The first thing I’d like to say about the treatment of OSA is that the most common treatment for patients who have OSA is… NO treatment. It’s estimated that 18-20 million Americans have OSA and most of these are never even diagnosed. For patients that are diagnosed with OSA, many of them unfortunately do not follow treatment recommendations. It’s also estimated that of all patients in the US with OSA, only 10-20% are getting proper treatment. So, this is a huge area of potential improvement for our health care system which could save lives, prevent serious illnesses, and save billions in health care spending.
That being said, I’d like to talk about the main non-surgical treatment options available to OSA patients. Traditionally, most patients have been treated with Continuous Positive Airway Pressure (CPAP, pronounced “see-pap”). CPAP has long been considered the “Gold Standard” for treating OSA. As we will see in the next post in this series, it is at best an imperfect solution to the problem.
The idea behind CPAP is that patients can wear a mask while sleeping which pumps air into their noses and mouths at a set pressure. This pressurized air prevents collapse of the throat tissues and allows air to pass without obstruction. Some patients wear a mask that covers their nose and mouth, and others will wear a mask that just covers their nose depending on their anatomy and preference.
If worn consistently all night every night, CPAP is an effective treatment at reducing or eliminating sleep apnea. Most patients should expect to wear the CPAP mask for the rest of their lives, barring a successful surgical treatment or weight loss which eliminates their OSA. As we will learn in the next post, this consistent use is rare. That being said, CPAP has traditionally been the best weapon we have to treat OSA, even with its imperfections. The biggest benefit of CPAP is it avoids the risks and post-operative pain associated with surgery for OSA.
Another common non-surgical treatment is an oral appliance. This is a device worn in the mouth (similar to a mouth guard) which acts to push the lower jaw forward. In this way, the tissues of the tongue and floor of mouth are pulled forward, clearing more room in the throat for air to pass. Oral appliances can potentially cure patients with mild OSA, but again, they must be worn all night every night. And if the patient gains weight or the OSA otherwise gets worse, the oral appliance can stop working.
Next, there are lifestyle changes that can help to treat OSA. Weight loss is very important, and is always something I encourage in all of my sleep apnea patients. The heavier someone is, the worse their OSA will be as a general rule. If an obese OSA patient is able to lose enough weight, their apnea can be cured as long as they can keep the weight off.
Alcohol and other sedatives can worsen OSA symptoms, or even trigger OSA in patients who otherwise breathe normally while sleeping. The reason is that sedating drugs do two things: First, they increase the relaxation in the body, which causes more collapse of the throat tissues during inspiration. Second, they make it harder for the brain to rouse the patient from deep sleep when the airway obstruction occurs. So, eliminating alcohol and other sedating medications can help to treat OSA.
Finally, patients can make positional changes in how they lie in bed. Sleep apnea tends to be worst when patients lie flat on their backs. Either using a pillow to keep themselves on their sides or stomachs, or sleeping with a pillow-chair or with the head of bed elevated can help eliminate this problem. Usually, the sleep study will show how many apneas the patient has in different sleeping positions, and if all the events are when lying on their back, positional treatment can be started.
Overall, non-surgical treatment can be very effective at treating OSA. Their major benefit is that there is no pain or morbidity that would be associated with a more invasive procedure. Their major downsides are that they do not create any permanent changes in the airway anatomy, and they usually require consistent use for the rest of the patient’s life to truly be effective.
The next post will take a deeper look at CPAP therapy.