What Is The Best Solution For Sleep Apnea If CPAP Is Not Tolerated?

2 Comments

1. Chris says:

   July 29, 2009 at 11:54 pm

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2. Nicky says:

   July 29, 2009 at 11:54 pm

   I don’t know if weight loss is an issue in this instance, but many people I have talked to about this disorder (my husband has it, and he will not tolerate his CPAP) said that the one thing that improved their apnea was losing weight. Do it the smart way: Eat right, drink water, exercise. If weight loss is not the issue here, then there is another solution: surgery. Ick. My brother-in-law’s apnea was caused by an abnormality in his nasal passages. They corrected it with surgery, and he is now apnea-free!There are also some other things you can do: avoid alcohol and sedative drugs trying to sleep only on your side stopping smoking avoid sleep deprivation  Use a Dental SplintOne of the reasons for the upper airway to become narrowed at night is because the tongue falls posteriorly, especially in the supine position. Since the tongue is attached to mandible this can be a significant problem in people with retrognathia and/or a very large tongue. It is possible to use a dental splint at night that effectively prevents the jaw and tongue from moving back when someone lies down and goes to sleep. There has been less experience with this type of treatment compared to CPAP.Since the upper airway can be narrowed for different reasons, this approach may not work for all patients.

   The splint may put some strain on the temporal mandibular joint, causing some discomfort. There are now many types of dental splints available but few have been extensively studied so that we are not able to predict the rate or degree of success with this type of treatment yet. It would be important to have follow-up investigations to ensure the sleep apnea is adequately treated if this type of treatment is selected. Patients should consult with dentists or orthodontists that are knowledgeable about sleep apnea  A surgical operation on the back of the throat to remove      redundant soft tissue. ( this is what my brother in law had done!)This kind of procedure would be performed in an attempt to increase the size of the upper airway. It usually involves removal of the part of the soft palate that hangs down in the back of the throat, as well as the tonsils if present, and other soft tissue if it is felt to be excessive. The operation is referred to as a uvulopalatopharyngoplasty (UPPP) and was initially described as an operation to improve heavy snoring. It is usually quite successful at decreasing the loudness of snoring but is not always successful at improving sleep apnea. There is currently no method that is widely available to predict which patients stand to benefit from this surgery. It is likely going to be less successful for patients with retrognathia. The surgery should not be considered as an option for patients with severe sleep apnea. Like dental appliances there should be some follow-up after surgery to ensure there has been a significant improvement in the severity of the sleep apnea. This surgery can be performed traditionally under general anesthesia in a hospital operating theatre. Short term results suggest a 50% chance of improvement (defined as a 50% reduction in the AHI). Longer term studies suggest that some patients relapse and their sleep apnea is no longer controlled. Part of the reason for this may be weight gain. More recently this type of surgery is being offered to patients in an outpatient setting using local anesthesia and laser assistance. While this looks like a promising treatment for snoring there are no well controlled, long term studies that can demonstrate a role for it in patients suffering from significant sleep apnea. One would expect the results might be similar to the standard UPPP. Currently neither type of operation should be considered as an option for treatment unless patients are unable or unwilling to tolerate CPAP. Hope this helps!!!