CPAP (continuous positive airway pressure) is the best treatment for people suffering from obstructive sleeping apnea. When used every night, it is almost 100 percent effective.
- Surgery should only be considered a last resort. Although there are some situations in which your surgeon and your sleep specialist will agree that surgery would be the best option, these are rare.
- The most effective treatment is the one that works for you.
- Nonsurgical treatments can be more conservative than sleep apnea surgery, and they may prove to be more effective.
- Before you have surgery to correct sleep apnea, get a second opinion from your sleep specialist.
- To verify that the treatment is effective in eliminating your sleep apnea, do a sleep study prior to and after the treatment.
Select the right treatment
The most conservative treatment will work for each individual. Which conservative treatment is best for you? This is a complicated and personal question that you and your sleep specialist should discuss with your family doctor. You should consider the severity of your apnea and your overall health when deciding on the treatment. A sleep specialist can help you choose the best treatment for you.
What does it mean to be most conservative? This is the treatment that has the lowest risk to you. Different doctors might have different treatment recommendations. Each doctor has unconscious and conscious biases that favor certain types of treatment. This is the result of their training, specialization, and personal experience. An internist may believe surgery is the best choice, while a surgeon might be more inclined to believe it is. It is your job to consider these biases as you and your doctors weigh the benefits and risks of each treatment and decide which one is best for you.
CPAP is the best treatment for most people with sleep apnea
CPAP (continuous negative airway pressure), is the best treatment for people suffering from sleep apnea. CPAP can completely eliminate sleep apnea and reduce the risk of developing cardiovascular or heart disease from untreated sleep apnea. CPAP improves sleep quality, energy, and enjoyment of life. This allows people to resume careers and other activities that were hindered by untreated sleep apnea.
CPAP is considered the most conservative treatment. If other treatments prove to be more effective, CPAP may be discontinued. This is a significant advantage over permanent treatments like surgery.
When someone mentions surgery
When you hear the term “sleep apnea surgery”, remember this:
- The most conservative treatment that works is the best.
- CPAP is the best treatment for sleep apnea for most people.
- Surgery comes with risks, and it is important to fully understand the risks.
Is insurance covered for sleep apnea treatment?
When you start to think about treatment for sleep apnea, it is a good idea to get in touch with your insurance company. Ask your insurance provider what treatments they will cover and what their coverage covers. If prescribed by a sleep specialist, most insurance companies will cover the most common sleep apnea treatments. Some surgical procedures might not be covered.
Who treats sleep apnea?
Depending on what treatment you need, where it will be done will depend on your particular treatment, how big your sleep center is, its staff size, and the importance of its programs. Some centers offer both sleep testing and treatment. Others only do sleep testing. Other sleep centers may specialize in treating sleep apnea. Still, others will refer patients to other facilities. You can expect the staff and sleep specialists to work with your family to plan your treatment. They may also recommend a specialist. At this point, your family doctor might be involved. The doctor might suggest a variety of treatments you can do on your own, such as quitting smoking or losing weight.
The sleep center might refer you to a nutrition counselor, a support group for smokers, or other programs that can help. If you are considering surgery and your sleep center doesn’t offer it, they will likely recommend or refer other specialists to you. These doctors will help to plan your treatment. You may want to consult an outside physician if your sleep center has a surgeon or other specialist who can treat you. The sleep center might prefer that you start medication, and then your family physician will oversee your recovery.
A breathing device is the most commonly used treatment. The device can be provided by the sleep center or arranged for by a homecare company or medical equipment company.
The first step in treatment: Get rid of the obvious
To treat sleep apnea, you must first eliminate any aggravating factors. This will help you avoid more complex treatments. These can make your sleep apnea worse.
- Even a single glass with dinner of alcohol in the evening can increase the frequency of apnea events. Alcohol consumption should be avoided by people with sleep apnea.
- The blood’s oxygen level is decreased by smoking. Smoking also causes inflammation of the airway which can lead to obstructive sleep apnea. It is a good idea to quit smoking if you suffer from sleep apnea.
- As well as swelling and obstruction of your airway, respiratory infections and allergies can also cause itching. Obstructive sleep apnea can be reduced by treating allergies and upper respiratory infections.
- Evening medication, such as tranquilizers or short-acting beta-blockers, can sometimes worsen sleep apnea. A sleep specialist might consult the doctor who prescribed the medication to determine if a change in the prescription or the medication schedule could help to eliminate symptoms of sleep apnea. (See Appendix for a complete list of medications that can affect sleep).
- Obesity is a major contributor to sleep apnea. Weight loss can reduce or eliminate sleep apnea. This article will discuss weight loss in greater detail.
- Shift work. Any activity that disrupts the quality or quantity of sleep, such as shift work, can lead to sleep apnea symptoms.
Ask your sleep specialist about how to improve your sleep while working shifts. It may be worth considering switching to a job that doesn’t require you to rotate shifts. These are often caused by bad habits and lifestyles that are hard to change. People often have the best success if they participate in a structured program to get rid of a habit. Ask your sleep center for a recommendation if you are struggling to solve a problem like losing weight or quitting smoking.
