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How to Treat Sleep Apnea

Obtaining a sleep history is key to recognizing sleep apnea, which is characterized by repeated episodes of interrupted breathing during sleep. Input from a bed partner can be especially important because the partner is likely to notice signs associated with frequent periods of apnea, such as snoring or gasping for breath.

Definitive diagnosis typically requires spending one night in a hospital sleep laboratory to undergo polysomnography, a set of sleep studies that monitor brain waves (to determine which stages of sleep are associated with episodes of apnea), heart rhythms, airflow and breathing patterns, eye and leg movements, and blood oxygen levels.

Some people are able to undergo monitoring at home using portable equipment. A sleep specialist can perform an evaluation to determine if you’re a candidate.

Sleep apnea treatment

Lifestyle measures that may reduce sleep apnea include losing weight for overweight and obese people, avoiding alcohol and sedatives at bed- time, quitting smoking, and sleeping on your side or in a more upright position. For someone who has hypothyroidism, treating that condition may help reduce apnea.

If these measures do not help, continuous positive airway pressure (CPAP) may be necessary. CPAP, which involves wearing a nasal mask that delivers a steady stream of air to maintain airway pressure and keep the airways open, is effective in 80 to 90 percent of people.

The mask is cumbersome, however, and can cause nasal dryness and congestion and skin irritation. Using a humidifier and making sure the mask fits properly can alleviate some of these problems.

Some people benefit from a dental appliance that helps maintain an open airway by keeping the jaw and tongue in a forward position during sleep. These devices are an option for people with mild or moderate sleep apnea who do not respond to or are not appropriate candidates for CPAP. However, most research has shown that CPAP is superior to oral appliances in reducing the number of sleep apnea episodes and in reducing daytime sleepiness.

A surgery option

Another option for carefully selected people who cannot tolerate CPAP is uvulopalatopharyngoplasty, a surgical procedure that increases the size of the upper airway by removing the uvula (the taglike structure that hangs down from the back of the throat) and any excessive tissue surrounding it. Better results have been reported in individuals with mild cases of sleep apnea. Tonsillectomy, surgical treatment of other upper airway obstructions, and facial reconstructive procedures may help in some cases.

An alternative for some is the Pillar Palatal Implant System. With this system, three polyester braids, each less than an inch long, are implanted in the back of the throat to stiffen the soft palate and reduce the vibration that causes snoring. While the device is approved by the U.S. Food and Drug Administration to treat snoring and mild to moderate sleep apnea, the jury is still out on its effectiveness.

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Some physicians may attempt to relieve sleep apnea using a variety of medications known to affect the sleep cycle, but the only drug approved by the FDA for use in sleep apnea, as an adjunct to other treatments, is Provigil (modafinil).

Originally approved to treat narcolepsy, Provigil can help people with sleep apnea to stay awake during the day. Unfortunately, Provigil does not treat the underlying problem in sleep apnea and may not reduce the risk of the many diaseases associated with untreated sleep apnea.

The most common side effects are headache, nausea, nervousness, stuffy nose, diarrhea, back pain, anxiety, trouble sleeping at night, dizziness, and upset stomach.

(Originally published Jun. 3, 2016; updated Feb. 24, 2017)

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