Severe sleep apnea, with more than 30 apneas/hypopneas with desaturation per hour sleep, increases risk of strokes and sudden cardiovascular death. Moderate sleep apnea (15-30 apneas/hypopneas with desaturation per hour sleep)  doubles risk of high blood pressure and heart attacks. Treatment of moderate to severe sleep apnea is necessary to improve health and longevity. Mild sleep apnea (5-15 apneas/hypopneas with desaturation per hour sleep) may cause sleepiness and may increase risk of high blood pressure. Treatment is advisable in the presence of sleepiness, high blood pressure or cardiovascular disease. Mild sleep apnea of the upper airway resistance type (less than 5 apnea/hypopneas with desaturation or arousal per hour sleep but less than 5 apneas/hypopneas with desaturation per hour sleep but more then 5 respiratory arousal per hour sleep) may cause sleepiness, and may benefit from treatment if sleepiness is present. Treatment for snoring without sleep apnea is not medically necessary.

Treatments for sleep apnea include:

1. Continuous Positive Airway Pressure (CPAP): This  is the definitive treatment.  CPAP is the most effective treatment for moderate to severe sleep apnea, and works almost all the time. It is the preferred first step. Follow-up studies show that patients treated with CPAP are less likely to have strokes, heart attacks, or die, than untreated patients. CPAP is a mask placed on the nose, connected by a hose to a small portable electrical pump in the room. It pumps room air into the airway. This inflates the airway and prevents it from collapsing. The snoring and the apnea stop. CPAP requires a commitment to use it every night. Although it is uncomfortable initially, most people get used to it. It is about as noisy as a fan, which is much less noisy than snoring.

To find the correct air pressure to prescribe, the device is used with different pressures during an overnight test. Once prescribed, the device may be obtained from any medical supply company. The initial prescription is typically for three months. If you are not tolerating it well, or it is not helping, contact us right away so we can try to solve the problems. If the device works well and is well tolerated, the next prescription is usually for a year. Thereafter, annual office visits and continuing prescriptions are necessary. Possible problems include: (a) Dry nose or congestion: A humidifier (especially a heated one) in the circuit helps. If you are still congested, do not use over the counter decongestants. You can use loratadine (Claritin), or call us for a prescription of nasal steroids or non-sedating antihistamines. If your mouth opens up, a chin strap or full-face mask may help. (b) Uncomfortable mask: Contact the supplier for a different size, a spacer between the nose and mask, or nasal pillows which fit on the nostrils. If the mask actually causes bruising, use a local steroid cream. (c) The air pressure feels too high: Lowering the pressure temporarily may help. A C-Flex/ EPR setting on the CPAP or a BiPAP unit may help by lowering the pressure when you breathe out. (d) Difficulty sleeping with the device: Medicines that help you sleep may help.

2. Surgery: Several types of surgery are available to treat sleep-related problems of snoring and sleep apnea. Nose surgery to unblock the nose may help with breathing and make it easier to use CPAP. Uvula surgeries such as the UPPP make the airway larger by removing the uvula (and tonsils, if present) They work less than 30% of the time for sleep apnea, though they work well for snoring. Oral surgery to reposition your jaw (MMA) works 60% of the time. The two surgeries combined work 90% of the time.

3. Bariatric surgery for extensive weight loss may also help. Untreated sleep apnea increases the complication risks of bariatric surgery. Therefore, patients should use CPAP in the weeks before and after bariatric surgery to reduce the risk of complications.

4. Oral devices: These fit on the lower teeth. The lower jaw is then pulled out by pressure from the upper jaw. These work about 50% of the time in mild to moderate sleep apnea if they are retained all night.

5. Behavioral techniques: Sleep apnea is worse on the back, and a wiffle ball sewn to the back of  the pajamas keeps you off your back. Avoiding alcohol at night helps. Weight loss helps but  must be kept off.

Follow-up testing: With any treatment except CPAP, success rates are limited. Snoring may stop, but apnea may persist. Therefore, follow-up testing 1-2 months after surgery or other treatments is essential to tell whether the treatment was successful. With CPAP, follow-up testing is needed if the apnea was not fully controlled during the testing to find the right pressure, if symptoms persist or return, or after several years on CPAP. Sleep apnea can be dangerous. Do not stop using CPAP on your own.