Sleep Apnea: Treatment Overview

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Treatment Overview

Treatment for obstructive sleep apnea (OSA) includes lifestyle changes, continuous positive airway pressure (CPAP) (to prevent the airway from closing during sleep), the use of dental devices (oral breathing devices) to help keep your airway open, and surgery. The goals of treatment are to relieve symptoms such as snoring and excessive daytime sleepiness and prevent other problems, such as high blood pressure. Your doctor will base your treatment on how severe your sleep apnea is.

Generally, your doctor will have you try lifestyle changes and CPAP first. Surgery might be a first choice only if the sleep apnea is caused by a blockage that is easily fixed.

You may need to be treated for other health problems before you are treated for sleep apnea. For example, people who also have inflammation of the nasal passages (rhinitis) may need to use nose spray to reduce the inflammation. People who have an underactive thyroid gland (hypothyroidism) need to take thyroid medicine.

Children have the same treatment options as adults. But surgery (tonsillectomy and adenoidectomy) generally is the first choice because enlarged tonsils or adenoids cause most cases of sleep apnea in children. Children are treated using CPAP if surgery is not possible or does not work.

Initial treatment

The first treatment for obstructive sleep apnea (OSA) consists of making lifestyle changes. Your sleep apnea may be helped if you:

Lose weight (if needed). Small studies have shown that losing weight decreases the number of times an hour that you stop breathing (apnea) or that a reduced amount of air enters your lungs (hypopnea).⁶ Experts agree that weight loss should be part of managing sleep apnea.⁶
Go to bed at the same time every night.
Sleep on your side. Try this: Sew a pocket in the middle of the back of your pajama top, put a tennis ball into the pocket, and stitch it shut. This will help keep you from sleeping on your back. Sleeping on your side may eliminate mild sleep apnea.⁷
Avoid the use of alcohol and some medicines, especially sleeping pills and sedatives, before bed. Taking Viagra (sildenafil) shortly before sleeping may make sleep apnea worse.⁴
Quit smoking. The nicotine in tobacco relaxes the muscles that keep the airways open. If you don't smoke, those muscles are less likely to collapse at night and narrow the airways.
Raise the head of your bed to by putting bricks under the legs of the bed. You can also use a special pillow (called a cervical pillow) when you sleep. A cervical pillow can help your head stay in a position that reduces sleep apnea. Using regular pillows to raise your head and upper body will not work.
Promptly treat breathing problems, such as a stuffy nose caused by a cold or allergies.

All people who have sleep apnea should make these lifestyle changes. They may be all that is needed to relieve mild sleep apnea.

Some people use nasal strips, which widen the nostrils and improve airflow. Although these strips may decrease snoring, they cannot treat sleep apnea.

First medical treatment

Continuous positive airway pressure (CPAP) is nearly always the first medical treatment for sleep apnea.

With CPAP, you use a breathing device that prevents your airways from closing during sleep.
CPAP is the preferred treatment for moderate or severe sleep apnea.
It may take time for you to be at ease when you use CPAP. You may find that you want to take the mask off, or you may find it difficult to sleep while using it. If you can't get used to it, talk to your doctor. You might be able to try another type of mask or make other adjustments.

Other medical treatment includes:

Devices that are similar to CPAP. These devices automatically adjust air pressure or use different air pressures when you breathe in or out. They are easier and more comfortable for some people to use.
Oral breathing devices. These devices reposition your tongue and jaw during sleep, which opens up your airways.

Surgery might be the first treatment when a blockage can be fixed easily, such as when you have overly large tonsils.

Ongoing treatment

Ongoing treatment for obstructive sleep apnea (OSA) includes using continuous positive airway pressure (CPAP) or an oral breathing device and making changes in your lifestyle. Lifestyle changes include losing weight (if needed), improving sleep habits (such as going to bed at the same time every night and sleeping on your side), avoiding the use of alcohol and certain medicines (especially sleeping pills and sedatives) before bed, and stopping smoking.

If CPAP is not working, you may need another sleep study to find out whether your CPAP machine needs to be adjusted. You may also need to think about surgery. Surgical choices include:

Uvulopalatopharyngoplasty, which removes excess tissue in the throat to make the airway wider. It is the most common surgery to treat sleep apnea in adults.
Tonsillectomy and/or adenoidectomy, which removes the tonsils and/or the adenoids. It may be used if you have enlarged tonsils and adenoids that are blocking your airway during sleep. This is often the first treatment option for children because enlarged tonsils and adenoids are usually the cause of their sleep apnea.
Other surgical procedures, which are used to repair bone and tissue problems in the mouth and throat.

Should I have surgery to treat obstructive sleep apnea?

Treatment if the condition gets worse

If your obstructive sleep apnea (OSA) gets worse, talk to your doctor. You may need another complete sleep study, and you may need to adjust your continuous positive airway pressure (CPAP) machine. You may also need treatment for problems that sleep apnea may cause, such as high blood pressure.

In some cases, you may need surgery. Surgical options include:

Uvulopalatopharyngoplasty, which removes excess tissue in the throat to make the airway wider. It is the most common surgery to treat sleep apnea in adults.
Tonsillectomy and/or adenoidectomy, which removes the tonsils and/or the adenoids. It may be used if you have enlarged tonsils and adenoids that are blocking your airway during sleep. This is often the first treatment option for children, because enlarged tonsils and adenoids are usually the cause of their sleep apnea.
Other surgical procedures, which are used to repair bone and tissue problems in the mouth and throat.
Tracheostomy, which creates a hole in the windpipe (trachea). A tube is then put in the hole to bring air in. Doctors rarely use this surgery because it may cause other health problems. But when other techniques have failed, almost all people who are treated with tracheostomy will be cured of their sleep apnea.
Bariatric surgery if you are extremely overweight (severely obese) and the excess weight is making your sleep apnea worse. This surgery is done only for people who cannot lose weight with diet and exercise. Bariatric surgery can promote weight loss that improves sleep apnea.⁸

Should I have surgery to treat obstructive sleep apnea?

What To Think About

Research shows that continuous positive airway pressure (CPAP) decreases daytime sleepiness, especially in people who have moderate to severe sleep apnea.^9,⁶ But CPAP may not work as well for people who have mild sleep apnea.⁶

CPAP can lower daytime and nighttime blood pressure.¹⁰

If you use CPAP to treat sleep apnea, you need to use it every night. If you do not use it, your symptoms will return right away.

Treatment of obstructive sleep apnea in people with coronary artery disease lowers the risk of some heart problems.¹¹

Laser-assisted uvulopalatoplasty may be used to treat snoring. It is sometimes used to treat mild to moderate sleep apnea, though it does not benefit all people. This surgery is not approved by the American Academy of Sleep Medicine to treat sleep apnea.¹²

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Last updated:	July 13, 2007
Author:	Maria G. Essig, MS, ELS
Reviewed By:	Caroline S. Rhoads, MD - Internal Medicine, Jan Ulfberg, MD, PhD - Sleep Disorders
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman

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