your sleep study demonstrated whether your sleep apnea occurred only on your back.
• Avoid excessive alcohol. Alcohol consumption close to bedtime makes both snoring and apnea worse predominantly because alcohol preferentially reduces the activity of the muscles around the windpipe, thereby allowing it to narrow and collapse more easily. In addition, alcohol can have other effects on sleep. Although alcohol may help to initiate sleep at the beginning of the night, there is often a rebound awakening in the middle of the night as the alcohol level falls in your blood. Finally, alcohol may make daytime sleepiness worse because of its sedative effects.
• Stop smoking - this causes nasal congestion, which can make the use of treatment with CPAP (described below) more difficult.
• Avoid lack of sleep - Sleep restriction due to busy lifestyles is very common in our society. If the quality of your sleep is reduced by sleep apnea, you are more sensitive to lack of sleep, which may aggravate your daytime sleepiness and ability to function optimally during the daytime.

Surgical treatment

Generally, surgery is not recommended for the treatment of obstructive sleep apnea unless there is an obvious and significant anatomical cause of upper airway obstruction such as enlarged tonsils and/or enlarged adenoids (mainly in children). These sources of upper airway obstruction can be removed by tonsillectomy and adenoidectomy.

Prior to the development of mechanical treatment in the 1980’s (see below), tracheostomy was used in severe cases. This is very rarely necessary now. Other surgical treatments that have been used for the treatment of OSA are:

Septoplasty
This operation involves the straightening of the division (called the nasal septum) between the nostrils. This may become crooked, often after an injury to the nose, resulting in partial or complete obstruction of the nasal airway. Although surgical straightening of the nasal septum (called “septoplasty”) may make breathing more comfortable, it usually does not improve snoring or OSA.

Uvulopalatopharyngoplasty (UPPP)
This operation involves the removal of soft tissue in the back of the throat (called the soft palate and the uvula) in addition to removal of the tonsils, if they are present. This is done under a general anesthetic and requires admission to hospital. Potential adverse effects include pain, bleeding, infection, voice change and greater difficulty adjusting to CPAP if this is required later. Unfortunately, UPPP does not correct OSA in the majority of patients although it can improve snoring in up to 50% of cases. Consequently, it is not recommended for the treatment of OSA but may be considered for patients with severe snoring that do not have obstructive sleep apnea.

Laser-Assisted Uvulopalatoplasty (LAUP)
Is a modification of the UPPP and is usually performed in an out-patient facility under local anesthetic with a laser device. The limitations and potential side-effects are the same as those for UPPP.

Mechanical Treatment

Dental Appliance
There are several types of dental appliances. The principle objective of all dental appliances is to advance the lower jaw and hold it in that position while the patient sleeps. They usually consist of an upper and lower dental plate. They are joined by a hinge, which allows the lower plate, and therefore the lower jaw, to move forward. This pulls the muscles attached to the lower jaw, including the tongue, forward, thereby increasing the size of the upper airway and making it less likely to obstruct.

• Need to be fit by a dentist that knows how to treat OSA
• Worn in your mouth all night
• Used for mild to moderate cases of OSA (not recommended for severe OSA)

Although not as effective as CPAP (Continuous Positive Airway Pressure), a dental appliance is more convenient especially for patients who need to travel frequently.

Continuous Positive Airway Pressure (CPAP)

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CPAP therapy ( pronounced "see-pap") is currently the only treatment that is 100% effective in treating Obstructive Sleep Apnea (OSA).

The CPAP machine provides a positive pressure that will hold your airway open while you sleep. This prevents snoring and the airway collapse causing OSA.

The CPAP machine connects to a mask that you can wear over your nose and/or mouth.

How do I start CPAP therapy?

When a patient is first diagnosed with OSA they may undergo a trial of CPAP. This trial will usually last for a month.

During this trial you will be educated, by your CPAP Provider, about how to use your CPAP machine and all the accessories that come with it. You will also be fitted for a mask that is suited especially for you.

How will I know CPAP is working?

The trial of CPAP will let you know. You should:

• feel less sleepy during the day
• have more energy during the day
• wake feeling more refreshed in the morning
• not fall asleep inadvertently during the day and require less naps

Some people are comfortable with CPAP equipment after only one or two nights. Most people need a few weeks before they can sleep comfortably with the CPAP. A few people have problems that can take longer to sort out.

Keep trying and get the help you need!

Costs for CPAP Therapy

• Currently, CPAP treatment is not covered through Alberta Health.
• If you have extra medical insurance (Manulife, Great West Life, Blue Cross) talk to your insurance representative to see if your CPAP equipment is covered.
• If you do not have insurance, CPAP providers usually offer affordable payment plans, or may even have a reconditioned unit at a discounted price.
• The Lung Association Sleep Apnea Society has an assistance plan that you can apply for. Information is available from the Sleep Centre.
• AISH and Social Services will provide funding if you have had the appropriate diagnostic testing performed.

CPAP costs approximately $1,800 to $2,500 in Alberta including a mask.

If our physician diagnoses you with Obstructive Sleep Apnea we will refer you to one of the local companies that provide CPAP. They will contact you to start a 1 month trial of CPAP. During this trial the company will educate you, fit you with a mask that will work for you and provide any troubleshooting as required.

After this CPAP trial, you will likely have a follow-up appointment with the physician or our CPAP Clinic. At this appointment we will determine if you received a benefit from CPAP and make a long-term plan for treating your OSA.