There are currently two proven treatments which are successfully used for patients who have sleep apnea:
- Oral Appliances
- CPAP (Continuous Positive Airway Pressure) machine
The CPAP machine was invented in 1981 by an Australian physician, Dr Colin Sullivan. Traditionally CPAP was offered to all people diagnosed with obstructive sleep apnea however this has now greatly changed. Many gold standard scientific studies have established oral appliances at the leading edge of treatment for snoring and sleep apnea. These studies demonstrate that for many people oral appliances are more comfortable and easier to use than CPAP and patient compliance is much higher.
There are many people who have attempted to use CPAP and are unable to do so. Many of these people are not being treated and are vulnerable for developing elevated blood pressure, heart disease and diabetes. Sleep apnea can also impact your quality of life leaving you sleepy and tired as well as affecting memory concentration and mood. Many of these people are unaware that oral appliances are a viable easy to use alternative.
1. Oral Appliances
New study demonstrates oral appliances are equal to CPAP for the treatment of sleep apnea and snoring.
A landmark study * just published in the prestigious American Journal of Respiratory and Critical Care Medicine Journal is the largest randomised trial comparing the two leading forms of treatment for Obstructive Sleep Apnea – oral appliances and continuous airway pressure (CPAP) on a range of health outcomes.
The study demonstrated that oral appliances are overall equivalent to CPAP as the two best treatments for sleep apnea.
Professor Peter Cistulli from the University of Sydney Medical School and Professor Ron Grunstein from Royal Prince Alfred Hospital in Sydney were the leading researchers in the study.
This study is good news for people who are unable to use CPAP as oral appliances are generally regarded as far more comfortable with high compliance rates. Studies show over 90% of people still using their appliance for most of the night two years post fitting.
* “Health Outcomes of CPAP versus Oral Appliance Treatment for Obstructive Sleep Apnea: A Randomised Controlled Trial”
American Journal of Respiratory and Critical Care Medicine February, 2013.
Craig L Phillips, Ronald R Grunstein, M. Ali Darendeliler, Anastasia S Mihailidou, Vasantha K Srinivasan, Brendon J Yee, Guy B Marks, and Peter Cistulli
2. CPAP (continuous positive airway pressure) machine
CPAP uses compressed air delivered by a tube to a facial mask to keep the air passage open so breathing continues normally during sleep. Straps around the mask fit it to the face over the mouth or nose.
The appropriate pressure values of the CPAP machine are determined during a sleep study and are mostly based on the degree of sleep apnea. However, many patients find the equipment onerous and the CPAP can actually cause wakefulness in some. Early CPAP machines were noisy, making it harder for users to fall asleep. The noise of air being pushed through the machine is also troubling to many users. Newer versions of CPAP units are quieter and more portable.
Even though the CPAP and its parts have improved, many people are still reluctant to use this equipment. Patients may not only experience interrupted sleep because of the noise, but may also suffer from chronic nasal congestion, eye and skin irritations, and dry throat. Partners of people who use the CPAP often find the noise disruptive to sleep and may need to sleep in a different bedroom.
By working closely with a CPAP therapist these problems can be reduced. A humidifier can address both nasal congestion and dry or sore throat.
If a patient with severe sleep apnea can’t, or won’t, use CPAP then it is very important that an oral appliance is used so they can have assistance with their breathing during sleep. An oral appliance is generally considerably more comfortable to use than CPAP and is now the main treatment for mild to moderate sleep apnea.
Oral appliances can also be successful in treating severe sleep apnea, however if you are in the very severe range and have pre existing medical problems such as hypertension and heart disease, then CPAP is the treatment of choice.
What if you can’t use CPAP?
There are a large percentage of people in the very severe range who are unable to use CPAP. The use of an oral appliance is then very important and while it may not overcome all the sleep apnea it is likely to reduce the apnea by around 70% or more. This is usually sufficient to feel more refreshed on waking, less sleepy with a reduction in snoring. It is also usually sufficient to no longer be in the high risk category for blood pressure problems, heart disease and stroke.
What else can be helpful?
If you are overweight, weight reduction may improve your snoring or sleep apnea. Weight gain deposits fat into and around the soft palate, tongue and neck structures consequently reducing the size of the airway. Weight loss can reduce these fat deposits and enlarge the airway size thereby reducing snoring as well as sleep apnea. Weight loss alone is generally insufficient to overcome sleep apnea but any reduction assists the effectiveness of oral appliances and CPAP
Elevating the head of your bed and avoiding sleeping on your back may be helpful for people with positional sleep apnea. This is when the apnea is mostly present when sleeping on thee back. For many people sleep apnea is present in all positions during sleep.
Avoid drugs and substances that cause airway narrowing.
Alcohol and most sleeping pills relax the muscles of the throat and can worsen snoring and sleep apnea. You should avoid alcohol for at least three hours prior to bedtime. Smoking can also worsen snoring and sleep apnea, due to swelling of the nasal tissues.
Surgery is not a common treatment for sleep apnea and the side effects can be significant. Surgical treatments can include jaw advancement and tongue reduction surgery. Weight reduction surgery can be very beneficial where significant obesity is assessed to be an important factor for the sleep apnea..
In summary, the established treatments for sleep apnea used by qualified physicians are oral appliances, CPAP and lifestyle changes.
Unproven and ineffective treatments
There are other treatments offered on the internet and in stores which include nasal strips, sprays, pillows, rings and breathing techniques. These methods are unproven and generally regarded as ineffective, with some being the subject of ACCC investigations. These treatments are not recommended by sleep physicians.
Are you and your partner ready for a peaceful night’s sleep?
SleepWise Clinic is the only clinic in Melbourne specialising in the field of dental sleep medicine. Our experienced practitioners provide the full range of state of the art oral appliances for the treatment of snoring and sleep apnea.
Contact us to find more about our sleep apnea solutions with proven results.