Sleep apnea treatment

Obstructive sleep apnea syndrome is manifested by snoring and respiratory arrest during sleep. The disease is accompanied by severe daytime sleepiness, restless, unrefreshing sleep, increased blood pressure (especially in the morning), headache, night sweats, frequent nighttime urination, decreased performance, irritability, impaired potency, depressive conditions.

The disease 5 times increases the risk of myocardial infarction and stroke, 4-6 times increases the risk of accidents and road traffic accidents due to involuntary falling asleep.

Obstructive sleep apnea must be treated. Treatment for sleep apnea is aimed at preventing the collapse of the airways during sleep. This eliminates snoring and respiratory arrest, which leads to the disappearance of symptoms and risks of illness.

What should be done for the treatment to help?

Sleep apnea treatment is effective only when the cause, form, and severity of the disorder is known. To determine them, a special study is carried out – polysomnography. It is the most reliable method, the “gold standard” for diagnosing any sleep disorder.

Polysomnography is done in a sleep center or at the patient’s home. Several sensors are attached to the human body, which register some physiological parameters of the body during sleep. In the morning after the study, the data obtained is deciphered, and a conclusion is drawn up on their basis. 

Further, a doctor’s consultation is carried out. First of all, the somnologist demonstrates the diagnostic results to the patient. On the diagrams and graphs, the patient can see respiratory arrest, episodes of suffocation (a drop in blood oxygen saturation), intermittent sleep, and heart failure. The video recording, which is carried out with polysomnography, clearly demonstrates the periods of snoring and respiratory arrest.

Consultation of somnologist R.V. Buzunov

The severity of the disease is established depending on the number of respiratory stops per hour: the more there are, the more serious the situation and the greater the risk of complications. This indicator is called the Apnea-Hypopnea Index (AHI). With a mild degree of apnea syndrome, AHI is 5-15, with an average 15-30, with a severe over 30 episodes per hour. There are patients in whom respiratory arrests are repeated 100 or more times per hour.

As part of the consultation, the doctor also determines the exact causes of the disease and draws up a treatment algorithm.

Methods That Don’t Help

Quite often, on the Internet, you can find the recommendations of “experts” who claim that drops, sprays, pills or clips in the nose, various folk remedies miraculously help from sleep apnea.

We recommend that you deliberately refuse them – such treatment will be a waste of money and a waste of time. Moreover, the latter is much more unpleasant and even dangerous: after all, while a person is trying to heal with folk remedies and useless devices, the apnea syndrome progresses and every night causes more and more harm to health. Do not succumb to provocations – the listed funds do not help!

Treatment for mild sleep apnea

Treatment for mild sleep apnea can be initiated by following general recommendations:

  • weight loss;
  • raised headboard, sleeping on the side;
  • exclusion of taking sleeping pills, drinking alcohol, quitting smoking a few hours before bedtime; 
  • improvement of nasal breathing – instillation of vasoconstrictors into the nose at night;
  • treatment of rhinitis, sinusitis and other diseases of the ENT organs.

However, these measures are often ineffective for sleep apnea, since breathing disorders are too serious in this disease. Sometimes recommendations can help with rare respiratory stops, but nothing more.

Oral appliances can also be used for treatment. They are placed in the mouth at bedtime and slightly move the lower jaw forward, which widens the lumen of the pharynx and allows air to circulate freely through the respiratory tract. These devices are effective in the treatment of uncomplicated snoring and mild (moderate) obstructive sleep apnea, but they do not help with severe snoring . It is advisable to use them primarily in persons with a reduced, backward-shifted lower jaw; for other causes of snoring, they do not help everyone.   

A few words about surgery for sleep apnea

Unfortunately, only about 30% of snoring patients actually begin to sleep quietly after surgery. As for patients with sleep apnea, there are even fewer people among them who have had any results. And for many of them, surgical treatment even harms: snoring and respiratory arrest remain or worsen, they are joined by problems with swallowing and voice.

Patients undergoing surgery with persistent snoring and severe apnea syndrome (archive of the Center for Sleep Medicine)

Soft palate surgery can be effective, but only when the cause of snoring is an elongated uvula, low soft palate, enlarged tonsils, and other factors that can be eliminated by surgery. In other cases, it is useless to operate, because removing the uvula does not eliminate snoring if it is caused by excess weight or, for example, by the structural features of the lower jaw.

Typically, in obstructive sleep apnea, the narrowing and collapse of the airways (the immediate cause of respiratory arrest) occurs at the level of the pharynx. This is below the level at which the operation is carried out. Consequently, in most cases, the operation does not in any way affect the number and duration of respiratory arrest, the disease continues to exist and cause harm to human health. It’s like treating gastritis by removing the appendix: pointless, painful, useless. And if an ENT operation is performed on a patient with sleep apnea, it is even harmful. 

Back in 2010, American somnologists concluded that when snoring, a person needs to undergo a special examination in order to confirm (exclude) sleep apnea syndrome, as well as to establish its cause. Only then can sleep apnea treatment be planned. The operation, and indeed any treatment whatsoever, is contraindicated without examination. This is against the interests of the patient. Therefore, any person with snoring is strongly advised to consult a somnologist and carry out polysomnography or another available type of diagnosis before taking any action on treatment.   

Treatment of moderate to severe sleep apnea

The most effective treatment for sleep apnea is CPAP therapy. It consists in creating and maintaining a constant positive pressure in the patient’s upper respiratory tract using a special device (CPAP device).

The apnea treatment device is actually a compressor that, while sleeping, delivers a stream of air at low pressure to the patient’s airway through a hose and mask.

Selection of a mask for CPAP therapy

The mechanism of action of CPAP therapy is the creation of an air “wedge” in the upper respiratory tract. The air straightens the walls of the pharynx, does not allow them to subside, keeps the root of the tongue, uvula and palatine curtain in the “correct” position. The pressure is selected by the doctor for each patient individually. Further, a person can independently use the apparatus for treating sleep apnea at home.  

Some patients are deliberately frightened by the unusualness and novelty of the method, although in fact there is nothing wrong with it. With a properly selected air pressure in the mask, it is impossible to suffocate, the air flow does not interfere with breathing and sleep at all, but only improves them.

The CPAP machine is easy to use and maintain. Modern devices are switched on and off without even pressing a button, but simply by a sharp exhalation into the mask. Accordingly, the patient is not required to do anything other than to put on the mask before going to bed and take it off after waking up. All settings are set in advance according to the doctor’s prescription, when the patient purchases a CPAP device for personal use.

How quickly does CPAP respond?

The most important advantage of the CPAP method is its positive effect in a short period of time. Already during the first CPAP session, snoring and respiratory arrest disappear, sleep becomes stronger, daytime sleepiness disappears, and general well-being improves. High blood pressure gradually decreases and other symptoms cease to bother.

The risks of the disease are reduced to population risks: if a person with sleep apnea undergoes CPAP therapy, the likelihood of developing a heart attack and stroke is the same as in people without sleep apnea.

Patient after CPAP initiation at the Sleep Medicine Center

Currently, improved CPAP devices Prisma Line from the new line of Loewenstein Medical (Germany, Weinmann) have been developed . Their use allows for the most effective and comfortable treatment of patients with obstructive sleep apnea syndrome.   

Below is an interview with a patient at the Sleep Medicine Center who has been using a CPAP machine for over 7 years. During this time, he lost 35 kg, began to play sports, although earlier he had difficulty climbing the stairs. His blood pressure readings improved, although he suffered from poorly controlled hypertension for many years. 

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