Treatment for Adult Sleep Apnea
People who snore constantly and loudly need medical attention. Those who have apnea need even more urgent intervention. Selection of the right treatment will depend on what specific causes result in snoring, and whether any complications have occurred.
Treatment of obstructive sleep apnea is directed at solving the current problems that the patient is experiencing as well as to avert the future complications that will arise if sleep apnea is left untreated. Current problems include daytime sleepiness, poor job performance, impaired cognitive and intellectual functioning, reduced motor skills, and increased risk while on the road. Future complications that may arise from untreated sleep apnea include hypertension, heart disease and stroke.
We always try to troubleshoot first before attempting to fix the problem. Proper diagnosis should always precede any therapeutic measures we take to alleviate the problem.
Obesity and weight gain play a dominant contributory role in many cases of obstructive sleep apnea. A rational dietary program that aims to help the patient lose weight is an important part of management. Other simple measures include abstinence from alcohol and sleeping pills, as these tend to exacerbate the severity of apnea.
The patient’s cardiovascular status should be evaluated. Many of these patients may already have hypertension without knowing it. Identification of hypertension is essential as it necessitates active management to prevent the future development of heart disease and stroke. Good control of hypertension is also a prerequisite for safe surgery. If this option is contemplated. Hormonal problems like low thyroid levels should also be looked for and treated when present.
Patients with blocked nose should have that treated. Nasal obstruction worsens snoring and apnea. This is because the lungs would need to generate a greater amount of suction in order to draw air past the obstructed nose into the lungs. A simple course of nasal sprays may be all that is required to alleviate the blocked nose.
The first choice of treatment for moderate to severe obstructive sleep apnea is continuous positive airway pressure (CPAP). This is a treatment method using a device that administers compressed air into the patients collapsible airways in order to keep them open, and to allow air to flow.. The patient wears a mask that fits over his nose. Administered compressed air converts the negative suctioning pressure in the airways that was generated by the lungs during inspiration into positive pressure. The hardware that is required is about the size and weight of a laptop computer. It can easily be carried around in case the patient travels. This cures the patient of snoring and sleep apnea as long as he patient wears the CPAP machine to sleep.
Some patients find CPAP cumbersome and are unable to tolerate using a mask for long periods of time. Others find it unappealing to entertain the prospect of having to use equipment for the rest of their lives. These people resort to surgery.
Surgery for snoring and obstructive sleep apnea may consist of removing the tonsils, trimming away excessive tissue at the back of the throat and refashioning the soft palate. This operation is called uvulo-palato-pharyngoplasty or UP3 for short.
When apnea is mild and snoring is associated with sleep fragmentation, then a lesser operation may be performed. This consists of simply fashioning the soft palate without any attempt to remove the tonsils using either a laser or electrocautery. This operation is known as Laser Assisted Uvulo-palatoplasty (LAUP).
Occasionally, when the tongue or small chin is the cause of airway collapse during sleep, operation can be performed to advance the chin and to draw the tongue forward. This would be done together with an oral maxillofacial surgeon.
When the nose is obstructed or when sinusitis is persistent and refractory to drug treatment, surgery may be performed to widen the nasal passageways, remove the adenoids or to facilitate the drainage of the sinuses.
Simple procedure includes radiofrequency (RF) treatment to the soft palate, can be done under local anaesthesia.
In the past before we had all this modern approach to surgery, the cure for snoring and sleep apnea was achieved by simply opening a hole in the trachea over the neck. This is called a tracheostomy. The operation achieved a cure by allowing air to flow directly into the trachea and lungs instead of having to flow through an obstructed and collapsed airway in the neck. In effect, the tracheostomy operation allowed air to bypass the obstruction in the neck. A tracheostomy is extremely effective in alleviating snoring and sleep apnea. The reason why it is not so often done nowadays is because of the social stigma of having a hole in the neck. Presently, a tracheostomy is performed for snoring and sleep apnea only when the problem is severe, life-threatening and when other options have failed in salvaging the situation.
Whatever the options, snoring is a problem that is highly amenable to treatment – surgical or otherwise.