Sleep apnoea - Treatment 

Treating sleep apnoea 

The didgeridoo

As unusual as it may sound, there is evidence to suggest that regularly playing the Australian wind instrument, the didgeridoo, can help to reduce the symptoms of mild to moderate OSA.

A study found that people who attended regular didgeridoo lessons and practised every day for four months felt significantly less daytime sleepiness.

This may be because regularly playing the didgeridoo strengthens the muscles in the upper airways.

Common treatments for obstructive sleep apnoea (OSA) include advice on lifestyle changes, and use of breathing apparatus while you are asleep.

Lifestyle changes

Mild cases of obstructive sleep apnoea (OSA) can usually be treated by making lifestyle changes, such as:

  • losing weight (if you are overweight or obese)
  • stopping smoking (if you smoke)
  • limiting your alcohol consumption

Men should not regularly drink more than 3 to 4 units of alcohol a day. Women should not regularly drink more than 2 to 3 units of alcohol a day. If you've had a heavy drinking session, avoid alcohol for 48 hours.

'Regularly' means drinking these amounts every day or most days of the week.

One unit of alcohol is equal to half a pint of normal-strength beer, a small glass of wine or a pub measure (25ml) of spirits.

Stopping smoking can also help sleep apnoea to resolve. See quitting smoking for more information, support and advice about giving up smoking.

Sleeping on your side, rather than on your back, may also help to relieve the symptoms of OSA, although it will not prevent the condition.

See prevention of sleep apnoea for more information about lifestyle changes that can help prevent sleep apnoea.

Continuous positive airway pressure (CPAP)

Moderate to severe cases of sleep apnoea may need to be treated using a type of treatment called continuous positive airway pressure (CPAP). This involves using breathing apparatus to assist with your breathing while you are asleep.

CPAP is used when you are asleep. A mask is placed over your nose, which delivers a continuous supply of compressed air. The compressed air prevents the airway in your throat from closing.

Earlier versions of CPAP often caused nasal dryness, nosebleeds and a sore throat. However, the latest version includes a humidifier (a device that increases moisture), which helps to reduce these side effects.

If CPAP causes you discomfort, inform your treatment staff because the device can be modified to make it more comfortable. For example, you can try using a CPAP machine that starts with a low air pressure and gradually builds up to a higher air pressure as you fall asleep.

As CPAP can feel peculiar to start with, you may be tempted to abandon the treatment. However, people who persevere with it quickly get used to wearing the mask, and their symptoms improve significantly.

CPAP is available on the NHS and it is the most effective therapy for treating severe cases of OSA. It reduces blood pressure and the risk of stroke by 40%, and lowers the risk of heart complications by 20%.

Possible side effects of CPAP include:

  • mask discomfort
  • nasal congestion, runny nose or irritation
  • difficulty breathing through your nose
  • headaches and ear pain
  • stomach pain and flatulence (wind)

If you have any of these side effects, discuss them with your sleep specialist who may be able to recommend an alternative treatment.

Mandibular responding splint (MRS)

A mandibular responding splint (MRS) is sometimes referred to as a mandibular advancement device or MAD. It is a dental appliance, similar to a gum shield, and is used to treat mild sleep apnoea. It is not recommended for more severe sleep apnoea.

An MRS is worn over your teeth when you are asleep. It is designed to hold your jaw and tongue forward to increase the space at the back of your throat and reduce the narrowing of your airway that causes snoring.

‘Off-the-shelf’ MSRs are available from specialist websites, but most experts do not recommend them, as poor-fitting MRSs can make symptoms worse. It is recommended that you have a MRS made for you by a dentist with training and experience in treating sleep apnoea.

If you have an MRS, avoid using hot water to clean it because this will damage it. Use cold water and a soft brush. A MRS may not be suitable treatment for you if you do not have many (or any) teeth. If you have dental caps, crowns or bridgework, consult your dentist to ensure that they will not be unduly stressed or damaged by an MRS.

Surgery

Surgery to treat OSA is usually not recommended because evidence shows that it is not as effective as CPAP in controlling the symptoms.

Therefore, surgery for OSA is usually considered as a last resort when all other treatment options have failed and if OSA is severely affecting your quality of life.

Surgery may be considered to correct sleep apnoea if you have any of the following:

  • deviated nasal septum  this is where the tissue in the nose that divides the two nostrils is bent to one side, often as a result of a sports injury
  • enlarged tonsils which can obstruct the airway
  • small lower jaw  a small lower jaw with an overbite (when the upper teeth overlap over the lower teeth) can make the throat narrow

A range of surgical treatments can be used to treat OSA. These include:

  • Tracheostomy  a tube is inserted directly into your neck to allow you to breathe freely, even if the airways in your upper throat are blocked.
  • Uvulopalatopharyngoplasty  this involves removing excess tissue in the throat to widen your airway. It is the most common type of surgery for treating sleep apnoea in adults. Some patients with particular anatomical abnormalities may benefit from this type of surgery.
  • Tonsillectomy  the tonsils are removed if they are enlarged and blocking your airway when you sleep.
  • Adenoidectomy  the adenoids (small lumps of tissue that are located at the back of the throat, above the tonsils) in children are removed if they are enlarged and are blocking the airway during sleep. This is often the first treatment for children with sleep apnoea as enlarged adenoids and tonsils are the main cause of sleep apnoea in children.
  • Bariatric surgery  this is for weight loss. It involves removing part of the stomach or using a device to reduce the size of the stomach. You may consider this type of surgery if you are severely obese (if you have a body mass index of 40 or more) and it is making your sleep apnoea worse.

Soft-palate implants

Soft-palate implants make the soft palate (part of the roof of the mouth) stiffer and less likely to vibrate and cause an obstruction. The implants are thin and are inserted into the soft palate under local anaesthetic.

The National Institute of Health and Clinical Excellence (NICE) has said that soft-palate implants are safe, but they are not recommended for treating OSA because there is a lack of evidence about their effectiveness. However, in exceptional cases, this form of treatment is recommended for treating snoring that is associated with sleep apnoea.

Page last reviewed: 25/06/2012

Next review due: 26/06/2014

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