CPAP & Other Non-Surgical Therapies
The standard non-surgical treatment of Obstuctive Sleep Apnea is called continuous positive airway pressure (CPAP). Through a mask, the CPAP device delivers room air under pressure into the breathing passage. The pressurized air prevents the collapse of the upper airway so that inspiration and expiration can occur without obstruction. Lack of long-term compliance is the major problem with CPAP treatment for OSA. There can be many issues with CPAP which prevent its use, limit its use or make side effects so intolerable that it is not used. CPAP pressures can not always be adequately adjusted to treat OSA. Some patients who frequently travel find it inconvenient and difficult to carry the CPAP device from place to place. The mask may cause local problems like skin irritation or air leakage into the eyes or from the mouth. A sense of suffocation, difficulty with exhaling, or nasal congestion are common complaints with CPAP use. Since CPAP therapy is not a cure, but a support measure, in my experience, patients can dread the likely need for lifetime use of the appliance. Fortunately after surgical intervention there is often no issue of compliance with treatment other than weight stabilization and prudent use of sedatives.
There are a host of other non-surgical approaches for treating OSA and some of them will be discussed. Weight loss for obese patients with OSA should be encouraged and recommended, but is not easily achieved in the short-term and more difficult to maintain in the long-term. Avoidance of alcohol and sedatives is common sense because both produce muscular relaxation and may predispose to or exacerbate OSA. Jaw advancement and tongue retaining appliances pull the airway open by thrusting the mandible or tongue forward. Only a small fraction of patients are “cured” of OSA using these appliances. With long-term use some will develop jaw joint dysfunction (TMJ) or unplanned movement of teeth with potential malalignment of the bite. Since OSA is often dependent on body position, avoidance of sleeping on one's back may be helpful for mild disease.
If non-surgical remedies are unable to resolve the OSA then the surgical strategy should be considered. The surgical strategy is also to prevent the tongue and palate from falling backwards by advancing, shortening or stiffening these structures. This may involve surgery at that particular site or indirectly on the adjacent jaws or neck.
The material on this site should not be used to diagnose or treat sleep apnea or any other medical problem. If you feel you may have the disorder, please consult your physician.