Treatments for Obstructive or Mixed Sleep Apnea
From the most conservative to the least conservative, there are currently several options for treating obstructive sleeping apnea. These include weight loss, changing your sleeping position, or using oral and/or medical devices. Mixed apnea is usually treated by treating the obstructive component. Central apnea usually ceases to exist once the obstructive component of your apnea has been controlled.
Modification in your Sleep Position
Obstructive sleep apnea sufferers are more likely to experience severe breathing problems when they lie on their backs. These people may be able to resolve their problems by changing their sleeping position. There is not enough evidence to prove that this method produces reliable results every Night.
Even though sleep testing may show fewer breath-holds at a specific position, it is possible that the airflow is still poor enough to disrupt sleep. You may feel more rested if you use CPAP than if you sleep on your side with CPAP. This is a strong indicator that you require more than positional treatment. Position training is not recommended for people suffering from severe apnea.
People who are:
- A sleep study has shown that obstructive sleep apnea can only occur while they lie on their backs.
- Can they reliably rest on their side?
Conditioning is key to learning how to avoid certain sleep positions. For those who roll onto their backs, there are many sleep position alarms that can alert them and help them choose a different sleeping position. You can either sew a small ball to the back of your pajamas or carry a small bag containing a bulky object and lie on your side. Most people need to practice for a few weeks before a new position in their sleep becomes a routine. They may also need to “retrain” themselves from time to time.
Weight Loss
Who can be helped by weight loss?
People with Pickwickian syndrome can lose weight.
- Apnea in overweight people is more often associated with weight gain than with anatomical obstructions of the airway (such as a stuffy nose or large tonsils).
- If sleep apnea is not a serious problem, the effects on your health such as heart disease or sleepiness may not be a threat to your life immediately.
People with overweight apnea who are motivated to improve their lives and health are more likely to succeed in weight loss.
How does weight loss work?
It works when it’s effective. There are other reasons that are being investigated. It reduces abnormal abdominal loading that can cause breathing difficulties and reduces fatty deposits in the throat tissue which may lead to obstructive sleep apnea. Weight loss can only be effective if:
- You can lose enough weight
- Permanent weight loss is possible
Failure to lose weight and weight gain are two of the main reasons this treatment fails. There may be a threshold weight above which extra weight can cause apnea symptoms, and below which symptoms can be relieved. This theory states that you must reduce your weight enough to reach the threshold to experience improvement in your apnea symptoms. The upper airway is soft-sided, collapsible, and can be affected by other factors, such as weight gain. A person with a small jaw that crowds the airway might not notice much improvement.
Some people may have difficulty losing weight or keeping it off if their sleep apnea remains untreated. They may experience fatigue, sleepiness, and low energy. This could make it difficult for them to be physically active enough in order to burn calories and build muscle. Combining CPAP (discussed below) with weight loss can be a powerful combination. Weight loss surgery can be a drastic way to lose weight. Recent evidence shows that weight loss surgery is a radical way to lose weight. However, severe obesity with a BMI over 40 could pose greater risks than having it treated. Weight loss surgery is not recommended as a conservative treatment. This topic will be discussed in the section on surgery.
CPAP and similar Breathing Devices
CPAP and other similar breathing devices are the best and most important treatments for sleep apnea. Breathing devices are used to treat obstructive sleep apnea. They use air pressure as a “splint”, which holds the upper airway open during sleep and prevents it from collapsing. Experts in sleep believe that these devices can also stimulate a person’s breathing reflexes.
CPAP, pronounced “SEE-pap”, is the most commonly used breathing technology to treat sleep apnea. CPAP (continuous negative airway pressure) is a technology that Dr. Colin Sullivan, a researcher at the University of Sydney Medical School in Australia, developed in 1981 (1.2). In 1984, it was used for the first time to treat sleep apnea in the United States.
CPAP is the best standard treatment for sleep apnea, whether it’s surgical or not. CPAP is the preferred treatment at most sleep centers. The standard CPAP system consists of a soft, flexible, and pliable mask, which is worn over the nose at night (but not the mouth). Flexible tubing connects the mask to an air pump that delivers slightly pressurized air into the nose through the tubing. The CPAP wearer inhales and the air pressure stabilizes the soft palate and tongue. It prevents the airway from collapsing. The pressure regulator is a customized set that is made for each patient in a sleep laboratory. It delivers the exact pressure the individual needs to eliminate apnea episodes, but not more than necessary. Each year, new CPAP models are released.
Visit the websites of major manufacturers to see the latest CPAP masks and models.
ResMed Corp. www.resmed.com 800-424-0737 Respironics, Inc. www.respironics.com 800-345-6643
CPAP pressure can be measured in centimeters (cm H2O) and barometric pressure in millimeters (mm Hg). Typical CPAP pressure settings are between 5 and 20 cm H2O.
Bi-level PAP, also known as BiPAP by Respironics, Inc., is a refined version of CPAP. The system allows the sleep specialist the ability to adjust the air pressure to two levels. Higher pressure is used when the person inhales to reduce snoring and a lower pressure for exhaling to make it easier.
