Obstructive sleep apnea (OSA) can be treated in numerous ways. What needs to be looked at is the patient’s medical history, the disorder’s severity, and crucially, the exact cause of the airway blockage.
Kids that have OSA do so typically due to chronically enlarged adenoids and tonsils. Tonsillectomies and adenoidectomies are successful at diminishing OSA substantially. The difficulty level associated with operations to reduce OSA in children can be very high, as for example with cases of reduced growth of the body alongside poor development of the right side of the heart. Fortunately, when OSA-associated high exhalation pressures are lowered complications to the cardiovascular system tend to reverse of their own accord. Careful precautionary practices are adhered to during the important postoperative period in children.
OSA treatment in adults who have poor oropharyngeal airways in combination with a large upper body frame are open to a variety of treatments. Unfortunately, this most common form of OSA tends not to have particular treatment methods that habitually work, each case needs specific evaluation over the best course of action.
Such methods for relieving obstructions consist of changes to the sufferer’s lifestyle, e.g. reducing alcoholic intake, avoiding medications that may relax the central nervous system (CNS) (e.g. sedatives, muscle relaxants), stopping smoking and reducing weight. Specially designed devices, such as pillows, that stop the sufferer from sleeping on their back can be effective in reducing OSA.
Oral appliances are sometimes used, these keep the patients airways open whilst they are asleep. Mandibular advancement splints (MAS) are sometimes advised to lessen mild to moderate OSA. MAS consists of a mouth guard, similar to that used with impact sports to protect the teeth, which holds the lower jaw a little more down and forward from its usual relaxed position. When in use the users tongue is moved farther from the back of the airways, possibly far enough so that some OSA sufferers are able to gain improved breathing.
When such methods fail to make enough of a beneficial impression GP’s will often suggest the use of continuous positive airway pressure (CPAP).
CPAP comes in the form of a mask attached to the face which has a tube running from an air pump to the sufferer’s mouth and/ or nose, forcing controlled bursts of air through the obstructed air passageways and into the lungs. CPAP uses a constant air pressure found by performing an overnight test or ‘titration’ on the sufferer. Recent models of CPAP contraptions are able to reduce the exhalation pressure for improved performance and patient comfort.
Variable positive airway pressure (VPAP), known also as bilevel or BiPAP, monitors the patients breathing with an electronic circuit. Two different pressures are adopted here, inhalation has a higher pressure than exhalation. This system is more expensive than CPAP and is often used on people that have other respiratory problems or who find sleeping with higher exhaling pressures from CPAP difficult.
Automatic positive airway pressure (APAP) uses sensors that measure air pressure in conjunction with a computer that monitors the patient’s performance with breathing. Pressures exerted by the air pump are constantly adjusted, i.e. heightened when the user is finding breathing difficult, lowered when pressures are considered higher than necessary.
Various surgical ways of widening airways, or removing or tightening tissues in that area are used, the success rate tends to be low with these practices. In some cases patients adopt a combination of such therapies to reduce their OSA. Surgery is typically a last resort, used when none of the above, as well as other more experimental OSA reduction methods (e.g. pharmaceuticals like methylxanthine theophylline and modafinil, and neurostimulation e.g. pacemaker stimulation), have been deemed effective.