Treatments For Sleep Disordered Breathing
Continuous Positive Airway Pressure (CPAP)
An CPAP unit is a device that helps you breathe better at night. Nasal CPAP is the preferred treatment for all sleep disordered breathing including:
How Nasal CPAP Works
Nasal CPAP is delivered with a mask held against the nose with a head strap. A tube leading into the mask is connected to a mechanism that blows air into the mask and maintains a fixed pressure. This pressure splints the collapsing airway, preventing obstruction.
Although the apparatus is not sexy, the fact of the matter is, it works. Patients do sleep with the CPAP machine, and those who use it successfully stop snoring, sleep better, feel better and recognize marked improvement in their ability to function both at work and at home.
During CPAP titration, the nasal CPAP is fitted by spending one night trying different pressures to determine the best possible pressure. Once determined, a fixed pressure CPAP machine is delivered. Some people find the forced air is drying and uncomfortable. For these individuals, humidifiers inserted in line with the CPAP will humidify the CPAP air and reduce nasal and pharyngeal discomforts.
Variable Pressure CPAP
The latest innovation in CPAP delivery is a variable pressure CPAP machine. Variable Pressure CPAP units contain software which recognize the collapsing airway and can modulate the pressure at the lowest possible number to maintain a patent or otherwise open airway.
The advantage of Variable Pressure CPAP is most airways do not require high pressures for all of the evening. It is these high pressure, high flow conditions which cause the drying. By lowering the pressure and lowering the flow, drying and pressure discomfort occur less frequently and are far less intrusive. The future is definitely with the Variable Pressure CPAP machines. For those who are having difficulty with Fixed Pressure CPAP machines, they are strongly encouraged to inquire about and try the Variable Pressure CPAP.
Nasal CPAP Variations
There are a lot of variations for nasal CPAP. Individuals with congestive heart failure can often be greatly improved by the use of specially designed CPAP machines. The same is true for individuals with transient eschemia attacks and strokes. They have a very different kind of breathing and need a different kind of CPAP delivery. Software is available to deliver whatever will improve the patient’s breathing. While nasal masks work for most, full face masks are sometimes required, particularly for those individuals who are obligate mouth breathers.
An individual challenged to use CPAP without spousal support is doomed to failure. Those whose spouses care enough, attend the CPAP fittings, CPAP demonstrations and CPAP instructions. They then go out of their way to encourage and support the use of the CPAP. Those whose spouses fail to provide this kind of loving support doom their bed partner to failure. While CPAP tends to be most successful in those with severe sleep apnea, it does work in milder forms and in many cases is very successful even in the treatment of snoring. For this reason, virtually anyone with sleep disordered breathing deserves a CPAP trial.
If CPAP is not a satisfactory treatment, other options exist. The best are surgical options.
Other options that some recommend are dental appliances. These devices shove the lower jaw forward at night. It is the author’s opinion that they move teeth and that they will ultimately cause problems with the temporomandibular joint. I personally could not imagine someone electing to wear a device that shoves their teeth and their jaw out of alignment 8 hours a night, 7 nights a week, year in year out for the remainder of their life. Nonetheless, there are those who believe in the oral appliances, and as you can well imagine, there is now a whole industry of dentists and companies producing these.
Not everyone does well with nasal CPAP -- some find it to be too intrusive while others find it claustrophobic or otherwise not tolerable. For these individuals, consultation for surgery is recommended.
Surgery is a good option for many forms of sleep disordered breathing, particularly for young individuals and individuals who have obvious anatomic obstructions. It is necessary for those who have tried CPAP and failed.
The evaluation of an individual interested in surgical therapy includes a thorough examination of the nose, mouth and pharynx (throat). If obvious obstructive anatomy is evident, and if the nature of the sleep apnea is such that surgery stands to improve the condition, then surgery will be recommended. Confused? Read More: Should I have surgery to treat obstructive sleep apnea ?
Surgical therapies vary from very simple operations with minimal risk to very complex operations with significant discomfort and concerning risks and potential complications, including:
- Septoplasty, an operation to straighten the cartilage on the interior of the nose
- Turbinate reduction
- Operation to reduce the natural filters of the nose which often become swollen and congested, particularly in patients with allergic rhinitis.
- Adenoidectomy for patients with swollen adenoids
- Tonsillectomy for patients with big tonsils, particularly those in whom the tonsils are felt by the examining physician to potentially play a role in the nighttime airway obstruction
- Removal of uvula to prevent snoring
- Maxillomandibular advancement
More On Snoring
Snoring is produced for the most part by vibrations of the uvula, the tissue that hangs down at the far end of your soft palate. Snoring is therefore often treated either by removing the uvula or removing a portion of the soft palate. Several variations on this theme exist and the operations are of necessity tailored to the individual.
The most difficult problems are those in whom the obstructions and the snoring are caused at least in part by the tongue falling backward. Several operations attempting to reposition the tongue have been developed. All are successful some of the time. None are successful all of the time. The names of these surgeries include: genioglossus advancement, hyoid suspension and tongue reposition. Read More About Snoring.
If all else fails, almost all sleep apnea can be successfully treated by maxillomandibular advancement, a complex operation in which the bones holding the upper teeth and the bones holding the lower teeth called the mandible are surgically cut and moved so that the lower part of your face is moved forward approximately 12 millimeters.
By doing this the airway in the back of the throat is expanded and the sleep apnea cured. While an excellent operation, this is the most extreme of undertakings and is only employed for disabling sleep apnea in patients in whom all other treatments have been unsuccessful.
To make an appointment at the Sleep Center, call 619-543-5713. A referral from you primary care doctor is needed in most cases.
Sleep Medicine Center
4th and Lewis Medical Offices
330 Lewis Street
San Diego, CA 92103