Healthcare Services

Continuous positive airway pressure (CPAP)

CPAP is the standard treatment option for moderate to severe cases of OSA and a good option for mild sleep apnea. CPAP blows air into a person’s windpipe at a set, steady pressure. This airflow keeps the airway open, preventing pauses in breathing and restoring normal oxygen levels.

Oral appliances

An oral appliance is an effective treatment option for people with mild to moderate OSA who either prefer it to CPAP or are unable to use CPAP therapy. Oral appliances look much like sports mouth guards, and they help maintain an open and unobstructed airway by repositioning or stabilizing the lower jaw, tongue, soft palate or uvula. Some are designed specifically for snoring, and others are intended to treat both snoring and sleep apnea. They should always be fitted by dentists who are trained in sleep medicine.

Surgery

Surgery is a treatment option for OSA when noninvasive treatments such as CPAP or oral appliances have been unsuccessful. It is most effective when there is an obvious anatomic deformity that can be corrected to alleviate the breathing problem. Otherwise, surgical options most often address the problem by reducing or removing tissue from the soft palate, uvula, tonsils, adenoids or tongue. More complex surgery may be performed to adjust craniofacial bone structures. Surgical options may require multiple operations, and positive results may not be permanent. One of the most common surgical methods is uvulopalatopharyngoplasty (UPPP), which trims the size of the soft palate and may involve the removal of the tonsils and uvula. Adenotonsillectomy, the surgical removal of the tonsils and adenoids, is the most common treatment option for children with OSA. Other children with sleep apnea may benefit from CPAP.

Behavioral changes

Weight loss benefits many people with sleep apnea, and changing from back-sleeping to side-sleeping may help those with mild cases of OSA.

Position Therapy

A treatment used for patients suffering from mild OSA. Patients are advised to stay off of the back while sleeping and raise the head of the bed to reduce symptoms.

Medications

• Prescription sleeping pills - Prescription hypnotics can improve sleep when supervised by a physician. The traditional sleeping pills are benzodiazepine receptor agonists, which are typically prescribed for only short-term use. Newer sleeping pills are nonbenzodiazepines, which may pose fewer risks and may be effective for longer-term use.
• Over-the-counter products - Most of these sleep aids contain antihistamine. They can help you sleep better, but they also may cause severe daytime sleepiness. Other products, including herbal supplements, have little evidence to support their effectiveness.
• Modafinil - This stimulant is a unique chemical compound that has replaced amphetamines as a first-line treatment for Excessive daytime sleepiness. Modafinil (Provigil) is an effective, FDA-approved treatment for narcolepsy with few side effects and a low potential for abuse.
• Amphetamines were formerly the most common treatment option for sleepiness in narcolepsy, but they carry a strong risk of addiction. Methylphenidate, pemoline and mazindol also have been used. Selegiline (Eldepryl) is a methamphetamine derivative. It may treat both sleepiness and cataplexy. Relatively few side effects have been reported with its use.
• GHB (gamma-hydroxybutyrate) can improve alertness and also reduce cataplexy. It tends to take about six weeks to nine weeks before it consistently reduces sleepiness. It is a preferred option to treat cataplexy because it has few side effects. Although the FDA approved Xyrem in 2002 for the treatment of cataplexy, all other uses of GHB are banned by the U.S. government’s controlled-substance laws.
• Tricyclic antidepressants formerly were the first treatment option for cataplexy. Severe side effects now make them a last resort. Other antidepressants (atomoxetine, clomipramine, fluoxetine, venlafaxine, zimeldine) have been effective and have produced fewer side effects. The use of antidepressants to treat cataplexy is not approved by the FDA.

Cognitive behavioral therapy (CBT)

CBT can have beneficial effects that last well beyond the end of treatment. It involves combinations of the following therapies:

• Cognitive therapy: Changing attitudes and beliefs that hinder your sleep
• Relaxation training: Relaxing your mind and body
• Sleep hygiene training: Correcting bad habits that contribute to poor sleep
• Sleep restriction: Severely limiting and then gradually increasing your time in bed
• Stimulus control: Going to bed only when sleepy, waking at the same time daily, leaving the bed when unable to sleep, avoiding naps, using the bed only for sleep and sex