Obstructive Sleep Apnea Treatments: Find the Right Solution

Has your partner ever complained that you “sound like a train coming through” when you’re sleeping at night? Maybe they have commented that you appear to “stop breathing” at times. Have you suddenly woken up during the night, gasping for air? All of these are potential signs of obstructive sleep apnea (OSA), which is more common than many people realize. It affects individuals across various age groups, genders, and ethnicities.

The prevalence of diagnosed OSA has been steadily increasing, particularly due to rising rates of obesity, which is a significant risk factor for the condition.

Sleep is more than just a luxury. It’s essential to every process in the body, affecting our physical and mental functioning, our ability to fight disease and develop immunity, and our metabolism and chronic disease risk. That’s why it’s so important to make sure you’re getting restful, uninterrupted sleep every night.

In this article, we’re going to take a close look at obstructive sleep apnea treatments — both the traditional ways and some innovative options.

What is obstructive sleep apnea?

People with obstructive sleep apnea repeatedly stop and then restart breathing while they sleep. It’s the most common sleep-related breathing disorder.

Obstructive sleep apnea occurs when the muscles in the back of the throat relax too much to allow for proper breathing. These muscles support the back of the roof of the mouth, known as the soft palate. The muscles also support the tongue and side walls of the throat.

When the muscles relax, the airway narrows or closes and obstructs your breathing. This can lower the level of oxygen in the blood and cause a buildup of carbon dioxide. Your brain senses this impaired breathing and rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don’t remember it.

You may awaken with shortness of breath that corrects itself quickly, within one or two deep breaths. Or you might make a snorting, choking or gasping sound. This pattern can repeat itself 5 to 30 times or more each hour, for the entire duration of rest. These disruptions impair your ability to reach the deep, restful phases of sleep, and you’ll probably feel sleepy during your waking hours.

Many people with obstructive sleep apnea are not aware of their irregular breathing patterns or interrupted sleep.

Woman covering ears with pillow due to man snoring as a result of obstructive sleep apnea

Common symptoms of obstructive sleep apnea

While these symptoms are not exclusive to OSA, multiple symptoms present can help doctors make a diagnosis.

  • Excessive daytime sleepiness and trouble focusing during the day.
  • Loud snoring.
  • Episodes of stopped breathing during sleep, possibly followed by gasping or choking.
  • Consistently waking up in the morning with a dry mouth, sore throat, and/or headache.
  • Sudden or frequent mood swings.
  • High blood pressure.

Obstructive sleep apnea vs. central sleep apnea

OSA isn’t the only type of sleep apnea. There is a less common form called central sleep apnea (CSA), which has a different underlying mechanism. Central sleep apnea occurs when the brainstem fails to send the proper signals to the muscles that control breathing, leading to a temporary cessation of breathing. Unlike OSA, there is no physical airway obstruction, and snoring is typically absent. It can cause similar symptoms of daytime sleepiness and poor sleep quality, but the apneas tend to be longer and more irregular.

Diagnosis of both CSA and OSA require a sleep study, which can differentiate them based on whether breathing efforts are present during apneas. The treatment approaches for OSA and CSA vary significantly, making accurate diagnosis crucial.

Common risk factors for OSA

Some genetic factors and/or lifestyle choices may increase the likelihood of receiving a sleep apnea diagnosis, including:

  • Excess weight. Most (but not all) people with obstructive sleep apnea are overweight. Fat deposits around the upper airway can obstruct breathing.
  • Age and sex. The risk of obstructive sleep apnea increases as you age but appears to level off after your 60s and 70s. In general, men are 2 to 3 times more likely as premenopausal women to have obstructive sleep apnea.
  • Narrowed airway. A naturally narrow airway is a trait that can be passed down through genetics. Or your tonsils or adenoids might become enlarged and block your airway. Also, obstructive sleep apnea occurs twice as often in those who have consistent nasal congestion at night, regardless of the cause.
  • High blood pressure (hypertension). Obstructive sleep apnea is relatively common in people with hypertension.
  • People who smoke are more likely to have obstructive sleep apnea.
  • A family history of sleep apnea. Having family members with obstructive sleep apnea might increase your risk.

When should I see a doctor about suspected sleep apnea?

Consult a health care professional if you have, or if your partner observes, the following:

  • Snoring loud enough to disturb your sleep or the sleep of others.
  • Waking up gasping or choking.
  • Pausing in your breathing during sleep.
  • Having excessive daytime drowsiness.

Snoring doesn’t necessarily indicate something potentially serious, and not everyone who snores has obstructive sleep apnea. Be sure to talk to a member of your health care team about all of your concerns and symptoms.

