Sleep apnea: Treatment and solutions

All sleep apnea treatments work similarly. The aim is to enlarge or keep airways open during sleep. There are several treatments that work: losing weight, sleeping position, dental devices, Continuous Positive Airway Pressure (CPAP) and, in extreme cases, surgery. The most commonly used and best known of the available treatments is CPAP. 

Sleep apnea: What treatment should you choose?

It’s not the patient but the doctor who decides which treatment is best. Sleep apnea is generally diagnosed in a sleep clinic or by a pulmonologist. 

When choosing an appropriate treatment, your medical practitioner will take all the necessary factors into account. The number of pauses in breathing per hour (known as the apnea-hypopnea index or AHI) is important. Other relevant factors include the actual breathing irregularities (oxygen saturation, sleep fragmentation etc.), symptoms and overall impact. 

Keep in mind that once sleep apnea has been diagnosed, it’s highly treatable. That said, given the associated risks, you need to be sure to have it checked out!

Treating sleep apnea with Continuous Positive Airway Pressure (CPAP) 

Continuous Positive Airway Pressure is the first-line treatment for sleep apnea. 

For people with mild to severe sleep apnea, CPAP is the only successful treatment.

How does CPAP work?

When you sleep, you wear a mask (nasal or facial), linked to a tube and an air blower. This blows air through your upper airways at a specific pressure (5 to 20 mbar). This air pressure keeps the airways open, thereby preventing breathing irregularities. Your sleep becomes restorative and this allows you to get your overall health back on track. 

CPAP treatment is often covered by insurance and provided for people scoring 30 and above on the index (with a pause in breathing every two minutes!). Once sleep apnea has been diagnosed, a qualified doctor (pulmonologist or sleep clinic) can prescribe CPAP treatment. A service provider then installs the machine in your home. 

Less frequently, it is prescribed for people with additional risks above 15 pauses in breathing per hour.

Mandibular advancement devices (MAD)

A mandibular advancement device (MAD) is a medical apparatus that looks like a mouthguard. Wearing a MAD while you sleep keeps the lower jawbone in a forward position.

The benefit to the user is twofold: first, it helps to keep the upper airways open (the jaw tends to slide backwards slightly during sleep, especially when sleeping on your back) and it also provides greater pharyngeal soft tissue tension. This reduces snoring and results in less breathing events. 

MADs create space that makes it easier to breathe through your mouth when your nose is blocked. They are the treatment of choice for light to moderate sleep apnea in the absence of daytime sleepiness. MADs are often used in conjunction with sleep hygiene rules and, where necessary, adapting sleeping position. 

They are also used as a second-line treatment for severe sleep apnea if the sufferer cannot use a CPAP machine.

MADs: Contra-indications

A few requirements need to be met to be able to wear a MAD. The person must have at least 6 to 8 teeth on both the upper and lower jaw. It may also be contraindicated in people suffering from jaw problems. Be sure to take these factors into account before use.

A competent dentist can provide a tailor-made MAD. Pharmacies also carry a range of options.

The size of a MAD can be adjusted using specialised rods. In addition, you can mould them over your teeth after putting them in hot water (see the product label for more information).

Weight loss

Excess weight can contribute to sleep apnea. In fact, around 50% of people suffering from the condition have a BMI (Body Mass Index) of more than 30.

If excess weight is a factor, losing weight can reduce the severity of the condition, and in rare cases it can even solve the problem. Unfortunately, weight loss is no easy feat. Especially considering the fact that a lack of quality sleep can contribute to weight gain. It’s a vicious circle that needs to be broken.

Conclusion: weight loss is a simple and beneficial way of dealing with sleep apnea. Do the best you can, your health depends on it. 

Positional sleep apnea treatment

What is positional sleep apnea?

Some people suffer from a type of sleep apnea we could call “positional”. They only have breathing events sleeping on their back.

More specifically, positional obstructive sleep apnea is when breathing events rise by over 50% when sleeping on one’s back. Exclusive positional obstructive sleep apnea is when a person experiences breathing events exclusively when on their back (i.e. 100% of their breathing events). 

How can I avoid sleeping on my back?

The treatment for positional sleep apnea involves simply preventing the person from sleeping on their back. But how does that work?

The humble tennis ball promoted to the role of medical device 

Positional sleep apnea is treated by preventing the person from sleeping on their back by making it too uncomfortable. Doctors simply ask their patients to sew a tennis ball to their pyjamas between the shoulders. Think of it as the elegant solution. 

This DIY approach is still in practice, though medical devices applying the same principle have also been launched, for example the Pasuldo medical device.

Technological solutions based on the same idea are also hitting the market: these devices vibrate as soon as a person rolls onto their back. This prompts the person to roll back onto their side without waking them fully. Studies have proven the effectiveness of these devices. So, if you know your sleep apnea is positional, you can start sewing or equip yourself with one of the products available.

Surgery for sleep apnea: the last resort

There are several surgeries available to treat sleep apnea. But these are considered a last resort. If at all possible, it’s best to use a CPAP or dental device. Having surgery doesn’t guarantee results. It’s also rarely effective in the treatment of severe sleep apnea. 

Uvulopalatopharyngoplasty (UP3) 

Uvulopalatopharyngoplasty (UP3) is a surgical procedure used when other treatments are not available. It involves removing excess tissue that might prevent the passage of air (tonsils, uvula, soft palate) and by improving pharyngeal soft tissue tension. This option is not routinely advised due to its relatively low success rate of only 50%.

Maxillomandibular osteotomy (MMO)

Maxillomandibular osteotomy (MMO) works according to the same principle as mandibular advancement orthotics. It is a surgical procedure that repositions the upper and lower jaw, moving them forward, to reduce airway obstruction.

MMO has a 90% success rate for cases that move the jaw forward by 10mm to 12mm. This surgery alters the patient’s appearance slightly but is nonetheless generally well regarded by patients.

Once again, this surgical operation is only used in cases where CPAP and orthotics don’t work. 

Nasal surgery for sleep apnea

Nasal surgery isn’t a dedicated treatment for sleep apnea, as it does not have a significant impact. However, it is used in cases where the person suffers from nasal obstruction. The aim of this surgery is to improve or facilitate use of a CPAP machine.

Sleep apnea treatment: Conclusion

There are several treatments available for obstructive sleep apnea. Depending on your diagnosis, your doctor will select the most suitable treatment for you.

Continuous Positive Airway Pressure (CPAP) is the first-line treatment for sleep apnea and is frequently used in severe cases. Mandibular advancement devices (MAD) also represent an effective treatment approach. Adjusting sleeping position also works in diagnosed cases where the problem is due to the person sleeping on their back. 

For the moment there is no effective pharmacological treatment available. Medication does not have any effect on the muscles of the upper airway passages during sleep. 

Now you know what solutions are available to treat sleep apnea. While the condition is quite common, it remains underdiagnosed. You should seek medical advice if you think you might suffer from this condition. 

If you’ve been diagnosed with sleep apnea, remember that it’s a very treatable condition (if you stick to your treatment of course!). If you want to improve your sleep, find out more about Dreem’s technology, which offers precise sleep tracking and helps optimise your sleep through personalised coaching.