International Surgical Sleep Society

Treatment of Sleep Apnoea

Sleep apnea treatment starts from lifestyle modification. There must be some sort of determination from the sleep apnoea sufferer to get rid of the problem. Because there is no magical pill for treating this common yet serious health condition.

What are the lifestyle modifications?

  • Weight Reduction: Losing as little as 10 percent of your excess body weight can lessen the amount of times your sleep apnea causes you to stop breathing.
  • Avoid alcohol or sedative drugs. These relax your throat muscles, increasing the likelihood that your airway will become blocked while you sleep.
  • Smoking constricts airways, veins, arteries, and just about every other part of your body responsible for circulation and respiration. Sleep apnea sufferers who stop smoking usually see a reduction in their breathing difficulties.

If I lose weight, will I cure my OSA?

  • Pathophysiology of sleep apnea is complex and multifactorial. Hence the answer to this question varies from person to person. Some people report experiencing less severe sleep apnea after losing weight. Others report no change in their sleep apnea with weight loss. Most experience some benefit by losing weight.

What is the first line of therapy?

Lifestyle modification alone can eliminate sleep apnoea or reduce its severity. For persistent moderate to severe sleep apnoea first line therapy is CPAP i.e. continuous positive airway pressure ventilation.

How does CPAP work?

This treatment requires you to wear a mask over your nose and mouth while you sleep. The mask is attached to a small machine that blows air into your nose and throat. The amount of air is just enough to keep your airway open. The pressure is can be adjusted according to individual requirement.

What are prerequisites of starting CPAP therapy?

The first step in getting CPAP therapy is to have a sleep study (polysomnogram) done. The results of a sleep study will inform your sleep specialist as to the severity of your condition and best treatment options.
If a CPAP machine is determined to be the best option, you will likely have to have a follow-up sleep titration study in which you will sleep overnight while wearing various CPAP masks and using a few different machines that will be specifically calibrated to the air pressure needed to clear your airway blockage.

How do I know that the machine is working properly?

Those who begin using their CPAP devices, often begin to experience immediate positive results including:

  • Elimination of snoring and breathing obstructions.
  • Improvement in quality of sleep.
  • Increased alertness during the day.
  • Significant decrease of excessive day time sleepiness

What are the most important factors for successful CPAP therapy?

  • Selection of proper mask
  • Right pressure settings
  • Compliance

Is CPAP curative?

It is the most relevant and common question asked by sleep apnoea sufferers. Unfortunately the answer is NO.
CPAP use is a therapy and not a cure. Hence you have to use CPAP regularly. Once you stop using it, your sleep apnoea is back with same severity.

How many hours do I need to use my CPAP each night?

Studies show that at least 6 hours of CPAP usage per night is needed to reduce long term health risks of obstructive sleep apnea. The best practice is to put the CPAP on at lights out each night and to make every attempt to put it back on after nighttime awakenings.

What are the common problems people complains during CPAP use?

  • Dry nose, Nosebleeds
  • Nasal congestion, Runny nose, Sinus discomfort
  • Sneezing, Sore throat, Dry mouth
  • Eye irritation, Conjunctivitis, Skin irritation
  • Chest discomfort, Difficulty exhaling
  • Air bubbles passing through mouth
  • Abdominal bloating

How do you get rid of those problems?

Most new CPAP users experience some discomfort for the first few days. This will often pass as you get used to the machine and become less sensitive.

Problems caused by dry air, including nasal and throat irritation, can be remedied by using humidification, or a saline nasal spray. A CPAP unit with heated humidity can alleviate most of these problems.

Dry mouth may be the result of dry air, or you may be sleeping with your mouth open. If you are sleeping with your mouth open, you can use a chin strap or try switching to a full mask.
(Do consult an Ear, Nose & Throat specialist before you wear a chin strap, as your nose should be open for the chin strap to work).

Chest discomfort and sinus pain are often the result of too much initial pressure. Many patients need to start out with low pressure and upgrade to the required pressure slowly.

Eye and skin irritation are typically the result of air leakage from mask. A mask that leaks will allow the air to flow over your eyes, causing dryness and irritation.

When do I need to readjust the machine or mask?

You need consultation if your symptoms come back.  Pressure settings may require change due to weight gain or loss and aging.

The CPAP pressure may be reduced if your mask is leaking. Your mask may be too big or too old. We would suggest you resize your mask to be sure you have the best fit. If your mask fits, but it is six to nine months old, it might need replacement.

Is it the only answer to all who suffers from sleep apnoea?

CPAP is most commonly advised therapy for sleep apnoea sufferers. But many people may not tolerate this therapy for various reasons. Some common subjective feelings which come with this therapy are claustrophobia, dryness, nasal congestion. There may be some structural problem in the airway for which CPAP alone may not be sufficient to treat sleep apnoea.

For those cases where CPAP did not work there are other options like oral appliance and special surgeries for sleep apnea.

But before declaring the apathy for CPAP use you must give yourself at least two to four weeks’ time to get accustomed to the mask and the air pressure. Make sure the mask is comfortable and the humidifier is working. Once you are comfortable with the therapy adherence is the most important factor.

Dr Srinivas Kishore, Hyderabad, India