Complications

Obstructive sleep apnea is considered a serious medical condition. Complications can include:

  • Daytime fatigue and sleepiness. Because of a lack of restorative sleep at night, people with obstructive sleep apnea often have severe daytime drowsiness, fatigue, and irritability. They might have difficulty concentrating and find themselves falling asleep while going about regular activities.
  • Cardiovascular problems. Sudden drops in blood oxygen levels that occur during obstructive sleep apnea increase blood pressure and strain the cardiovascular system. Many people with obstructive sleep apnea develop high blood pressure, which can increase the risk of heart disease. Obstructive sleep apnea also increases the risk of heart rhythm problems known as arrhythmias.
  • Complications with medicines. Sedatives, prescription painkillers, and general anesthetics may relax the upper airway and worsen obstructive sleep apnea.
  • Eye problems. Research has found a connection between obstructive sleep apnea and certain eye conditions, such as glaucoma.
  • Sleep-deprived partners. Loud snoring can keep others in your household from getting good rest. This can harm their health and disrupt your relationships.
  • Obstructive sleep apnea might be a risk factor for COVID-19. People with obstructive sleep apnea have been found to be at higher risk for developing a severe form of COVID-19.

Diagnostic approaches for OSA

The first step in diagnosing OSA typically involves a comprehensive medical evaluation, which includes a detailed history and physical exam. This helps to identify symptoms, risk factors, and potential signs of the condition. Then, your doctor will develop a diagnostic solution. Common diagnostic techniques include:

Polysomnography (PSG)

Polysomnography, also known as an overnight sleep study, is the gold standard for diagnosing OSA. It is typically performed in a sleep center or hospital, where the patient is monitored throughout the night.

What it measures. Polysomnography records a variety of physiological parameters while the patient sleeps, including (but not limited to):

  • Brain activity (via EEG)
  • Heart rate and ECG
  • Eye movements (to monitor sleep stages)
  • Muscle activity (EMG) and leg movements
  • Respiratory effort (using belts around the chest and abdomen) and airflow (measured via nasal cannula or thermistor)
  • Blood oxygen levels (via pulse oximeter)

Home sleep apnea testing (HSAT)

Home sleep apnea testing (HSAT) is a common and convenient diagnostic tool, especially for patients with a high likelihood of OSA. This method allows patients to undergo monitoring in their own home rather than in a sleep center.

HSAT typically monitors fewer parameters than full polysomnography, focusing primarily on:

  • Airflow, via nasal breathing sensor
  • Respiratory effort, using chest and abdominal belts
  • Oxygen saturation, via a pulse oximeter

Generally, the nasal breathing sensor estimates snoring, but sometimes an actual microphone is used to measure snoring. A sound sensor attached to the neck can also record sound and pressure. All of the sensors typically connect to the data collection device, either via wires or flexible tubes. HSAT is usually recommended for individuals with a high pre-test probability of OSA and no significant co-morbidities that might complicate diagnosis (like heart failure or significant neurological disorders).

Obstructive sleep apnea treatments

It’s important that you take into account your lifestyle, budget, and comfort levels as you discuss treatment options with your healthcare team.

Lifestyle changes

The most cost-effective and least-invasive way to address OSA is a measured adjustment in lifestyle choices, especially in mild to moderate cases.

  • Weight loss. Obesity is a major risk factor for OSA. Weight loss can reduce the amount of fatty tissue around the neck and throat, which helps keep the airway open. Even a modest weight loss (5-10%) can result in significant improvements in OSA symptoms. Regular physical activity can also help reduce body fat, improve muscle tone (including in the throat), and enhance overall sleep quality.
  • Positional therapy. Some people experience OSA primarily when sleeping on their back. Positional therapy involves side sleeping, which may reduce the frequency of apneas.
  • Avoid alcohol and sedatives. Alcohol, sleeping pills, and sedatives relax the muscles in the throat, worsening airway obstruction. Avoiding these substances, especially before bedtime, can help reduce sleep apnea.
  • Quit smoking. Smoking increases inflammation and fluid retention in the upper airway, which can worsen OSA. Quitting smoking can help reduce these effects and improve airway function.

Continuous positive airway pressure (CPAP)

CPAP is the most common and effective treatment for moderate to severe OSA. It involves wearing a mask over the nose (or mouth and nose) during sleep to deliver a continuous stream of air to keep the upper airway open.

The CPAP machine maintains constant positive pressure in the throat, preventing the airway from collapsing during sleep.

