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Sleep Disorders Treatment Guide

Treatment for sleep disorders can be very effective. With up to 80% of people who have sleep apnea, insomnia, narcolepsy or periodic limb movements finding relief and a restful night’s sleep with treatment.

For sleep apnea, treatment options include weight loss, CPAP (a mask worn at night connected to a small air compressor), surgery, or dental appliance. For narcolepsy and periodic movements of sleep, medication usually is very effective. For insomnia, sleep hygiene measures and judicious use of sleeping pills are usually very helpful.

Your physician or one of our sleep specialists can direct you to the appropriate treatment. Below you will find treatment options that may help in lessen or eliminating your sleep disorder symptoms.

Weight Loss

We do not know why, but increased weight worsens breathing during sleep. In general, a 10% -15% loss of body weight leads to a 50% improvement in snoring or OSA; therefore, for example, if a 220 pound person loses 22-33 pounds, his or her problem will be half-way better. Weight loss is slow, and should be done under the guidance of your primary physician. Weight loss is recommended for all patients with snoring or OSA, often in combination with one or more of the treatments below. After substantial weight loss, often other treatments can be discontinued. These decisions should be made in follow-up visits with your doctors.

Avoidance of Alcoholic Beverages and Certain Sleeping Pills

Alcoholic beverages and certain types of sleeping pills may relax the throat muscles more than other body muscles and may dramatically worsen snoring or OSA. They should be avoided initially, but may be used under some circumstances after other treatments have been started.

Snoreball

If your snoring or OSA occurs only when lying on your back, we usually note it during the sleep study. In that case a tee shirt, with one or more tennis balls in a pocket on the back, may be used to keep you on your side or front, and allow a good night's sleep.

Drug Therapy

People with mild snoring or OSA may improve sufficiently during treatment with vivactyl or medroxyprogesterone. Vivactyl was originally developed as an antidepressant, and medroxyprogesterone is a hormone; we are not sure how either works on the air passages. Even among people whose sleep test shows only mild problems, some do not respond well to these medicines, while others may have bothersome side effects. Nasal decongestants or antihistamines also may be prescribed.

Dental Appliances

A dental appliance is a small plastic device, similar to an orthodontic retainer or an athletic mouth guard. It is worn each night during sleep; by either thrusting forward the lower jaw or pulling forward the tongue, it increases the breathing space behind the tongue. Dentists with special training can design, construct and fit these special appliances to meet your individual needs. In general, dental appliances may lead to 50% or more improvement in some patients, but we cannot predict which people will respond best. After you have become comfortable with a device and seem to be sleeping and working better, a repeat sleep test usually is needed to determine how effectively the appliance improves your snoring or OSA.

Continued Positive Airway Pressure (CPAP)

The base CPAP unit operates as a blower, similar to a vacuum cleaner in reverse. To it we attach a length of tubing that delivers pressurized room air, not flammable oxygen, to a mask that fits around or under your nose. Air is directed through this tube and mask, into your nasal passageways and throat. The pressurized air keeps your throat open, allowing your body to breathe and sleep normally. The machine does not breathe for you; rather, it keeps the throat open so that air can pass through it into your lungs. It is effective for snoring and for OSA, in over 90% of people. The unit is portable, and most people take it with them when they travel. The humming noise it makes is usually less bothersome to bed partners than is a person's original snoring or gasping. Disadvantages, however, include the expense and inconvenience of a second sleep test to determine how high a pressure you may need, and the need to use the machine each night. Over time, only about 50-70% of people continue to use their CPAP units regularly. CPAP is the best treatment for most people with moderate or severe OSA, and it may be useful in some people with milder OSA or with snoring.

Uvulopalatopharyngoplasty (UPPP, OR UP3)

This surgical procedure, performed by an Ear, Nose, and Throat specialist doctor, or otorhinolaryngologist, involves removal of unneeded tissue from the interior of your throat, leaving a larger air passageway. Surgery may cure your problem, leaving you no need for CPAP, dental appliance, or medications, but it is not always successful; in general, it improves snoring or OSA by over 50%, in 40-70% of patients who undergo surgery. Many people after an operation therefore continue to rely on alternative treatments such as those above.

Laser-Assisted Surgery

New techniques include using a laser as an "electronic scalpel," rather than a conventional steel scalpel to cut and remove tissue. Surgeons can use a laser to operate on the back of the throat as they do in the UP3 described above. Laser-assisted surgery has advantages: it may be performed in the office or outpatient setting rather than in the hospital, and it may allow for more gradual cutting away of tissue. On the other hand, the procedure is so new that we do not have good statistical information about how often it is successful over the long term. We expect that laser-assisted surgery will be more helpful for people with simple snoring, than for people with OSA.

Other Surgical Procedures

Tonsillectomy may be very helpful, particularly in children with OSAS. Nasal surgery may correct snoring in many people, but is not often helpful for OSA. If UPPP has not been a complete success, then other operations to reduce the tongue size, or push forward the upper and lower jaw, may be very helpful. Tracheotomy is direct and curative, but rarely is used.

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