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Marshall James Nev, PLC | Treatments for Obstructive Sleep Apnea in Richmond

Lexington-Richmond Headache Clinic
Marshall James Ney, DMD, FAAOP
Fellow American Academy of Oral Facial Pain

527 W. Main St.
Richmond, 40475
(859) 623-3761

Treatments for Obstructive Sleep Apnea
 

Treatments for Obstructive Sleep Apnea

Sleep apnea symptoms can include

  • Excessive daytime sleepiness
  • Poor performance at home or work
  • Depression

Obstructive sleep apnea syndrome (OSAS) is a medical condition that requires careful attention and treatment. It can be life-threatening and involve the collapse of the airway during sleep, resulting in partial or complete blocakage of air.

OSAS symptons include being excessively sleepy during the daytime, depression, and the inability to perform well at home or work. During sleep, the muscles in the throat are more likely to collapse than when awake because they are relaxed. The lungs pull air through a narrow airway and this pressure may cause the breathing passageway to collapse — like flattening a straw by pinching one end closed and sucking on the other end.

Several treatments can prevent the serious problems associated with OSAS and help you correct your sleeping breathing problem.

Lifestyle Changes

Lifestyle changes are one way you can reduce or eliminate sleep apnea.

Sleep-position training

When you sleep on your back, gravity pulls on the soft issues in the back of your throat and neck. This causes the airway to narrow and can cause the airway to collapse completely. Sleep training can help you sleep on your side, therefore improving your symptoms.

The most basic sleep-position training is referred to as the "tennis ball technique," whereby you sew a pocket on the back of your pajama top and insert tennis balls in the pocket. When you start to roll over in your sleep, the pressure from the tennis balls will cause you to roll back on your side. You can accomplish the same thing with a foam wedge strapped to your back. There are also devices you can uy with alarms that will help you stay on your side during sleeping. Your medical professional can tell you how long this type of treatment should last.

Elevate your head or the head of your bed

Sometimes apnea can be managed by elevating your body from the waist up. You can do this with a wedge pillow or by putting a brick under each leg at the head of your bed.

Weight loss and regular exercise

Sometimes weight loss can help the symptoms. Once you reach your weight goal, it is important to maintain it because with weight gain, the sleep apnea and snoring will return. You should consult your healthcare professional to discuss weight loss programs.

Quit smoking

Studies suggest that smoking may contribute to snoring and sleep apnea.

Avoid sedatives and alcohol

Just one glass of wine before bedtime can worsen your snoring and sleep apnea, so don't drink alcohol within 4 hours of bedtime. Sleeping pills, anti-depressants, pain medications, and alcohol can cause the tissues in your throat to relax more than usual and obstruct the airway. Sedatives and alcohol can make it harder for the brain to "wake up" and notice the lack of oxygen in the system, resulting in longer and more dangerous periods of abnormal breathing.

Continuous positive pressure airway devices (CPAP)

A continuous positive pressure airway device is a very effective therapy that uses air pressure to hold the airway open during sleep. CPAP machines pump air through a compressor that is connected by a hose to a mask that fits ove the nose and/or mouth. The mask fits over the top of the head and is held in place with straps. The appropriate CPAP pressure level is determined during a sleep study. The pictures show two types of masks. The tubing is hooked to a pump which keeps your airway open by keeping light pressure in the airway from your nose down to your lungs.

cpap_conventional_mask.jpg
Conventional Mask

cpap_nose_pillow.jpg
Nasal Pillow

Nasal pillows

Nasa pillows are an alternative to the mask method of CPAP delivery. They consist of soft pieces of plastic that are placed directly into the nostrils. Your sleep professional can recommend which brand of CPAP you should consider. A few patients using CPAP therapy may experience dryness in the nose or a little claustrophobia, but these problems can be solved with a few adjustments. A humidifier can reduce dryness, and relaxation techniques can be taught to relieve the claustrophobia. CPAP is successful 95% of the time.

