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Physician’s Guide to Sleep Apnea: Treatment Options

The Third in a Series Providing Busy Physicians with a Helpful Overview of This Serious Sleep Disorder

Sleep apnea—obstructive sleep apnea (OSA), central sleep apnea (CSA), and mixed sleep apnea (MSA)—is a serious disorder that, if untreated, can lead to other chronic health conditions. Fortunately, a variety of options can help effectively treat sleep apnea.

Lifestyle Changes

Lifestyle changes are an important first step to help people reduce sleep apnea symptoms. It is important to encourage people with sleep apnea to follow the methods that are most appropriate for their condition.

Maintain a Healthy Weight

Obesity, especially in the upper body, can increase the risk of airway obstruction and cause sleep apnea. Even a modest weight reduction helps keep airways clear and reduce sleep apnea symptoms.

Change Sleeping Position

Studies have found that sleeping position may be the cause of more than half of sleep apnea cases. Sleeping on your back can worsen symptoms, while sleeping on the side may encourage normal breathing.

Avoid Alcohol and Smoking

Tobacco use contributes to the inflammation and swelling of airways, which can block airflow. Drinking alcohol relaxes the throat muscles that control breathing, which causes snoring and interrupts the sleep cycle.

Follow a Heart-healthy Diet

It’s important for people with sleep apnea to think about what they eat before going to bed. People with sleep apnea should avoid the following before bedtime:

  • Spicy Foods—and anything else that causes acid reflux or heartburn.
  • Caffeine—in all its forms: coffee, energy drinks, chocolate desserts, and even dark chocolate, which is an excellent source of antioxidants but also contains more caffeine.
  • Fatty and Greasy Foods—such as bacon, fried chicken, burgers and fries, and certain cheeses.
  • Excessive Amounts of Sugar—desserts, sweetened beverages, or anything with excessive sugar can impact the quality of sleep.
  • Excessive Amounts of Fluids—This may cause too many trips to the bathroom, interrupting sleep.

Exercise More

Exercise can increase energy levels, strengthen the heart, and improve sleep by helping people relax as they go to bed.

Develop Healthy Sleeping Habits

Adopting daytime and nighttime routines can help improve sleep. Before bedtime, people with sleep apnea should limit the use of technology. If people with sleep apnea have trouble falling asleep, encourage them to read a book or try meditating.

Decrease Congestion

Below are some helpful tips to help decrease congestion during sleep:

  • Humidifiers add moisture to the air and can open airways, decrease congestion, and encourage clearer breathing.
  • Nasal Sprays act as decongestants, moistening the nasal passages to relieve blockages.
  • Nasal Irrigation Devices use saline solution to moisten nasal passages and flush out mucus that may be preventing proper breathing.
  • Honey is a natural moisturizer and an anti-inflammatory that helps decrease swelling in the nasal passages and the throat.


Medical Devices

In addition to changes to patients’ lifestyle, healthcare providers may recommend trying one of the many products designed to help treat sleep apnea. Options include:

Continuous Positive Airway Pressure (CPAP)

CPAP is considered the “gold standard” for treating sleep apnea. There are more than 8 million CPAP users in the US. A CPAP machine uses a hose and mask, or nosepiece, to deliver constant, steady, single air pressure that prevents upper airway collapse. Studies demonstrate that CPAP increases the size of the upper airway by approximately 20% while increasing functional residual capacity (FRC), which improves oxygenation.

CPAP involves wearing a mask over your nose or mouth while sleeping. The mask is connected to a machine that delivers a constant flow of air to keep airways open to ensure normal breathing and sleeping.

Bilevel Positive Airway Pressure (BiPAP)

A common complaint about CPAP machines is that patients find the constant single pressure uncomfortable to breathe, especially when they exhale.

For this reason, BiPAP devices are a valuable alternative. Both CPAP and BiPAP require a face mask and tubing connected to a device that pumps air to help normalize breathing; however, BiPAP delivers pressurized air at two alternating levels: one level for inhalation, and a lower pressure level for exhalation. Many people find BiPAP more comfortable than the single pressure delivered by CPAP machines.

Improving Compliance with CPAP and BiPAP

Even though both CPAP and BiPAP effectively treat sleep apnea, compliance is a primary concern to healthcare providers. Studies suggest that from one-third to more than half of patients stop using their devices for a variety of reasons, including:

  • Nasal side effects, like dryness, burning, and congestion
  • Feeling claustrophobic
  • Difficulty falling asleep
  • Difficulty tolerating forced air
  • Dry mouth
  • Leaky mask, skin irritation, or pressure sores
  • Unintentionally removing the device
  • Noisy

Following are ways to help people with sleep apnea improve compliance with their CPAP and BiPAP devices:

Get a Mask That Fits

If the mask is uncomfortable, chances are people won’t wear it. This is why it’s critical to find a mask that fits properly. People with sleep apnea may also want to have a few masks in case they have soreness on certain pressure points on their face.

Clean the Device, Mask, and Tubing

This should be part of a patients’ daily routine. Unclean masks can increase bacteria counts and lead to colds and stuffy noses. Special cleaners and wipes help make this job easier.

Change Filters Regularly

Dust and particles collect in the filter, restricting airflow and forcing the device to work harder. Plus, the particles collect in the mask and tube and mask and, ultimately, the user’s airways. Changing the filter is easy and should be done whenever needed.

Understand Facial Interface Options

Many are available to improve comfort and compliance, including full-face masks, nasal masks, heated humidifiers, nasal pillows, nasal cushions, silicone pads, tubing accessories, and cleaning devices.

Encourage Patients to Play an Active Role in Their Care

Educating patients about their condition and their CPAP and BiPAP devices empowers them to play an active role in their treatment—and helps optimize outcomes and satisfaction.

Support Your Patient

Several studies have confirmed that intensive support and simple follow-up measures increase compliance rates.

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