One kind of sleep-disordered breathing is known as sleep apnea. Sleep-disordered breathing is an umbrella term that refers to disorders that cause people to breathe improperly or have pauses in their breathing when they are sleeping.
And the most common sleep disorder among people is the obstructive and central types of sleep apnea. Obstructive sleep apnea (OSA) is characterized by pauses in breathing or decreased breathing while asleep, and it can be caused by total or partial obstructions of the airway. In contrast, those with central sleep apnea (CSA) have pauses or complete cessation in breathing while asleep.
This condition is caused by problems in the brain or neurological system. When a patient exhibits symptoms of both obstructive and central sleep apnea, medical professionals will diagnose them as having mixed sleep apnea.
Estimates of the number of persons who suffer from sleep apnea vary widely depending on the research study that was conducted. According to several studies, obstructive sleep apnea might affect as much as 38 percent of the population, with males and older folks being more likely to be affected.
According to research conducted on people over the age of 60, obstructive sleep apnea affects up to 90 percent of males and 78 percent of females. CSA is far less prevalent than other cancers, affecting just about 1 percent of people. This rate increases to 4% among people who report having suffered cardiac failure at some point in their lives.
People who have OSA have a higher chance of developing hypertension, type 2 diabetes, and a variety of other health complications. According to research, OSA that is not treated can potentially result in transient brain damage.
The good news is that a variety of sleep apnea therapies are now on the market and can assist in lowering the risk of these consequences. They are discussed in detail below.
Several different non-invasive therapy methods are available for those who suffer from sleep apnea, and some are more successful than others. Oral appliances and positive airway pressure (PAP) devices are the two categories that fall within the non-surgical treatment alternatives.
1. Continuous Positive Airway Pressure (CPAP)
Continuous positive airway pressure (CPAP) is the treatment that most medical professionals regard as the “gold standard” for obstructive sleep apnea. Therefore, it is typically the first treatment suggested to those diagnosed with mild to severe obstructive sleep apnea.
A CPAP machine will often be plugged into an outlet and placed next to the sleeper’s bed. It will then be connected to the sleeper’s face by a tube that leads to a mask that either covers the sleeper’s mouth and nose or only their nostrils. After that, the CPAP machine will blast air into the sleeper’s airway, reducing the likelihood of their airway closing while they are breathing while they are asleep.
Even though CPAP is often regarded as the most efficient treatment for OSA, a significant number of patients who have been given the device do not use it as frequently as they ought to. The CPAP therapy is not nearly as effective when it is applied to the treatment of central sleep apnea. When treating persons who have CSA or mixed sleep apnea, it is common practice to use oxygen in conjunction with a CPAP machine.
The continuous positive airway pressure (CPAP) equipment can only exhale air at one pace, which the attending physician would often tune to the average rate that the patient requires while sleeping. Alternative choices may be made in light of the fact that some individuals have problems enduring this consistent level of air pressure.
2. Bilevel Positive Airway Pressure (BiPAP)
In the event that a patient suffering from sleep apnea would be unable to endure treatment with CPAP, their doctor may recommend that they use a bilevel positive airway pressure (BiPAP or BPAP) machine instead.
The BiPAP machine functions in a manner that is analogous to that of a CPAP device. It attaches to the face of the individual using a tube and a mask, and then it exhales air in order to maintain the airway open.
However, in contrast to a CPAP machine, a BiPAP machine delivers air at a greater pressure during the inhale phase of a sleeper’s breathing cycle and at reduced pressure during the exhale phase of their breathing cycle.
Because of this characteristic, the BiPAP is an excellent option for those who have difficulty exhaling into the flow of air with a greater pressure that is produced by a CPAP machine. People who not only have sleep apnea but also have significant obesity or certain other health issues, such as chronic obstructive pulmonary disease or hypoventilation, are occasionally recommended to use BiPAP equipment.
3. Automatic Positive Airway Pressure (APAP)
Automatic positive airway pressure machines, also known as APAP or Auto-CPAP machines, function in a manner that is analogous to that of CPAP machines in that they attach to the face of a sleeper through a tube and mask and then expel air in order to maintain an open airway in that sleeper.
APAP devices are distinct from CPAP machines in that they can automatically alter the air pressure delivered by the device. This feature can make the machine more pleasant to use than a CPAP since people who sleep need varying degrees of pressure at different periods of the night based on their sleeping position, the state of sleep they are in, or the amount of congestion they have.
The term “auto-titrate” refers to the process through which automated positive airway pressure (APAP) machines use pressure sensors and a computer algorithm to “determine exactly the air pressure a sleeper requires at any specific moment.
Because of this, a person who finds that the constant pressure of air that is released from a CPAP machine is uncomfortable may find that an APAP machine works better for them. In addition, sleep experts can configure APAP devices to only release air at levels within a certain range, which helps to guarantee that the therapy is successful.
4. Adaptive Servo-Ventilation (ASV)
Adaptive servo-ventilation, often known as ASV, is a therapy typically administered to patients suffering from central sleep apnea. The user wears a tube and mask during the use of the ASV, and the air is expelled from the device in a manner analogous to that of the PAP therapy.
However, rather than supplying a predetermined amount of air on inhaling and expiration, the ASV is designed to release a tailored air pressure that adjusts in real-time. This allows the ASV to anticipate and respond to events associated with central apnea.
5. Expiratory Positive Airway Pressure (EPAP)
Expiratory positive airway pressure (EPAP) equipment is not motorized equipment like other sleep apnea therapies such as CPAP and BiPAP. Instead, the EPAP therapy consists of two tiny valves that are placed inside the patient’s nostrils. The EPAP treatment keeps the patient’s airway pressure stable by creating resistance, which keeps the airway expanded even if the patient is exhaling.