Oral appliances

These are devices that help keep the airway open by holding the jaw or tongue forward which increases the airway space behind the tongue. Most of these devices require a clear airway for success. An experienced dentist can construct a device that fits your individual needs. The success of oral appliances can be improved by not sleeping on your back, elevating your body with a wedge pillow, elevating the head of the bed, weight loss, and/or following other sleep hygiene suggestions.

Tongue-retaining devices

These are placed in your mouth right before bedtime to create a slight suction that will hold the tongue forward and keep it from falling back in your throat. These are often effective in mild to moderate apnea.

Jaw-advancement devices

These are made to fit over the top and bottom teeth in a way that pulls the lower jaw slightly forward, as in the picture below.

Success Rate of Oral Appliances

 

              Events/Hour  Success Rate

    Mild OSA         5-15           76%

Moderate OSA        15-30           61%

  Severe OSA           30           40%

A Word About Success

In treating sleep apnea, success means two events have to occcur:

  1. The device or recommended treatment, CPAP, oral appliance, or weight loss has to work.
  2. The patient has to use the device or lose the weight.

In general, CPAP is more effective than oral appliances. However, oral appliances have a higher acceptance rate with patients.

Surgery

If your sleep professional finds an obstruction in your airway, or if conservative treatments have not worked, surgey may be an option. An operation is not always the right choice, so be sure you are aware of all the possible risks and side effects before undergoing any procedure.

Medications and Alternative Treatments

Medication alone offerslimited benefits for effectively treating snoring and OSAS. Medication may be more effective in mild apnea cases or when used as part of an overall treatment plan.

Nasa Sprays

Over-the-counter sprays that help clear the nasal passages. However, these can be habit-forming and should only be used for a few days. Prescription nasal sprays can be effective in unblocking the nose, but they may take days or weeks to work. If there is a permanent blockage caused by a growth or a deviated septum, nasal sprays are not usually effective.

Decongestants

These relieve congestion in the nose, but they are not considered a treatment for sleep apnea. While decongestants can help you breathe better, they can also cause sleep problems.

Respiratory stimulants

Protriptyline is an antidepressant used to treat mild apnea. It decreases dreaming sleep (REM), which is when apneas are more frequent and longer. Protriptyline may help tone and strengthen the muscles of the throat. Dry mouth and constipation are possible side effects, and this drug is not recommended for anyone with high blood pressure or an abnormal heart rhythm. Medroxyprogesterone, a hormone, is occassionally prescribed to treat OSAS, but its effectiveness is inconsistent and the side effects could include unwanted hair growth, mood changes, and fluid retention.

Oxygen

Oxygen can be used to correct low oxygen blood levels due to heart or lung disease. Oxygen is used along with CPAP treatment for best results.

Follow-up Care

Regardless of which treatment is used for OSAS, you must have a follow-up sleep study done by a sleep professional in order to evaluate the success of the treatment. It is also essentialto keep regular follow-up appointments with your doctor because the severity of apnea may change with age.

How to sleep well

The following guidelines can help alleviate all types of sleep disorders and help most people sleep well.

  • Get up about the same time every day.
  • Go to bed only when you are sleepy.
  • Set a relaxing pre-bed routine. For example: take a warm bath or read for 10 minutes.
  • Exercise regularly. Do vigorous exercises at least 6 hours prior to bedtime. Do simple exercise, like walking or stretching, at least four hours prior to bedtime.
  • Organize yourself. Meals, medications, activities done at a regular time help to keep your inner clock running smoothly.
  • Do not ingest caffeine within 6 hours of bedtime. Don't drink alcohol when you are sleepy. Even a small drink can have a potent effect when you are tired.
  • Do not smoke close to bedtime.
  • If you nap, take only short naps at a regular time every day.
  • Use sleeping pills with caution. Most doctors don't prescribe sleeping pills for longer than 3 weeks.
  • Do not drink alcohol if you are taking sleeping pills.

 

 
 
Richmond Dentist | Treatments for Obstructive Sleep Apnea. Marshall James Ney is a Richmond Dentist.