Sleep Disorders – What You Must Know

Sleep Disorder Society Malaysia

Treatment

Depending on the main cause for your sleep apnea, treatment may vary. They can be classified into a several categories, namely, behavioural intervention, medical devices therapy, surgical intervention and pharmacologic intervention.

Behavioural Intervention

Behavioural intervention is self-approaches. In other words, you made a lifestyle changes. These always be your first-line treatment to help you overcome your sleep apnea in the very early stage, especially if you have an excess weight (overweight / obese). Those changes include:

  • Weight reduction
  • Quit smoking
  • Balance diet
  • Exercise regularly (at least 30 minutes of walking)
  • Avoid alcoholic beverages

Most of the time, early teenager to young adults tend to sleep late or have a different bedtime every night due to work, school or social needs. Those with poor sleep hygiene always sleep deprived, and have a higher risk of developing sleep apnea later. Practice of good sleep hygiene includes:

Some patients with mild sleep apnea or position-related sleep apnea have fewer breathing problems when they are lying on their sides instead of their backs, though changing your sleep position might help.

Medical Devices Therapy

  • CPAP Device: According to American Academy of Sleep Medicine (AASM), the gold standard for OSA treatment is using CPAP device. CPAP, or Continuous Positive Airway Pressure is a device which delivers a continuous, constant pressurized air into your upper airway passage to open and prevent it from collapse. This mechanism is meant to eliminate obstructive sleep apnea and snoring.

Some people might find the mask cumbersome, uncomfortable or suffocating. You may need to try different types to find a suitable mask. Several options are available, such as nasal pillows, nasal masks, oro-nasal masks or face masks. Also, with some practice, most people learn to adjust the mask to obtain a comfortable and secure fit.

  • Oral or Dental Device / Mandibular Advancement Device (MAD): Though positive airway pressure is often an effective treatment, oral appliances are an alternative for some people with mild or moderate OSA, whose unable or having difficulty tolerating PAP therapy. These devices are designed to keep your throat open. Some devices keep your airway open by bringing your jaw forward, which can sometimes relieve snoring and OSA. Other devices hold your tongue in a different position.
    If you and your doctor decide to explore this option, you’ll need to see a dentist experienced in dental sleep medicine appliances for the fitting and follow-up therapy. A number of devices are available. Close follow-up is needed to ensure successful treatment.
    However, dental devices do have some potential drawbacks, including altered bite, movement of teeth, pain, arthritis of the temporal mandibular joint (TMJ), dry lips, and excessive salivation

Surgical Intervention

Surgery is usually considered only if other therapies haven’t been effective or haven’t been appropriate options for you.

  • Nasal surgery to remove polyps or straighten a crooked partition between your nostrils (deviated septum).
  • Surgery to remove enlarged tonsils or adenoids (adenotonsillectomy).
  • Surgical removal of tissue. Uvulopalatopharyngoplasty (UPPP) is a procedure in which your doctor removes tissue from the back of your mouth and top of your throat. Your tonsils and adenoids may be removed as well. UPPP usually is performed in a hospital and requires a general anesthetic.
  • Jaw surgery. In this procedure, called maxillomandibular advancement, the upper and lower parts of your jaw are moved forward from the rest of your facial bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely.
  • Implants. This minimally invasive treatment involves placement of three tiny polyester rods in the soft palate. These inserts stiffen and support the tissue of the soft palate and reduce upper airway collapse and snoring.
  • Surgical opening in the neck (tracheostomy). You may need this form of surgery if other treatments have failed and you have severe, life-threatening OSA. In this procedure, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe. Air passes in and out of your lungs, bypassing the blocked air passage in your throat.

Pharmacologic Intervention

Pharmacologic therapy is generally not a part of the primary treatment recommendations for sleep apnea. However there are a few medications was approved by US Food and Drug Administration (FDA) for use in patients who have residual daytime sleepiness despite optimal use of CPAP. Parasomnia, however, if associated with depression might benefit from anti-depressant.

The best treatment for sleep apnea depends on a number of factors, including the severity of your problem, the physical structure of your upper airway, other medical problems you may have, as well as your personal preference. You should work with your doctor or sleep specialist to select the best treatment option for you.