Obstructive sleep apnoea - Treating obstructive sleep apnoea

Common treatments for obstructive sleep apnoea (OSA) include making lifestyle changes and using breathing apparatus while you sleep.

OSA is a long-term condition and many cases will require lifelong treatment.

Lifestyle changes

In most cases of OSA, you will be advised to make healthy lifestyle changes, such as:

• losing weight if you are overweight or obese
• stopping smoking if you smoke
• limiting your alcohol consumption, particularly before going to bed – men should not regularly drink more than three to four units a day and women should not regularly drink more than two to three units a day
• avoiding sedative medications and sleeping tablets

Losing weight, reducing the amount of alcohol you drink and avoiding sedatives have all been shown to help improve the symptoms of OSA. 

Although it's less clear whether stopping smoking can improve the condition, you'll probably be advised to stop for general health reasons.

Sleeping on your side, rather than on your back, may also help relieve the symptoms of OSA if you have been diagnosed with the condition.

Continuous positive airway pressure (CPAP)

As well as the lifestyle changes mentioned above, people with moderate to severe OSA will usually need to use a continuous positive airway pressure (CPAP) device.

This is a small pump that delivers a continuous supply of compressed air to you through a mask that either covers your nose or your nose and mouth. The compressed air prevents your throat closing.

CPAP can feel peculiar to start with and you may be tempted to stop using it. But people who persevere usually soon get used to it and their symptoms improve significantly.

CPAP is available on the NHS and is the most effective therapy for treating severe cases of OSA. As well as reducing symptoms such as snoring and tiredness, it can also reduce the risk of complications of OSA, such as high blood pressure.

Possible side effects of using a CPAP device can include:

• mask discomfort
• nasal congestion, runny nose or irritation
• difficulty breathing through your nose
• headaches and ear pain
• stomach pain and flatulence (wind)

Earlier versions of CPAP also often caused problems such as nasal dryness and a sore throat. However, modern versions tend to include humidifiers (a device that increases moisture), which helps to reduce these side effects.

If CPAP causes you discomfort, inform your treatment staff as the device can be modified to make it more comfortable. For example, you can try using a CPAP machine that starts with a low air pressure and gradually builds up to a higher air pressure as you fall asleep.

Mandibular advancement device (MAD)

A mandibular advancement device (MAD) is a dental appliance, similar to a gum shield, sometimes used to treat mild OSA. They are not generally recommended for more severe OSA, although they may be an option if you are unable to tolerate using a CPAP device.

An MAD is worn over your teeth when you are asleep. It is designed to hold your jaw and tongue forward to increase the space at the back of your throat and reduce the narrowing of your airway that causes snoring.

Off-the-shelf MADs are available from specialist websites, but most experts do not recommend them, as poor-fitting MADs can make symptoms worse. It is recommended you have an MAD made for you by a dentist with training and experience in treating sleep apnoea.

MADs are not always available on the NHS, so you may need to pay for the device privately through a dentist or orthodontist.

An MAD may not be suitable treatment for you if you do not have many (or any) teeth. If you have dental caps, crowns or bridgework, consult your dentist to ensure that they will not be stressed or damaged by an MAD.

Surgery

Surgery to treat OSA is not routinely recommended because evidence shows it is not as effective as CPAP in controlling the symptoms of the condition. It also carries the risk of more serious complications.

Surgery is usually only considered as a last resort when all other treatment options have failed, and if the condition is severely affecting your quality of life.

A range of surgical treatments have been used to treat OSA. These include:

• tonsillectomy – where the tonsils are removed if they are enlarged and blocking your airway when you sleep
• adenoidectomy – where the adenoids (small lumps of tissue at the back of the throat, above the tonsils) are removed if they are enlarged and are blocking the airway during sleep
• tracheostomy – where a tube is inserted directly into your neck to allow you to breathe freely, even if the airways in your upper throat are blocked
• weight loss (bariatric) surgery – where the size of the stomach is reduced if you are severely obese and this is making your sleep apnoea worse

Surgery to remove excess tissue in the throat to widen your airway (uvulopalatopharyngoplasty) used to be a common surgical treatment for OSA, but it is performed less often nowadays.

This is because more effective treatments are available, such as CPAP. This type of surgery can mean you are unable to use a CPAP device properly in the future if you need to.

Soft palate implants

Soft palate implants make the soft palate (part of the roof of the mouth) stiffer and less likely to vibrate and cause an obstruction. The implants are inserted into the soft palate under local anaesthetic.

The National Institute of Health and Care Excellence (NICE) has said soft palate implants are safe, but they are not currently recommended for treating OSA as there is a lack of evidence about their effectiveness.

However, this form of treatment is recommended for treating snoring associated with OSA in exceptional cases.