Oxygen may be prescribed for severe cases of obstructive sleeping apnea. An auto-PAP, or smart-PAP, is a new type of CPAP. This machine adjusts the pressure to suit the user’s needs. The device detects user’s breathing patterns, adjusts pressure to compensate for changes in breathing throughout the night. There are many smart-PAP manufacturers. Each one uses different breathing signals for controlling their devices. There are different designs that are more comfortable than others and which are better suited for specific types of users.
A smart-PAP costs more than a regular CPAP. Many people suffering from sleep apnea would not consider the additional cost. Most insurance and health plans will not pay for smart-PAPs unless they are prescribed. Dual- or variable-pressure systems are the preferred treatment for severe cases of sleep apnea. Insurance will usually cover the additional cost if the specialist prescribes one. This field is rapidly changing in technology. Talk to your homecare representative and staff about the different types of breathing devices available if you’re a candidate for CPAP. It is possible to try several and choose the one that suits you best.
Who can benefit from CPAP?
CPAP can be a “miracle cure” for people who haven’t slept or breathed normally in years, and who are very ill from long-term cardiac and respiratory effects. CPAP is used by more than 350,000 Americans today. This number keeps growing each year.
Many people find that CPAP can be difficult to adjust to. This is why patience and perseverance are important. CPAP treatment should be initiated and assessed in the sleep center during an overnight study.
This allows the sleep technician to adjust the pressure accurately, establish a baseline to monitor the effectiveness of treatment, and avoid ineffective or inappropriate use of CPAP. CPAPs might be able to do this in the patient’s own home over time. But that is still a long way off.
Getting used to CPAP
CPAP is a difficult procedure that requires perseverance and motivation. It takes a few minutes to wash your face each night before you go to bed, just like brushing your teeth. Then, take a few minutes each morning to wash the mask. Once CPAP becomes part of your bedtime routine, you will be able to use it every night. For better health and a longer life expectancy, one must make a commitment each night to use the system.
CPAP users are generally willing to accept the inconvenience after they have experienced the results. A follow-up study with 20 CPAP users found that 16 of them still used their CPAP every night after a year. This high level of compliance reflects the patients’ enthusiasm for the treatment. High compliance means that the center for sleep disorders has a policy that provides conscientious care to assist new CPAP patients with any questions or problems that may arise. The main drawbacks to CPAP lie in the idea that CPAP is cumbersome and inconvenient. It may also cause irritation to the nasal passages in some people.
Some people are able to get used to the mask in a matter of days or weeks. Others may need several weeks. Some CPAP users find the fan-like sound of the air pump motor annoying. Patients who have CPAP machines that are more recent find it difficult to hear the machine. They may wake up at night to discover that their CPAP machine is no longer audible. Once they get used to it, it will be a habitual sound that they can hear. People don’t mind CPAP and most people prefer it to snore.
CPAP can be used all night and every night to provide positive results that almost seem like an instant cure. Most people feel better within days of using CPAP than they did in years. People report feeling more rested, awake in the morning, alert throughout the day, and having the energy and motivation to accomplish the things they desire.
Regular CPAP users who stop using the device for a night, such as during a power outage, are often eager to get back to CPAP. This is because their symptoms and apneas quickly return. Many people who have used CPAP for a while and then slept without it report feeling more aware of the choking sensations they felt with each apnea event. They may dream of heavyweights being placed on their chests or feel suffocated when they go to sleep without CPAP. This is why they don’t often want to quit CPAP.
What are the long-term effects of CPAP?
Since the 1980s, CPAP has been monitored closely by sleep scientists to ensure that there are no adverse long-term effects. CPAP has been used by thousands of people for over 20 years. No serious adverse effects have been documented in the medical literature. Although no one can ensure safety for sleeping for more than 30-40 years at slightly higher pressures, the medical literature indicates that sleep apnea is much more dangerous than the potential long-term consequences of using CPAP.
What is the cost of CPAP devices?
CPAP systems are available for rent or purchase. Renting a system for a few months is a great way to get started. You can then see how it works and maybe try a few other models. The cost of CPAP units varies across the country. Currently, CPAP units are available for rent at a cost of $250 to $350 per month. The purchase price is around $1,500 to $3,000 The mask and tubing may need to be purchased separately (about $200). Masks need to be replaced regularly because they absorb oil from the skin.
Silicone masks can last for up to 18 months. Unheated humidifiers can be as low as $100, while a heated humidifier costs $500. Your insurance policy may cover some, if not all of the cost of CPAP rental or purchase. For more information on CPAP, talk to your insurance representative.
How do you get a CPAP unit?
To be eligible for a CPAP machine, you must have a prescription from your doctor. The staff at your sleep center can connect you to a company that will provide you with a CPAP machine. A representative from the homecare company will show you how to use your CPAP device. In the event of a breakdown, they should be able to provide immediate service.
Some sleep centers rent or directly sell CPAP machines. Most do not have the staff or desire to rent CPAP systems.