Oral appliances that treat snoring and obstructive sleep apnea are small plastic devices that are worn in the mouth, similar to orthodontic retainers or sports mouth guards. These appliances help prevent the collapse of the tongue and soft tissues in the back of the throat, keeping the airway open during sleep and promoting adequate air intake. Currently, there are approximately 40 different oral appliances available. Oral appliances may be used alone or in combination with other means of treating OSA, including general health and weight management, surgery, or CPAP. Oral Appliance Therapy has several advantages over other forms of therapy: Oral appliances are comfortable and easy to wear. Most people find that it only takes a couple of weeks to become acclimated to wearing the appliance. Oral appliances are small and convenient making them easy to carry when traveling. Treatment with oral appliances is reversible and non-invasive.
Apneas tend to be worse when sleeping on the back (the supine position) as gravity makes it more likely for the tongue to fall back over the airway and/or for the airway muscles and other tissue (like the tonsils) to collapse and block the airway. Hence not sleeping on the back may reduce the number of apneas. To avoid the supine position, some people use homemade remedies, such as putting tennis balls in a tube sock and pinning the sock to the back of the nightshirt. Others purchase products such as a tube or cushion designed specifically to prevent supine sleeping. The U.S. Food and Drug Administration has approved one pillow for snoring and mild sleep apnea; it is meant to position the neck so the airway is more likely to remain open. Positional alarms are also on the market: they are intended to prevent supine sleeping by making a noise when one begins to sleep on the back. However, they may disrupt sleep so much that the subsequent sleep fragmentation causes a concern. One study found sleeping on the back but with the back elevated from the waist up may also reduce the collapsibility of the airway and therefore reduce the apneas. Foam wedges, not soft pillows that can actually push the chin towards the chest and worsen apnea, should be used.
Sleep apnea can be weight-related. Additional fat around the neck may make the airway narrower, making obstructions more likely to occur. For some overweight people, especially those with mild cases, losing weight can be an effective treatment. Or weight loss may reduce the severity of the sleep apnea. However, it may be hard to lose weight when you have untreated sleep apnea: you may be too tired to exercise and you may eat to stay awake. Also, it may take some time before the weight loss is achieved, so in light of the potential consequences of untreated OSA, using another treatment option while working towards the weight loss goal may be an option. Losing weight may also improve your health in other ways, but it is always advisable to talk to your doctor before beginning a weight-loss program. Remember that sleep apnea occurs in thin people as well; the airway can close during sleep for a number of reasons, not just excess weight.
Avoiding alcohol and other CNS depressants
Alcohol and medications that act as central nervous system (CNS) depressants-such as pain killers, sedatives, and muscle relaxants-can worsen sleep apnea by relaxing the airway muscles further and/or by reducing the respiratory drive and causing more apneas to occur. Hence avoiding alcohol and CNS depressants close to bedtime may be helpful. Ask your doctor or pharmacist if medications you take prescription or over-the-counter or herbal, affect your sleep apnea. The prescribed sleep apnea treatment may be adjusted to take into consideration the use of medications that are CNS depressants.
The intention of surgery is to create a more open airway so obstructions are less likely to occur. There are several different surgical procedures with different effectiveness rates, and surgery can also sometimes worsen the apnea. In addition, there are also several non-surgical procedures that can remove excess or obstructive tissue or harden the soft palate by inserting three small polyester rods. For more about this treatment option, see the ASAA publication "Considering Surgery for OSA?"
Continuous Positive Airway Pressure (CPAP)
CPAP works by gently blowing pressurized room air through the airway at a pressure high enough to keep the throat open. This pressurized air acts as a "splint." The pressure is set according to the patient's needs at a level that eliminates the apneas and hypopneas that cause awakenings and sleep fragmentation. Pressure that is too low will not be as effective in eliminating the apneas and hypopneas. CPAP is currently the most effective method for treating severe obstructive sleep apnea.
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