CPAP therapy is highly effective in treating OSA, reducing apneas, improving sleep quality, and preventing complications like cardiovascular disease and hypertension. It significantly reduces daytime sleepiness and improves cognitive function. One of the biggest challenges with CPAP is patient adherence, as many find the mask uncomfortable or the medical device disruptive.

BiPAP (also known as Bilevel PAP) is a variation of CPAP that provides two different pressures — one for inhalation (higher pressure) and one for exhalation (lower pressure). It is generally used for patients who have difficulty tolerating CPAP or those with more complex cases of OSA.

BiPAP is often recommended for individuals with severe OSA or COPD, as it can provide more comfortable breathing during exhalation.

Mandibular advancement device

Mandibular advancement devices are used to treat mild to moderate OSA, particularly in patients who cannot tolerate CPAP. They are custom-fitted by a dentist or orthodontist and work by repositioning the lower jaw (mandible) slightly forward to prevent the airway from collapsing. They’re more comfortable and easier to use than CPAP, but they may not be as effective for severe OSA.

Long-term use of MADs can sometimes cause jaw discomfort, tooth movement, or bite changes. Regular follow-ups are recommended to maintain proper fit and function.

Surgical options

Surgical treatments for OSA are usually considered when other treatments are not effective, or if anatomical issues are identified that may be contributing to airway obstruction. Common surgical procedures include, but are not limited to:

  • Uvulopalatopharyngoplasty (UPPP). This removes excess tissue from the throat to widen the airway and reduce obstruction.
  • Genioglossus Advancement (GA). The muscles that control the tongue are repositioned to prevent the tongue from collapsing backward and obstructing the airway during sleep.
  • This is a less-invasive technique that uses radiofrequency energy to shrink and tighten soft tissue in the throat.

Inspire®: The new frontier of OSA treatment

Inspire® therapy is a mask-free solution for people with obstructive sleep apnea who have tried and struggled with CPAP. Through a simple-to-use system including the Inspire surgical implant, remote and app, Inspire therapy allows patients to control OSA treatment from the palm of their hand.

The core problem with OSA is that the tongue relaxes into a position that blocks the airway — and that’s exactly what Inspire addresses. The Inspire® implant delivers gentle pulses to the nerve that controls your tongue. This hypoglossal nerve (upper airway) stimulation moves your tongue out of the way each time you take a breath, keeping your airway open while you sleep soundly. No mask, hose, or loud machines required.

Clinical trials have shown outstanding results, and Inspire® therapy is proving to be a safe and effective way to manage OSA, preventing symptoms and complications from affecting your overall well-being.

Julia Pfaff, DO Top Provider of Inspire Procedure

Julia Pfaff, DO – Top Provider of Inspire Procedure in Florida

How important is sleep … really?

Sleeping is one of the essential functions our bodies need to stay alive. The CDC recommends that adults 18-60 get 7 or more hours of restful, uninterrupted sleep each night. For individuals aged 61-64 years, that increases to 7-9 hours.

When you get enough quality sleep each night, you:

  • Get sick less often.
  • Stay at a healthy weight.
  • Reduce stress and improve your mood.
  • Lower your risk of chronic conditions like:
  • Lessen the risk of motor vehicle crashes and related injury or death.
  • Improve your attention and memory to better perform daily activities.

Find the right treatment for you

Ready for a good night’s sleep? Effective diagnosis and treatment for OSA is tailored to the individual’s needs, and should be discussed thoroughly with a sleep specialist. At Florida Medical Clinic, we are committed to expertly treating patients with a number of sleep disorders, such as insomnia or sleep apnea. In conjunction with a specialized Otolaryngology department and Pulmonology & Sleep Disorders team, our Sleep Lab is thoroughly equipped to conduct sleep tests to diagnose your condition and develop an appropriate customized therapy or treatment.

To schedule an appointment with our experienced Otolaryngology team, please contact us today.

Meet Dr. Pfaff, DO, MPH, FACS

Dr. Julia Pfaff is a board-certified otolaryngologist and head and neck surgeon, specializing in a comprehensive range of disorders. Her areas of expertise include sinus disease, allergies, head and neck cancer, voice disorders, salivary gland disorders, thyroid and parathyroid disorders, and surgical interventions for sleep apnea. She is among the few physicians in Florida qualified to perform the Inspire Implant procedure for sleep apnea, in addition to her proficiency in minimally invasive thyroid and parathyroid surgeries.

Dr. Pfaff is ready to talk with you about the exciting new innovations in OSA treatments so you can start getting a better night’s sleep.

To make an appointment, call (727) 553-7100 or register online.

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Otolaryngology

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