There is no definite "cure" for obstructive sleep apnea and sleep-related breathing disorders. The basic treatment and management principle of snoring and obstructive sleep apnea is to keep the airway open and normalize the airflow during sleep. Depending on the severity of symptoms, physiologic and anatomical condition of the airway, and the patient's acceptance and compliance, one or combination of the following management/treatment modalities are utilized. CPAP: Surgery: Oral Appliance:
It will also be of great benefit to include a lifestyle modification such as weight loss, regular exercise, avoidance of heavy alcohol, tobacco, sedatives, and hypnotic drugs. Especially if you are over weight, weight reduction will be the best and the most important thing you will want to do.
CONTINUOUS POSITIVE AIR PRESSURE (CPAP):
A CPAP is a device that delivers continuous positive air pressure through a facemask or nasal tube atached to a pump that sits next to the bed and keeping the airway unobstructed during sleep. This device is very effective (95-100%) and the most widely used device for the treatment of sleep-related breathing disorders, and the first choice for severe obstructive sleep apnea patients.
Proper fitting and adjustment of the CPAP is vital to achieve maximum clinical benefits and minimal side effects. There are many different types of masks and different ways of applications: include a change from constant pressure to alternating pressures for inhalation and exhalation (BiPAP), the addition of warm air humidifiers, smaller more portable and more quiet units, etc.
Despite these recent improvements, patient adaptation and long-term compliance is still notorously low because of cumbersom nature of its application and various side effects: difficulty fitting of the mask, air leakage from mask, skin irritations, stomach bloating to the air pressure, noisy machine disturbing a quiet night's sleep, restricted movement during sleep, latex allergy, claustropobia, etc.
If anatomical abnormalities are the main cause of airway blockage, surgery may be an effective treatment if performed competently and on correctly identified specific anatomic sites that contribute to upper airway obstruction. Various minor and major surgical methods have been developed to prevent airway collapse and maximize the airflow.
UPPP (uvulopalatopharyngoeplasty): Removing the uvula, tonsils, adenoids, and reducing the size of the soft palate was at one time very often utilized. It can be effective in treating people with snoring and mild sleep apnea. However, the most recent rates of success measured at six months for sleep apnea are often reported to be below fifty percent, and there is a significant level of pain associated with the procedure.
LAUP (laser-assisted uvulopalatoplasty) and RF (radio frequency) surgery to shrink the soft palate and tongue base were commonly used, but has been essentially abandoned due to a low level of success.
MMA (maxillo-mandibular advancement): This surgery involves bony cuts to advance the upper and lower jaws to pull forward and tighten the soft palate, tongue and other attached soft tissues. This process enlarges and stabilizes the entire upper airway and know as the most effective and acceptable surgical treatment of OSA, and has published success rates ranging from 94 to 100 percent.
Tracheostomy: This operation bypasses the entire upper airway by creating an opening in the larynx, or windpipe. Although having the highest therapeutic efficacy for OSA, tracheostomy has many psychosocial problems and endangerment of infection, and is reserved as a last resort for the treatment of severe OSA.