EPAP is a treatment that does not require power, makes very little to almost no noise, and is very compact and lightweight. Because of this, it might be a more convenient alternative than using CPAP for certain people. Nasal EPAP has more commonly been tested for usage in persons diagnosed with OSA as opposed to CSA.
EPAP therapy is more recent; however, it is recommended far less frequently than the other PAP treatments.
The use of an oral device to open the airway can help alleviate the symptoms of sleep apnea. Oral appliances, much like EPAP, are normally only used if a patient has concluded that they are unable to handle one of the PAP devices and has exhausted all other options. The two most often used oral appliances are:
1. Mandibular Advanced Splints (MAS)
This therapy entails wearing a dental appliance that is created to order and fits over the upper and lower teeth. It keeps the lower jaw moved forward and stabilizes the bite. In addition, the mandibular advancement strategy (MAS) brings the jaw and the tongue forward. This increases the likelihood that the airway will remain open.
When a person is unable to use a PAP machine, one of the therapies that are most usually given is called MAS therapy; however, the degree to which it is successful varies greatly depending on the individual using it. MAS may be most useful in treating cases of snoring that disrupt sleep as well as mild to moderate OSA.
2. Tongue-Retaining Devices
The purpose of these devices is to maintain the airway clean by employing suction to keep the tongue positioned in a forward posture. It has been demonstrated that tongue-retaining devices can dramatically lessen the severity of obstructive sleep apnea (OSA) symptoms, despite the fact that they are not as effective as CPAP in treating the illness.
Researchers believe that their usage should be limited to a shorter time frame. One further advantage of these gadgets is that they are easily accessible and do not require a doctor’s prescription to buy.
The use of surgical procedures to treat sleep apnea is not nearly as successful as the use of CPAP and oral appliances. However, there are a number of surgical treatments available that might make the use of a CPAP machine or an oral appliance less difficult. If CPAP or oral appliance therapy is unsuccessful for you, your doctor may suggest that you undergo one of many surgical procedures.
The most frequent treatment options are to shrink or remove the excess tissue in your throat, which helps prevent it from collapsing and blocking your airway when you sleep. Your bone structures, including your jaw, nose, and facial bones, may be adjusted through operations that are more sophisticated.
The majority of children who snore or have sleep apnea also have enlarged tonsils, adenoids, or both of these structures. The surgical excision of these tissues is successful in curing sleep-related respiratory disorders in the majority of those instances.
Children who have issues breathing while they sleep are often recommended to have their tonsils and adenoids removed as the first line of therapy. This recommendation comes from the American Academy of Pediatrics.
A board-certified sleep physician will be able to guide you through the process of choosing whether or not undergoing surgical therapy is the best option for you to pursue. There is also the option of undergoing surgical procedures for the purpose of losing weight.
Several aspects of one’s lifestyle have the potential to lessen the severity of obstructive sleep apnea symptoms.
1. Weight Loss
Research has shown that for many persons, a reduction in body weight can lead to an amelioration of the symptoms of obstructive sleep apnea (OSA). Because of this, medical practitioners could suggest that their obese patients with OSA engage in bariatric surgery and a healthy diet and exercise routine.
2. Exercises of The Throat
Throat activities entail making repetitive motions with the tongue, soft palate, and throat. These exercises are often referred to as oropharyngeal exercises. These exercises have been shown to lower the severity of OSA symptoms.
In addition, participants in a number of studies that used these exercises had an improvement in their OSA symptoms after consistently practicing these exercises for a period of three months.
However, the experts do not yet understand the mechanisms behind the beneficial effects of these activities.
3. Altering The Position in Which You Sleep
It is also known as a positional treatment and can alleviate the severity of OSA symptoms in some people. Because many people who have OSA have more severe symptoms when they sleep on their backs, positional treatment often entails attempting to train a person to cease sleeping on their back.
4. Avoid Alcohol
People who have OSA should try their best to avoid drinking alcohol and using sedatives in the hours leading up to bedtime, if at all feasible. It is believed that alcohol exacerbates the symptoms of OSA by relaxing the muscles that are linked with the airway, which in turn causes obstructions.
5. Quit Smoking
Because smoking cigarettes increases a person’s likelihood of developing obstructive sleep apnea (OSA), medical professionals advise smokers who already have OSA to stop smoking. On the other hand, there is a need for further research before we can say for sure that giving up smoking will help lessen OSA symptoms.
Typically, a person’s sleep expert is the one who determines which therapy for sleep apnea is appropriate for them. This decision is made taking into account the individual’s particular symptoms as well as their current state of health. A CPAP machine is typically the initial therapy that is recommended for sleep apnea; however, further treatments for any underlying health concerns may also be necessary.
CPAP therapy is thought to be most effective and dependable in patients who are able to exhibit compliance with the treatment and who can tolerate it. If a patient cannot tolerate CPAP therapy, their sleep expert may prescribe an alternate treatment option such as BiPAP, ASV, EPAP, or an oral device. Surgical intervention is often not contemplated until less invasive therapeutic options have been exhausted first.
The appliance must be used continuously as part of the treatment for many types of sleep apnea. Alterations to your lifestyle, such as dieting or giving up smoking, can be helpful in managing sleep apnea in addition to any treatment that your physician may recommend.
You should, despite this, keep using the remedies that have been recommended to you by your primary care physician or a sleep expert until you are given more instructions.